Abstract
This study examined the feasibility and accessibility of brief perinatal mindfulness-based interventions (1 prenatal, 2 postnatal) aimed at supporting the wellbeing of women and their infants living in the context of low income. First time expectant mothers (n = 202) were recruited through clinics and community-based organizations. We examined the feasibility of recruitment, research assessments and intervention implementation, and the acceptability of the intervention programs. Feasibility was assessed by recruitment and attendance numbers, and participant self-report on barriers and facilitators to participation. Intervention acceptability was assessed by class evaluation questions and qualitative interview. The study showed mixed feasibility with successful recruitment and retention in the study, attributable to incentives and strong community relationships which lead to high levels of completion of research assessments. However, there were low levels of group intervention attendance in the postpartum groups due to significant barriers to in-person program attendance. In qualitative interviews, participants indicated having an online or combined online and in-person option would address attendance challenges. Program evaluation and participant interview data show high levels of program acceptability, with over 95% reporting satisfaction with skills and information taught. The high level of class satisfaction across all three intervention programs, along with responses in the qualitative interviews suggests that a mindfulness approach is accepted and valued by this population. Intervention groups were valued by participants, pointing to the need for future iterations of such interventions to explore the use of online and combined online and in-person formats to assess their success in addressing attendance barriers.
Highlights
-
Perinatal mindfulness interventions were accepted and valued by a diverse sample of mothers with low income.
-
Expectant and new first-time mothers valued the connections and support of other new mothers in the intervention group setting.
-
Significant barriers to attendance for low-income mothers in the perinatal period undermine the feasibility of in-person interventions.
-
Adapting the perinatal interventions to an online or combination online and in-person program was desired by participants and may address attendance barriers.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ammerman, R. T., Putnam, F. W., Stevens, J., Bosse, N. R., Short, J. A., Bodley, A. L., & Van Ginkel, J. B. (2011). An Open Trial of In-Home CBT for Depressed Mothers in Home Visitation. Maternal and Child Health Journal, 15(8), 1333–1341. https://doi.org/10.1007/s10995-010-0691-7
Baer, R. A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10, 125–143. https://doi.org/10.1093/clipsy/bpg015
Bardacke, N. (2012). Mindful birthing: Training the mind, body, and heart for childbirth and beyond (1st ed). HarperOne
Beardslee, W., & Knitzer, J. (2004). Mental health services: A family systems approach. In K. I. Maton, C. J. Schellenbach, B. J. Leadbeater, & A. L. Solarz (Eds.), Investing in children, youth, families, and communities: Strengths-based research and policy (pp. 157–171). American Psychological Association. https://doi.org/10.1037/10660-009
Berens, A. E., Jensen, S. K. G., & Nelson, C. A. (2017). Biological embedding of childhood adversity: From physiological mechanisms to clinical implications. BMC Medicine, 15(1), 135. https://doi.org/10.1186/s12916-017-0895-4
Bernard, K., Nissim, G., Vaccaro, S., Harris, J. L., & Lindhiem, O. (2018). Association between maternal depression and maternal sensitivity from birth to 12 months: A meta-analysis. Attachment & Human Development, 20(6), 578–599. https://doi.org/10.1080/14616734.2018.1430839
Bowen, D. J., Kreuter, M., Spring, B., Cofta-Woerpel, L., Linnan, L., Weiner, D., Bakken, S., Kaplan, C. P., Squiers, L., Fabrizio, C., & Fernandez, M. (2009). How we design feasibility studies. Am J Prev Med, 36(5), 452–457. https://doi.org/10.1016/j.amepre.2009.02.002
