First-time Families Research Articles

Factors influencing client recall of contraceptive counseling at community-based distribution events in Kinshasa, Democratic Republic of the Congo

BackgroundClients must recall information from contraceptive counseling sessions to properly use their chosen method. Client recall in community-based settings is challenging given the public nature of these events and the presence of many potential distractions. Understanding the factors that influence client recall during community-based distribution events can guide future training of providers to improve proper use of contraceptive methods and client satisfaction.MethodsThis cross-sectional study employed a convenience sample of 957 women ages 15–49 old who sought contraceptive services from community-based contraceptive distribution events in Kinshasa, Democratic Republic of the Congo, known as Lelo PF. Recall scores were developed by matching direct observations with client exit interviews. The association between recall and client characteristics, provider characteristics and an index for the quality of the provider-client interaction were tested using multivariate linear regression.ResultsThe average recall score was 67.6%. Recall scores were higher among clients who accepted methods with simpler administration procedures, such as CycleBeads (81.3%), compared to methods requiring more medically advanced administration procedures, such as DMPA-SC (56.6%) and Implanon-NXT (62.1%). This relationship held even after controlling for amount of information each client received. Status as a first-time user was associated with a 5.8 percentage point decrease in recall score (p = 0.002). Time since the provider’s initial family planning training and clients’ perception of the provider-client interaction were associated with higher client recall scores.ConclusionResults of this study suggest that to improve client recall at Lelo PF events, future provider training should focus on how to deliver clear, specific information to clients, making sure clients feel at ease during the counseling session, and treating clients with respect. First-time family planning users and clients who select methods with more medically advanced administration procedures may require extra attention during the consultation to ensure they are able understand and remember the information. Results suggest that providers who have been offering services longer may be more effective in conveying information in a way that clients can remember. Program managers should consider requesting input from experienced providers to improve training sessions.

Modelling ambivalent triads in family research

This research focuses on ambivalence in family networks and presents a framework for investigating how triadic configurations, beyond specific dyads, may affect individual outcomes such as well-being. First, the paper introduces the ambivalent triad census, counting the frequencies of 18 non-isomorphic triads in which ties can be positive, negative, or ambivalent, in non-directed networks, and proposes the linear combinations of three theoretical mechanisms (ambivalent balance, diffusion of stress, divide and conquer) predicting how embeddedness in an ambivalent triad may affect individual well-being. Second, the ambivalent triad census is applied to 300 non-directed family networks, 150 stepfamilies and 150 first-time families, in which mothers reported about the relationships with and between family members. Results show that mothers embedded in triads exhibiting more ambivalent balance and less diffusion of stress score higher on social self-esteem. The study emphasizes the importance of studying ambivalence in higher-level relational structures, such as triads, in families.

A Community-enabled Readiness for first 1000 Days Learning Ecosystem (CRADLE) for first-time families: study protocol of a three-arm randomised controlled trial

BackgroundEnhanced parenting self-efficacy (PSE) contributes to positive parenting and future parental-child health. First-time parents, in particular, are in need of support since the pregnancy until post-delivery to strengthen their early PSE. However, there is a lack of effective and sustainable relevant programmes in the community. The Community-enabled Readiness for first 1000 Days Learning Ecosystem (CRADLE) aims to develop a self-learning eco-community throughout the pregnancy and early childhood to promote PSE among first-time parents. We apply choice architecture strategy using behavioural nudges and midwife-led continuity care during the first 1000 days, and test their effects on PSE and mother-child health for first-time families in Singapore.MethodsThis three-arm randomised controlled trial will recruit up to 750 pregnant women from the KK Women’s and Children’s Hospital, Singapore. Participants will be randomly assigned to receive: (1) standard routine care; (2) behavioural nudges (text messages) along with the use of a social media platform; or (3) midwife-led continuity care involving individualised teleconferencing sessions, during pregnancy and post-delivery. Using web-based questionnaires, participants will be assessed for baseline socio-demography and health status in the first visit, with follow-up assessments in the third trimester, at birth, 6-week (primary end-point), 6-, 12-, 18- and 24-month post-delivery. The primary outcome is PSE. Secondary outcomes include health and birth experience, mental wellness, feeding practice, maternal and child nutritional status. Intention-to-treat and per-protocol analyses will be performed using general linear models to test the effects of interventions across three arms. Recruitment has begun in June 2020 and is estimated to complete in September 2022.DiscussionThis study may identify a sustainable effective strategy in the community by helping first-time parents to have a positive experience during the pregnancy, childbirth and parenthood, leading to an enhanced PSE and health outcomes for both mother and child. Findings from this study will provide insight into the implementation of early parenting and mother-child care programmes.Trial registrationClinicalTrials.gov NCT04275765. Registered on 19 February 2020.

