Recent years have seen increasing recognition of the importance of prevention and early intervention programmes to support parents, alongside a growing pool of high quality research in Ireland that provides important insights into the lives of children and their families (e.g. Department of Children and Youth Affairs [DCYA], 2014; McGilloway et al., 2014; Nixon, Swords and Murray, 2013). Sensitive parenting has been shown to have a positive impact on a child’s cognitive, emotional and physical development (Shonkoff and Phillips, 2000). Conversely, negative and conflicted parentchild relationships and ineffective parenting practices have been linked to maladjusted child developmental trajectories (Capsi et al., 2004; Lorber and Egeland, 2011).
The birth of a child can bring much happiness and enjoyment in new parents’ lives, but can also lead to significant stress and disrupted family relationships. Parental resilience in the face of parenting stressors is important. The psychosocial health of parents and the ability of parents to create home environments characterised by social, emotional and cognitive support constitute important protective factors in the lives of children. More positive transitions to parenthood may help to bolster parental self-confidence and encourage the acquisition of more effective parenting skills, whilst also protecting against depressive symptoms, stress and anxiety (Kohlhoff and Barrett, 2013; Leahy-Warren and McCarthy, 2011). Positive parental adjustment during this vulnerable period can also contribute to the development of positive parent-child relationships, thereby providing a sound basis for healthy child behavioural and socio-emotional development into the future (Overbeek et al., 2007; Serbin and Karp, 2004).
This study examines parental adjustment over the first two years of an infant’s life. The research outlined in this paper was conducted as part of a larger evaluation of a new community-based, early parenting intervention, the Parent and Infant (PIN) programme, which aims to improve parenting competencies and infant outcomes in the earliest years of life. The PIN programme is a wraparound-inspired, prevention and early intervention model delivered by Public Health Nurses (PHNs) in collaboration with community-based services. The intervention combines a range of developmentally-appropriate parent and infant supports, including the Incredible Years (IY) Parent and Baby and Parent and Toddler programmes (Webster-Stratton and Reid, 2008); Baby Massage; paediatric firstaid training and other workshops, which are delivered in a single intervention process from birth to two years of age. The PIN programme is part of the new Area Based Childhood (ABC) Programme in Ireland (DCYA, 2013) which involves the implementation of 13 area-based approaches to prevent and reduce child poverty in socially deprived areas. Two of these - the Blue Skies Initiative in Clondalkin and the Genesis Programme in Drogheda/Dundalk - are currently delivering the PIN programme as one of a number of services in their area-based approaches. This paper provides a brief description of the health and well-being of parents with very young infants who are participating in a non-randomised controlledtrial evaluation of the PIN programme. The aim of this current study was to assess parental characteristics and self-reported experiences of parenting during infancy, with a focus on the first two months of life.
Participants and settings
The study was conducted in Dublin South West and Drogheda/Dundalk, Co. Louth. Both are urban areas that include neighbourhoods characterised by significant socio-economic disadvantage such as high rates of early school leaving and lone parent families (Fleming and Gallagher, 2004; Haase and McKeown, 2003;
Louth Children’s Services Committee, 2012). Participants were eligible for inclusion if they: (a) were aged 16 years or older; (b) had an infant aged 6-20 weeks; (c) were willing to participate in the study; and (d) were able to communicate in English. Mother-infant dyads were recruited to the study via community-based health clinics and community-based child and family services. Mothers were recruited on a phased basis during December 2014–June 2016. A total of 239 agreed to be contacted, 190 of whom (79%) provided written informed consent to participate in the research (Figure 1).
Demographic and background information on all families (e.g. age, marital status, living arrangements, employment status) was collected using a Profile and Demographic Information Form (PDIF). Additional information was obtained on the general health and relationships of the principal carer and family members, perceived stress, and difficulty with routine care activities using items adapted from the Growing Up in Ireland Study (Thornton et al., 2013). The Parental Sense of Competence (PSOC) scale (Johnston and Mash, 1989) was used to assess parental self-efficacy and parent satisfaction, whilst maternal depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9; Spitzer et al., 1999).
