During the postpartum period, a birth parent’s level of functioning (ability to perform the activ... more During the postpartum period, a birth parent’s level of functioning (ability to perform the activities and roles required to maintain wellbeing) is critical in determining the health of parents and their infants. However, existing approaches to support postpartum parents are insufficient, especially in the United States, and these individuals face barriers to care. The utilization of internet-based intervention may be an effective solution allowing access to resources for this population. In this study, we developed a patient-centered online tool to bolster postpartum functioning, and collected data on the feasibility, acceptability, and initial impact of this tool on functioning and emotional wellbeing. Data collection took place between February and June 2021 from a sample of 124 individuals who were within the first ten months postpartum and living in the US. Results suggest that the tool is acceptable, though there are barriers to feasibility of use. Additionally, pilot-efficacy...
Background Postpartum maternal functioning has the potential to affect the quality of interaction... more Background Postpartum maternal functioning has the potential to affect the quality of interaction between mother and child. A proper assessment of maternal functioning requires a comprehensive and accurate tool. The objective of this study was to prepare a Persian version of the Barkin Index of Maternal Functioning (BIMF) and evaluate its psychometric properties in order to determine its applicability in Iranian mothers.Methods The BIMF was translated into Persian and then culturally adapted for Iranian women. After evaluating face and content validity, a cross-sectional study was conducted using the Persian version of BIMF. The data was collected from two unique groups of 250 mothers (in all 500 mothers); the women had infants who were 2 to 12-months old and were selected using a two-stage cluster sampling method. Factor analysis, Pearson’s correlation, intra-class correlation coefficients (ICC), composite reliability (CR) and Cronbach’s alpha were employed in order to evaluate str...
Journal of the American Psychiatric Nurses Association
Perinatal mental health has been characterized primarily via depression evaluation. However, ther... more Perinatal mental health has been characterized primarily via depression evaluation. However, there may be advantages to complementary assessment of postpartum functional status. The purpose of this study was to examine sociodemographic and clinical factors associated with maternal functioning in low-income obstetrics patients. One hundred and twenty-eight women receiving postpartum obstetrical care at a large medical center in medically underserved, Middle Georgia were screened for depressive symptoms with the Edinburgh Postnatal Depression Scale. The women also completed the Barkin Index of Maternal Functioning and a sociodemographic survey. Multivariate analysis was performed to elucidate factors independently associated with maternal functioning. Higher Edinburgh Postnatal Depression Scale scores ( p < .0001) and being married ( p = .043) were associated with decreased maternal functioning. Health care providers should be cognizant of the relationship between postnatal depress...
Journal of the American Psychiatric Nurses Association, 2016
Women are faced with the task of gathering information and making subsequent decisions for themse... more Women are faced with the task of gathering information and making subsequent decisions for themselves and their families as they are often the primary caregivers. The purpose of this study was to elucidate prominent themes related to information management and Internet usage in new motherhood. While the advantages to online support have been explored, triggered anxiety has not been a focus of the literature. A focus group study of 31 adult, postpartum women was held at a large, urban medical center in the Northeastern United States. Data related to information management were extracted and analyzed thematically. Women reported experiencing (a) a forcible, internal drive for information related to family health and (b) a high level of anxiety surrounding health-related Internet searches. Health care providers must be aware that women will consult the Internet for information and that at least a portion of those individuals will experience anxiety as a result.
Journal of obstetric, gynecologic, and neonatal nursing : JOGNN
To examine access to perinatal nurse home visiting services for high-risk pregnant women who have... more To examine access to perinatal nurse home visiting services for high-risk pregnant women who have diabetes or hypertension. Secondary data analysis. Philadelphia, PA. Pregnant women who had a live birth during 2012 and those referred to a community-based agency for perinatal nurse home visiting because of their diagnosis of diabetes or hypertension. Access to services was measured by examining referral information (dosage, diagnosis, gestational age at time of referral, and insurance type) retrieved from administrative logs of the community-based organization that provides perinatal home visiting to high-risk pregnant women. The population-based prevalence rates of hypertension and diabetes were calculated from birth record data provided by the Philadelphia Department of Public Health. During 2012, 595 pregnant women were referred for perinatal nurse home visiting services. The mean gestational age when referred for services was 24.9 weeks (standard deviation = 8.5) with a mean numb...
