Prenatal expectations in Mexican American women: development of a culturally sensitive measure

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<ul><li><p>ORIGINAL ARTICLE</p><p>Prenatal expectations in Mexican Americanwomen: development of a culturally sensitive measure</p><p>Jenna L. Gress-Smith &amp; Danielle S. Roubinov &amp;Rika Tanaka &amp; Keith Cirnic &amp; Nancy Gonzales &amp;Craig Enders &amp; Linda J. Luecken</p><p>Received: 20 December 2012 /Accepted: 27 March 2013 /Published online: 17 April 2013# Springer-Verlag Wien 2013</p><p>Abstract Prenatal expectations describe various domains awoman envisions in preparation for her role as a new motherand influence how women transition into the maternal role.Although the maternal role is strongly influenced by theprevailing familial and sociocultural context, research char-acterizing prenatal expectations in ethnic minority and low-income women is lacking. As part of the largest growingminority group in the USA, Latina mothers represent animportant group to study. Two hundred and ten low-income Mexican American women were administered thePrenatal Experiences Scale for Mexican Americans(PESMA) that was adapted to capture specific cultural as-pects of prenatal expectations. Measures of current support,prenatal depressive symptoms, and other sociodemographiccharacteristics were also completed to assess validity. Ex-ploratory factor analysis identified three underlying factorsof prenatal expectations: paternal support, family support,and maternal role fulfillment. Associations among thesesubscales and demographic and cultural variables wereconducted to characterize women who reported higher andlower levels of expectations. The PESMA demonstratedgood concurrent validity when compared to measures ofsocial support, prenatal depressive symptoms, and othersociodemographic constructs. A culturally sensitive mea-sure of prenatal expectations is an important step towardsa better understanding of how Mexican American womentransition to the maternal role and identify culturally specifictargets for interventions to promote maternal health.</p><p>Keywords Expectations . Pregnancy . Mexican American .</p><p>Social support . Family support</p><p>Introduction</p><p>The transition to motherhood begins prenatally, with prepa-rations for the parental role. Becoming a mother has beendescribed as a transformational process during which wom-en anticipate and cognitively rehearse for their postpartumrole by forming expectations of what life may be likefollowing childbirth (Lederman 1996). The construct ofprenatal expectations has been used in prior researchto describe various domains of parenthood that a wom-an envisions during pregnancy. The maternal role hasbeen described as a social construct with qualities thatare strongly influenced by the prevailing familial andsociocultural context (Guendelman et al. 2001;Sagrestano et al. 1999). Yet, research characterizingmaternal prenatal expectations has been largelyconducted among samples of middle-class, Caucasianwomen, with little attention to how ethnic minorityand low-income women approach motherhood. As thelargest minority group in the USA with fertility rates3040 % higher than any other ethnic group (Hamiltonet al. 2005; US Census Bureau 2011), Hispanic mothersrepresent a particularly important cultural group to stud-y. Among Hispanic women, Mexican Americans1 havethe highest birthrates (Martin et al. 2012) and are alsomore likely to be exposed to life stressors that may bear</p><p>1 For the purposes of this research, Mexican American refers to anywomen of Mexican heritage residing in the USA, regardless of nativityor citizenship.</p><p>J. L. Gress-Smith (*) :D. S. Roubinov : R. Tanaka :K. Cirnic :N. Gonzales :C. Enders : L. J. LueckenDepartment of Psychology, Arizona State University, 950 S.McAllister St., P.O. Box 871104, Tempe, AZ 85287-1104, USAe-mail: jgress@asu.edu</p><p>Arch Womens Ment Health (2013) 16:303314DOI 10.1007/s00737-013-0350-2</p></li><li><p>considerably on the pregnancy period, including decreasedlikelihood of having insurance, lower levels of financial re-sources, and increased discrimination (Flores et al. 2008;Hamilton et al. 2006; Ramierez and de la Cruz 2002). Theunique socioeconomic and psychosocial risk factors facingMexican American women during the transition to parent-hood support a dedicated study of their prenatal experiences.The current study describes the psychometric properties of anexisting measure that was adapted to evaluate prenatal expec-tations among low-income Mexican American pregnantwomen and explores the demographic, cultural, and psycho-social correlates of womens anticipated views of the earlypostpartum period.