Instruments

Parenting satisfaction and parenting self-efficacy were used as the dependent variables. Independent variables included several parent, infant and environmental attributes. Both dependent and independent variables, including the number of items, scales, scoring technique used and the instruments used during both cohort I and II data collection, are listed in Table 2. All instruments except PSE and parental perception of infant had been

previously validated and had shown good internal consistency reliability. In addition, all instruments were pilot-tested with doctoral-level maternity care professionals (N=7) and infants’ parents (N=70 families; response rate for mothers 71% and fathers 55%) in a university hospital setting.

4.6.1 Parenting satisfaction instrument

Parenting satisfaction was assessed with the Evaluation subscale (11 items) of the revised What Being the Parent of a New Baby is Like instrument (WPBL-R, Pridham & Chang 1989). This study was the first time that the WBPL-R instrument was used among Finnish parents. Therefore, it was translated into Finnish using the back translation technique, that is, the instrument was translated into Finnish and then back into English in order to ascertain the adequacy of the translation (Polit & Beck 2006).

4.6.2 Parenting self-efficacy instrument

The parenting self-efficacy instrument was specially developed for this research. The PSE instrument was based on Bandura’s (1997) self-efficacy theory, previous research (e.g. Brazelton & Cramer 1990, Brazelton & Sparrow 2006), national infant care recommendations (Finnish Ministry of Social Affairs and Health 2004) and tacit knowledge. The PSE is composed of three dimensions: level, strength and generality (Bandura 1997). All items were worded positively as recommended by Bandura (1997). The items reflect day-to-day infant care tasks as well as interactive behaviours (Barnard 1989). In this study, level refers to task difficulty, strength to the person’s degree of confidence and generality to the modalities in which different tasks are expressed. Factor analysis was performed to test the selected three modalities. The results supported the use of the affective, cognitive and behavioural skills related to PSE (Article III).

4.6.3 Parent, infant and environmental attributes

Parent attributes

The parent attributes were age, parity, education, marital status and delivery type. Self- concept was evaluated using an instrument developed by Saari and Majander (1985). The self-concept instrument measures the individual’s level of self-esteem. Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS; Cox et al. 1987, 1993). Individual scores for self-concept and depressive symptoms (EPDS) were calculated by summing the scores for all items in the instrument. Cox et al. (1993) recommend an EPDS score of 13 or more as a cut-off point for depressive symptoms; therefore, it was also used as a cut-off point in this study. Attitude towards parenthood during pregnancy evaluated whether the parent was feeling afraid, concerned, insecure, relaxed or confident about their imminent parenthood. In addition, the respondents rated

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their experience of childbirth in terms of how pleasant, painful, frightening, demanding, enjoyable, “as expected” and “under control” the delivery was (Tarkka et al. 2000). Life change and infant centrality were measured with the subscales of the What Being the Parent of a New Baby is Like-Revised (the WBPL-R; Pridham & Chang 1989). Parent’s state of mind on discharge was measured with an instrument measuring whether the parent was fearful, strained, tired and saddened (Tarkka et al. 2000). Computer skills, computer use in general and use of the internet-based intervention were evaluated among the parents in cohort II. (Table 2.)

Table 2. List of variables including number of items, scales, scoring technique and use of instruments in different cohorts

Variables Items Scale Score Cohort

Dependent variables

Parenting satisfaction, WBPL-R 11 9-point Osgood scale M, 1-9↑ I, II

Parenting self-efficacy, PSE 27 M, 1-6↑

Cognitive skills 11

From 1=”strongly disagree” to 6=”strongly agree” I, II Affective skills 7 Behavioural skills 9 Independent variables Parent attributes

Age, parity, education, marital status, delivery type

5 Scale/ Ordinal/ Nominal - I, II Self-concept 10 5-point Likert scale S, 10-50↑ _I Depressive symptoms, EPDS 10 From 0 to 3 according to

severity of symptoms

S, 0-30↓ _{I, II} Parenting attitude during pregnancy 1 Ordinal - I Experience of childbirth 8 5-point Osgood scale M, 1-5↑ _I Centrality, WBPL-R 8 9-point Osgood scale M, 1-9↑ _I Life change, WBPL-R 6 9-point Osgood scale M, 1-9 I State of mind on hospital discharge 4 5-point Osgood scale M, 1-5↑ _I Computer use, computer skills,

intervention use

4 Scale/ Ordinal/ Nominal - II Infant attributes

Gestational weeks, birth weight, gender

3 Scale/ Nominal - I, II

Current age, health 2 Scale/ Nominal - I

Perception of infant 9 5-point Osgood scale M, 1-5↑ I Environmental attributes

Family functioning, FAFHES Family health, FAFHES

21 21

From 1=”strongly disagree”

to 6=”strongly agree” M, 1-6

↑ _I

Social support from nursing professionals, FAFHES

21 From 1=”no support at all”to 6=”a great deal of support”, 0=”no need for support”

M, 0-6↑ _{I, II}

Advice 8 5-point Likert scale M, 1-5↑ _I

Rooming-in, father present, feeding practices

3 Nominal - I

WBPL-R, What Being the Parent of a New Baby is Like-Revised; EPDS, Edinburgh Postnatal Depression Scale; FAFHES, Family Functioning, Health and Social Support; S, Sum of scores;M, mean score of all items; ↑_{The higher the better;} ↓_{The lower the better}

Infant attributes

The infant attributes were gestational weeks, birth weight, current age and gender (Table 2). Parents’ perception of the infant was measured with an instrument specially developed for this study. Perceptions measured included those of eating, sleeping, contentment, activity level, clarity of cues, adaptability, soothability and general perception of the child’s health and how demanding the infant is. An open-ended question evaluated the infant’s health problems. For analysis, the responses were divided into two categories: no problems or any kind of health problem. (Table 2.)

Environmental attributes

The environmental attributes were family functioning, family health and social support, which were evaluated with subscales of the Family Functioning, Health and Social Support instrument (FAFHES, Åstedt-Kurki et al. 2002, 2009). Family functioning includes variables related to structural characteristics of the family, family relationships, relationships outside the family, family resources, and risk factors (Paavilainen 1998). Family health as an everyday experience consists of values, knowledge, activities, well- being and ill being (Åstedt-Kurki 1992). Social support from nursing professionals consisted of three modes of support: affect, affirmation and concrete aid (Kahn 1979; Tarkka et al. 2000). Advice from nursing professionals was measured with a variable in which the respondents were asked to evaluate whether the advice was adequate, accurate, encouraging, understandable, individual, consistent with previous knowledge, consistent among ward personnel and whether both parents were acknowledged (Tarkka et al. 2000). The practice of rooming-in, father’s presence on the maternity ward and infant’s feeding practices were also evaluated. (Table 2.)