Date of Conferral

2017

Degree

Ph.D.

School

Health Services

Advisor

Patrick Tschida

Abstract

Through the creation of the Indian Health Service in 1955, the health status of American Indian and Alaska Native (AI/AN) has improved; however, AI/AN women of reproductive age still have some of the poorest health outcomes of all populations. This study aimed to examine effective interventions that seek to improve the health of AI/AN women during pregnancy, and immediately postpartum (up to 12 months post delivery). This study addressed the research question: What effect does parental competence have on early parenting and/or infant/toddler outcomes? The life course conceptual framework was used to demonstrate how life experiences impact current health. The methodology followed the preferred reporting items for systematic reviews and meta-analyses statement. A literature review from 1993-2015 using derivatives for race and pregnancy was conducted. Inclusion and eligibility were determined using a priori criteria and application of the population, intervention, comparator, outcome, and study design(s) approach. Study quality was assessed using the Cochrane risk of bias tool and an expert review panel. A meta-analysis was conducted to determine the impact of parental competence through parenting knowledge and self-efficacy. The findings of this study suggest that evidence based interventions focused on: reducing multiple risky maternal health behaviors, through education and treatment options (creating positive social change at the individual, family, and societal levels); increasing access to prenatal care early in pregnancy, through community based participatory research (creating change at the societal level); and supporting parental competence, through training (creating change at the organizational level), will promote positive birth outcomes in AI/AN women.

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