</p><p>Forming expectations serves an important purpose duringmajor transitions, countering the uncertainty associated withsignificant life changes by contributing to the sense thatevents are predictable and under ones personal control(Lawrence et al. 2007). Rubin (1984) suggested that prena-tal expectations are conjectures or hypotheses of what par-enthood will entail that originate from values, priorexperiences, and contexts with which women approach thematernal role. Expectations formed prenatally about thepostpartum period may be adaptive, preparing women tocope with parenting stressors, and successfully transitioninto the maternal role following the birth of a child.Pancer et al. (2000) observed that pregnant women whoenvisioned more positive infant caring experiences ex-perienced lower levels of depression and increased self-esteem following childbirth as compared to women whoendorsed poorer expectations for the postpartum period.</p><p>In prior research, frequently assessed domains ofprenatal expectations include womens projections aboutparenting self-efficacy, fulfillment anticipated from thematernal role, expected changes in employment, lifestyleor household responsibilities, anticipated receipt of so-cial support during the early postpartum period from herpartner and family, and assumptions of positive/negativechanges in other social relationships (Coleman et al. 1999;Delmore-Ko et al. 2000; Kiang et al. 2004; McHale et al.2004; Tamis-Lemonda and Kahana-Kalman 2009). Categoriesof prenatal expectations have been formed on the basis ofqualitative analysis of in-depth prenatal interviews (Delmore-Ko et al. 2000; Pancer et al. 2000; Tamis-Lemonda andKahana-Kalman 2009) and quantitative analysis of self-reportscales (Coleman et al. 1999; Kiang et al. 2004; McHale et al.2004). Expectations may vary along a continuum of verypositive to very negative; although expectant mothers mayanticipate parenthood with enthusiasm and excitement, theprenatal period may also be marked by significant concernsabout the challenges of caring for a newborn (Fox et al. 2000).</p><p>Although little is known about the demographic andpsychosocial characteristics of women who form higherand lower prenatal expectations, previous experience with</p><p>infants and confidence in ones ability to handle the care of anewborn baby may contribute to more positive expectationsfor transitioning into the maternal role. Other characteristicssuch as family context, socioeconomic status, and maternaleducation level may also bear on the formation of prenatalexpectations. For example, anticipated postpartum paternalsupport may be higher among women married to and/orresiding with the father of their baby, while expectationsof the financial impact of a child may vary depending onwomens socioeconomic status and levels of current finan-cial hardship. Additionally, relations between expectationsand prenatal mood are important to explore, as negativeprenatal expectations have been posited to correlate withprenatal distress (Lucas 2010). Prenatal distress, in turn,has been associated with poor birth outcomes and elevatedrisk of postpartum depression (Field 2011).</p><p>Prenatal expectations likely vary across cultures, but ethnicand cultural considerations have rarely been addressed in priorstudies. The influence of social and ecological forces onmaternal prenatal expectations may be accentuated amongMexican American women for whom the meaning of moth-erhood is shaped by strong cultural values and norms relatedto motherhood and family relationships. Hispanic womenhave been described as adhering strongly to familism valuesthat emphasize attachment to the nuclear and extended family(Germn et al. 2009; Rafaelli and Ontai 2004), and priorqualitative research has observed that the prenatal expecta-tions of Mexican American women are more likely includethemes related to the effect of a new child on the family unit ascompared to women from other ethnic groups (Tamis-Lemonda and Kahana-Kalman 2009). Familism values arealso related to marianismo, a construct that sets forthgender-specific role expectations regarding the centrality ofmotherhood and childcare in the lives of Hispanic women(Castillo et al. 2010). Mexican American women often incor-porate the maternal role into their self-identity, finding valueand meaning in being a mother. Culturally specific constructsrelated to mothering (e.g., motherhood as a valued and re-warding life experience) have been associated with positivepregnancy and birth experiences among Mexican Americanwomen (Page 2004). The content of Mexican Americanwomens prenatal expectations and their relation to culturalvalues may vary with level of acculturation. The transition toparenthood may be influenced by acculturation as majorityculture values of individualism, self-development, and per-sonal goals, and egalitarian gender role attitudes are increas-ingly adopted (Wilson 1998).</p><p>Cultural beliefs related to parenthood and child rearingoffer a unique framework by which Mexican American wom-en prepare to assume the maternal role, requiring adaptation ofexisting measures of prenatal expectations that were devel-oped for majority populations. The current paper describes thedevelopment and validation of the Prenatal Experiences Scale</p><p>304 J.L. Gress-Smith et al.