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Title: A pilot randomised controlled trial to explore Telephone Support Intervention as a means of supporting young mothers in the immediate postnatal period in western Kenya
Author: Kirop, Elijah
ISNI:       0000 0005 0290 0448
Awarding Body: University of Manchester
Current Institution: University of Manchester
Date of Award: 2019
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Background: Globally, pregnancy among the young/adolescent women is a growing public health issue of concern. This group of women are often socially and economically disadvantaged due to their age and low status, including low level of education. Most young/adolescent women (and/or mothers) are less likely to attend the recommended antenatal and/or postnatal visits. Consequently, this puts them and their babies/infants at a considerable health risk. Evidence suggests that adolescent mothers have exhibited lower self-esteem and more depressive symptoms, including low breastfeeding and general self-efficacy compared to older mothers. Trials and systematic review evidence on telephone support intervention (TSI), however, suggest a promising opportunity to offer supportive maternity care. Aim(s): To explore the feasibility of conducting a main trial comparing telephone support versus no support for young mothers in improving maternal physical, psychological and social wellbeing during the immediate postnatal period. Methods: A pilot randomised-controlled trial of a telephone support intervention was conducted between October 2016 and August 2017 using a mixed-methods approach. A sample of 52 young mothers (12-19years) were recruited in two referral hospitals and randomised into intervention and usual care groups, with n=43 retained in the pilot trial and analysed. The usual care group received standard postnatal care while the intervention group received an additional telephone support (weekly SMS, and telephone call after every 3 weeks) for 10 weeks postpartum. Descriptive statistics were used to analyse data (mean, median, 95%CIs), including Chi-square test, Independent- samples t-test and Mann-Whitney U test. Results: Mothers who received telephone-support appeared to have higher maternal self-esteem (median=25 vs 22, 95%CI for difference in median=0.001 to 4.00), with moderate effect-size=0.54; and less infant-related anxiety (median=1.50 vs 4.00, 95%CI for difference in median= -3.00 to 1.00) respectively; and were less likely to report: being ill (22.7% vs 71.4%, 95%CI=-0.68 to -0.19); experiencing difficulty in breastfeeding (9.1% vs 38.1%, 95%CI=-0.51 to -0.03); and initiating early-weaning (22.7% vs 52.4%, 95%CI=-0.53 to -0.009). The results should, however, be interpreted with caution as this small pilot was not powered for significance. Qualitative results highlighted five main themes: social support needs for young mothers; maternal role modelling in maternal role transition and attainment; social support systems available to young mothers after birth; the (perceived) role of TSI; and the feasibility and acceptability of TSI among young mothers and midwives. Overall, the results suggest that TSI is feasible and acceptable among young/teenage mothers and health care providers (midwives) in Kenya. Discussion: Young/teenage mothers in LMICs settings such as Kenya still lack knowledge and maternal competence as they transit to motherhood. Thus, it is important to understand the social support needs for such a group of mothers so as to meaningfully and effectively meet their needs, including the social support systems available to them. Moreover, innovative/novel strategies such as TSI may provide opportunities for addressing the gaps in maternal and infant care practices in such settings. Conclusions: This pilot trial suggests that it is possible to recruit young/teenage mothers in LMICs such as Kenya for main trials. TSI appears helpful and acceptable to both midwives (and other service providers) and young mothers.
Supervisor: Lavender, Tina ; Smyth, Rebecca Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available