Adverse Childhood Experiences, Postpartum Health, and Breastfeeding: A Mixed Methods Study

McCloskey, Rebecca J ProQuest Dissertations & Theses The Ohio State Uni 2020 해외박사(DDOD)

소속기관이 구독 중이 아닌 경우 오후 4시부터 익일 오전 9시까지 원문보기가 가능합니다.

Postpartum depression and anxiety (PPD/A) represent the most common side effects of childbirth. In addition to distress, mothers’ with untreated PPD/A are more likely to have poorer breastfeeding outcomes and worse postpartum physical health. For women who have had adverse childhood experiences (ACEs)—most frequently identified as abuse, neglect, and household instability—the transition to motherhood may be fraught with particularly challenging cognitive and emotional responses frequently labeled as PPD/A. A few recent studies have demonstrated a link between ACEs and postpartum mental health. This dissertation—via a two-phase, explanatory sequential mixed methods design—makes a novel contribution to the perinatal mental health field by utilizing a combination of life course theory and the liberation health social work model to examine the association between a broad range of adverse childhood experiences (ACEs) and four interrelated outcomes—PPD/A, postpartum physical health, and breastfeeding challenges—and whether or not the variables of social support, experiences of discrimination, and material (economic) hardship influence this association.In phase I, a fairly diverse sample of United States’ mothers age 18 and older who delivered a live baby within the previous year (N = 306) completed an online survey on (a) ACEs (including the original 10 core questions as well as childhood experiences of discrimination, community violence, forced migration, and economic hardship); (b) depression (Edinburgh Postnatal Depression Scale); (c) anxiety (Perinatal Anxiety Screening Scale); (d) experiences of discrimination (Everyday Discrimination Scale); (e) social support (Multidimensional Scale of Perceived Social Support), (f) material hardship; and (g) demographics, childbirth, breastfeeding, and self-rated postpartum physical health. In phase II, a strategically selected and diverse (i.e., age, income, race, and ethnicity) subset of participants (n = 22) with ACEs scores of 4 or greater—half who experienced 3 – 4 negative outcomes (PPD/A, poor postpartum physical health, and/or breastfeeding challenges) and half who experienced 0 – 1 negative outcomes—participated in semi-structured, individual telephone interviews to elicit insights into potential risk and protective factors that may have influenced postpartum outcomes. Participants were incentivized for partaking in both phases of the study.Multiple linear regression was performed to examine the association between ACEs and PPD/A. Logistic regression tested the association between ACEs and postpartum physical health and breastfeeding challenges. Binomial regression was used to assess for associations between ACEs and the total number of breastfeeding challenges reported. Further, interaction terms were created using ACEs and each potential moderator variable (i.e., social support, material hardship, and experiences of discrimination) and entered into the regression models to assess for interaction effects. A codebook was developed and the author and a co-coder independently analyzed the data. Thematic analysis—using initial, axial, and theoretical coding—and coder consensus were employed to identify the final four themes of the data: (a) social support; (b) economic factors; (c) work-related factors; and (d) self-care. Phase I and II results were integrated, summarized, and presented using a joint display of the results.Mothers who reported higher perceived social support and who did not experience ACEs, discrimination, or material hardship fared better postpartum. The associations were statistically significant between ACEs and postpartum physical health and ACEs and the amount of breastfeeding challenges reported. However, for PPD/A, the effect of ACEs disappeared when all variables of interest were added to the regression model. Material hardship was a significant predictor of all four outcomes and moderated the associations between ACEs and postpartum physical health and ACEs and the number of breastfeeding challenges experienced. Results demonstrated significant associations between experiences of discrimination, material hardship, inadequate social support, and PPD/A. Findings were further endorsed by interview data which also illuminated mothers’ desire for an improved work-life balance and time and support for self-care. Despite the commonality of adverse postpartum outcomes, the majority of women do not seek help with their postpartum struggles. Together, study results emphasize the need to focus on preventing ACEs and attending to modifiable factors (e.g., social support, economic hardship, discrimination) in order to reduce health disparities and improve maternal health and related outcomes.

Three Essays in Health Economics

Hettinger, Katlyn Christine Michigan State University ProQuest Dissertations & 2023 해외박사(DDOD)

소속기관이 구독 중이 아닌 경우 오후 4시부터 익일 오전 9시까지 원문보기가 가능합니다.

