Salutogenesis and Self-efficacy-based Childbirth Education Programme for Preventing Postpartum Depression

Effectiveness of Childbirth Education Based on Salutogenic Perspective and Self-Efficacy Theory in Preventing Postpartum Depression Among Ethiopian Teenage Mothers: a Pilot RCT Study

Although the transition to motherhood is often a joyful experience, there is evidence that teenage motherhood can present many stressful challenges, potentially leading to the development of postpartum depression. Postpartum depression (PPD) remains a public health issue with negative consequences for both mothers and their babies. The aim of this study is to assess the feasibility of implementing childbirth education underpinned by salutogenic and self-efficacy perspectives among teenage mothers in low-income settings. The study also aims to provide preliminary findings on the intervention's effectiveness in preventing postpartum depression among Ethiopian teenage mothers. The theoretical based childbirth education approach can enhance the psychosocial well-being of first-time teenage mothers. The intervention consists of six sessions: three during the antenatal period and three in the postpartum period. These sessions contain two individual face-to-face educations (each lasting 60-90 minutes), two phone calls (each lasting 30 minutes), and two group discussion (each lasting 90-120 minutes), as supported by the existing evidence. The study expected to support the feasibility of the study design. Preliminary findings are anticipated to show a significant difference in postpartum depression scores between the intervention and control groups, with teenage mothers in the intervention group having a lower risk of postpartum depression compared to those in the control group. Integrating sense of coherence and self-efficacy theories into maternity care services could provide empirical support for preventive efforts against postpartum depression. The findings of this study may address research gaps regarding the psychosocial wellbeing of teenage mothers, serving as baseline evidence for large scale interventional studies that consider the sociocultural and economic contexts of low-income countries.

Study Overview

• Status: Recruiting
• Conditions: Postpartum Depression (PPD)
• Intervention / Treatment: Behavioral: Childbirth education programme; Other: Usual Care

Detailed Description

Postpartum depression (PPD) is a common mental health disorder that occur following childbirth. It typically develops within the first 12 weeks of the postpartum period, although researchers and public health experts consider PPD to be prevalent up to one year after giving birth. Although postpartum depression remains a global public health concern, it is often overlooked in the maternal healthcare system, particularly in low-and middle-income countries. The existing maternity care service often prioritizes addressing obstetrical issues while neglecting the mental well-being of labouring mothers. In Ethiopia, the prevalence of PPD among teenage mothers has reached 37%, which is much higher than the global average of 18%. Consequently, depression following childbirth continues to pose a significant risk to the overall well-being of both mothers and newborns. This study is significant in providing evidence to policymakers and health stakeholders, urging them to integrate mental health and health promotion interventions in maternity care services without imposing an additional financial burden on the healthcare system.

The role of maternity care provision during the antenatal and postnatal period is to enhance mothers' birth preparedness and complication readiness to achieve optimal maternal and infant health. However, it is crucial to practically evaluate the effectiveness of childbirth education underpinned by salutogenesis and self-efficacy perspectives in preventing PPD by enhancing mothers' sense of coherence, parenting self-efficacy, and perception of social support throughout the transition to motherhood. The findings of this study provide significant evidence for the integrating of the current disease prevention-focused approach of maternal care services with health-protective salutogenic interventions to maintain mothers' psychosocial well-being during childbirth and the parenting experience. Furthermore, the evidence may encourage countries, including Ethiopia, to implement childbirth classes that are not yet conducting in maternity care.

• Study Type: Interventional
• Enrollment (Estimated): 130
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Lebeza Alemu Tenaw; Phone Number: 852 52242797; Email: lebeza.tenaw@connect.polyu.hk

Study Locations

• Ethiopia
  • Amhara
    • Bahir Dar, Amhara, Ethiopia
      • Completed
      • Addis Alem Hospital
    • Bahir Dar, Amhara, Ethiopia
      • Recruiting
      • Felege Hiwot Specialized Hospital
      • Contact: Temesgen Mekonnen; Phone Number: 0913512832; Email: temesgenm@gmail.com
    • Bahir Dar, Amhara, Ethiopia
      • Completed
      • Tibebe Gion Hospital
    • Dessie, Amhara, Ethiopia
      • Completed
      • Dessie Specialized Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• married first-time teenage mothers aged 13-19 years attending antenatal follow-up in the selected hospitals
• a single pregnancy with 28-30 weeks of gestational age
• no pregnancy complications contraindicating vaginal delivery
• plan to have institutional delivery and postnatal visits at the selected health hospitals and who reside for a minimum of 12 weeks postdelivery around the selected hospitals

Exclusion Criteria:

• have self-reported history or current mental health problems
• participated in similar interventional programmes
• have serious medical and obstetrics problems
• having foetus with diagnosed congenital anomalies