We examined 1) women&amp;amp;amp;amp;#39;s perceptions regarding self-care, 2) applications o... more We examined 1) women&amp;amp;amp;amp;#39;s perceptions regarding self-care, 2) applications of self-care, and 3) barriers to practicing effective self-care. Four focus groups were conducted in a low-income, pregnant population. Focus group recruitment and discussions took place at a large medical center in a medically underserved area of central Georgia. Thirty-two adult pregnant women attending a high-risk obstetric clinic were included. Data related to holistic self-care were identified and grouped into one of three categories: women&amp;amp;amp;amp;#39;s valuations of self-care, applications of self-care, and barriers to self-care. The results were synthesized and compared to results from a study of postpartum women in which the same analytic framework for examining self-care practice was applied. Although women tended to understand the importance of self-care, they had difficulty practicing all forms of self-care on a regular basis owing to financial constraints, limited family support, health complications due to their high-risk obstetric status, external commitments, and childcare and household responsibilities. Applications of self-care were typically inexpensive and mainly required time rather than money. Socioeconomic status seems to influence the specific applications of and barriers to self-care. Health care providers should be aware of existing low-cost resources in the community that may assist prospective and new mothers in tending to their own emotional and physical needs. Providers should also discuss the importance of self-care with women during the perinatal period. Efforts should be made to educate school administrators regarding the impact of spontaneous requests for money for school activities, supplies, and field trips on the family budget.
Functional assessment may represent a valuable addition to postpartum depression screening, provi... more Functional assessment may represent a valuable addition to postpartum depression screening, providing a more thorough characterization of the mother&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s health and quality of life. To the authors&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; knowledge, this analysis represents the first examination of postpartum maternal functioning, as measured by a patient-centered validated tool aimed at ascertainment of functional status explicitly, and its clinical and sociodemographic correlates. A total of 189 women recruited from a large, urban women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s hospital in the northeastern United States who both (1) screened positive for depression between 4 and 6 weeks postpartum and (2) completed a subsequent home (baseline) visit between October 1, 2008, and September 4, 2009, were included in this analysis. Multiple linear regression was conducted to ascertain which clinical and sociodemographic variables were independently associated with maternal functioning. The multivariate analysis revealed independent associations between bipolar status, atypical depression, depression score (17-item Hamilton Rating Scale for Depression), and insurance type with postpartum maternal functioning. The beta coefficient for bipolar status indicates that on average we would expect those with bipolar disorder to have maternal functioning scores that are 5.6 points less than those without bipolar disorder. Healthcare providers treating postpartum women with complicating mental health conditions should be cognizant of the potential ramifications on maternal functioning. Impaired functioning in the maternal role is likely to impact child development, although the precise nature of this relationship is yet to be elucidated.
This study aims to evaluate the fitness of the Barkin Index of Maternal Functioning (BIMF) for po... more This study aims to evaluate the fitness of the Barkin Index of Maternal Functioning (BIMF) for postpartum functional assessment in a low-income obstetric population in medically underserved, Central Georgia (USA). Cognitive interviewing, a best practices approach to instrument development and validation, was performed on 24 new mothers. The BIMF was comprehensible to this population of disadvantaged women. The BIMF has broad appeal due to its comprehensibility, patient-centered assessment style, and psychometric profile. Method of questionnaire administration and characteristics of the study and/or patient population should routinely be considered when implementing any type of self-reported health screening.
Journal of obstetric, gynecologic, and neonatal nursing : JOGNN / NAACOG
To evaluate the psychometric properties of the Barkin Index of Maternal Functioning (BIMF). Princ... more To evaluate the psychometric properties of the Barkin Index of Maternal Functioning (BIMF). Principal component factor rotation was used to conduct an exploratory factor analysis of the BIMF to determine if more concise versions exist. Patients were recruited from a large, urban medical center in the Northeast. The BIMF was administered at an initial home visit along with several other self-report and clinical assessments to women who scored ≥ 10 on the Edinburgh Postnatal Depression Scale during the 4- to 6-week postpartum period. The BIMF was administered between October 2008 and September 2010. The distribution of BIMF item responses was examined along with interitem correlations. To establish construct validity, correlation coefficients were produced for the BIMF in relation to several other variables or assessments. A factor analysis was performed using principal component factor rotation. The factor analysis revealed a two-factor solution. The items that loaded on factor 1 gau...