</p></li><li><p>for Mexican Americans (PESMA), a culturally sensitive as-sessment of prenatal expectations for low-income MexicanAmerican women. Taking prior empirical research and cultur-al considerations into account, the Prenatal Maternal Expec-tations Scale (Coleman et al. 1999) was extensively modifiedto evaluate prenatal expectations for life following the birth ofa child in low-income Mexican American women. Explorato-ry factor analyses examined the structure underlying prenatalexpectations. Additional analyses evaluated relations amongexpectations and concurrent measures of social support, de-pression, cultural constructs (e.g., familism and acculturation),and other sociodemographic factors to further characterize thenature of prenatal expectations among low-income MexicanAmerican women and provide concurrent validation for thePESMA.</p><p>Materials and methods</p><p>Participants</p><p>Participants included 210 self-identified Mexican Americanwomen (M age=27.4 years, SD=6.4) recruited for a largerlongitudinal study of maternal and infant health thatfollowed women and their infants for 3 years followingthe birth. Data collected during the prenatal assessment onlywere used for the current study. Women were invited toparticipate if the following eligibility criteria were met: (1)self-identification as Mexican American, (2) English orSpanish language fluency, (3) age 18 or older, (4) low-income status (self-reported income below $25,000 or eli-gibility for federal emergency medical services funding),and (5) anticipated delivery of a healthy, singlet baby. De-mographic characteristics of the sample are shown inTable 1.</p><p>Procedures</p><p>Women were recruited from a hospital-based clinic that pro-vides prenatal care to low-income women in the surroundingurban community. During prenatal care appointments, preg-nant women prior to 38 weeks gestation were introduced to thestudy by a female, bilingual interviewer. A total of 343 womenwere approached for recruitment during a prenatal care ap-pointment. Of these, 286 (83 %) agreed to be contacted toschedule a prenatal home visit, at which informed consent wasobtained. Of the women who agreed to schedule a home visit,36 (13%) could not be contacted to schedule the visit, 17 (6%)refused to participate, and 23 (8 %) were ineligible (were notMexican American, delivered prior to completing a prenatalhome visit, had a miscarriage, or moved out of state). Our finalsample consisted of 210 women who consented to be part ofthe study.</p><p>Prenatal home visits took place between 23 and 41 weeksgestation (M=35.2, SD=2.9). Interviews were conducted inthe language with which participants were most comfortable(82% Spanish and 18% English). Due to variations in literacy,informed consent and all study questions were read aloud towomen, and responses were entered by the interviewer into alaptop computer. Women were compensated $75 for the inter-view and received small gifts in preparation for their babysbirth (e.g., bath oils, lip balm, and lotion).</p><p>Measures</p><p>Validated Spanish versions of the measures were used whenavailable. For measures without a validated Spanish version,measures were translated and back translated by certifiedSpanishEnglish translators. The translations were thenchecked for accuracy by a separate team of bilingual studypersonnel to ensure they were culturally sensitive and ap-propriate to the local population of Spanish speakers. Anydiscrepancies were resolved by principal investigators or thelead translators.</p><p>Demographic characteristics</p><p>Women were queried about marital status, number of bio-logical children, total number of children under 18 years ofage residing in the home, educational history, age, andcountry of birth. Because the majority of the women wereborn in Mexico (86 %), women were also asked how longthey had lived in the USA.</p><p>Economic hardship</p><p>Perceived financial difficulties were assessedwith the econom-ic hardship scale (EHS; Barrera et al. 2001). The EHS wasdeveloped for low-income families and measures psychologi-cal aspects of poverty, including overall financial strain, lack ofmoney for necessities, need for economic adjustments or cut-backs, and inability to make ends meet. Assessing the subjec-tive nature of financial difficulties, rather than categorical totalincome, provides more information regarding need and depri-vation in impoverished families (Barrera et al. 2001). Partici-pants considered their financial situation for a 3-month timeframe and answered 20 questions using a Likert scale rangingfrom 1 to 5, with lower scores indicating higher levels offinancial strain. Scores from the four subscales were standard-ized and combined to form a single score of economic hardship(=0.74)</p><p>Prenatal depressive symptoms</p><p>Depressive symptoms were measured with the EdinburghPostnatal Depression Scale (EPDS; Cox et al. 1987). The</p><p>Prenatal expectations in Mexican American women 305</p></li><li><p>EPDS has demonstrated moderate to good testretest reli-ability, adequate internal consistency, and concurrent valid-ity (Boyd et al. 2005) and has been validated in Spanish-speaking samples (Garcia-Esteve et al. 2003). Cronbachsalpha for the current sample was 0.86.</p><p>Prior experiences with a baby</p><p>Women were asked to describe their level of prior experie...</p></li></ul>

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