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention group	Behavioral: Childbirth education programme; The intervention framework is underpinned by a converging of salutogenic and self-efficacy perspectives, aiming to enhance mothers' ability to adapt to new motherhood life despite stressors, and to address the question, "How do teenage mothers stay well despite stressful events of transition to motherhood?" The intervention consists of six sessions: three of which will be provided in the antenatal period and the other three in the postpartum period. The sessions contain two individual face-to-face educations (each lasting 60-90 minutes), two phone calls (each lasting 30 minutes), and two group discussion sessions (each lasting 90-120 minutes), as supported by the existing evidence.
Active Comparator: Control group:	Other: Usual Care; The control group will receive the usual maternity care.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Edinburgh Postnatal Depression Scale	Edinburgh Postnatal Depression Scale is a 10-item self-report scale assessing the presence of depressive symptoms in the postnatal period. Each item is scored on a 4-point scale with total scores ranging from 0 to 30. Higher score indicates greater depressive symptoms, i.e. worse outcome.	6 weeks postpartum

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Edinburgh Postnatal Depression Scale	Edinburgh Postnatal Depression Scale is a 10-item self-report scale assessing the presence of depressive symptoms in the postnatal period. Each item is scored on a 4-point scale with total scores ranging from 0 to 30. A higher score indicates greater depressive symptoms, i.e. worse outcome.	12 weeks postpartum
Sense of Coherence Scale	Sense of Coherence Scale is a 13-item scale assessing the extent to which teenage mothers perceive the transition to motherhood as meaningful, comprehensible and manageable. Each item is scored on a 7-point scale, with total scores ranging from 7 to 91. Higher scores indicate a stronger perception of life coherence, i.e. better outcome.	6 weeks postpartum
Sense of Coherence Scale	Sense of Coherence Scale is a 13-item scale assessing the extent to which teenage mothers perceive the transition to motherhood as meaningful, comprehensible and manageable. Each item is scored on a 7-point scale, with total scores ranging from 7 to 91. Higher scores indicate a stronger perception of life coherence, i.e. better outcome.	12 weeks postpartum
Parenting Self-Efficacy Scale	Parenting self-efficacy scale has 20 items, scored on a 4-point Likert scale, assessing teenage mothers' beliefs about their abilities to handle a set of stressful situations during the childbearing period. Higher scores indicate a stronger parenting self-efficacy, i.e. better outcome.	6 weeks postpartum
Parenting Self-Efficacy Scale	Parenting self-efficacy scale has 20 items, scored on a 4-point Likert scale, assessing teenage mothers' beliefs about their abilities to handle a set of stressful situations during the childbearing period. Higher scores indicate a stronger parenting self-efficacy, i.e. better outcome.	12 weeks postpartum
Social Support Questionnaire (modified version)	The modified version of social support questionnaire (SSQ) assessing the perceived social support during transition to motherhood, which has 6 items with 6 Likert scale points with total scores ranging from 6 to 36. Higher scores indicate a stronger perception of social support, i.e. better outcome.	6 weeks postpartum
Social Support Questionnaire (modified version)	The modified version of social support questionnaire (SSQ) assessing the perceived social support during transition to motherhood, which has 6 items with 6 Likert scale points with total scores ranging from 6 to 36. Higher scores indicate a stronger perception of social support, i.e. better outcome.	12 weeks postpartum
Perceived Stress Scale	Perceived stress scale (PSS) is a 10 items scale with 5-point Likert scoring from 0 to 4 to assess one's perceived stress level during transition to motherhood. Out of 10 items, six are negative questions (1, 2, 3, 6, 9, 10) and four are positive (4, 5, 7, 8), indicating 'perceived distress' and 'perceived coping', respectively. A higher score indicates greater perception of stress level, i.e. worse outcome.	6 weeks postpartum
Perceived Stress Scale	Perceived stress scale (PSS) is a 10 items scale with 5-point Likert scoring from 0 to 4 to assess one's perceived stress level during transition to motherhood. Out of 10 items, six are negative questions (1, 2, 3, 6, 9, 10) and four are positive (4, 5, 7, 8), indicating 'perceived distress' and 'perceived coping', respectively. A higher score indicates greater perception of stress level, i.e. worse outcome.	12 weeks postpartum

Collaborators and Investigators

• Sponsor: The Hong Kong Polytechnic University

Study record dates

Study Major Dates

• Study Start (Actual): December 5, 2024
• Primary Completion (Estimated): May 30, 2025
• Study Completion (Estimated): July 15, 2025

Study Registration Dates

• First Submitted: November 15, 2024
• First Submitted That Met QC Criteria: November 18, 2024
• First Posted (Actual): November 20, 2024

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: March 11, 2025
• Last Verified: November 1, 2024

More Information

Terms related to this study

• Keywords: Intervention; Postpartum depression; Teenage mothers; Childbirth education
• Additional Relevant MeSH Terms: Urogenital Diseases; Mental Disorders; Female Urogenital Diseases and Pregnancy Complications; Pregnancy Complications; Behavioral Symptoms; Mood Disorders; Puerperal Disorders; Depression; Depressive Disorder; Depression, Postpartum
• Other Study ID Numbers: HSEARS20240907003

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No