CHAPTER 1: Intertemporal Substitution in Response to Non-Linear Health Insurance ContractsHealth insurance contracts with high annual deductibles have become increasingly popular in the U.S. This feature of insurance contracts allows consumers to substitute healthcare in one period for healthcare in another period by, for example, increasing consumption in the year the annual deductible was met and decreasing future consumption. I obtain an estimate of the causal effect of meeting the deductible on healthcare consumption in the following year. I exploit variation in the timing of an injury that generates significant healthcare expenses and a regression discontinuity design to identify the effect of meeting the deductible. Data for the analysis are from the Marketscan database of medical claims on privately insured individuals at large firms. Estimates indicate that there is intertemporal substitution in healthcare consumption. Reaching the coinsurance arm in one year leads to $13,263 less healthcare consumed, $788 less paid out of pocket, and 7.4 fewer care dates in the following year. For those induced to consume more healthcare by reaching the coinsurance arm of their plan, I find that for every dollar of discretionary healthcare consumed in the year the coinsurance arm is reached, roughly $0.56 less is consumed in the following year. CHAPTER 2: Postpartum Medicaid Eligibility Expansions and Postpartum Health Measures (with Claire Margerison)Maternal mortality and morbidity in the US are high compared to similar countries, and racial/ethnic disparities exist, with many of these events occurring in the later postpartum period. Proposed federal and recently enacted state policy interventions extend pregnancy Medicaid from covering 60 days to a full year postpartum. This work estimates the association between maintaining Medicaid eligibility in the later postpartum period (relative to only having pregnancy Medicaid eligibility) with postpartum checkup attendance and depressive symptoms using regression analysis, overall and stratified by race/ethnicity. People with postpartum Medicaid eligibility were 1.0-1.4% more likely to attend a postpartum checkup relative to those with only pregnancy Medicaid eligibility overall, primarily driven by a 3.8-4.0% higher likelihood among Hispanic postpartum people. Conversely, postpartum Medicaid is associated with a 2.2-2.3% lower likelihood of postpartum checkup attendance for Black postpartum people. Postpartum eligibility is also associated with a 9.7-11.6% lower likelihood of self-reported depressive symptoms compared to only pregnancy Medicaid eligibility for white postpartum people only. Postpartum Medicaid eligibility is associated with some improvements in maternal health care utilization and mental health, but differences by race and ethnicity imply that inequitable systems and structures that cannot be overcome by insurance alone may also play an important role in postpartum health.Chapter 3: The Effects of State Medical Amnesty Policies on Alcohol UseMedical Amnesty policies (MAP) eliminate legal consequences relating to underage drinking when minors seek emergency assistance. I exploit the variation in state policy enactment in a difference-in-differences framework to examine the effects of MAP on alcohol use. Data on self-reported drinking behaviors for 18–20-year-old comes from the 2011-2018 Behavioral Risk Factor Surveillance System. Using 95% confidence intervals, my results can rule out increases larger than 3.5 and 3.3 percentage points for drinking and binge drinking, respectively. My main results support the conclusion that there is no significant long-term increase in underage drinking behaviors due to state MAP implementations.

