| Objective:The purpose of this study is to conduct a cross-cultural adaption of the Postpartum Depression Literacy Scale(Po DLi S)and to test its psychometric properties among Chinese maternal women using a descriptive cross-sectional design.Through quantitative research methods,the current situation of postpartum depression literacy was investigated,the relationship between postpartum depression literacy,perceived social support and general self-efficacy was explored,and the influencing factors of postpartum depression literacy were clarified.Qualitative research method was used to describe the maternal training needs of postpartum depression literacy under the social and cultural background of China.Based on the results of quantitative research,qualitative research,literature analysis and expert meeting,an intervention program to improve the maternal postpartum depression literacy was preliminarily constructed,which provided a theoretical basis and reference of the postpartum depression literacy intervention in maternity schools.Methods:A mixed-methods study Part I:Psychometric properties of the Postpartum Depression Literacy Scale(Po DLi S)among Chinese maternal womenIn this part,the Postpartum Depression Literacy Scale was translated according to Brislin’s translation theory,with the authorization of the original author,the Chinese version of Po DLi S was initially formed through forward translation,back translation,cross-cultural adaptation and preliminary investigation.From August 2020 to December 2020,convenient sampling method was adopted to invite 635 maternal women in three hospitals to apply the questionnaire.The research tools included the general demographic questionnaire,the Chinese version of the Postpartum Depression Literacy Scale,and the Chinese version of the Mental Health Literacy Scale.SPSS24.0 and AMOS24.0 software were used for data analysis,the reliability and validity of Chinese version of Po DLi S were evaluated by item analysis,content validity,structure validity,criterion correlation validity,internal consistency reliability and test-retest reliability.Part II:The current status and influencing factors of maternal postpartum depression literacyThis part is a cross-sectional design,386 cases of maternal women in three hospitals from January 2021 to March 2021 were selected by using the convenient sampling method.Data were collected using the general demographic questionnaire,Chinese version of the Postpartum Depression Literacy Scale,Perceived Social Support Scale,General self-efficacy Scale,and self-rated visual analog health condition Scale.SPSS24.0,AMOS24.0software were used for statistical analysis by descriptive statistical analysis,univariate analysis,multivariate analysis and structural equation model analysis.Part III:Qualitative study on training needs of maternal postpartum depression literacy Using descriptive qualitative research methods,18 maternal women in a hospital from April 2021 to June 2021 were selected by the purpose sampling method combined with maximum difference sampling strategy to conduct semi-structured interviews.NVivo12.0software was used to sort out and analyze the transcribed text data by content analysis.Part IV:The construction of maternal postpartum depression literacy intervention program This part combined the results of quantitative research and qualitative research,as well as the results of the content analysis of relevant literatures,with the purpose of preliminarily construct the postpartum depression literacy intervention program.Through expert meeting,the intervention program was revised and improved,and the final draft of the intervention program was formed.SPSS24.0 software was used to evaluate experts’enthusiasm,authority coefficient,coordination coefficient and item variation coefficient.P<0.05 was considered statistically significant in this study.Results:Part I:Psychometric properties of the Postpartum Depression Literacy Scale(Po DLi S)among Chinese maternal womenA total of 700 questionnaires were sent out in this study,of which 635 were valid,with effective recovery of 90.7%.(1)The Chinese version of the Postpartum Depression Literacy Scale contains 31 items and 6 dimensions,ability to recognize postpartum depression(6 items),knowledge of risk factors and causes(5 items),knowledge and belief of self-care activities(5 items),knowledge and beliefs about professional help available(4 items),attitudes which facilitate recognition of postpartum depression and appropriate help-seeking(6 items),knowledge of how to seek information related to postpartum depression(5 items).(2)The results of item analysis showed that the correlation coefficient between the scores of each item and the total score of the Chinese version of Po DLi S was 0.402～0.609(P<0.001),and the CR values ranged from 5.568 to 11.815,all of which were>3.000 with statistical significance(P<0.001).(3)The results of content validity analysis showed that S-CVI at scale level was 0.968,I-CVI at item level was between 0.8～1.(4)The results of structural validity analysis showed that six factors were extracted from exploratory factor analysis,the loading coefficients of each factor ranged from 0.547 to0.881,and the cumulative variance contribution rate was 60.757%.Confirmatory factor analysis showed that the factor loading of each item in this dimension were≥0.30,The fitting indexes of the six-factor structural model were c~2/df=1.003,RMSEA=0.003,and GFI,AGFI,IFI,TLI and CFI were all greater than 0.90,indicating that all indexes in this study met the fitting requirements of structural equation model.(5)The results of criterion-related validity showed that here was a positive correlation between the total score of postpartum depression literacy scale and the total score of mental health literacy scale,r=0.685(P<0.001).The correlation coefficients between the score of the Chinese version of postpartum depression literacy dimensions and the score of mental health literacy dimensions were 0.290～0.411(P<0.001)(6)The results of reliability showed that the Cronbach’sαcoefficients of the Chinese version of the postpartum depression literacy were 0.896,and the Cronbach’sαcoefficients of each dimension were 0.770～0.872.The retest reliability of the total scale was 0.87Part II:The current status and influencing factors of maternal postpartum depression literacyA total of 400 questionnaires were sent out,and 386 valid questionnaires were collected with effective recovery of 96.5%.(1)The average score of postpartum depression literacy in 386 cases was(3.56±0.32),and the score of each dimension from low to high was:knowledge and beliefs about professional help available(3.21±0.53),knowledge of how to seek information related to postpartum depression(3.21±0.74),ability to recognize postpartum depression(3.41±0.67),attitudes which facilitate recognition of postpartum depression and appropriate help-seeking(3.51±0.61),knowledge and belief of self-care activities(3.79±0.45),knowledge of disease risk factors and causes(4.09±0.63),the total score of the scale was at a moderate level and each dimension was scored unevenly.