Date of Conferral





Health Services


Patrick Tschida


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.