The Effect of Counseling with Skills Training Approach on Maternal Functioning: a Randomized Controlled Clinical Trial

Abstract

Abstract: Introduction: Maternal functioning in the postpartum period is one of the important factors in successful maternal transition to maternal role and an important predictor of maternal behavior, self-efficacy and infant care behavior. Therefore, it is important to consider that a proper evaluation of postpartum performance helps to provide valuable information about maternal ability levels in the maternal role. The aim of this study was to determine the effect of counseling with skill training approach on postpartum maternal functioning (primary outcome) and maternal self-efficacy and infant care behavior (secondary outcomes). Methods: This randomized controlled trial was performed on 68 delivered women referred to health centers of Tabriz-Iran in 2019. Participants were randomly assigned into two groups of counseling and control by block randomization stratified on the number of delivery (first or second parity) and type of delivery (vaginal or cesarean section). The intervention group received four counseling sessions using the skills training approach. Before and two weeks after the completion of the intervention, the Barkin Index of Maternal Functioning (BIMF), maternal self-efficacy and infant care behavior questionnaires were completed by the participants. The independent t-test and ANCOVA (Analysis of Covariance) were used to analyze the data. Results: There was no statistically significant difference between the two groups in terms of socio-demographic characteristics (P>0.05). Before the intervention, the mean (SD) total score of the BIMF in the intervention group was 73.1 (8.5) and in the control group, it was 71.6 (4.8). There was no statistically significant difference between the two groups based on the independent t-test (P=0.383). After intervention, the mean (SD) of the total score of the BIMF in the intervention group was 95.8 (11.8) and in the control group, it was 70.3 (4.5). Based on the ANCOVA test and after adjusting the baseline score, the mean total score of the BIMF was significantly higher in the intervention group than the control group (adjusted mean difference (AMD): 22.9; 95%Confidence Interval (95% CI): 18.2 to 27.6; P<0.001). In regards to domains of the BIMF, there was no significant difference between the two groups before the intervention based on the independent t-test. However, after the intervention, the mean score of all dimensions was significantly higher in the intervention group compared to the control group (P<0.05). After intervention, the mean )SD) of total maternal self-efficacy score was 35.6 (5.7) in the intervention and 30.9 (1.9) in control group, and based on the ANCOVA test with baseline control, it was significantly higher in the intervention group than the control group (AMD: 2.9; 95% CI: 0.8 to 5.1; P= 0.008). After intervention, the mean (SD) score of infant care behavior in the intervention was 78.9 (3.8) and in the control group was 76.2 (3.6) and based on the ANCOVA test with baseline control, it was significantly higher in the intervention group than the control group (AMD: 2.8; 95% CI: 1.6 to 4.1; P<0.001). Conclusions: Counseling with skill training approach is effective on postpartum maternal functioning as well as maternal self-efficacy and infant care. Therefore, this method is recommended to improve maternal-child outcomes.