Doctoral Dissertations

Date of Award

12-1999

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Major

Nursing

Major Professor

Debra C. Wallace

Committee Members

Martha R. Alligood, Mary Ann Curry, Patricia Droppleman,, William Seaver

Abstract

The primary purpose of this study was to test the Holistic Obstetrical ProblemEvaluation (HOPE) theory, derived from Watson's Theory of Care (1979), by examining the relationship of socio-demographic factors, biophysical, psychosocial, spiritual and perceptual components to birth weight, gestational age, APGAR score and unplanned cesarean birth. A prospective correlational research design was used. A convenience sample of 120 pregnant women, between ages 14-44 and 16-28 weeks gestation from three prenatal sites was interviewed using; (1) Socio-demographic factors; (2) thePrenatal Psychosocial Profile tPPPl: (3) the Abuse Assessment Screen (AASV (4) theSpiritual Perspectives Scale (SPS); and (5) perception of pregnancy questions.Biophysical data from prenatal records was transferred to the Bowman Grave Risk Index For scoring and birth outcomes were obtained from delivery records.Multiple and logistic regression analysis revealed that the HOPE theory was partially supported to predict birth weight, gestational age and preterm birth and not supported for APGAR score. Socio-demographic factors, psychosocial, spiritual and perceptual components were significantly related to perinatal outcomes, while factors within the biophysical component were not.African-American race from the socio-demographic factors and no support from partner from the psychosocial component were related to delivering lower birth weight infants. Lower levels of self-esteem and use of drugs and alcohol from the psychosocial component, and active religiosity from the spiritual component were associated with shorter length of gestation at birth. Multiple logistic regression analysis revealed that can lower levels of self-esteem, from the psychosocial component, and more negative views towards the pregnancy from the perceptual component, emerged as significant predictors of preterm birth. Newly reported findings included the relationship of: 1) partner support with birth weight; 2) self-esteem and religiosity with weeks of gestation; and 3) self esteem and perception of pregnancy with preterm birth. Two significant findings, the relationship of African-American race with birth weight, and use of drugs and alcohol with gestational age have been reported previously. Testing the HOPE theory to identify both risks and protective factors for delivering lower birth weight infants, delivering infants at an earlier gestation or at preterm gestation provided preliminary support for:1) further development of the theory of HOPE; 2 ) a holistic approach to prenatal care assessments and interventions; 3) holistic instrument development; 4) delivery system models that allow time for a holistic approach to prevent lower birth weight, early gestation and preterm birth and; 5) policy and payment decisions that may improve birth outcomes. Further research on the HOPE theory with a larger and more diverse sample is needed.

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