Daoud Nihaya, Shoham-Vardi Ilana
Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, 84015, Beer Sheva, Israel,
Matern Child Health J. 2015 Mar;19(3):538-47. doi: 10.1007/s10995-014-1535-7.
National maternal and child health (MCH) care systems often deliver universal health care recommendations that do not take into consideration the social context of infant care (IC) for marginalized groups. We examined associations between maternal perceptions of social context (MPSC) and adherence by minority Bedouin mothers in Israel to three commonly recommended IC practices. We conducted personal interviews with 464 mothers visiting 14 MCH clinics using a structured questionnaire based on findings from a previous focus-group study, and guided by constructs of the Health Beliefs Model. Items were tested for validity and reliability. We used multivariate analysis to identify MPSC constructs associated with adherence to MCH clinic recommendations (timely postnatal first visit, sustaining breastfeeding, and use of infant car seat). Social context, when perceived as a barrier to IC, was negatively associated with adherence to timely first postnatal MCH clinic visit (odds ratio, 95 %, confidence intervals (OR 1.45, 95 % CI 1.24, 1.70) and use of infant car seat (OR 1.43, 95 % CI 1.21, 1.69). However, social context was positively associated with sustained breastfeeding (OR 0.54, 95 % CI 0.37, 0.79). Perceptions of the severity of infant health problems, and family financial and relationship problems had less significant associations with adherence to MCH clinic recommendations. Adherence by marginalized mothers to MCH clinic recommendations is related to their perceptions of social context. When there are higher financial and other living conditions barriers mothers tend toward lower adherence to these recommendations. MCH policy makers and service providers must consider MPSC in planning and delivery of MCH recommendations.
国家妇幼保健（MCH）系统通常提供普遍的医疗保健建议，而没有考虑到边缘化群体婴儿护理（IC）的社会背景。我们研究了以色列少数族裔贝都因母亲对社会背景的认知（MPSC）与对三项普遍推荐的IC做法的依从性之间的关联。我们使用基于先前焦点小组研究结果并以健康信念模型的构念为指导的结构化问卷，对访问14家妇幼保健诊所的464名母亲进行了个人访谈。对各项内容进行了有效性和可靠性测试。我们使用多变量分析来确定与遵守妇幼保健诊所建议（产后及时首次就诊、持续母乳喂养和使用婴儿汽车安全座椅）相关的MPSC构念。当社会背景被视为IC的障碍时，它与产后及时首次前往妇幼保健诊所就诊的依从性呈负相关（优势比，95%，置信区间（OR 1.45，95% CI 1.24，1.70））以及与使用婴儿汽车安全座椅的依从性呈负相关（OR 1.43，95% CI 1.21，1.69）。然而，社会背景与持续母乳喂养呈正相关（OR 0.54，95% CI 0.37，0.79）。对婴儿健康问题严重程度的认知以及家庭经济和关系问题与遵守妇幼保健诊所建议的关联较小。边缘化母亲对妇幼保健诊所建议的依从性与其对社会背景的认知有关。当存在较高的经济和其他生活条件障碍时，母亲对这些建议的依从性往往较低。妇幼保健政策制定者和服务提供者在规划和提供妇幼保健建议时必须考虑MPSC。
