Cox, P., Docherty, K. (2008) Assessing the impact of a first-time parenting group. Nursing Times; 104: 21, 32-33.
BACKGROUND: The transition to parenthood can be stressful for first-time parents. This can affect their psychological well-being and their relationship with their baby.
AIM: This study evaluated a health visitor-led first-time parent group and its impact on the well-being of those who attended. It also aimed to determine whether any improvements could be made to the group.
METHOD: Seven five-session groups were run over a six-month period. Parents were asked to complete the general health questionnaire 12 before and after attendance to assess their psychological well-being. They also completed pre- and post-group evaluation questionnaires.
RESULTS: Mean GHQ-12 scores were reduced after parents had attended the group, indicating their psychological well-being had improved. Parents’ evaluations were also generally extremely positive.
CONCLUSION: The study suggests first-time parenting groups run by health visitors increase parents’ confidence, coping skills and psychological well-being.
Paula Cox, PhD, MA, PG Dip, is assistant psychologist, Parsons Dowd Psychological Ltd; Kathleen Docherty, BA, HV cert, RGN, is specialist health visitor, Community Health and Care Partnership, West Glasgow.
The transition into parenthood can be stressful for first-time parents (Hsu and Lavelli, 2005), whose stress levels may be amplified if they are anxious, have low expectations about their ability to cope with a newborn or have inadequate social support (Porter and Hui-Chin Hsu, 2003). Research also highlights the importance of a stable and secure care-giving environment in the early years, which acts as a protective factor against psychological, emotional and social problems in later life (Ahlborg and Strandmark, 2006). This suggests that support for new parents as they learn parenting skills would be beneficial to both them and their babies.
Barlow et al (2007) have shown that parenting programmes can improve maternal mental health and cut depression rates by reducing anxieties and increasing self-esteem. Furthermore, Barlow and Parsons (2007) have shown that parenting programmes run for the parents of 0-3-year-olds can improve the emotional and psychological well-being of children as well as mothers.
This article investigates a health visitor-led first-time parenting group run by a pre-five family service. Barlow et al (2004) indicate that health visitor-led post-birth parenting programmes significantly improve mothers’ psychological health by building their confidence and improving the parent-infant relationship. This group aims to ease the transition into parenthood by giving first-time parents information relating to pregnancy, birth, immunisations, weaning, accident prevention and cot death. The group strives to develop parents’ knowledge and skills and promote the well-being of both parents and infants. It also provides social support with the aim of reducing social isolation.
Through the group, parents have the opportunity to ask questions and discuss concerns with a health visitor. The aim of this additional support is to allay fears and build their confidence, which is important as confidence can contribute significantly to first-time mothers’ psychological well-being and is also important for a positive relationship between mother and child (Conrad et al, 1992).
This study aimed to establish whether the first-time parenting group provides useful information that will benefit first-time parents and improves the well-being of the families attending, and to determine whether any improvements could be made to the group.
The pre-five family service ran seven first-time parenting groups over the evaluation period (February-October 2006). Each was run over five sessions and a total of 56 parents took part in the groups.
Each parent attending was asked to complete the general health questionnaire-12 (GHQ-12) (Goldberg, 1978), a 12-item questionnaire that can be used to screen for cases of psychological ill health, both at the beginning and end of the five-session programme. The GHQ-12 does not diagnose specific mental health problems, but defines a case as an individual experiencing a recent loss of ability to carry out normal healthy functions, and/or the development of new psychological phenomena of a distressing nature. The questionnaire was administered with the aim of assessing whether participation in the group resulted in improved psychological well-being.
Parents were also given a pre-group questionnaire asking for information including how they heard about the group, transport and their expectations. All 56 parents who attended the first session of the groups completed the pre-group questionnaire. At the end of the final session, they were asked to complete a post-group questionnaire designed to evaluate their experience of the group.
Table 1 shows the attendance for each group. Seventy parents were invited to take part in a total of seven groups run over the evaluation period and 56 did so. Of these, 55 were first-time mothers and one was a first-time father. The pre-group questionnaire gathered a range of information from those who attended.