산후 6개월 완전모유수유 실천율 추이와 관련요인

이순주 중앙대학교 건강간호대학원 2020 국내석사

연구 배경: UNICEF와 WHO에서는 아기의 출산과 동시에 산후 6개월 동안 모유만 공급하는 완전모유수유를 권장하고 있으나, 우리나라의 산후 6개월 완전모유수유 실천은 전 세계 평균에 미치지 못하고 있다. 산후 6개월 완전모유수유 실천에 영향 미치는 요인을 확인하여 향후 완전모유수유 실천 증진을 위한 중재방안을 마련하는데 도움이 되고자 시행되었다. 연구 방법 : ‘2015년 전국 출산력 및 가족보건·복지실태조사’와 ‘2018년 전국 출산력 및 가족보건·복지실태조사’ 원시자료를 사용하였고, 자료 분석은 통계 프로그램 SPSS 26.0 Version을 이용하였다. 산후 6개월 완전모유수유 실천에 따른 일반적 요인과 산과적 요인에 대하여 빈도 및 카이제곱 검정(chi-square test)을 시행하였고, 일반적 요인과 산과적 요인에서 산후 6개월 완전모유수유 실천에 영향 미치는 요인을 분석하기 위해 이분형 로지스틱 회귀분석(Logistic Regression Analysis)을 시행하였다. 연구 결과 : 본 연구의 산후 6개월 완전모유수유 실천율은 2015년 41.6%, 2018년 25.0%이었다. 산후 6개월 완전모유수유 실천에 영향 미치는 요인으로 2015년은 월평균 가구소득, 아기출생 순위, 자연분만여부, 조산여부이고, 2018년은 취업상태, 조산여부, 자연분만여부이다. 2015년에는 월평균 가구소득 349만 원 이하보다 350~499만 원에서 산후 6개월 완전모유수유 실천할 확률이 1.348배(95% CI; 1.018-1.786, P=0.037) 증가하였고, 500만 원 이상은 0,871배(95% CI; 0.655-1.160, P=0.346) 감소하였다. 아기출생 순위는 둘째 이상에서 산후 6개월 완전모유수유 실천할 확률이 1.265배(95% CI; 1.000-1.600, P=0.05) 증가하였고, 자연분만에서 산후 6개월 완전모유수유 실천할 확률이 1.627배(95% CI; 1.276-2.073, P<0.001) 증가하였으며, 분만 주수 36주 이하에서 산후 6개월 완전모유수유 실천할 확률이 0.457배(95% CI; 0.256-0.818, P=0.008) 감소하였다. 2018년에는 취업한 경우에서 산후 6개월 완전모유수유 실천할 확률이 0.672배(95% CI; 0.500-0.904, P=0.009) 감소하였고, 분만 주수 37주 이상에서 산후 6개월 완전모유수유 실천할 확률이 0.291배(95% CI; 0.124-0.685, P=0.005) 감소하였으며, 자연분만에서 산후 6개월 완전모유수유 실천할 확률이 1.582배(95% CI; 1.178-2.126, P=0.002) 증가하였다. 결론 : ‘전국 출산력 및 가족보건·복지실태조사’의 이차자료를 이용하여 산후 6개월 완전모유수유 실천에 영향 미치는 요인을 분석하였는데, 현재 산후 6개월 완전모유수유 실천율은 감소하고 있으며, 산과적 요인 뿐 아니라 취업상태 등 직업적 요인이 완전모유수유 실천에 영향을 주는 관련요인이다. 더 나아가 산후 6개월 완전모유수유 실천 향상을 위해서는 모유수유의 중요성에 대한 인식을 높이는 것이 필요하다. Background Although UNICEF and WHO recommend exclusive breastfeeding that provides only 6 months postpartum at the same time as the baby is born, 6 months postpartum exclusive breastfeeding practice of South Korea is less than the global average. This study was conducted to help determine the factors affecting the practice of exclusive breastfeeding in the 6 months after postpartum, and to help prepare an intervention plan to promote exclusive breastfeeding practice in the future. Research Method Raw data of the ‘2015 National Fertility and Family Health and Welfare Survey’ and the ‘2018 National Fertility and Family Health and Welfare Survey’ were used, and the statistical program SPSS 26.0 Version was used for data analysis. Frequency and chi-square tests were performed on general and obstetric factors of practice of 6 months postpartum exclusive breastfeeding. Also, in order to analyze factors affecting the practice of 6 months postpartum exclusive breastfeeding in general and obstetric factors, a binary logistic regression analysis was performed. Results of the Study According to the practice, rate of exclusive breastfeeding for 6 months after postpartum was 41.6% in 2015 and 25.0% in 2018. The factors affecting the practice of exclusive breastfeeding for 6 months after postpartum in 2015 are monthly household income, baby birth ranking, spontaneous delivery and premature birth, and factors in 2018 are employment status, premature birth status and spontaneous delivery. In 2015, the probability of practicing exclusive breastfeeding for 6 months after postpartum is 1.348 times high (95% CI; 1.018-1.786, P=0.037) in household with 3.50-4.99 million won monthly income, compare to the household with less than 3.49 million won, while that of household with more than 5.00 million won income decreased by 0,871 times (95% CI; 0.655-1.160, P=0.346) compare to the household with less than 3.49 million won. The order of baby birth infect 6 months postpartum exclusive breastfeeding practice: rate for second and above increased by 1.265 times (95% CI; 1.000-1.600, P=0.05) compare to the first child. Also, the probability of practicing 6 months postpartum exclusive breastfeeding in spontaneous delivery increased 1.627 times (95% CI; 1.276-2.073, P<0.001), and the probability of practicing exclusive breastfeeding for 6 months postpartum was reduced by 0.457 times (95% CI; 0.256-0.818, P=0.008) at less than 36 weeks of delivery. In 2018, the probability of practicing exclusive breastfeeding for 6 months after postpartum decreased 0.672 times (95% CI; 0.500-0.904, P=0.009) when mother is employed and the probability of practicing exclusive breastfeeding for 6 months postpartum was reduced by 0.291 times (95% CI; 0.124-0.685, P=0.005) at 37 weeks or more after delivery. In spontaneous delivery, the probability of practicing exclusive breastfeeding for 6 months postpartum increased by 1.582 times (95% CI; 1.178-2.126, P=0.002). Conclusion The secondary data of the ‘National Childbirth Force and Family Health and Welfare Status Survey’ were used to analyze the factors affecting the practice of exclusive breastfeeding for 6 months after postpartum. Currently, the practice rate of exclusive breastfeeding for 6 months after postpartum is decreasing, in addition to obstetric factors, professional factors such as employment status are the related factors that affect the practice of exclusive breastfeeding. Increasing awareness of the importance of breastfeeding is necessary to improve the practice rate of exclusive breastfeeding for 6 months after postpartum.