Characteristics of first-time family planning users and methods used at mobile clinics in rural Malawi

Setting: Malawi committed to increase modern contraceptive prevalence rate to 60% for all women by 2020, but current use ranges from 37% to 59% among women of different ages and marital status.Objectives: To describe characteristics of first-time family planning (FP) users and associations between characteristics and methods used among women of childbearing age accessing injectables, oral contraceptives and implants in rural mobile clinics in Mulanje, Malawi, in 2017–2018.Design: This was a cross-sectional retrospective study.Results: Among 2120 first-time FP users, 65% were <25 years. Half (50%) had 2–4 live children and only 1% were nulliparous. HIV infection rate among all users was 4%. Of the three methods, injectables were used most (75%), with a significantly higher use in HIV-positive clients (91%). Nearly 25% of first-time users used implants and the proportion increased from 21% in 2017 to 34% in 2018.Conclusion: This study demonstrated that FP can be provided to young women in remote areas if the availability of well-trained providers is ensured. It highlighted the need to target younger and nulliparous women with a broad mix of contraceptives to improve access to, and uptake of, FP services to reach national commitments.

Clinical Guidelines for Working With Stepfamilies: What Family, Couple, Individual, and Child Therapists Need to Know.

This article draws on four decades of research and clinical practice to delineate guidelines for evidence-informed, clinically sound work with stepfamilies for couple, family, individual adult, and child therapists. Few clinicians receive adequate training in working with the intense and often complex dynamics created by stepfamily structure and history. This is despite the fact that stepfamilies are a fundamentally different family form that occurs world-wide. As a result many clinicians rely on their training in first-time family models. This is not only often unhelpful, but all too often inadvertently destructive. The article integrates a large body of increasingly sophisticated research about stepfamilies with the author's four decades of clinical practice with stepfamily relationships. It describes the ways in which stepfamilies are different from first-time families. It delineates the dynamics of five major challenges stepfamily structure creates: (1) Insider/outsider positions are intense and they are fixed. (2) Children struggle with losses, loyalty binds, and change. (3) Issues of parenting, stepparenting, and discipline often divide the couple. (4) Stepcouples must build a new family culture while navigating previously established family cultures. (5) Ex-spouses (other parents outside the household) are part of the family. Some available data are shared on the impact of cultural and legal differences on these challenges. A three-level model of clinical intervention is presented: Psychoeducational, Interpersonal, and Intrapsychic/Intergenerational Family-of-Origin. The article describes some "easy wrong turns" for well-meaning therapists and lists some general clinical guidelines for working with stepfamily relationships.

Stepfamilies Doing Family: A Meta‐Ethnography

The present review examines how stepfamily members without a shared history co-construct a shared family identity and what family processes are relevant in this stepfamily formation. Three databases (Web of Science, PsycInfo, and ProQuest) were systematically searched, resulting in 20 included qualitative studies. The meta-ethnography approach of Noblit and Hare allowed synthesizing these qualitative studies and constructing a comprehensive framework of stepfamilies doing family. Three interdependent family tasks were identified: (a) honoring the past, (b) marking the present, and (c) investing in the future. Stepfamily members' experiences of these family tasks are strongly affected by the dominant societal perspectives and characterized by an underlying dialectical tension between wanting to be like a first-time family and feeling the differences in their family structure at the same time. These findings clearly demonstrate the family work that all stepfamily members undertake and provide a broader context for interpreting stepfamilies' co-construction of a new family identity.

The Space of the Family: Emotions, Economy and Materiality in Homeownership

The role of emotions in housing markets has come under scrutiny in the housing market bubble and subsequent dramatic decline from which markets are still recovering. Thus, the performativity of housing markets has become an object for sociological analysis. Using qualitative interview data from 11 Danish first-time home-buying families, this article investigates the relations between emotions and economic behaviour in a market that has become unpredictable because of volatile price developments since the early 2000s. Identifying the relationship between economic behaviour, emotions and the materialities of homes, the article finds that home-buying is intermeshed with emotional attempts at creating or stabilizing the family as a unit. Homeownership therefore is an emotional investment through financial and material means in the future of the family, and the article therefore argues that markets are saturated with love, desire, fear, anxiety and hope.

