Holistic Obstetrical Problem Evaluation (HOPE): testing a theory to predict birth outcomes in a group of women from appalachia.

The purpose of this study was to test the Holistic Obstetrical Problem Evaluation (HOPE) theory by determining the effects of prenatal factors from the biophysical, psychosocial, spiritual, and perceptual domains of the HOPE theory with infant birth outcomes. Face-to-face interviews were conducted using standard and reliable questionnaires with a convenience sample of 120 pregnant women between the ages of 14 and 44 years and 16-28 weeks gestation, and attending three prenatal clinics in East Tennessee. Based on the multiple regression analysis, absence of maternal partner support during pregnancy and African-American race predicted variance for infant birth weight (p <.05), while lower levels of self-esteem, use of drugs and alcohol, and active religiosity predicted shorter length of gestation at birth (p <.05). The multiple logistic regression analysis model revealed that the HOPE theory was significantly related to a greater incidence of preterm birth (p =.03), Chi(2) = 28.16, R(2) =.22. Within this model, lower levels of self-esteem and a woman's negative perception of her pregnancy, were significant predictors for preterm birth (p <.05). Although there was preliminary support for this holistic theory, further research with a larger and more diverse population of women is needed.