출산 전후 산모의 근골격계 통증에 관한 연구

황적원 연세대학교 보건환경대학원 2004 국내석사

The purpose of this study was to analyze various forms of musculoskeletal pain during different stages such as antenatal, pregnancy, delivery, and postpartum. The data for this study were collected through a self-administered survey with a structured questionnaire to 113 subjects. The survey was administered from May, 2003 to March, 2004 with subjects selected from postpartum centers in 3 different areas: Kangnam, Kangbook, and Bucheon. Analytical tools used for this study were frequency analysis, crosstabulation, percentage analysis, independent t-test, chi-square, and multiple response analysis.The findings of this study were as follows: 1. Comparison study of musculoskeletal pain according to variables including a pregnant woman''s age, delivery techniques, different types of delivery such as primiparity, multiparity, dystocia, easy delivery, shows that these relationships are statistically not significant (p>0.05). 2. A total of 61.9% gave positive responses for the question about the relationship between musculoskeletal pain during postpartum and that in preparation of labor, but shows that this relationship was statistically not significant (p>0.05). 3. Relationships between forms of musculoskeletal pain in different phases are significant (p<0.05). The compared phases are: premarriage and pre-pregnancy, premarriage and antenatal, premarriage and postpartum, premarriage and lactiferous phase, pre-pregnancy and antenatal, pre-pregnancy and postpartum, and pre-pregnancy and lactiferous phase. However, results for the comparison between antenatal and postpartum, antenatal and lactiferous phase, and postpartum and lactiferous phase show that these relationships are statistically not significant (p>0.05). According to this study, musculoskeletal pain which occurred during antenatal is significantly related to the pain occurring during postpartum. Results produced from this study might be used as a helpful tool for developing educational programs aiming at teaching self pain-detection performable at home or at the workplace and body maintenance during the course of antenatal and postpartum. 이 연구의 목적은 산후 조리 상태에 있는 산모를 대상으로 임신 전, 임신 중, 출산 시, 출산 후에 경험한 근골격계 통증 형태에 대하여 알아보는 것이다. 조사 대상은 2003년 5월부터 2004년 3월까지 서울 강남의 산후조리원 1개소, 강북의 산후조리원 1개소, 부천의 산후조리원 1개소에서 산후조리를 받고 있는 113명의 설문응답자를 대상으로 하였다. 연구도구로는 설문지를 이용하였고 통계분석을 위해서 빈도, 교차분석, 백분율, 독립 t-검정(independent t-test), 카이제곱(chi-square)검정, 그리고 다중응답에 대한 빈도분석을 하였다. 결과는 아래와 같다. 1. 노령 산모, 분만 방법, 초산과 경산, 순산과 난산에 따라 출산 후 근골격계의 통증 개수 비교에서 유의한 차이가 없었다(p>0.05).2. 분만 준비 과정에서 유발된 통증과 출산 후 근골격계의 통증과의 관계에서 61.9%가 관련 있다고 응답하였으나 유의한 차이가 없었다(p>0.05). 3. 결혼 전과 임신 전, 결혼 전과 출산 전, 결혼 전과 출산 후, 결혼 전과 수유 시, 임신 전과 출산 전, 임신 전과 출산 후, 임신 전과 수유 시 등 각각의 통증 개수 대응 비교에서 각 통증 간에 유의한 관련성이 있었고(p<0.05), 출산 전과 출산 후, 출산 전과 수유 시, 출산 후와 수유 시 통증 개수 간에는 유의한 관련성이 없었다(p>0.05). 본 연구 결과 결혼 전, 임신 전에 있었던 근골격계 통증이 임신 중이나 출산 후 통증과 관련성이 있는 것으로 나타났다. 그러므로 차후 가정, 직장 내에서 적극적인 출산 전, 출산 후 통증 예방 및 관리를 위한 교육 프로그램 개발이 필요하다.

