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研究生：	瓦琳達 Dlamini, Lindelwa Portia
論文名稱：	史瓦帝尼產後母親之產後憂鬱、母性自我效能，和與母性角色實現之關係 Postpartum Depression, Maternal Self-Efficacy and their Relationship with Maternal Role Competence Among Postpartum Mothers in Eswatini
指導教授：	許玉雲 Hsu, Yu-Yun
學位類別：	碩士 Master
系所名稱：	醫學院 - 護理學系 Department of Nursing
論文出版年：	2020
畢業學年度：	108
語文別：	英文
論文頁數：	114
中文關鍵詞：	產後時期、產婦的作用、產後抑鬱、產婦自我效能感
外文關鍵詞：	Postpartum period, Maternal role, Postpartum depression, Maternal self-efficacy
相關次數：	點閱：76 下載：1
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背景：產後婦女最大的壓力來自產後母親角色的轉換。產後期是產後婦女嘗試學習新角色轉換的階段，也是產後憂鬱發生的時期，產後憂鬱會影響母親角色能力的發展。全世界約有17%的婦女有產後憂鬱，在斯威士蘭約有47%婦女有產後憂鬱。產後階段，母育自我效能在產後憂鬱和母育角色能力兩者之間扮演著重要關鍵。無論如何，目前在非洲沒有相關研究調查，影響婦女產後憂鬱的機制和母育角色能力的相關因素。

目的:本研究將探討產後憂鬱、母育自我效能和母育角色能力的關係，並檢測母育自我效能為中介變項的角色在產後憂鬱和母育角色能力之間。

方法：採用橫斷面設計，方便取樣來自斯威士蘭的三個主要衛生保健機構的343位分娩後第四個月的產後婦女，收案條件為母親年齡在18歲以上、單胎，沒有產科併發症，能使用斯威士蘭語進行讀寫。排除條件有精神疾病的家庭史或個人病史，以及早產和新生兒有重大疾病。使用愛丁堡產後憂鬱量表、產婦自我效能量表，和母親角色能力量表進行資料收集。使用IBM SPSS和SPSS AMOS檢測線性回歸模型和測試母親自我效能為中介變項.

结果：多數參與者失業約67.1％，受過高中或初中教育約74.3％，有61％產婦是意外懷孕，接受母職角色學習，86.6％產婦來自產前照護教育，58％產婦來自自己的母親。調整人口學變項、產科相關變相和社會變項後，產後憂鬱與母親自我效能
(β = -.24, P < .001）和母親角色能力（β = -.22, P < .01）呈負相關，而母育自我效能與母育角色能力呈正相關（β = .41, P < .001）。放入母育自我效能變項後，發現產後憂鬱透過母育自我效能間接地影響母育角色能力（β = -.10，P < .01)。

結論：經結果表明，母育自我效能是一個中介變項，在產後憂鬱與母育角色能力之間的關係，由此可知母育自我效能關鍵作用在母育角色產後的早期便開始.

Background: Transition into the maternal role has been identified as the most stressful period for mothers. As they try to learn this new role, the early postnatal period is also a season for postpartum depression, which further challenges the development of maternal role competence. About 17% of postpartum women worldwide and 47% in Eswatini suffer from postpartum depression. At this stage, developing a higher sense of efficacy in ones’ maternal abilities (maternal self-efficacy) may play a crucial role in the relationship between postpartum depression and maternal role competence. However, this mechanism through which postpartum depression, may influence maternal role competence has not been investigated in an African population.

Purpose: To examine the relationship among postpartum depression, maternal self-efficacy and maternal role competence, and to test the hypothesized mediating effect of self-efficacy in the relationship between postpartum depression and maternal role competence.

Methods: Utilizing a cross-sectional design, we conveniently sampled 343 mothers in their first four months after birth from three primary health care facilities in Eswatini. We included mothers who were aged 18 years and above, had a singleton birth with no intrapartum complications, and were able to read and write in SiSwati. We excluded those who have a family or self-history of a mental disorder, who came for sick baby services and those who had a preterm birth. Data were collected using the Edinburg Postpartum Depression Scale, Maternal Self-efficacy Scale, and Perceived Competency Scale. IBM SPSS and SPSS AMOS were used to run multiple linear regression models and structural equation modeling aimed at examining associations and testing for mediation.

Results: A majority of the participants were unemployed (67.1%), with high or junior high school education (74.3%), had unintended pregnancy (61%), and received maternal role teachings at antenatal care (86.6%) and from their mothers (58%). Adjusting for demographic, obstetric, and social covariates, postpartum depression negatively associated with maternal self-efficacy (β= -.24, P<.001) and maternal competence (β= -.22, P<.01), while maternal self-efficacy positively associated with maternal role competence (β= .41, P<.001). Introducing the effect of maternal self-efficacy, postpartum depression only related to maternal role competence indirectly through the mediation of maternal self-efficacy (β= -.10, P<.01).

Conclusion: The results suggest that maternal self-efficacy fully mediate the relationship between depression and maternal role competence and may play a crucial role in maternal role during the early postpartum period.