Hormone-based contraceptives affect mood in healthy women or in women with premenstrual dysphoric... more Hormone-based contraceptives affect mood in healthy women or in women with premenstrual dysphoric disorder (PMDD). No study has yet examined their association with mood in women with major depressive disorder (MDD). The purpose of this study was to determine whether estrogen-progestin combination or progestin-only contraceptives are associated with depression severity, function and quality of life, or general medical or psychiatric comorbidity in women with MDD. This analysis focused on a large population of female outpatients less than 40 years of age with non-psychotic MDD who were treated in 18 primary and 23 psychiatric care settings across the US, using data from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Baseline demographic and clinical information was gathered and compared between three groups based on hormonal use: combination (estrogen-progestin)(N=232), progestin-only (N=58), and no hormone treatment (N=948). Caucasians were significantly m...
Pediatric primary care providers (PCPs) are being asked to care for children with mental health (... more Pediatric primary care providers (PCPs) are being asked to care for children with mental health (MH) disorders but cite inadequate training as a barrier. An intensive workshop may improve the PCPs&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; level of knowledge and lead to an increase in quality care for children with MH disorders. We compared pediatric PCPs&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; knowledge, comfort, and practice in the evaluation and management of pediatric patients with attention deficit-hyperactivity disorder, depression, anxiety, and autism spectrum disorders before and after a 2-day educational workshop. Study participants (n = 30) were recruited from rural areas of Pennsylvania. A pre- and posttest design was used. A 15-question multiple choice knowledge test and a 19-question survey of comfort and practice were administered before and after the workshop. The mean knowledge test number correct increased from 9.19 before the workshop to 12.23 after the workshop (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001). Survey scores increased from 34.6 before the workshop to 44.14 after the workshop (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001). Intensive workshops may be an effective method of training PCPs on provision of MH care in pediatric primary care practice.
During the postpartum period, a birth parent’s level of functioning (ability to perform the activ... more During the postpartum period, a birth parent’s level of functioning (ability to perform the activities and roles required to maintain wellbeing) is critical in determining the health of parents and their infants. However, existing approaches to support postpartum parents are insufficient, especially in the United States, and these individuals face barriers to care. The utilization of internet-based intervention may be an effective solution allowing access to resources for this population. In this study, we developed a patient-centered online tool to bolster postpartum functioning, and collected data on the feasibility, acceptability, and initial impact of this tool on functioning and emotional wellbeing. Data collection took place between February and June 2021 from a sample of 124 individuals who were within the first ten months postpartum and living in the US. Results suggest that the tool is acceptable, though there are barriers to feasibility of use. Additionally, pilot-efficacy...
Background Postpartum maternal functioning has the potential to affect the quality of interaction... more Background Postpartum maternal functioning has the potential to affect the quality of interaction between mother and child. A proper assessment of maternal functioning requires a comprehensive and accurate tool. The objective of this study was to prepare a Persian version of the Barkin Index of Maternal Functioning (BIMF) and evaluate its psychometric properties in order to determine its applicability in Iranian mothers.Methods The BIMF was translated into Persian and then culturally adapted for Iranian women. After evaluating face and content validity, a cross-sectional study was conducted using the Persian version of BIMF. The data was collected from two unique groups of 250 mothers (in all 500 mothers); the women had infants who were 2 to 12-months old and were selected using a two-stage cluster sampling method. Factor analysis, Pearson’s correlation, intra-class correlation coefficients (ICC), composite reliability (CR) and Cronbach’s alpha were employed in order to evaluate str...
