An exploration of factors which influence maternal self-efficacy in primiparous women in China during the initial postnatal period: a longitudinal study

Background: There are many problems of parenting during infancy for Chinese primiparous women. As an important determinant of good parenting, maternal self-efficacy (MSE) should be paid more attention by researchers. At present, the limitations of previous research examining MSE during infancy are that most studies were related to a homogeneous sample (approximately 90% white) and lacked the consideration of cultural effect; the influencing factors remained poorly explored; and there were few studies related to Chinese women. Therefore, it is necessary to assess MSE and to thoroughly explore the factors influencing MSE among Chinese primiparous women in consideration of the Chinese postnatal culture of “Doing the month” to fill the research gap. Aim: The aim of this study was to describe MSE and to explore factors which may influence MSE in primiparous women in China in the first three months postnatally. Methods: A quantitative longitudinal study using questionnaires was conducted. In total, 420 primiparous women were recruited in obstetric wards at three hospitals in Xiamen City, China. Initial baseline questionnaires to measure socio-demographic and clinical characteristics at three days postnatally were distributed to participants face-to-face by the researcher on the postnatal ward. Participants’ contact details were also collected. Follow-up questionnaires at six and 12 weeks were sent via email by the researcher to participants, including the Self-efficacy in Infant Care Scale (SICS), the Edinburgh Postnatal Depression Scale (EPDS) and the Postpartum Social Support Scale (PSSS) to measure MSE, postnatal depression symptoms and social support, respectively. These were returned by participants via email. Quantitative data were analysed using SPSS. Results: The mean MSE score at six weeks postnatally was 74.92 (SD=11.05), and increased to 77.78 (SD=11.13) at 12 weeks postnatally. The mean social support scores at six and 12 weeks postnatally were 40.99 (SD=9.31) and 43.00 (SD=9.55). The mean EPDS scores decreased from 9.09 (SD=4.33) at six weeks postnatally to 8.63 (SD=4.40) at 12 weeks postnatally; the proportion of women with an EPDS score of ten or more at the two time points declined from 47.4% to 38.3%. The mean score of how satisfied women were with “Doing the month” was 68.73 (SD=17.65) at six weeks postnatally, with most women (91.4%) thinking that “Doing the month” after childbirth was necessary. In the multivariate analysis, the variables: social support scores, women’s satisfaction with “Doing the month” scores, EPDS scores, maternal education, maternal occupation, baby health scores, and baby fussiness scores affected MSE scores during the initial postnatal period. Conclusions: In this study, Chinese primiparous women had a moderate level of MSE and received a moderate level of social support at six and 12 weeks postnatally, and a higher proportion of Chinese women had postnatal depression symptoms than did women in Western countries. From six to 12 weeks postnatally, the mean MSE scores and social support scores had a statistically significant increase; the mean EPDS scores had a statistically significant decrease. “Doing the month” was still popular in Chinese modern society and almost half of the women felt satisfied about their experience of “Doing the month”. Obstetric nurses and women’s family members need to be aware of the significant contribution of social support, women’s satisfaction level with “Doing the month” in positively influencing primiparous women’s MSE, and the significant effect of postnatal depression symptoms in negatively impacting on first-time mothers’ MSE; they should pay more attention to primiparous women with less education, unemployed mothers, women with unskilled occupations, women with an unhealthy baby, and women with a baby with a difficult temperament to improve their comparatively lower MSE levels during the initial postnatal period