Date of Award

2015-4

Degree Name

PhD Nursing

Dissertation Committee

Cynthia D. Connelly, PhD, RN, FAAN (Chair), Jane M. Georges, PhD, RN, Andrea L. Hazen, PhD

Keywords

antenatal medical complications, health disparities, Latinas, perinatal depression, preterm birth

Abstract

Purpose/Aims: Despite the notable 15 year low in overall preterm birth (PTB), a 10% improvement since the 2006 peak with declines for each of the largest race and Hispanic origin groups, the United States has the highest rate of PTB of any industrialized country with estimates of 11.5% or approximately 500,000 infants annually. The Institute of Medicine (2006) recommends researchers focus on PTB causes including reasons for health disparities. The purpose of this study was to identify factors associated with PTB among a sample of racially and ethnically diverse women with depressive symptomatology (Edinburgh Postnatal Depression Scale [EPDS], score of ≥10).

Rationale/Conceptual Basis/Background. The conceptual framework, derived from the empirical literature, identifies variables shown to increase risk for PTB: age, race/ethnicity, primary language, marital status, partner presence, education, income, depression, alcohol abuse, drug abuse, tobacco use, intimate partner violence, gravida, and antenatal medical complications (AMC).

Methods: Descriptive, correlational design using secondary data analysis of perinatal and birth data obtained from a sample of mothers who participated in the Perinatal Maternal Health Study, a randomized clinical trial conducted by Connelly et al. (2010; 2013). Descriptive and inferential statistics were used.

Results: Purposive sample (N = 302) was diverse although predominately Latina (80.5%), White (8.9%), Black (5.6%), Asian/Pacific Islander (3.6%), other (1.3%); EPDS mean 13.9 + 3.67; 12.5% PTB. Statistically significant lower drug abuse scores M=1.4 + .89 and more AMC M=2.72 + 1.75 for PBT vs term mothers M=3.56 + 2.03, t (35) = 2.32, p=R2= .156 R2adj =.147, F (3,275), = 16.912, p = .000. Logistic regression indicates the overall model was successful in classifying 87% and significantly predicted the likelihood of PTB (χ2 (3) = 31.517, p = .000).

Implications: The perinatal period provides unique opportunities to simultaneously assess maternal psychosocial and physical health care needs. Knowing health factor relationships among ethnically diverse women allows for informed advocacy for health policy targeting screening guidelines and management.

Document Type

Dissertation: Open Access

Department

Nursing

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