Journal of the American Psychiatric Nurses Association
Perinatal mental health has been characterized primarily via depression evaluation. However, ther... more Perinatal mental health has been characterized primarily via depression evaluation. However, there may be advantages to complementary assessment of postpartum functional status. The purpose of this study was to examine sociodemographic and clinical factors associated with maternal functioning in low-income obstetrics patients. One hundred and twenty-eight women receiving postpartum obstetrical care at a large medical center in medically underserved, Middle Georgia were screened for depressive symptoms with the Edinburgh Postnatal Depression Scale. The women also completed the Barkin Index of Maternal Functioning and a sociodemographic survey. Multivariate analysis was performed to elucidate factors independently associated with maternal functioning. Higher Edinburgh Postnatal Depression Scale scores ( p < .0001) and being married ( p = .043) were associated with decreased maternal functioning. Health care providers should be cognizant of the relationship between postnatal depress...
Journal of the American Psychiatric Nurses Association, 2016
Women are faced with the task of gathering information and making subsequent decisions for themse... more Women are faced with the task of gathering information and making subsequent decisions for themselves and their families as they are often the primary caregivers. The purpose of this study was to elucidate prominent themes related to information management and Internet usage in new motherhood. While the advantages to online support have been explored, triggered anxiety has not been a focus of the literature. A focus group study of 31 adult, postpartum women was held at a large, urban medical center in the Northeastern United States. Data related to information management were extracted and analyzed thematically. Women reported experiencing (a) a forcible, internal drive for information related to family health and (b) a high level of anxiety surrounding health-related Internet searches. Health care providers must be aware that women will consult the Internet for information and that at least a portion of those individuals will experience anxiety as a result.
Journal of obstetric, gynecologic, and neonatal nursing : JOGNN
To examine access to perinatal nurse home visiting services for high-risk pregnant women who have... more To examine access to perinatal nurse home visiting services for high-risk pregnant women who have diabetes or hypertension. Secondary data analysis. Philadelphia, PA. Pregnant women who had a live birth during 2012 and those referred to a community-based agency for perinatal nurse home visiting because of their diagnosis of diabetes or hypertension. Access to services was measured by examining referral information (dosage, diagnosis, gestational age at time of referral, and insurance type) retrieved from administrative logs of the community-based organization that provides perinatal home visiting to high-risk pregnant women. The population-based prevalence rates of hypertension and diabetes were calculated from birth record data provided by the Philadelphia Department of Public Health. During 2012, 595 pregnant women were referred for perinatal nurse home visiting services. The mean gestational age when referred for services was 24.9 weeks (standard deviation = 8.5) with a mean numb...
We examined 1) women&amp;amp;amp;amp;#39;s perceptions regarding self-care, 2) applications o... more We examined 1) women&amp;amp;amp;amp;#39;s perceptions regarding self-care, 2) applications of self-care, and 3) barriers to practicing effective self-care. Four focus groups were conducted in a low-income, pregnant population. Focus group recruitment and discussions took place at a large medical center in a medically underserved area of central Georgia. Thirty-two adult pregnant women attending a high-risk obstetric clinic were included. Data related to holistic self-care were identified and grouped into one of three categories: women&amp;amp;amp;amp;#39;s valuations of self-care, applications of self-care, and barriers to self-care. The results were synthesized and compared to results from a study of postpartum women in which the same analytic framework for examining self-care practice was applied. Although women tended to understand the importance of self-care, they had difficulty practicing all forms of self-care on a regular basis owing to financial constraints, limited family support, health complications due to their high-risk obstetric status, external commitments, and childcare and household responsibilities. Applications of self-care were typically inexpensive and mainly required time rather than money. Socioeconomic status seems to influence the specific applications of and barriers to self-care. Health care providers should be aware of existing low-cost resources in the community that may assist prospective and new mothers in tending to their own emotional and physical needs. Providers should also discuss the importance of self-care with women during the perinatal period. Efforts should be made to educate school administrators regarding the impact of spontaneous requests for money for school activities, supplies, and field trips on the family budget.
