Promoting Healthy Development in Early Childhood At-Risk Populations: A Three-Part Study to Understand Maternal Role Beliefs and Health Behaviors Affecting Their Child’s Early Developmental Outcomes



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Background: Health inequity exists in the United States and child health disparities by race, ethnicity, and socioeconomic status are persistent and pervasive. While many children achieve healthy development, some are more likely to be at risk for adverse developmental outcomes before their first day of school. Recognizing that maternal-infant health is multifaceted has led to health and education policy that addresses individual-level factors as well as the health services and education centers that have a role in development. Purpose: Three studies examined outcomes during early childhood by studying factors such as maternal role beliefs, maternal health behaviors, and health systems interventions. Study One aimed to better understand a mother’s role in early cognitive development with preschool-aged children at risk for early language deficits. Study Two synthesized evidence to better understand what effect integrated health care (IBH) models implemented in obstetric primary care settings have on maternal and neonatal health outcomes. Study Three aimed to understand the relationship between depression screen scores, pregnant woman’s gestational age at the first prenatal visit, attending a behavioral health appointment, and their neonate’s gestational age and birthweight within an IBH model. Methods: Study One utilized focus groups and self-report questionnaires to elicit mothers' perceived roles and beliefs about their children's early language and literacy development. Mixed methods were used to analyze and identify focus group themes. Study Two, a scoping review, followed Joanna Briggs Institute guidelines and the PRISMA-ScR reporting framework. Study Three retrospectively examined the relationship between pregnant women’s depression screen scores and gestational age at an initial prenatal appointment, access to IBH services, and their neonate gestational age and birthweight. Both logistic and linear regression analyses included known covariates. Results: Study One results indicated mothers used a direct teaching style to develop a prescribed set of knowledge and skills important for kindergarten. Study Two results indicated that IBH in obstetric primary care improves life functioning, health-promoting behaviors, and neonate birth outcomes. The collaborative care model was the term most used to describe IBH. Study Three found that with each point increase in depression screen score at the initial prenatal visit was associated with an 18% increase in odds of attending an initial behavioral health appointment. Additionally, no statistically significant relationships between pregnant women's depression screen scores at the initial prenatal visit and neonate birth outcomes. Conclusions: Findings have implications for practice in pediatric and obstetric health and early childhood educational settings, especially those serving low-income, ethnic, racial, and linguistically diverse populations. Study One findings provide recommendations for culturally informed home interventions for oral language development. Study Two findings broadly indicate that IBH models in obstetric primary care result in a maternal-infant health benefit. Methodological heterogeneity across studies defining and describing the IBH model limits the available evidence to make decisions about healthcare delivery systems and policy. Study Three adds to evidence about the relationship between depression symptoms reported at the first prenatal visit seeking behavioral health care, a critical step in addressing maternal mental health service equity.



Infant and early childhood development, Early literacy, Maternal mental health, Behavioral health