The average age of mothers at baseline (at the birth of the index child) was 31.6 years (SD=5.4), compared to 34 years (SD=5.5) for fathers. Over half (55%) were first time mothers, almost onequarter were lone parents or living apart, whilst approximately one in five (19%) were non-Irish nationals (Table 1). Educational attainment was generally high with most participants having completed at least post-primary education (89%) and in full-or part-time employment (71%). However, one-third of the sample had a
household income of less than €24,000 per annum (33%), whilst 18% were deemed to have children who were ‘at risk’ of developing conduct problems at a later date (calculated using a ‘risk factor score’ based on, single parenthood, teenage parenthood, parental depression, family poverty, and parental history of drug abuse or criminality (Webster-Stratton, 1998).
Infants comprised roughly equal numbers of boys and girls who were almost two months old when assessments were conducted. The self-reported health of participants and their infants was in the main very good; most mothers reported no health problems or only minor illness for themselves (36%) and their infants (19%). Significant illnesses were reported for only seven parents and two infants. Almost half of the sample (48%) reported at least some stress due to looking after their baby. Approximately one third (28%) reported minor difficulties with routine baby care activities, whilst a further 14% reported ‘moderate’ to ‘large’ difficulties coping with their baby’s sleeping and crying patterns. A further 19% of participants reported having worries or concerns about their baby’s health or behaviour, which most commonly included excessive crying/colic, sleep-related problems, health issues and reflux or feeding problems.
Mothers reported typically low levels of depressive symptoms (PHQ-9); only 3% (n=5) reported moderate to severe depressive symptomatology. Scores on the PSOC scale indicated generally high levels of parental
self-efficacy, which are important in protecting against parental stress and poor quality parenting, as well as poor infant developmental outcomes (Goodman et al. 2011; Hess, Teti and Hussey-Gardner, 2004). However, a substantial minority of parents reported moderate to low levels of parenting satisfaction and self-efficacy (Table 2).
Most parents reported ‘good/very good’ relationships with their partner and/or wider family circle, as well as a high level of support from family and friends (Table 3). Most participants reported feeling closer to their partner after the birth of the index child, whilst father involvement in the upbringing of their child was reported as high. Most parents had attended a GP and/or seen a nurse or midwife in the weeks after leaving hospital. However, 12% of parents reported no contact with any health or social service professionals regarding their own health and well-being since leaving hospital (Table 3).
The post-natal period can be a time of considerable vulnerability and stress for parents. This study examined family demographics, parent characteristics, well-being and parenting experiences (e.g. parenting-related stress, difficulty with routine baby care activities and parental self-efficacy) in a sample of Irish parents with young infants in the ABC Programme. Overall, the findings paint a generally positive picture of parental and child health and well-being in the earliest months of a child’s life, with most parents reporting good health, low levels of depressive symptoms and high levels of social support as well as typically low levels of parenting-related stress and a high sense of parenting competence. However, a
sizeable proportion experienced stress in their parenting role, and our findings also suggest the
existence of one or more potentially vulnerable sub-groups including the significant minority (almost 20%) who reported considerable difficulty in managing their baby’s care as well as lower levels of parent satisfaction and self-efficacy (28%). For instance, contextual stressors such as parents living in disadvantaged areas and lone parenthood led to a decreased sense of competency.
This baseline study provides interesting insights into the lives of parents living in mainly disadvantaged areas in Ireland who are providing care to young infants. Further assessments will be undertaken when children are 8, 16 and 24 months old in order to assess parent and infant outcomes over time, as well as
the impact of prevention and early intervention services (the PIN programme) on family health and well-being. The sub-groups who are faring less well, including the 17% of infants deemed to be at risk of conduct problems, will also be monitored closely. Additional process evaluation and economic data will be used in the ongoing work to establish the overall effectiveness of the new PIN service model and to identify key
lessons for other areas of service provision. It is anticipated that the findings will make an important contribution to the development and implementation of community-based early parenting interventions designed to promote positive parent-child relationships and build resilience in the earliest years.
We acknowledge with thanks the funding provided for this study by the Health Research Board under its Collaborative Applied Research Grant scheme. We also extend our thanks to the PHNs and the community organisations with whom we are working as part of this research – including the Blue Skies and Genesis initiatives in Dublin and Dundalk/Drogheda respectively. Lastly, we owe a debt of gratitude to all of the parents who kindly agreed to take part in this study.