Child maltreatment and risk patterns among participants in a child abuse prevention program

The relationship between risk factors and Child Protective Services (CPS) outcomes in families who participate in home visiting programs to prevent abuse and neglect and who are reported to CPS is largely unknown. We examined the relationship between parental risk factors and the substantiation status and number of CPS reports in families in a statewide prevention program. We reviewed CPS reports from 2006 to 2008 for families in Connecticut's child abuse prevention program. Six risk factors (histories of CPS, domestic violence [DV], mental health, sexual abuse, substance abuse, and criminal involvement) and the number of caregivers were abstracted to create risk scores for each family member. Maltreatment type, substantiation, and number of reports were recorded. Odds ratios were calculated. Of 1,125 families, 171 (15.6%) had at least one CPS report, and reports of 131 families were available for review. Families with a substantiated (25.2%) versus unsubstantiated (74.8%) first report had a high number of paternal risk factors (OR=6.13, 95% CI [1.89, 20.00]) and were more likely to have a history of maternal DV (OR=8.47, 95% CI [2.96, 24.39]), paternal DV (OR=11.23, 95% CI [3.33, 38.46]), and maternal criminal history (OR=4.55; 95% CI [1.32, 15.60]). Families with >1 report (34.4%) versus 1 report (65.6%) were more likely to have >3 caregivers, but this was not statistically significant (OR=2.53, 95% CI [0.98, 6.54]). In a prevention program for first-time families, DV, paternal risk, maternal criminal history, and an increased number of caregivers were associated with maltreatment outcomes. Targeting parental violence may impact child abuse prevention.

Bonding and Bridging Social Capital in Step- and First-Time Families and the Issue of Family Boundaries

Divorce and remarriage usually imply a redefinition of family boundaries, with consequences for the production and availability of social capital. This research shows that bonding and bridging social capitals are differentially made available by families. It first hypothesizes that bridging social capital is more likely to be developed in stepfamilies, and bonding social capital in first-time families. Second, the boundaries of family configurations are expected to vary within stepfamilies and within first-time families creating a diversity of family configurations within both structures. Third, in both cases, social capital is expected to depend on the ways in which their family boundaries are set up by individuals by including or excluding ex-partners, new partner's children, siblings, and other family ties. The study is based on a sample of 300 female respondents who have at least one child of their own between 5 and 13 years, 150 from a stepfamily structure and 150 from a first-time family structure. Social capital is empirically operationalized as perceived emotional support in family networks. The results show that individuals in first-time families more often develop bonding social capital and individuals in stepfamilies bridging social capital. In both cases, however, individuals in family configurations based on close blood and conjugal ties more frequently develop bonding social capital, whereas individuals in family configurations based on in-law, stepfamily or friendship ties are more likely to develop bridging social capital.

Le ricomposizioni familiari in una prospettiva configurativa

This article offers a configurational insight on the issue of family recomposition after separation or divorce. Stepfamilies are often regarded as lacking social capital and therefore putting at risk their members, especially children. Results from a study based on 300 women with a biological child, half from a first-time family, and half from a stepfamily, reveals that a variety of family configurations characterize stepfamilies, with distinct consequences for social capital. Results are discussed in the light of the configurational perspective on families.

Sexuality, Intimacy, and Marital Satisfaction in Iranian First-Time Parents

This study aims at investigating the sexual relationship and intimate of postpartum spouses and the effect of those relationships on their marital satisfaction. A sample of 128 postpartum couples having given birth to their first child (6–36 weeks postpartum) participated in this study during 2009. A nonexperimental, cross-sectional survey design was conducted using Sexual Interest and Desire Inventory, Personal Assessment of Intimacy in Relationship Scale and Revised Dyadic Adjustment Scale. Using univariate and multivariate regression analysis, results suggested that there were higher levels of sexual desire reported by husbands and there was a significant positive relationship between sexuality and marital satisfaction, for both genders. Moreover, high intimacy diminished the negative effects of marital satisfaction due to reported low sexual satisfaction. Regarding negative effects of marital dissatisfaction in first-time families, it is important to assess main related issues such as postpartum sexuality and intimacy, to obtain knowledge for health care providers to provide support to the postpartum families.