Boyd, R. C., Zayas, L. H., & McKee, M. D. (2006). Mother-infant interaction, life events and prenatal and postpartum depressive symptoms among urban minority women in primary care. Maternal and Child Health Journal, 10(2), 139–148. https://doi.org/10.1007/s10995-005-0042-2
Burchinal, M., Vernon-Feagans, L., & Cox, M. (2008). Cumulative social risk, parenting, and infant development in rural low-income communities. Parenting, Science and Practice, 8(1), 41–69. https://doi.org/10.1080/15295190701830672
Clearfield, M. W., & Jedd, K. E. (2013). The effects of socio-economic status on infant attention: SES and infant attention. Infant and Child Development, 22(1), 53–67. https://doi.org/10.1002/icd.1770
Cuijpers, P., Weitz, E., Karyotaki, E., Garber, J., & Andersson, G. (2015). The effects of psychological treatment of maternal depression on children and parental functioning: A meta-analysis. European Child & Adolescent Psychiatry, 24(2), 237–245. https://doi.org/10.1007/s00787-014-0660-6
Dedoose Version 9.0.17. (2021). [Web application for managing, analyzing, and presenting qualitative and mixed method research data]. SocioCultural Research Consultants, LLC. http://dedoose.com
Dhillon, A., Sparkes, E., & Duarte, R. V. (2017). Mindfulness-based interventions during pregnancy: A systematic review and meta-analysis. Mindfulness, 8(6), 1421–1437. https://doi.org/10.1007/s12671-017-0726-x
Dimidjian, S., Goodman, S. H., Felder, J., Gallop, R., Brown, A. P., & Beck, A. (2016). Staying well during pregnancy and the postpartum: A pilot randomized trial of mindfulness based cognitive therapy for the prevention of depressive relapse/recurrence. Journal of Consulting and Clinical Psychology, 84(2), 134–145. https://doi.org/10.1037/ccp0000068
Dumas, J. E. (2005). Mindfulness-Based Parent Training: Strategies to Lessen the Grip of Automaticity in Families With Disruptive Children. Journal of Clinical Child & Adolescent Psychology, 34(4), 779–791. https://doi.org/10.1207/s15374424jccp3404_20.
Duncan, L. G., & Bardacke, N. (2010). Mindfulness-based childbirth and parenting education: Promoting family mindfulness during the perinatal period. Journal of Child and Family Studies, 19(2), 190–202. https://doi.org/10.1007/s10826-009-9313-7
Duncan, L. G., Coatsworth, J. D., & Greenberg, M. T. (2009). A model of mindful parenting: Implications for parent-child relationships and prevention research. Clinical Child and Family Psychology Review, 12(3), 255–270. https://doi.org/10.1007/s10567-009-0046-3
Duncan, L. G., Cohn, M. A., Chao, M. T., Cook, J. G., Riccobono, J., & Bardacke, N. (2017). Benefits of preparing for childbirth with mindfulness training: A randomized controlled trial with active comparison. BMC Pregnancy and Childbirth, 17(1), 140. https://doi.org/10.1186/s12884-017-1319-3
Felder, J. N., Roubinov, D., Bush, N., Coleman-Phox, K., Vieten, C., Laraia, B., Adler, N., & Epel, E. (2018). Effect of prenatal mindfulness training on depressive symptom severity through 18-months postpartum: A latent profile analysis. Journal of Clinical Psychology, 74(7), 1117–1125. https://doi.org/10.1002/jclp.22592
Filene, J. H., Kaminski, J. W., Valle, L. A., & Cachat, P. (2013). Components associated with home visiting program outcomes: A meta-analysis. Pediatrics, 132(Suppl 2), S100–S109. https://doi.org/10.1542/peds.2013-1021H
Finn, C. A., & Sladeczek, I. E. (2001). Assessing the social validity of behavioral interventions: A review of treatment acceptability measures. School Psychology Quarterly, 16, 176–206. https://doi.org/10.1521/scpq.16.2.176.18703
Grote, N. K., Swartz, H. A., Geibel, S. L., Zuckoff, A., Houck, P. R., & Frank, E. (2009). A randomized controlled trial of culturally relevant, brief interpersonal psychotherapy for perinatal depression. Psychiatric Services, 60(3), 313–321. https://doi.org/10.1176/ps.2009.60.3.313
Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. The Guilford Press
Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology Science and Practice, 10(2), 144–156. https://doi.org/10.1093/clipsy.bpg016
Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. Bantam Books
Kabat-Zinn, M., & Kabat-Zinn, J. (1997). Everyday blessings: The inner work of mindful parenting. Hyperion
Kazdin, A. E. (1980). Acceptability of alternative treatments for deviant child behavior. Journal of Applied Behavior Analysis, 13(2), 259–273. https://doi.org/10.1901/jaba.1980.13-259
Kendrick, D., Elkan, R., Hewitt, M., Dewey, M., Blair, M., Robinson, J., Williams, D., & Brummell, K. (2000). Does home visiting improve parenting and the quality of the home environment? A systematic review and meta analysis. Archives of Disease in Childhood, 82(6), 443–451. https://doi.org/10.1136/adc.82.6.443
Khoury, B., Lecomte, T., Fortin, G., Masse, M., Therien, P., Bouchard, V., Chapleau, M.-A., Paquin, K., & Hofmann, S. G. (2013). Mindfulness-based therapy: A comprehensive meta-analysis. Clinical Psychology Review, 33(6), 763–771. https://doi.org/10.1016/j.cpr.2013.05.005
Knitzer, J., Theberge, S., & Johnson, K. (2008). Reducing maternal depression and its impact on young children. National Center for Children in Poverty, 28
Lengua, L. J., Thompson, S. F., Calhoun, R., Long, R. B., Prince, C., Kantrowitz-Gordon, I., Shimomaeda, L., Nurius, P. S., Katz, L. F., Sommerville, J., Booth-LaForce, C., Treadway, A., Metje, A., Whiley, D. J., & Moini, N. (2023). Preliminary evaluation of the effectiveness of perinatal mindfulness-based well-being and parenting programs for low-income new mothers. Mindfulness. https://doi.org/10.1007/s12671-023-02096-6
Lerner, S. (2015). The real war on families: Why the U.S. needs paid leave now. In These Times. https://inthesetimes.com/article/the-real-war-on-families
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press
Luo, Z.-C., Wilkins, R., & Kramer, M. S. (2006). Effect of neighbourhood income and maternal education on birth outcomes: A population-based study. Canadian Medical Association Journal, 174(10), 1415–1420. https://doi.org/10.1503/cmaj.051096
MacQueen, G. M., Frey, B. N., Ismail, Z., Jaworska, N., Steiner, M., Lieshout, R. J. V., Kennedy, S. H., Lam, R. W., Milev, R. V., Parikh, S. V., & Ravindran, A. V. (2016). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: Section 6. Special populations: youth, women, and the elderly. The Canadian Journal of Psychiatry, 61(9), 588–603. https://doi.org/10.1177/0706743716659276
McKelvey, L. M., Fitzgerald, H. E., Schiffman, R. F., & Von Eye, A. (2002). Family stress and parent-infant interaction: The mediating role of coping. Infant Mental Health Journal, 23, 164–181
Miranda, J., Chung, J. Y., Green, B. L., Krupnick, J., Siddique, J., Revicki, D. A., & Belin, T. (2003). Treating depression in predominantly low-income young minority women: a randomized controlled trial. JAMA, 290(1), 57–65. https://doi.org/10.1001/jama.290.1.57
NICE. (2014). Antenatal and postnatal mental health: Clinical management and service guidance. NICE. https://www.nice.org.uk/guidance/cg62
O’Mahen, H., Himle, J. A., Fedock, G., Henshaw, E., & Flynn, H. (2013). A pilot randomized controlled trial of cognitive behavioral therapy for perinatal depression adapted for women with low incomes. Depression and Anxiety, 30(7), 679–687. https://doi.org/10.1002/da.22050
Pan, W.-L., Chang, C.-W., Chen, S.-M., & Gau, M.-L. (2019). Assessing the effectiveness of mindfulness-based programs on mental health during pregnancy and early motherhood—A randomized control trial. BMC Pregnancy and Childbirth, 19(1), 346. https://doi.org/10.1186/s12884-019-2503-4
Park, S. Y., Nicksic Sigmon, C., & Boeldt, D. (2022). A framework for the implementation of digital mental health interventions: The importance of feasibility and acceptability research. Cureus, 14(9), e29329. https://doi.org/10.7759/cureus.29329
