Graduation Date

Summer 8-9-2019

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Programs

Nursing

First Advisor

Barbara Jackson, PhD

Second Advisor

Lani Zimmerman, PhD

Abstract

Maternal cognitions are beliefs, perceptions, and expectations that guide parenting practices. For at-risk infants born prematurely, these maternal constructs may influence the caregiving environment and opportunities for motor experience. The impact of maternal cognitions on motor development in infants born preterm is not well-documented. This three-part dissertation systematically explores: 1) the nature and extent of existing evidence supporting the link between maternal cognitions and motor development of infants born preterm, 2) if maternal perception of infant vulnerability as measured by an adapted Vulnerable Baby Scale (VBS) can be validly and reliably quantified in mothers of infants born preterm and near term-adjusted age, prior to discharge from the Newborn Intensive Care Unit (n=41), and finally, 3) the relationship between maternal cognitions, specifically perception of infant vulnerability and parenting confidence, and sensorimotor based maternal-infant play interactions (n=7) at near-term infant adjusted age. Existing evidence from a scoping review, though contradictory, implicates a plausible link between maternal cognitions such as depression, decreased parenting confidence, and increased maternal perception of infant vulnerability and a variety of adverse infant developmental outcomes including motor. Psychometric testing of an adapted VBS demonstrated strong content validity and test-retest reliability, moderate internal consistency. A component factor analysis aligned the self-report measure with three primary and relevant constructs: worries about baby, protective care practices, and perceptions about general health. Finally, mixed method analysis of mother-infant sensorimotor play interactions prior to NICU discharge revealed parenting confidence scores were not correlated with maternal or infant sociodemographic variables; perception of infant health vulnerability scores were correlated with maternal age and infant movement duration; inversely correlated with infant exploratory behaviors, and frequency of maternal alerting behaviors. Despite uncertainty, Mothers demonstrated foundational knowledge about interactive play and intuitively used both alerting and soothing sensorimotor strategies to engage with infants born preterm. Further study is warranted to determine if parent-mediated, early-infancy play may be targeted as a NICU developmental risk screening or intervention approach.

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