Intolerance of Uncertainty as a Predictor of Depression Symptom Severity in the Perinatal Period

Lemon, Elizabeth University of Colorado at Boulder ProQuest Dissert 2022 해외박사(DDOD)

소속기관이 구독 중이 아닌 경우 오후 4시부터 익일 오전 9시까지 원문보기가 가능합니다.

Mood symptoms are common during the perinatal period and, left untreated, are associated with negative outcomes for both mother and baby. Effective preventative interventions exist, but it is essential to identify those women at risk for developing perinatal depression who would benefit most from such interventions. Although a history of depression is currently one of the most well supported predictors of depression during the perinatal period, it is an incomplete predictor and it is important to examine additional predictors of depression. One potentially valuable predictor is intolerance of uncertainty (IU), a cognitive factor reflecting the tendency to view ambiguous events or unknown outcomes as unacceptably threatening. In this prospective longitudinal sample of women followed from early pregnancy through 6-months postpartum we examined the relationship between IU and depression symptoms, incorporating both self-report and behavioral measures of IU. We addressed three specific aims. First, we examined the extent to which women with a history of depression differed on IU from late pregnancy to 6-months postpartum, compared to women with no history of depression. Second, we tested the extent to which IU predicted change in depression symptom severity from late pregnancy through 6-months postpartum, above and beyond a history of depression. Finally, we tested whether the relationship between a stressful birth experience and symptoms of postpartum depression was moderated by IU.We found that women with a history of depression generally reported higher IU than women included in the comparison group, and that both groups generally reported higher IU in the postpartum period than during pregnancy. We found mixed evidence to support IU in late pregnancy as a predictor of change in depression symptom severity from late pregnancy through the postpartum period, and we found that, among women with high IU, a stressful birth experience that included loss of control was associated with symptoms of depression at 6-months postpartum.This study contributes to the evidence that IU appears to be a mechanism worth continued study during pregnancy and postpartum. Understanding the mechanisms of depression during pregnancy and postpartum is an important step in developing treatments that are more efficacious, effective, and efficient.

Maternal Hypertensive Disorders in Pregnancy and Maternal Morbidity at Delivery and Postpartum

Harvey, Elizabeth Marilyn ProQuest Dissertations & Theses The Johns Hopkins 2017 해외박사(DDOD)

소속기관이 구독 중이 아닌 경우 오후 4시부터 익일 오전 9시까지 원문보기가 가능합니다.

Background: Rates of hypertensive disorders and other chronic conditions in pregnancy are increasing among childbearing women in the United States. This study examined the relation of maternal hypertensive disorders and other chronic and pregnancy-associated conditions with severe maternal morbidity (SMM) at delivery and postpartum rehospitalization.Methods: Birth certificates and fetal death records (BCFD) were linked to delivery-related hospital discharge (HDD) records in Massachusetts from 2000-2012, using the Pregnancy to Early Life Longitudinal (PELL) data system (n=960,982). Non-injury emergency department (ED), observational stay (OS) and non-delivery hospital discharge (HD) records in the first year postpartum also were linked to corresponding BCFD and HDD deliveries from 2002-2011 (n=735,576); a subset of deliveries to women without chronic medical conditions were also examined (n=685,228). Multivariate logistic regression models estimated the odds of SMM at delivery, multivariate log-binomial and Poisson models estimated the risk of rehospitalization within six weeks and one year postpartum; analyses used a generalized estimating equations approach to account for correlation due to repeat births of women and adjusted for social and biological characteristics. Analyses also examined whether SMM modified the relation between hypertensive disorders and rehospitalization.Results: Between 2000-2012, maternal hypertensive disorders were documented in 8.7% of deliveries and the SMM rate was 101.9 per 10,000 deliveries; 5.2% of deliveries from 2002-2011 had at least one rehospitalization within six weeks and 19.9% within one year postpartum. Hypertensive disorders and other chronic conditions increased the odds of SMM and the risk of rehospitalization up to one year postpartum; this risk varied by type of hypertensive disorder. SMM at delivery independently increased rehospitalization risk in the first six weeks and year postpartum and slightly moderated the relation between hypertensive disorders and rehospitalization.Conclusions: Maternal hypertensive disorders and other chronic conditions were associated with adverse maternal health outcomes at and after delivery and SMM at delivery was associated with increased risk of rehospitalization within one year postpartum. Our study highlights the need to prevent and manage hypertensive disorders and other chronic and pregnancy-associated conditions before, during, and after pregnancy as well as the need to address preventable SMM and mitigate its impacts after delivery.

