Construction Of The Content System Of Sensitivity Intervention For Mothers Of Hospitalized Premature Infants Based On Attachment Theory

Objective:To provide scientific guidance for clinical practice,a targeted,scientific and reliable sensitivity intervention content system based on attachment theory for mothers of hospitalized premature infants was constructed and the weight was set reasonably.Methods:(1)Investigating the level and influencing factors of mother-infant attachment among mothers of hospitalized premature infantsA convenience sampling method was used to select mothers of premature infants who were hospitalized in the neonatal intensive care unit of a third-level Grade A Children’s Specialty Hospital in Chongqing from June 2019 to December 2019 as the survey subjects.Using general information questionnaire,The Chinese version of Maternal Attachment Inventory,Self-Rating Anxiety Scale and Edinburgh Postpartum Depression Scale to carry the investigation,and using descriptive analysis,univariate analysis and multiple linear regression analysis to analyze the level and determinants of mother-infant attachment among premature neonates’ mothers.(2)Formulating the content system framework of maternal sensitivity intervention preliminarilyBy taking full advantage of searching databases such as CNKI,Wanfang,Vip.com,Pub Med,Cochrane Library etc,literature consulting and document collection about mother-infant attachment and maternal sensitivity was conducted to summarize and analyze the core elements that affect the establishment and development of mother-infant attachment,and filtrate important indicators to build an index system framework.(3)Establishing the content system of maternal sensitivity intervention finallyA total 22 experts were selected for two rounds consultation,and each round of experts consultation was issued and returned by paper questionnaires or e-mails.Excel2019,SPSS23.0 statistical software were used to calculate the expert positive coefficient,authority coefficient,expert opinion concentration degree and harmony coefficient.The screening criteria were the mean importance of index is beyond 3.5,the percentage of maximum score is beyond 50% and the coefficient of variance is less than 0.25.(4)Setting the weight of each index of the maternal sensitivity intervention content systemAnalytic hierarchy process is used to determine the weight of first-level indicators and carry out consistency test.The equal distribution method is used to determine the weight of second-level and third-level indicators,and the combined weight of second-level and third-level indicators is calculated with the accumulative product method.Results:(1)A total of 294 questionnaires were distributed and 285 questionnaires were returned,with an effective recovery rate of 96.94 %.For mothers of premature infants who hospitalized in NICU,the score of maternal attachment with a median value of 71.00 and a quartile interval of56.00,anxiety score was(30.79±7.06),25(8.77%)had anxiety,postpartum depression score was(8.32±5.90),104(36.49%)had postpartum depression.The results of multiple linear regression showed that maternal age,family economic status and postpartum depression were independent influencing factors of mother-infant attachment relationship(all P < 0.05).(2)The content system of maternal sensitivity intervention for hospitalized premature infants based on attachment theory was preliminarily formulated,including 6 first-level indicators,namely maternal sensitivity,maternal early contact,maternal emotion,intergenerational transmission of attachment,infant temperament and maternal attachment related concepts,15 second-level indicators and 49third-level indicators.(3)The questionnaire response rates of the two rounds of expert consultation were 95.65% and 95.45%,the expert authority coefficients were 0.84,0.85 and the coefficients variation of the experts were 0.15 and0.11,respectively.Kendall’s W was 0.198 and 0.144(both P<0.001).In the second round of consultation,the average score of all the indicators was greater than the first round,and all were greater than 3.50,and the coefficient variation were less than 0.25.Finally,a sensitivity intervention program system consisting of 4 first-level indicators,13 second-level indicators,and 47 third-level indicators was constructed.The weight setting results of the four first-level indicators were as follows: related concepts about maternal-infant attachment(0.1390),maternal sensitivity and attachment(0.3934),early mother-infant contact and attachment(0.2338),premature infants’ temperament and attachment(0.2338),and the index consistency ratio CR <0.10.Conclusion:(1)The status and influencing factors of mothers’ maternal attachment of preterm infants during hospitalizationDuring the hospitalization of premature infants,the mother’s mother-infant attachment is at a low-to-medium level and influencing factors including mother’s age,family economic status,and postnatal depression.We should pay attention to the negative emotions of mothers of premature infants and provide necessary psychological support in order to promote the formation of good mother-infant attachment relationship in early life stage.(2)Construction of the content system of sensitivity intervention for mothers of hospitalized premature infants based on attachment theoryThe content system of sensitivity intervention for mothers of hospitalized premature infants based on attachment theory is scientific and reasonable,authoritative and active,with high concentration and coordination degree of expert opinions,and high reliability and credibility of the content system.The weight setting is scientific and reasonable,which could suggest the focus of maternal sensitivity intervention for medical staff,and provide scientific guidance for the clinical practice further.