TABLE OF CONTENT

ABSTRACT ............................................ I
CHINESE ABSTRACT .................................... III
ACKNOWLEDGMENTS ..................................... V
TABLE OF CONTENT .................................... VII
LIST OF TABLES ........................................ XIII
LIST OF FIGURES ..................................... XIV
CHAPTER ONE ........................................ 1
INTRODUCTION ........................................ 1
1.1 Background ....................................... 1
1.2 Statement of Research Purpose ....................... 5
1.3 Specific Objectives............................... 6
CHAPTER TWO ............................................. 7
LITERATURE REVIEW........................... 7
2.1 Maternal Role Competence .................. 7
2.1.1 Determinants of Maternal Role Competence .......... 8
2.1.2 Conclusion ............................ 10
2.2 Postpartum Depression ........................ 11
2.2.1 Postpartum Depression and Maternal Role Competence ...... 11
2.2.2 Conclusion ........................ 13
2.3 Maternal Self – Efficacy ....................... 13
2.3.1 Self-efficacy and Maternal Role Competence ... 13
2.3.2 Maternal Self-efficacy and Postpartum Depression .. 15
2.3.3 Self-Efficacy the Mediator Between Postpartum Depression and Maternal Role Competence .... 16
2.3.4 Other Determinants of Maternal Self-Efficacy .. 17
2.3.5 Conclusion ............................ 17
2.4 Influence of Culture on Depression, Self-Efficacy and Maternal Role Competence..... 18
2.4.1 African Culture and Maternal role Competence ..18 
2.4.2 African Culture and Postpartum Depression...... 19 
2.4.3 African Culture and Maternal Self-Efficacy ...20 
2.5 The Maternal Role Attainment Theory ... 20
2.6 Measures of Maternal Role Competence .... 21
CHAPTER THREE ............................. 23
METHODS………. ......................... 23
3.1 Design and Sampling ......................... 23
3.2 Study Setting .................................. 24
3.3 Research Framework .......................... 25
3.4 Conceptual and Operational Definitions ............. 27
3.4.1 Main Study Variables ............................. 27
3.4.2 Demographic Covariates ................... 28
3.4.3 Obstetric Covariates ....................... 29
3.4.4 Social Covariates .......................... 30
3.5 Measurements .................................. 31
3.5.1 Sociodemographic and Obstetric Variables ......... 31
3.5.2 Postpartum Depression ....................... 31
3.5.3 Maternal Self-Efficacy ......................... 32
3.5.4 Maternal Role Competence ................... 33
3.5.5 Family APGAR Scale .......................... 33
3.5.6 Social Support ............................. 34
3.6 Translation and Adaptation Process .................. 35
3.7 Instrument Validity and Reliability ........... 36
3.8 Data collection Method and Procedure ............... 36
3.9 Ethical Considerations ............................ 37
3.10 Data Analysis .............................. 39
3.10.1 Linear Regression and SEM Model Building ......... 41
CHAPTER FOUR ................................ 42
RESULTS…................................... 42
4.1 Participants  Characteristics................... 42
4.2 Description of Major Study Variables ........... 44
4.3 Demographic and Obstetric Associates of Postpartum Depression, Maternal Selfefficacy and Maternal Role Competence ............................ 45
4.4 Social Associates of Postpartum Depression, Maternal Self-efficacy and Maternal Role Competence ............. 48
4.5 Relationship Between Postpartum Depression and Maternal Self-efficacy ..... 49
4.6 Relationship Between Maternal Self-efficacy and Maternal Role Competence50
4.7 Relationship Between Postpartum Depression and Maternal Role Competence50
4.8 The Mediation Effect of Maternal Self-efficacy in the Relationship Between Postpartum Depression and Maternal Role Competence ................................. 54
CHAPTER FIVE .................................. 56
DISCUSSIONS .................................. 56
5.1 Demographic characteristics .................... 56
5.2 Demographic and Obstetric Associates of Postpartum Depression, Maternal Self-efficacy and Maternal Role Competence .................................. 57
5.3 Social Associates of Postpartum Depression, Maternal Self-Efficacy and Maternal role Competence................... 61
5.4 Relationship Between Postpartum Depression and Maternal Self-Efficacy ..... 62
5.5 Relationship Between Maternal Self-Efficacy and Role Competence ............. 63
5.6 Relationship between postpartum depression and maternal role competence .. 63
5.7 Mediation Effect of Maternal Self-Efficacy in the Relationship Between Postpartum Depression and Maternal Role Competence .................................. 64
5.8 Strengths and Limitations .................. 65
5.9 Implications .............................. 66
5.10 Conclusion ............................... 68
REFERENCES ................................... 69
APPENDIXES ....................................... 82
Appendix A: Maternal Role Attainment Theory ............ 83
Appendix B: Directed Acyclic Graph (DAG) ......... 84
Appendix C - Information sheet ..................... 86
Appendix D - Consent Form .......................... 87
Appendix E : Information Sheet and Consent Form (SiSwati Version) ....................... 88
Appendix F – Sociodemographic Questions .............. 91
Appendix G: Sociodemographic Questions (SiSwati Version) .................................... 92
Appendix H: The Edinburg Postpartum Depression Scale ........................................... 93
Appendix I: Edinburg Postpartum Depression Scale (SiSwati Version) ...................... 94
Appendix J: Maternal Self-Efficacy Scale ............... 95
Appendix K: Maternal Self-Efficacy Scale (SiSwati Version) ..................................... 96
Appendix L: Perceived Competence Scale ................. 97
Appendix M: Perceived Competence Scale (SiSwati Version) .................................. 101
Appendix N: Family APGAR Scale ...................... 104
Appendix O: Family APGAR Scale (SiSwati version) ...... 105
Appendix P: Perceived Social Support Scale ............ 106
Appendix Q: Perceived Social Support Scale (SiSwati Versions).............................. 107
Appendix R: Permission to use the Maternal Self-efficacy Scale .............................. 108
Appendix S: Permission to use the Maternal Competence Scale ............................... 109
Appendix T: Ethical Clearance ...................... 110
Appendix U: Clearance From Study Sites ................. 111
Appendix V: Differences in Intended pregnancy Status Maiden Home Visit ............ 114
                                    

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