Use of Contraceptives among Postpartum Women in Nepal: A case of Makawanpur District

Niroj GHIMIRE 한양대학교 2017 국내석사

Background: The use of contraceptive methods by the postpartum women has the potential to reduce the unwanted pregnancies and help in reduction of both maternal and childhood mortality and morbidity arising from unsafe abortions and inadequate spacing of births. However, its use remains low in Nepal and very little is known about the factors affecting its use. This information is vital to develop the programming strategies on postpartum family planning. Therefore, the study was conducted to identify the prevalence and determinants of postpartum contraceptives in Nepal. Methods: We conducted a community based cross sectional quantitative study in October 2016 among the women aged 15 to 49 years who delivered a child within the last one year of the survey date. Multi-stage sampling technique was used to interview a total of 313 women of Makawanpur district through household survey using structured questionnaire. We used chi-square analysis to test the association between the independent and dependent variables. Binary logistic regression analysis was used for those variables which were found significant in chi-square test. Odds ratios with 95% confidence intervals were computed to identify factors associated with contraceptive use. Results: Almost half (49.8%) of the women in the postpartum period were using a method of contraception. The most commonly used method was injectable Depo-Provera (35.9%). The use of postpartum contraceptives was found to be significantly associated with the income, education, ethnicity, religion, menstruation status, planned spacing for next child and easy access to health facility. More importantly, the study suggested the strong positive association between the use of postpartum contraceptives and use of maternal health services (ANC, institutional delivery and PNC) in the previous pregnancy. Conclusion: The use of postpartum contraceptives still remains low especially among rural, poor and lower caste groups. Specific programs need to be implemented to address the unmet need of marginalized group. Integrating postpartum contraceptives service in maternal and child health care programs and strengthening the counseling service would help to increase contraceptive use in the postpartum period.

중국 소비자의 가사 도우미 플랫폼 지속이용의도에 관한 연구

SUN XIAOYUN 충북대학교 경영대학원 2024 국내석사

With the continuous development of socio-economic conditions and the changing economic environment, a new form of consumer market is emerging, and industries represented by emerging services are further unleashing their development potential. China has maintained the traditional practice of "sitting the month" since ancient times, but with the transformation of medical practices, ad justments in family relationships, and women' increased attention to health care concepts, new organizations for maternal and child care, characterized by professional medical skills for the care of women during the postpartum period and infants, are emerging. This trend will effectively fill the demand gap for specialized health care services for women in the postpartum period and infants, providing comprehensive postpartum care services, including rehabilitation therapy, scientific dietary arrangements, and more importantly adapting to the needs and changes of modern society. The rise of new maternal and child care organizations reflects the pursuit of higher levels of health care services and propels the service industry to further meet the continually rising social demands. The research objective of this paper is to study the causal relationships between models by investigating the recommendation intentions of Chinese women during the postpartum period. According to the research objectives, this paper employs specialized data analysis programs SPSS and AMOS for factor analysis, reliability analysis, differentia l analysis (t-test, ANOVA), and path analysis on survey questionnaires completed by 505 pregnant women. The results are listed as follows: First, according to the differential analysis of demographic characteristics, the survey results show that in terms of the number of children, women with one child are more concerned about appearance, while those with multiple children are more inclined to the services of postpartum care centers. Regarding the postpartum care period, the longer the postpartum duration, the better evaluation results the postpartum nursing centers will get. In terms of education level, women with higher education tend to seek professional help and guidance, thus being more inclined to postpartum care centers. In terms of occupation, female civil servants with higher education may possess a higher demand for health, appearance, and high-quality services. Due to their relatively high social status, civil servants typically take on certain responsibilities in their careers, emphasizing personal health and appearance. Second, according to the results of path analysis, the constitutive factors of postpartum care center characteristics have a positive impact on perceived value and recommendation intentions. Among them, facility modernity exhibits the strongest impact, indicating that Chinese consumers consider modern facilities and latest equipment to be crucial in selecting postpartum care centers. Key words: Postpartum care center, Characteristics of postpartum care center, Facility modernity, Choice intention of postpartum care center

