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Research Investigation The Role of Culture in Primiparous Puerto Rican Women s Postpartum Infant and Self-Care Anne M. Fink, PhD, RN, CNE
Purpose & Significance Rapid Hispanic population growth will increase service use Hispanics have a higher incidence of postpartum complications, fewer preventive services, & report decreased satisfaction with care 50% have literacy issues & low literacy is associated with low incomes (Ferguson, 2008) & low income with postpartum concerns (Sword & Watt, 2005) Puerto Ricans: Highest infant mortality rate of Hispanic groups; Highest risk of altered health status than any Hispanic sub-population; More health disparities across all health outcomes Calls for research, limited in the region, & no similar studies Literature Findings Women reported having concerns, feeling unprepared, or lacking confidence about ability to care for their infants Quantitative studies sampled affluent, well-educated, privately insured, partnered, breastfeeding, English-speaking, Caucasian women
A Descriptive Qualitative Study 22 primiparous English-speaking Puerto Rican women recruited via the social network sampling method Completed informed consent & demographic questionnaire with face & content validity 15 to 45 minute semi-structured interview interviews were conducted until saturation was achieved Researcher & participants verified transcripts Demographic data were analyzed using descriptive statistics & transcript data analyzed using content analysis Methods to enhance rigor and trustworthiness were employed Theoretical Framework - Malcolm Knowles Adult Learning Theory
Findings: Literacy & Language Literacy issues were more important than language issues Had lower health literacy (associated with poor health outcomes & higher healthcare costs) Although all spoke English many still had difficulty understanding medical terminology, big words, the demographic questionnaire, & interview questions Young age at delivery inhibited learning through life experience Video education needs to be re-evaluated given the cultural practice of family members visiting & celebrating the birth Women do not watch videos due to frequent interruptions (Maloni, 1994) Internet resources are inaccessible for lower income Latinas who did not have e-mail accounts or home computers
Findings: Socioeconomic Status (SES) & Access Majority fell $8,170 to $10,918 below HHS Poverty Guidelines Low SES is associated with health literacy issues (Potter & Martin, 2005) Low literacy associated with health problems & under-utilizing resources (Kendig, 2006; Potter & Martin, 2005) Public transportation & location need to be considered Hospital outside city had limited public transportation (fewer births) Multiple facilities have potential for poor quality care, serious complications, fewer preventative services & decreased satisfaction Many used WIC services, free parenting & programs for the homeless; Most obtained health care in free clinics Use likely to grow evaluate funding due to positive ratings & outcomes Over-worked, understaffed, & overwhelmed community agencies need to be re-energized to create/ enhance programs
Findings: Infant Feeding Low breastfeeding rates (14%) consistent with the literature 45% were using both bottle & breast as a method of feeding Due to use of WIC services & ability to purchase food & formula? College degree & upper SES is related to breastfeeding (Moss,1981) but participants had low SES & less education Advice: Respect nurses education but also respect family tradition & mother s experience in raising children Families enlarge the nipple to add foods to the bottle Rationale: full stomach helps infant sleep better; cultural belief that a fat baby is a healthy baby; perception of others that the family has an economic advantage & can afford food in abundance (Torres, 2008) Health risks: choking hazard, obesity, & allergies Increased family support for breastfeeding is needed
Findings: Social Support All but one lived in multi-person households with extended family & 73% said these people assisted with advice & care Female family members & friends were most helpful resources 86% lived with their mother or the mother of the infant s father Self-identified as insular community which limits access to resources 2 were legally married & 30% lived with the father of the baby In contrast to the literature, husbands/ father of the baby were not the primary source of support for these women Fatigue was not prevalent; social support is associated with less fatigue (Lemmer, 1987; McQueen & Mander, 2003) Transience of population hinders telephone home contact Folk remedies must be addressed with Puerto Rican clients Support groups for new mothers may be beneficial
Recommendations Research Extend research to cesarean births, multiparas, those with complications & potentially use a Puerto Rican researcher Examine the insular nature & transience of this group Demonstrate to the community the value of research on practice Analyze covariant factors affecting school drop-out rates & retention in the mainland U.S. Create & evaluate effectiveness of publically assisted programs & programs Practice Evaluate preferred language & assess learning in this language Include family in health teaching & assess effective teaching methods Examine public Internet access & evidenced-based sites in Spanish & English Address family support for breastfeeding & effect of SES on continuation Encourage self-efficacy in decision-making for women to employ practices that safely incorporate evidenced-based health teaching & cultural practices
Limitations of the Study Generalizability may be limited Due to the convenience sample Due to the limited geographic region Selection bias of participants who chose to be part of the study Data analysis proceeded on both verified & unverified transcripts Inexperience of the researcher in conducting qualitative research May have led to potential bias despite the implementation of measures to reduce subjectivity
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References (continued) Maloni, J. A. (1994). The content and sources of maternal knowledge about the infant. Maternal-Child Nursing Journal, 22(4), 111-120. McQueen, A., & Mander, R. (2003). Tiredness and fatigue in the postnatal period. Journal of Advanced Nursing, 42(5), 463-469. Moss, J. R., (1981). Concerns of multiparas on the third postpartum day. JOGNN: Journal of Obstetric, Gynecologic, and Neonatal Nursing, 10, 421-424. Pope, C. (2005). Addressing limited English proficiency and disparities for Hispanic postpartum women. JOGNN: Journal of Obstetric, Gynecologic, and Neonatal Nursing, 34(4), 512-520. Portillo, C. J., Villarruel, A., Siantz de Leon, M. L., Peragallo, N., Calvillo, E. R., & Eribes, C. M. (2001). Research agenda for Hispanics in the United States: A nursing perspective. Nursing Outlook, 49(6), 263-269. Potter, L., & Martin, C. (2005). Health literacy fact sheets. Lawrenceville, NJ: Center for Health Care Strategies, Inc.
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