METHODS

Research Design
This study will utilize quantitative, descriptive correlational design. A
quantitative method aims to quantify attitudes, opinions, behaviors, and other
defined variables and generate data for statistical treatment that will be used
to generalize results to a larger sample population. Descriptive design will be
used to determine the degree of psychosocial stress among prenatal mothers.
Correlational design on the other hand involves the systematic investigation of
association among the given variables. It will describe and attempt to explain
the nature of relationships between two or more variables of interest.
Locale and Population
The study will be conducted in Baguio City Philippines and the respondents will
include those who are pregnant women to 1-month post-partum women. The
inclusion criteria are as follows:

Aged 18 years old and above regardless of their parity

Those who have partners or are married

The exclusion criteria are as follows:

Pregnant women who are 17 years of age and below

Unmarried or single

Sample size was determined based on the number of pregnant women for the
year 2015 which was taken from the records of Baguio Health Department. A
total of ___ pregnant clients was listed. Using Open Epi with pregnancy rate of
50%, with a confidence level of 95% and confidence interval of .3, there will be a
total of ____ respondents for this study. Participants will be accessed through the
Baguio Health Department (BHD) and Barangay Health Centers of Baguio City
after approval of the head of BHD, which has a total of ____ health centers. The
researchers will use convenience quota sampling, wherein all respondents
consulting at the ____ health centers for the specific days of data gathering
schedule for the research group will be recruited to take part in the study.
Data Gathering Tools

The researchers will use the following tools to measure the study variable: DASS,
Maternal Self-Efficacy Tool developed by Barnes and Adamson-Marcedo, MSPSS
and Antenatal Psychosocial Health Assessment Guide (ALPHA).
The Depression, Anxiety and Stress Scale (DASS 21) authored by Fernando
Gomez will be utilized to measure the psychosocial stress of the respondents.
This is a 21 item self-report questionnaire designed to measure the severity of a
range of symptoms common to both Depression and Anxiety. In completing the
DASS, the individual is required to indicate the presence of a symptom over the
previous week. Each item is scored from 0 (did not apply to me at all over the
last week) to 3 (applied to me very much or most of the time over the past
week). The essential function of the DASS is to assess the severity of the core
symptoms of Depression, Anxiety and Stress.
The Perceived maternal parenting self-efficacy (PMPS-E) by Christopher R. Barnes
and Elvidina N. Adamson-Macedo, will measure the degree of maternal selfefficacy. The tools total score is a general indicator of self-efficacy level, but that
the subscales can also be used to understand what support and help each
individual mother may require. It is a 20 points Likert scale (1-4). The lower the
score, the lower the self-efficacy. The questionnaire measures 4 factors which
are: Care taking procedure of the infant, Evoking behavior that can affects the
infant, Reading behavior or signaling and Situational beliefs. The numbers 16,
17, 18, 19 indicates the care taking procedure, it shows how the mother take
care of the baby to provide the nutritional needs, safety needs and hygiene. The
evoking behavior is determined by numbers 5, 8, 9, 10, 11, 12, 14 which
indicates how the mother would give emotional support to the baby. The
numbers 1, 2, 3, 4, 13 and 15 indicates the connection between the mother and
the baby. The last factor which is situational beliefs assessed by numbers of 6, 7
and 20 is about how the mother feels the response of the infant to the things and
efforts given to the infant.
The Multidimensional Scale of Perceived Social Support (MSPSS) authored by
Nancy Dahlem, Sara Zimet, Gordon Farley, Gregory Zimet will measure the
degree of support the client receives. This is a brief research tool designed to
measure perceptions of support from 3 sources: Family, Friends, and a Significant
Other. The scale is comprised of a total of 12 items, with 4 items for each
subscale. The lower the score, the lower the degree of perceived social support.

The State Self-Esteem Scale is a 20-item scale that measures a participants selfesteem at a given point in time. This tool will be used to measure the
participants degree of self-esteem. The State Self-Esteem Scale (SSES) was
designed specifically for measuring state self-esteem, which is defined as the
temporary fluctuations in self-esteem. Studies have shown the SSES to be
psychometrically sound regarding factor structure, content validity, and
construct and discriminative validity. The 20 items are subdivided into 3
components of self-esteem: (1) performance self-esteem (Cronbachs = .78),
social self-esteem ( = .80), and appearance self-esteem ( = .82). All items are
answered using a 5-point scale (1= not at all, 2= a little bit, 3= somewhat, 4=
very much, 5= extremely), but the scale was modified in this study to use a 4point Likert scale (1=not at all/never, 2= sometimes, 3= most often, 4= always)
with permission from its author. The 4-point Likert scale was created for easier
understanding of the intended population of the study. The tool is free to use
and the authors only ask to be acknowledged for its use. (Heatherton & Polivy,
1991).
The maternal and family factors that will be correlated in this study will be made
part of the questionnaire through asking specific items related to the factors.
Data Gathering Process
After approval of the proposed study is given by the Review Ethics Committee of
SLU, data gathering will commence guided by the following procedures:
1

A letter of request to the City Health Officer of Baguio Health Department

will be given to ask permission to conduct the study signed by the
researcher and adviser. After the approval of the head of BHD is given,

the following steps will be undertaken:

Researchers will access the participants through the Barangay Health
Centers in coordination with the public health doctor, nurse, or midwife

assigned in the unit.