산후우울, 사회적 지지, 모성정체성이 산욕기 산모의 삶의 질에 미치는 영향

심희정 경북대학교 대학원 2021 국내석사

Purpose : The purpose of this study was to identify the effects of postpartum depression, social support, maternal identity on quality of life among women in postpartum period. Method : Descriptive, cross-sectional study design was used. A total of 188 women in postpartum period participated from breast-feeding clinics and internet community network. A packet of self-report questionnaires including Edinburgh postnatal depression scale, social support, semantic differential scale-maternal identity, maternal postpartum quality of life tools was used to collect the data. The collected data were analyzed using descriptive statistics, t-test, one-way ANOVA, Pearson’s correlation coefficients and stepwise multiple regression with SAS 9.4 program. Result : Postpartum depression was negatively associated with maternal postpartum quality of life. And husband support, significant others support, myself as mother, my baby were positively correlated with maternal postpartum quality of life. It was found that postpartum depression (β=-.33, p<.001), husband support (β=.16, p=.005), significant others support (β=.19, p=.001), Myself as mother (β=.37, p<.001) were factors influencing maternal postpartum quality of life. These factors explained 50% of the variance of maternal postpartum quality of life. Conclusion : The findings of this study indicated the importance of developing and implementing postnatal nursing interventions that can not only ameliorate postpartum depression, but also enhance social support from husband and significant others, and maternal identity such as myself as mother to improve maternal postpartum quality of life.

중국 산후조리원(月子中心) 의 추천의도에 관한 연구

LIU MEINA 충북대학교 경영대학원 2024 국내석사

With the continuous development of socio-economic conditions and the changing economic environment, a new form of consumer market is emerging, and industries represented by emerging services are further unleashing their development potential. China has maintained the traditional practice of “sitting the month" since ancient times, but with the transformation of medical practices, adjustments in family relationships, and women' increased attention to health care concepts, new organizations for maternal and child care, characterized by professional medical skills for the care of women during the postpartum period and infants, are emerging. This trend will effectively fill the demand gap for specialized health care services for women in the postpartum period and infants, providing comprehensive postpartum care services, including rehabilitation therapy, scientific dietary arrangements, and more importantly adapting to the needs and changes of modern society. The rise of new maternal and child care organizations reflects the pursuit of higher levels of health care services and propels the service industry to further meet the continually rising social demands. The research objective of this paper is to study the causal relationships between models by investigating the recommendation intentions of Chinese women during the postpartum period. According to the research objectives, this paper employs specialized data analysis programs SPSS and AMOS for factor analysis, reliability analysis, differential analysis (t-test, ANOVA), and path analysis on survey questionnaires completed by 505 pregnant women. The results are listed as follows: First, according to the differential analysis of demographic characteristics, the survey results show that in terms of the number of children, women with one child are more concerned about appearance, while those with multiple children are more inclined to the services of postpartum care centers. Regarding the postpartum care period, the longer the postpartum duration, the better evaluation results the postpartum nursing centers will get. In terms of education level, women with higher education tend to seek professional help and guidance, thus being more inclined to postpartum care centers. In terms of occupation, female civil servants with higher education may possess a higher demand for health, appearance, and high-quality services. Due to their relatively high social status, civil servants typically take on certain responsibilities in their careers, emphasizing personal health and appearance. Second, according to the results of path analysis, the constitutive factors of postpartum care center characteristics have a positive impact on perceived value and recommendation intentions. Among them, facility modernity exhibits the strongest impact, indicating that Chinese consumers consider modern facilities and latest equipment to be crucial in selecting postpartum care centers. Key words: Postpartum care center, Characteristics of postpartum care center, Facility modernity, Choice intention of postpartum care center * A thesis for the degree of Master in February 2024.