Poverty USA. (2019). Maps & data, King County, Washington. https://www.povertyusa.org/data/2019/WA/king-county
Price, C., Kantrowitz-Gordon, I., & Calhoun, R. (2019). A pilot feasibility study of mindfulness childbirth education for women with a history of sexual trauma. Complementary Therapies in Clinical Practice, 37, 102–108. https://doi.org/10.1016/j.ctcp.2019.09.005
Riley, J. R., & Masten, A. S. (2005). Resilience in Context. In R. D. Peters, B. Leadbeater, & R. J. McMahon (Eds.), Resilience in children, families, and communities: Linking context to practice and policy (13–25). Kluwer Academic/Plenum Publishers. https://doi.org/10.1007/0-387-23824-7_2
Rotundo, G. (2011). Centering pregnancy: The benefits of group prenatal care. Nursing for Women’s Health, 15(6), 508–518. https://doi.org/10.1111/j.1751-486X.2011.01678.x
Ruberry, E. J., Klein, M. R., Kiff, C. J., Thompson, S. F., & Lengua, L. J. (2018). Parenting as a moderator of the effects of cumulative risk on children’s social-emotional adjustment and academic readiness. Infant and Child Development, 27(3), e2071. https://doi.org/10.1002/icd.2071
Shorey, S., & Ng, E. D. (2021). The efficacy of mindful parenting interventions: A systematic review and meta-analysis. International Journal of Nursing Studies, 121, 103996. https://doi.org/10.1016/j.ijnurstu.2021.103996
Silva, M. R., Collier‐Meek, M. A., Codding, R. S., & DeFouw, E. R. (2020). Acceptability assessment of school psychology interventions from 2005 to 2017. Psychology in the Schools, 57(1), 62–77. https://doi.org/10.1002/pits.22306
Social Determinants of Health. (n.d.). Social Determinants of Health | Healthy People 2020. https://wayback.archive-it.org/5774/20220413203948/https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health
Tandon, S. D., Perry, D. F., Mendelson, T., Kemp, K., & Leis, J. A. (2011). Preventing perinatal depression in low-income home visiting clients: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 79(5), 707–712. https://doi.org/10.1037/a0024895
Thompson, S. F., Kiff, C. J., & McLaughlin, K. A. (2018). The neurobiology of stress and adversity in infancy. In C. H. Zeanah (Ed.), The handbook of infant mental health (4th ed., p. 14). The Guildford Press
Thompson, S. F., Klein, M. R., Ruberry, E. J., Kiff, C. J., Moran, L., Zalewski, M., & Lengua, L. J. (2021). Clarifying the unique effects of pre‐ and postnatal depression on pre‐schoolers’ adjustment. Infant and Child Development, 30(1). https://doi.org/10.1002/icd.2202
van Agteren, J., Iasiello, M., Lo, L., Bartholomaeus, J., Kopsaftis, Z., Carey, M., & Kyrios, M. (2021). A systematic review and meta-analysis of psychological interventions to improve mental wellbeing. Nature Human Behaviour, 5(5), 631–652. https://doi.org/10.1038/s41562-021-01093-w
Wickham, S., Whitehead, M., Taylor-Robinson, D., & Barr, B. (2017). The effect of a transition into poverty on child and maternal mental health: A longitudinal analysis of the UK Millennium Cohort Study. The Lancet Public Health, 2(3), e141–e148. https://doi.org/10.1016/S2468-2667(17)30011-7
Funding
Funding for this project was provided as a gift from the Maritz Family Foundation.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no competing interests.
Ethical approval
All aspects of this study were reviewed and approved by the University of Washington Institutional Review Board.
Informed consent
Participants provided informed, signed consent prior to being included in the study and participating in study procedures.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Calhoun, R., Thompson, S.F., Treadway, A. et al. Assessing the Feasibility and Acceptability of Pre- and Postnatal Mindfulness-based Programs with Mothers Experiencing Low Income. J Child Fam Stud 32, 3076–3089 (2023). https://doi.org/10.1007/s10826-023-02657-2
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10826-023-02657-2