Table 1. Attendance for the first-time parenting groups
|Start date||Group size|
|29 March 06||9|
|3 May 06||9|
|28 June 06||7|
|9 August 06||6|
|20 September 06||7|
|25 October 06||9|
The average age of the babies whose parents attended the group was 16.09 weeks. The majority of parents (50) found out about the group from their health visitor. Three heard about it through a friend and another from a midwife. One made independent enquiries about the service and the remaining two did not state where they heard about the group. The largest proportion (29) walked to the group, while 19 came by car, eight came by public transport and one came by taxi.
When asked what they would like to gain from the group, 50 parents said they would like to meet other parents. Thirty-eight wanted support from the group and 48 wanted to obtain advice.
At the beginning of the first session of each group, the parents completed the GHQ-12 to assess their psychological well-being. A score of 4 or above suggests an individual is experiencing a diagnosable mental health problem, while scores of 3 or below suggest the individual is not experiencing any significant mental health problems. The mean score for the pre-group GHQ-12 was 1.4, which indicates that the majority of the parents were not experiencing diagnosable mental health difficulties. However, five had scores of 4 or over, showing they were experiencing diagnosable mental health problems.
At the end of each group, parents were asked to complete a group evaluation questionnaire. In total, 38 of the 56 who had begun the group completed the evaluation.
General satisfaction: Of those who completed the post-group evaluation, 25 parents rated the venue as ‘very suitable’ and 12 rated it as ‘suitable’. One felt it was unsuitable due to the difficulty of carrying her pram upstairs.
The majority (25) of parents who completed the evaluation found the group ‘very helpful’ and the remaining 13 rated it as ‘helpful’.
All 38 parents stated that the information and advice given was ‘about right’, and all found the group relaxing, enjoyable, informative, sociable and a good way to meet other parents.
Most parents (32) found the health visitor ‘very approachable’ and the remaining six ‘approachable’. Thirty-five parents felt that they had learnt about other local services by attending the groups, although two felt that they had not learnt anything about other local services and one was unsure.
Asked about their confidence in their parenting skills, 37 parents said that they felt more confident, while one mother was unsure. Thirty-five thought the group had been a good way to obtain extra advice/support from health visitors, one was unsure and two did not think it was a good way.
Open-ended responses: When asked to describe what they had enjoyed most about the group, the majority of parents said they had enjoyed meeting new parents (22). Others (six) had enjoyed hearing the experiences of other parents and having time to ask questions (four). Three said they liked knowing that other parents were going through the same thing as they were and one mother expanded on this point, saying that ‘I feel more secure’. One highlighted that she enjoyed the weaning classes and information describing safety in the home, while another liked learning about other classes she could join.
Ten parents made further comments and suggestions. Six thought the classes were really helpful and were grateful for the opportunity to attend. Another mother agreed with this but stated that a lot of parents were waiting to get onto the group. One mother felt the group was ‘good support’ and another was pleased that it was free. One felt the group should ‘ensure that everyone is encouraged to participate and ensure that the topic is covered before moving on’.
Five parents suggested that they would have liked some additional aspects to the group. Their comments are outlined below:
One would have preferred to begin the group when her baby was three months old rather than four months;
One would have liked more information about sleep patterns, behaviour and developmental milestones;
One suggested a ‘granny group’ should be run specifically for grandparents as some look after children when parents go back to work;
One suggested ‘coffee at the end would be good to give time to chat informally to other parents’;
One wished the group went on for longer.
At the end of the group, 38 parents completed the GHQ-12. The mean score had reduced to 0.7. A Wilcoxon signed ranks test indicates that the GHQ scores were significantly reduced, z = -2.948, p< 0.05. This suggests that the psychological well-being of parents improved after attending the group.
Of the five parents found to have diagnosable mental health problems, three completed the post-group GHQ-12; all three scores had reduced to 3. Drops in score from 4 or above to 1 or 0 suggest a likely change from experiencing diagnosable mental health problems to experiencing no significant mental health problems. Although their scores were reduced, this difference was not statistically significant, and the parents were still experiencing mental health difficulties after completing the group.
All GHQ-12 scores were fed back to the health visitors who had initially referred each family. They then assessed whether further interventions were necessary for the two parents who were not assessed post-group and the three who may still have been experiencing mental health difficulties.