(2)Univariate analysis results:There were statistically significant differences in the scores of postpartum depression literacy in age,planned pregnancy,education level,employment status,history of depression and complications(P<0.05).(3)Correlation analysis results:The score of postpartum depression literacy scale was positively correlated with the score of general self-efficacy scale(r=0.209～0.395,P<0.001),and with the score of perceived social support scale(r=0.239～0.407,P<0.001).General self-efficacy score was positively correlated with perceived social support score(r=0.249～0.344,P<0.001).(4)Multivariate analysis results:Planned pregnancy,education level,history of depression,self-efficacy,perceived social support(other support dimension and family support dimension)were included in the regression equation,indicating that the above variables were influencing factors of overall postpartum depression literacy,accounting for 36.8%of the cumulative variation.Planned pregnancy,education level,history of depression,self-efficacy,perceived social support(other support dimension)were included in the regression equation suggested that these variables were influencing factors of“ability to recognize postpartum depression”,accounting for 13.7%of cumulative variation.Education level and perceived social support(other support dimension)were included in the regression equation,indicating that the above variables were influencing factors of“knowledge of risk and causes of postpartum depression”,accounting for 17.2%of cumulative variation.Planned pregnancy,education level,self-efficacy and perceived social support(family support dimension)were included in the regression equation,indicating that the above variables were influencing factors of“knowledge and belief of self-care activities”,accounting for 18.0%of cumulative variation.Education level,comorbidities,self-efficacy,perceived social support(family support dimension)were included in the regression equation,indicating that the above variables were influencing factors of“knowledge and beliefs about professional help available”,accounting for21.2%of cumulative variation.Self-efficacy and perceived social support(other support dimension and family support dimension)entered the regression equation,indicating that the above variables were influencing factors of“attitudes which facilitate recognition of postpartum depression and appropriate help-seeking”,accounting for 17.8%of cumulative variation.Education level,history of depression,self-efficacy and perceived social support(other support dimension and family support dimension)were entered into the regression equation,indicating that the above variables were influencing factors of“knowledge of how to seek information related to postpartum depression”,accounting for 28.4%of cumulative variation.(5)The results of structural equation model test:Perceived social support can directly affect the postpartum depression literacy,also can affect postpartum depression literacy through the general self-efficacy,general self-efficacy played an mediating effect between perceived social support and postpartum depression literacy,the mediating effect accounted for 16.7%of the total effectPart III:Qualitative study on training needs of maternal postpartum depression literacy A total of 18 maternal women were included,with an average age of(29.18±3.06)years,including 15 postpartum women(15/18),1 case with religious belief(1/18),2 cases(2/18)with history of depression,14 cases(14/18)with EPDS score>13,3 cases with complications(3/18).After interviewing,summarizing and refining the training needs related to maternal postpartum depression literacy,three themes and thirteen sub-themes were obtained:(1)The training content needs of maternal postpartum depression literacy included depression identification,disease etiology,self-protection section,professional help,cognitive help and depression information.(2)The enabling factors of maternal postpartum depression literacy included family care degree and parenting competence feeling.(3)The training style needs of maternal postpartum depression literacy included:the training targets were expected to involve maternal women,their husbands and their families,the teaching staff were expected to be composed of obstetricians,nursing staff and psychological experts,the intervention time was hoped to be in the middle of pregnancy,the teaching style is expected that will be combined online and offline,supplemented by brochures,videos and other forms.Part IV:The construction of maternal postpartum depression literacy intervention program A total of 10 depression literacy intervention literatures were included for content analysis,and a maternal postpartum depression literacy intervention draft was preliminarily constructed based on quantitative,qualitative research and content analysis results.7 experts were invited to participate in the expert meeting to evaluate the intervention draft,the expert authority coefficient was 0.89,the expert positivity was 100%,and coordination coefficient was 0.461(P<0.001).Experts put forward 10 suggestions for modification,and finally formed an maternal intervention program for postpartum depression literacy,including 3 modules,9 intervention themes and 28 intervention contents.Conclusion:(1)The Chinese version of the postpartum depression literacy scale had adequate psychometric properties and this tool could be used to evaluate the level of maternal postpartum depression literacy.(2)The maternal postpartum depression literacy is generally at a medium level,with uneven levels in various dimensions,and there is still room for improvement.A survey of general demographic data(planned pregnancy,education level,history of depression)may help identify key groups of postpartum depression literacy.However,self-efficacy and perceived social support(family support dimension and other support dimension)are the enabling factors of maternal postpartum depression literacy.Self-efficacy plays a mediating role in understanding the relationship between social support and postpartum depression literacy,suggesting that a maternal postpartum depression literacy intervention program can be constructed from three aspects:mental health literacy,self-efficacy and social support.(3)There are still many deficiencies in maternal postpartum depression literacy,and there is an urgent need for training of maternal postpartum depression literacy.Therefore,it is necessary to build a systematic intervention program for maternal postpartum depression literacy.During the implementation of the program,the promotion effect of family care degree and parenting competence feeling on mental health literacy should be effectively utilized,and the maternal women’s expectations on training objects,teaching personnel,intervention timing and teaching form should be included in the implementation of the intervention program.(4)The constructed for maternal postpartum depression literacy intervention program,which includes 3 modules(mental health literacy,social support and self-efficacy),9intervention themes and 28 intervention contents,which can provide references for the implementation of postpartum depression literacy intervention of maternal women in maternity schools and communities at all levels. |
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