Date of Award
Fall 2022
Document Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
Department
Nursing
First Advisor
Sadler, Lois
Abstract
Adverse outcomes for adolescent mothers and their children are significant, often resulting in long-term health inequities. Women who have a first child in adolescence face concurrent demands of parenting and complex developmental demands. Supportive interventions, such as early home visiting programs (EHV), promote positive and nurturing parenting. Minding the Baby® (MTB) is an EHV program designed to improve parenting outcomes among young mothers living in medically underserved communities. The MTB intervention (from pregnancy through the child’s second birthday) was tested through two 2-group randomized controlled trials (RCT; 2002-2016). In the MTB early school-age (ESA) follow-up study (2016-2018), researchers described associations among maternal experiences, post-traumatic stress disorder (PTSD) symptoms, and caregiving patterns among RCT participants (2-8 years after RCT) and included both adult and adolescent mothers in the sample. Understanding adolescent mothers’ long-term outcomes and experiences over time after completing these programs will aid the tailoring and testing of strategies to sustain the effects of EHV interventions. Specifically, the phases of emerging (18-29) and early (through age 40) adulthood are understudied among women who become parents during adolescence. This lack of knowledge has contributed to a limited understanding of adolescent mothers as they develop as individuals and mothers over time. Access to the MTB cohort provided an opportunity to examine this knowledge gap. This dissertation study addresses the yet undocumented changing needs, strengths, and lasting EHV effects as adolescent mothers mature into early adulthood. This dissertation comprises three manuscripts. In the first manuscript, “Parenting Stress Among Adolescent Mothers: An Integrative Literature Review” (published in Western Journal of Nursing Research), I conducted an integrative literature review to identify risk and protective factors for parenting stress among adolescent mothers. Guided by Belsky’s Determinants of Parenting Model (1984), this study was implemented using Whittemore and Knafl’s (2005) five-stage method for conducting integrative reviews. Risk and protective factors for parenting stress were categorized into themes within the context of Belsky’s framework, including maternal attributes (e.g., maternal self-efficacy, depressive symptoms, parenting behaviors), child characteristics (e.g., child temperament, child development, infant attachment patterns), and contextual influences (e.g., perceived social support, father involvement, intimate partner violence). In the second manuscript, “Virtual Interviewing with Marginalized Young Adult Mothers: Appreciating the New Norm,” I described a qualitative content analysis related to specific questions about the experiences of virtual interviewing with emerging and young adult mothers. The qualitative data collected for the analysis were part of the larger explanatory sequential mixed methods dissertation study. The sample for the qualitative interviews included young adult mothers who had previously participated in randomized controlled trials testing MTB. In this manuscript, I reviewed detailed methodological components of virtual interviewing, noting strategies for optimizing the experience for researchers and participants. I also discussed the benefits and limitations of virtual interviewing with marginalized young mothers. The overarching theme was Zoom: Appreciating the New Norm. The identified categories were Practical Benefits of Virtual Interviewing, Sharing Stories, and Drawbacks of Virtual Interviewing. Findings supported virtual interviewing as a feasible and acceptable approach with the sample. However, future research is indicated to explore the feasibility and functionality of virtual interviewing with other diverse and marginalized populations. This manuscript is currently under peer review. In the third manuscript, I used an explanatory sequential mixed methods design to examine parenting outcomes and experiences of parenting among a sample of former adolescent mothers enrolled in a clinical trial (2002-2016) testing the Minding the Baby® (MTB) home visiting program. The study had three aims. First, I examined associations between maternal experiences (maternal early life experiences, PTSD symptoms) and parenting outcomes (parental reflective capacity, parenting behaviors, maternal report of child behavior) in a secondary analysis of previously collected survey data from the MTB follow-up Early School Age (ESA; child ages 4-10) Study (quantitative). Second, I explored the experiences of parenting over time through interviews with former adolescent mothers sampled from the ESA subsample based on quantitative findings (qualitative). Third, I integrated the quantitative and qualitative data to construct a comprehensive understanding through joint displays of integrated results. These included metainferences about relationships between maternal experiences, parenting outcomes, MTB experiences, and participants’ parenting experiences in early adulthood (mixed). The quantitative sample (N=71) included a subsample of ESA participants under 22 years at first birth, who self-identified as Black (32%), Hispanic/Latina (63%), and 43% had less than high school education. Significant quantitative findings included an association between maternal early life adversity and lower reflective parenting (β= -0.29, p=.04). Maternal PTSD symptoms were associated with more reported child behavior problems (β= 0.34, p=<.001). Intervention group (MTB) mothers reported lower hostile/coercive parenting behaviors and fewer child behavior problems. Findings from a survey of reflective parenting, a core principle of MTB intervention, guided the purposive sampling for the qualitative interviews (n=31). Qualitative data analysis was conducted using interpretive description and thematic analysis guided the analytic approach. Codes were clustered and linked in networks and patterns that informed six themes (“We Grew up Together,” Balancing Act, “My Child Saved Me,” Support over Time, Parenting Challenges, Putting Kids First). In the integration phase, quantitative and qualitative data were merged to synthesize the data related to (1) mothers’ personal growth and parenting experiences through emerging and early adulthood and (2) the lasting effects of participation in the MTB clinical trial. The outcomes may serve to inform future efforts to tailor, test, and sustain effects of EHV models, and to enhance support for adolescent mothers as they experience emerging and young adult development. This manuscript has been submitted to Journal of Mixed Methods Research. Adolescent mothers face significant challenges, particularly related to transitioning to the parenting role during rapid adolescent development. Not only do they face competing demands of their parental role responsibilities and adolescent developmental tasks, but their developmental trajectory into adulthood can be quite different from that of their non-childbearing peers. Next steps in this research include a community-engaged approach to develop and test a pilot intervention that promotes the unique strengths and mitigates specific stressors experienced by former adolescent mothers’ as they continue to mature. Ultimately, larger studies with more diverse populations of young mothers will inform approaches and policies that reduce long-term health and developmental inequities associated with adolescent childbearing.
Recommended Citation
Flaherty, Serena, "Parenting Experiences and Outcomes Among Former Adolescent Mothers: A Mixed Methods Study" (2022). Yale Graduate School of Arts and Sciences Dissertations. 744.
https://elischolar.library.yale.edu/gsas_dissertations/744