The effect of health visitors’ postpartum home visit frequency on first-time mothers: Cluster randomised trial

Background Postpartum home visiting by nurses can benefit higher-risk families. Yet, little is known about the effects of universal services which provide care for all families including those at lowest risk (e.g. provision by health visitors-United Kingdom specialist community public health nurses). Objective It was to determine the effect of frequency of health visitors’ home visits on ‘low-risk’ first-time families’ outcomes to 8 weeks postpartum and 7 months follow-up. Design A cluster randomised controlled trial. Setting Within one health and social care managerial area in Northern Ireland. Participants First-time ‘low risk’ mothers who had given birth during 2002–2004 and were visited by a health visitor who had agreed to take part in the study, were invited to participate. In total, n = 39 health visitors were allocated to ‘intervention’ and n = 41 to ‘control’. Of n = 295 ‘low-risk’ first-time mothers who agreed to take part, n = 136 with intervention health visitors were offered six home visits 2–8 weeks postpartum and n = 159 within the control group were offered one planned visit. Methods Self-completed measures of parenting, maternal wellbeing and service use were gathered pre-intervention, 8 weeks and 7 months postpartum. The main outcome was the Edinburgh Postnatal Depression Scale (EPDS). At 8 weeks and 7 months postpartum, n = 129 and n = 115 intervention mothers, also n = 151 and n = 141 control mothers completed outcome measures. Results An intention to treat analysis was performed using multilevel modelling analysis which statistically controlled for pre-home visit outcomes, clinic attendance and antenatal contact. The intervention had no impact on most outcomes, however, it was associated with an increased EPDS score (after adjustment: 0.16, 2.36 95%CI) at 8 weeks (before accounting for outliers) but not at 7 months (−0.62,1.65 95%CI). Intervention mothers had higher service satisfaction (7.7, 21.28, 95%CI 8 weeks; 4.69, 22.71, 7 months) and were less likely to have used emergency medical services for their infants to 8 weeks (OR: 0.15, 0.85, 95%CI). Conclusion Weekly postpartum visits to ‘low-risk’ mothers had variable effects, therefore, practitioners and researchers should consider further development and application of effective, evidence based home visiting content.

Male Soldier Family Violence Offenders: Spouse and Child Offenders Compared to Child Offenders

Army data from 2000 to 2004 were used to compare two groups of married, male, Army soldier, first-time family violence offenders: 760 dual offenders (whose initial incident included both child maltreatment and spouse abuse) and 2,209 single offenders (whose initial incident included only child maltreatment). The majority (81%) of dual offenders perpetrated physical spouse abuse; however, dual offenders were less likely than single offenders to perpetrate physical child abuse (16% vs. 42%) or sexual child abuse (1% vs. 11%), but they were more likely to perpetrate emotional child abuse (45% vs. 12%). These findings may be, at least in part, explained in light of the Army Family Advocacy Program policy, which considers spouse offenders as also being emotional child abuse offenders since children may be traumatized by exposure to spouse abuse.

The family dynamics of childbearing and childrearing families in Finland

Within the context of an international comparative family dynamics project, this study had two chief goals: to describe the family dynamics of childbearing and childrearing families in Finland, and to study changes in family dynamics after childbirth. The sample consisted of families expecting (n = 118) and rearing (n = 94) their first or second child in Finland. Two instruments were used in data collection, i.e. the Family Dynamics Questionnaire and the Family Dynamics Measure; both these tools have been developed in the USA. According to the results, childbearing and childrearing families were thought to function quite well. Pregnant mothers described their family dynamics in more positive terms than fathers, reporting greater flexibility and clearer communication. Similarly, mothers reported more individuation and mutuality than their partners. First-time expectant families reported more mutuality than families expecting their second child. Childrearing mothers reported more individuation, but also more role conflict than did fathers. Communication in families rearing their first child was clearer than in families rearing their second child. The birth of a child affected family dynamics by bringing about various changes such as role conflict, isolation and distorted communication.

Neonatal Bathing and Massage Intervention with Fathers, Behavioural Effects 12 Weeks after Birth of the First Baby: The Sunraysia Australia Intervention Project

A total of 32 first-time families from the Sunraysia district in Victoria, Australia participated in a study on the effects of a training programme (demonstration of baby massage and the Burleigh Relaxation Bath technique) with a particular emphasis on the father-infant relationship. The infants, whose parents received the training at 4-weeks post-partum, differed from comparison group infants on a constellation of behaviours at the 12 week home observation. Treatment group infants greeted their fathers with more eye contact, smiling, vocalising, reaching, and orienting responses and showed less avoidance behaviours. As well, in a 10 minute observation, the treatment group fathers showed greater involvement with their infants than comparison group fathers. The brief intervention at four weeks seems to have favourably affected the father-infant relationship in ways which would assist in the establishment of a positive bond between the first-time fathers and their infants.