Functional assessment may represent a valuable addition to postpartum depression screening, provi... more Functional assessment may represent a valuable addition to postpartum depression screening, providing a more thorough characterization of the mother&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s health and quality of life. To the authors&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; knowledge, this analysis represents the first examination of postpartum maternal functioning, as measured by a patient-centered validated tool aimed at ascertainment of functional status explicitly, and its clinical and sociodemographic correlates. A total of 189 women recruited from a large, urban women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s hospital in the northeastern United States who both (1) screened positive for depression between 4 and 6 weeks postpartum and (2) completed a subsequent home (baseline) visit between October 1, 2008, and September 4, 2009, were included in this analysis. Multiple linear regression was conducted to ascertain which clinical and sociodemographic variables were independently associated with maternal functioning. The multivariate analysis revealed independent associations between bipolar status, atypical depression, depression score (17-item Hamilton Rating Scale for Depression), and insurance type with postpartum maternal functioning. The beta coefficient for bipolar status indicates that on average we would expect those with bipolar disorder to have maternal functioning scores that are 5.6 points less than those without bipolar disorder. Healthcare providers treating postpartum women with complicating mental health conditions should be cognizant of the potential ramifications on maternal functioning. Impaired functioning in the maternal role is likely to impact child development, although the precise nature of this relationship is yet to be elucidated.
This study aims to evaluate the fitness of the Barkin Index of Maternal Functioning (BIMF) for po... more This study aims to evaluate the fitness of the Barkin Index of Maternal Functioning (BIMF) for postpartum functional assessment in a low-income obstetric population in medically underserved, Central Georgia (USA). Cognitive interviewing, a best practices approach to instrument development and validation, was performed on 24 new mothers. The BIMF was comprehensible to this population of disadvantaged women. The BIMF has broad appeal due to its comprehensibility, patient-centered assessment style, and psychometric profile. Method of questionnaire administration and characteristics of the study and/or patient population should routinely be considered when implementing any type of self-reported health screening.
Journal of obstetric, gynecologic, and neonatal nursing : JOGNN / NAACOG
To evaluate the psychometric properties of the Barkin Index of Maternal Functioning (BIMF). Princ... more To evaluate the psychometric properties of the Barkin Index of Maternal Functioning (BIMF). Principal component factor rotation was used to conduct an exploratory factor analysis of the BIMF to determine if more concise versions exist. Patients were recruited from a large, urban medical center in the Northeast. The BIMF was administered at an initial home visit along with several other self-report and clinical assessments to women who scored ≥ 10 on the Edinburgh Postnatal Depression Scale during the 4- to 6-week postpartum period. The BIMF was administered between October 2008 and September 2010. The distribution of BIMF item responses was examined along with interitem correlations. To establish construct validity, correlation coefficients were produced for the BIMF in relation to several other variables or assessments. A factor analysis was performed using principal component factor rotation. The factor analysis revealed a two-factor solution. The items that loaded on factor 1 gau...
Hormone-based contraceptives affect mood in healthy women or in women with premenstrual dysphoric... more Hormone-based contraceptives affect mood in healthy women or in women with premenstrual dysphoric disorder (PMDD). No study has yet examined their association with mood in women with major depressive disorder (MDD). The purpose of this study was to determine whether estrogen-progestin combination or progestin-only contraceptives are associated with depression severity, function and quality of life, or general medical or psychiatric comorbidity in women with MDD. This analysis focused on a large population of female outpatients less than 40 years of age with non-psychotic MDD who were treated in 18 primary and 23 psychiatric care settings across the US, using data from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Baseline demographic and clinical information was gathered and compared between three groups based on hormonal use: combination (estrogen-progestin)(N=232), progestin-only (N=58), and no hormone treatment (N=948). Caucasians were significantly m...
Pediatric primary care providers (PCPs) are being asked to care for children with mental health (... more Pediatric primary care providers (PCPs) are being asked to care for children with mental health (MH) disorders but cite inadequate training as a barrier. An intensive workshop may improve the PCPs&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; level of knowledge and lead to an increase in quality care for children with MH disorders. We compared pediatric PCPs&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; knowledge, comfort, and practice in the evaluation and management of pediatric patients with attention deficit-hyperactivity disorder, depression, anxiety, and autism spectrum disorders before and after a 2-day educational workshop. Study participants (n = 30) were recruited from rural areas of Pennsylvania. A pre- and posttest design was used. A 15-question multiple choice knowledge test and a 19-question survey of comfort and practice were administered before and after the workshop. The mean knowledge test number correct increased from 9.19 before the workshop to 12.23 after the workshop (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001). Survey scores increased from 34.6 before the workshop to 44.14 after the workshop (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001). Intensive workshops may be an effective method of training PCPs on provision of MH care in pediatric primary care practice.
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Papers by Jennifer Barkin