Faculty of Health and Life Sciences, Oxford Brookes University, Jack Straws Lane, Marston, Oxford, UK.
Int J Nurs Stud. 2013 Jan;50(1):5-15. doi: 10.1016/j.ijnurstu.2012.08.008. Epub 2012 Sep 16.
Given the significance of reliably detecting cases where mother-infant relationships are not developing successfully, it is important that initial assessment processes are as sensitive and specific as possible.
This study sought to examine the processes by which health visitors identify problems in mother-infant relationships in the post-natal period.
Mixed methods.
Two universities and two primary care trusts.
In Phase One 17 first-time mothers and their 6- to 16-week-old infants were recruited. In Phase Two, a sample of 12 health visitors participated.
The study incorporated two data collection phases. In Phase One, each mother's interaction with her baby was video-recorded for 20min in an observation laboratory. The video-recordings were coded and resultant data were analysed to derive a number of quantitative measures of interaction quality, including mothers' responsiveness and sensitivity to their infants as rated by the Global Ratings Scales (GRS) of Mother-Infant Interaction. In Phase Two, 12 health visitors rated and assessed 9 clips of the video-recorded mother-infant interactions. The rationales for their ratings were then explored through in-depth interviews. Health visitor ratings of the video clips were compared to the GRS ratings. The relationship between the main focus of each health visitor rating, as reported in the interview, and the consistency of ratings with the GRS ratings were then investigated.
Correlations between individual health visitors' ratings and the GRS ratings ranged from .17 to .83 and were statistically significant in only four cases. There was a weak relationship with health visitors' years of experience (r(s)=.47, NS). When explaining their judgements, health visitors tended to comment on the mother's behaviours or the relationship between the mother and baby and often ignored the behaviour of the baby. There was a highly significant relationship between the consistency of health visitor/GRS ratings and the number of references to the baby in the health visitors' explanations (r(s)=.75, p=.005).
This study contributes to the understanding of how health visitors make assessments of mother-infant interactions. The frequent lack of attention and reference to the baby's behaviour suggests an area for further training.
鉴于可靠地检测母婴关系未成功发展的情况非常重要，因此初始评估过程应尽可能敏感和具体。
本研究旨在探讨健康访视员在产后期间识别母婴关系问题的过程。
混合方法。
两所大学和两个初级保健信托。
在第一阶段，招募了 17 名初产妇及其 6-16 周大的婴儿。在第二阶段，有 12 名健康访视员参与。
该研究包括两个数据收集阶段。在第一阶段，每位母亲在观察实验室中与她的婴儿进行了 20 分钟的视频记录。对视频记录进行编码，并对所得数据进行分析，得出一些衡量互动质量的定量指标，包括母亲对婴儿的反应性和敏感性，这些指标是通过婴儿互动的全球评分量表（GRS）来评定的。在第二阶段，12 名健康访视员对 9 段视频记录的母婴互动进行了评分和评估。然后通过深入访谈探讨他们评分的理由。将健康访视员对视频剪辑的评分与 GRS 评分进行比较。然后研究了每个健康访视员报告的主要评分重点与评分与 GRS 评分的一致性之间的关系。
个别健康访视员的评分与 GRS 评分之间的相关性范围从.17 到.83，只有在四种情况下具有统计学意义。与健康访视员的工作年限有微弱的关系（r(s)=.47，不显著）。在解释他们的判断时，健康访视员往往会评论母亲的行为或母亲和婴儿之间的关系，而经常忽略婴儿的行为。健康访视员/GRS 评分的一致性与健康访视员解释中对婴儿的提及次数之间存在高度显著的关系（r(s)=.75，p=.005）。
本研究有助于了解健康访视员如何对母婴互动进行评估。频繁地忽略婴儿的行为并提及较少，这表明需要进一步的培训。