After finding eligible participants, the purpose, expectations, process, risks
and benefits and involvement in the study will be explained. Queries will
also be entertained to ensure full understanding of their participation in

this study.
When the respondent provides her written consent, the self-administered
questionnaire will be given. Questions will be entertained as deemed
needed by the participants. Throughout the whole course of the research

process, ethical considerations such as autonomy, confidentiality, and

anonymity will be strictly implemented and upheld by the researcher for
5

the respondents best interest.

When questionnaires are already retrieved, the researchers will check for
completeness of entries before finally acknowledging the participation of
the participants. Should the participant be willing to know the results of
her responses, the respondents name and contact number will be taken.
This can as well serve as a way to fulfill reciprocity roles should the
participant fall on high risk depression/stress/anxiety level. Necessary
interventions/referral process will be done as appropriate.

Statistical Treatment
In determining the DASS 21, the scale to which each item belongs is indicated by
the letters D (Depression), A (Anxiety) and S (Stress). For each scale (D, A & S)
sum the scores for identified items. Because the DASS 21 is a short form version
of the DASS (the Long Form has 42 items), the final score of each item groups
(Depression, Anxiety and Stress) needs to be multiplied by two (x2). Once
multiplied by 2, each score can now be transferred to the DASS profile sheet,
enabling comparisons to be made between the three scales and also giving
percentile rankings and severity labels. DASS severity rating table below:
Severity

Depressi

Anxiet

Stress

on

Normal

0-9

0-7

0-14

Mild

10-13

8-9

15-18

Moderate

14-20

10-14

19-25

Severe

21-27

15-19

26-33

Extremely

28+

20+

34+

severe

High scores on the DASS would certainly alert the researchers to a high level of
distress in the patient and this would need to be explored further within the
interview process. Similarly, low scores on the DASS should not be a substitute
for a comprehensive clinical interview. High DASS scores which are not
changing, may prompt the researchers to look for explanations and perhaps

augment dosages or change medication. Here again, the DASS should be

interpreted alongside the clinical interview. Changes in scores in one scale (EG:
Depression), with consistently high and unchanging scores in another scale
(Anxiety) may alert the researchers to pay particular attention to the presence of
a coexisting anxiety disorder which may need specific treatment in its own right.
Similarly, decreasing depression scores alongside unchanging Stress scores may
alert the clinician to the presence of some life event or problem, which may need
to be addressed directly.
In determining the Multidimensional Scale of Perceived Social Support, for each
assessment, there is an algorithm leading to one of three acuity ranges. The
logic for the user receiving specific feedback is included in the algorithms below:
Score

Interpretation

69-84

High Acuity

49-68

Moderate Acuity

12-48

Low Acuity

To determine the degree of self-esteem of each participant, the weighted mean

of the individual items will be summed up to establish the state self-esteem. The
scale of interpretation for the state self-esteem is as follows:
Score

Interpretation

61-80

High Self-Esteem

41-60

Moderate SelfEsteem

20-40

Low Self-Esteem

To determine the level of perceived maternal self-efficacy, the weighted

mean of the individual items will be summed up to establish the perceived
maternal self-efficacy of the participant. Higher scores indicate a higher
perceived maternal self-efficacy. The scale of interpretation is as follows:

Score

Interpretation

61-80

High Perceived Maternal Self-Efficacy

41-60

Moderate Perceived Maternal Self-Efficacy

20-40

Low Perceived Maternal Self-Efficacy

To determine significance difference in the degree of Perceived psychosocial

support and maternal self-efficacy when grouped accordingly to perinatal period
and parity, ANOVA and Pearson will be used respectively.

To determine relationship between and among degree of Perceived maternal

support, Maternal Self-efficacy, Self-esteem and perinatal psychosocial support.
Pearson correlation coefficient will be use.

To determine among of perceived psychosocial support and maternal self-efficacy

to family factors of experience of spousal violence, problems with child discipline,
concern with relationship with in laws and quality of couples relationship, T-test
and Pearsons correlation will be use.