Attendance was generally high, with an average of eight parents attending each group out of a possible 10 places. General attendance may have been high as the parents were generally satisfied with the way in which the group was operated (location, the level of information given and approachability of the health visitor). Attendance was lower during the summer months, which may be because of summer vacations and other family commitments at this time of year.
The pre-group questionnaire indicated that parents expected to gain social support and advice by attending the group. The results of the post-group questionnaire indicate that the group met parents’ needs and expectations by providing social support and enhancing their knowledge and skills.
The scores for the post-group GHQ-12 (Goldberg, 1978) indicated that three parents were still experiencing diagnosable mental health difficulties after completing the group. Although their scores were not significantly reduced, they were at least clinically reduced, which may indicate that the first-time parenting group may be useful as part of a wider programme of psychological interventions to improve mental well-being for this group.
The pre-group GHQ-12 scores show that the majority of parents were not experiencing diagnosable mental health difficulties before attending the groups, but their psychological well-being was still significantly improved after attending the group. This suggests the group may act as a protective factor against psychological deterioration of first-time parents. Further evidence for this conclusion comes from the post-group questionnaire. The parents stated that the group had been a useful and positive experience and the vast majority felt more confident about their parenting skills after attending.
The results also suggest that the group was a good way to socialise, gain additional advice from a health visitor and learn about other local services. This is supported by Barlow et al (2004), who highlighted that health visitor-led post-birth parenting programmes significantly improve maternal psychological well-being.
More specifically, the first-time parenting literature suggests that low levels of anxiety, maternal confidence and social support are important for a positive relationship between mother and child (Ahlborg et al, 2006; Porter and Hsu, 2003; Conrad et al, 1992). It is therefore possible that the first-time parenting group is an effective intervention as it taps into the psychological and social needs of first-time parents with diagnosable mental health difficulties.
In addition, the information the parents receive may alleviate anxieties and increase their confidence in their ability to cope and subsequently prevent the occurrence of mental health difficulties and relationship difficulties with their child in later years.
Finally, the group provides first-time parents with social support from the others experiencing parenthood for the first time.
The results of this evaluation indicate that attendance at the first-time parenting group led to improvements in psychological well-being for those who completed the post-group questionnaire. However, it is important to highlight the limitations of this evaluation. The post-group results are based on data from 38 parents who attended the last session of the groups, as 18 had dropped out of the groups by the last session. This may indicate some may not have found the group useful, which may have been the result of an inappropriate referral or lack of motivation by group members. In contrast, some may have felt they had received sufficient support and information from the first few sessions and therefore did not require further input. Since these parents were not given a post-group questionnaire, it is not possible to establish the reason behind the drop-out rate.
A further limitation is that socio-economic factors were not gathered in the pre-group questionnaire, so it is not possible to identify whether different social groups with varying psychological vulnerabilities are benefiting from the group.
As stated earlier, the majority of group members were not experiencing any diagnosable mental health difficulties. In conjunction with this, the group has been shown to reduce mental health difficulties to a clinically significant level. Therefore, a further limitation of the group may be that it is difficult to engage first-time mothers with post-birth mental health problems who could benefit from it.
Overall, the findings of this evaluation suggest that the first-time parenting group improved the psychological and social well-being of the families who attended. Before the groups commenced, the respondents stated that they required advice and social support. The post-group questionnaire indicated that they were generally satisfied - their need for advice and support was met and they reported that they had gained confidence in their ability to parent by attending the groups. The GHQ scores were significantly reduced after the attending the group, which suggests that the first aim of this study was achieved as the first-time parenting group may have improved parents’ quality of life by providing information that benefited them.
The second aim was to determine whether any improvements could be made to the group. Four recommendations are outlined below.
One mother stated that the group would have been useful when her baby was three months old. This suggests health visitors should consider referring families to the service at an earlier stage. However, this recommendation is based on one respondent so may not be of benefit to all parents.
Add information into the group curriculum on sleep patterns, behaviour and the developmental milestones of infants.
Consider referring grandparents and other carers to future groups.
Allow additional time at the end of each session for parents to talk informally about their experiences.
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