Pakiaka Tupuora Parenting From the Start : evaluating a preventative intervention to improve attachment and health outcomes for mothers and their babies : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Te Kungenga ki Pūrehuroa Massey University, Manawatū, New Zealand

Abstract

Background: Parenting interventions can improve individual and societal outcomes but few are brief, preventative, or consistent with Indigenous knowledge. This is the first based on the latest multidisciplinary theory – the evolved developmental niche (EDN).

Objective: To evaluate the one-day (8hr) preventative antenatal Parenting From the Start workshop in terms of infant attachment and other medium-term outcomes.

Methods: Randomised controlled trial with two parallel arms open to pregnant residents of the Manawatū/Horowhenua regions of Aotearoa New Zealand. 57 English-speaking women aged 24 to 44 years were randomly assigned to intervention (n = 27) or wait-list control (n = 30) groups alongside standard free maternity care and parental leave. Retention rates were 81% at the home visit (n = 22 intervention; n = 24 control), and 74% at the clinic assessment (n = 20 intervention; n = 20 control). Primary analyses were based on maternal sensitive responsiveness as measured by the Ainsworth Sensitivity Scales, Mini-Maternal Behavior Q- Sort, and Observational Measure of Sensitivity and Responsiveness (11 to 24 months post birth) and infant attachment on the Strange Situation Procedure (11-22 months post birth). Secondary outcomes included a range of self-reported parenting intentions and strategies.

Findings: Intervention group infants had higher rates of secure attachment (90%) than the control group (64%). This effect was significant at the level of 3-way attachment security (p = .011, Cramer’s V = 0.448), and attachment subcategory (p = .047, Cramer’s V = 0.552), but not 2-way attachment security (p = .059, Cramer’s V = 0.342). Maternal sensitive responsiveness did not differ across study conditions (p = .097, RBC = 0.288). Parenting intentions relating to breastfeeding, proximal care, room sharing, and elimination communication were significantly increased in the intervention group, as were responsive parenting beliefs, and frequency of positive care reported over the infants’ first year.

Interpretation: The intervention significantly increased responsive parenting intentions and beliefs, positive care over the first year, and rates of secure attachment. Parenting From the Start warrants further study as a brief, preventative, bicultural intervention.

Trial registration ACTRN12617000321347, universal trial number U111111840331. Trial information can be found at: http://www.ANZCTR.org.au/ACTRN12617000321347.aspx