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Healthy Mommy and Me

Grant Proposal:

Healthy Mommy and Me

Vanessa Garcia
15 December 2015
HSC 405 T/Th 9:30 am
Theodora Papachristou, MPH
California State University, Long Beach

Healthy Mommy and Me

Table of contents
Pages
2-4
...
...

...

Specific aims/ Importance of the Topic

Goals
Objectives
Program
Sampling
Experimental Design

4-9

Background and Significance

...

Importance of topic
Critical Review on Similar Programs
Linking Goals and Objectives to their Theoretical Relevance
Hypothesis

...

9-18

Methods

Design of experimental methodology

Operationalization of concepts

Formative evaluation methods

Process evaluation methods

Rationale for choice of statistical techniques

Timeline of activities to be accomplished

19-26

Appendix

Description of the population and method of sample selection

References
Post test

Healthy Mommy and Me

Specific aims
Goal:
The purpose in having Healthy Mommy and Me is to improve the health and well-being
of Hispanic and Latina women and their infant in the community of Santa Ana, California.
Objectives:
1) By June 2017 mother of the experimental group will increase their knowledge by 30%
by being able to identify at least 3 health behaviors techniques to stay calm with their crying
baby. This will be done with an in class activity.
2) By completion of the program the experimental group participants will have a
knowledge change of 20% by being able to identify three health risks that put their infants at risk
for fatality.
3) By the completion of the program participants in the experimental group will change
their behavior by increasing their bonding techniques by 20% by engaging in various activity
with their infant (singing, dancing, painting,) at least 4 times a week for 60 minutes a day.
Objective outcome:
The rate of the participants health and wellness will increase this will improved by 20 %
for mother and infant in Santa Ana.
Program:
Healthy Mommy and Me Program will be offered to mothers at the time of registration
in the hospital and/or before the mother leaves the hospital. Mothers will build leadership,
confidence, and have the opportunity to network with other moms and staff by engaging them to
maintain independence for themselves and their newborn. The program will consist of

Healthy Mommy and Me

workshops to inform mothers on how to maintain their well-being afterbirth. These workshops
will include topics such as: syndromes/ disorders, breastfeeding tips and bonding.
The program is intended to reduce postpartum depression, sudden unexpected infant
deaths (SUID), sudden infant death syndrome (SIDS), shaken baby syndrome (SBS), and
diseases. Mothers will learn bonding techniques such as: singing, dancing and playing music,
and will learn the importance of breastfeeding.
Population:
Health Mommy and Me will assist single, first time Latina mothers in Santa Ana.
Women ages 14-44 have 195.3 per 1000 live birth and 11% of these women who have had live
birth are at a low socio-economic status. They tend to lack educational background, 24% speak
spanish. The program will provide education to mothers to stay healthy with their newborn.
Sampling
The sampling method for both the control and experimental group will be cluster
sampling. Participants from the hospital, Coastal Community of Santa Ana (experimental) and
from Western Medical Santa Ana (control). Participants (experimental) will receive an invitation
to participate in the program.
Experimental Design
This would be a quasi-experimental design will use a nonequivalent comparison design
with the experimental and control group. This design is applied because there is no random
assignment nor will it be based on individuals characteristics, rather based on similar group

Healthy Mommy and Me

characteristics. Participants at Western Medical Santa Ana will be in the control (comparison)
group and participants at Coastal Community hospital will be in the experimental group.
Background and significant
Importance of topic
In the United States there are about 3,500 newborns. It is reported that infants to one year
of age die suddenly and unexpectedly each year (CDC, 2015). This is known as sudden
unexpected infant deaths (SUID) and sudden infant death syndrome (SIDS). There is no clear
explanation as to what is the cause of the death, however in most cases reported it is known that
the infant was asleep in an unsafe area or environment. Such environment include sleeping with
parents, stuffed animals, toys, pillows, too many blankets around the sleeping area, and lying the
infant with a bottle in mouth unsupervised. Other causes include the temperature of the room: too
hot or cold (CDC, 2015). Another syndrome is the shaken baby syndrome (SBS). This is due to
an abusive head trauma (AHT) and inflicted traumatic brain injury (ITBI) (CDC, 2015). This
occurs when infants are violently shaken by their caretaker. The tragedy occurs when the
caretaker becomes overwhelmed with the infant crying constantly and having difficulty calming
them. Mothers at times can go through postpartum depression (PPD) also referred as baby blues,
mood swings: anxiety, sadness and a sense of feeling overwhelm. They might lose their appetite,
or have trouble sleeping (U.S National Library of Medicine, 2013). Other signs include: feeling
of hopelessness, and a lose interest in the baby. More severe signs are thoughts of hurting
themselves or the baby. This can last a few weeks or up to a year (U.S National Library of
Medicine, 2013). One in seven mothers will have been diagnosed with postpartum depression
(Neighmond, 2013).

Healthy Mommy and Me

The program is intended to benefit Mothers, as it educates on how to prevent fatality, and
build to increase the life of the infant. Having an infant is costly enough, then having a tragic
event happen, such as SUID), SIDS, or SBS can begin to add expenses on, hospital bills,
lawyers, and counseling. A portion of the program will be dedicated on self-awareness. This is
intended to show mothers how to reduce spending, best alternatives to purchasing formula,
roughly $1,733.75 (Hamm, T., 2013), for the first year. This does not include: bottles, nipples,
and bottle cleaners. An example of a self-awareness topic will include breastfeeding.
Understanding the benefit to breastfeeding on how it builds a stronger immune system, decreases
the risks of type 2 diabetes, obesity thus increasing their life expectancy.

Critical review of research on similar programs

There are similar programs that assist in improving the health and well-being of mothers
and child. Educational programs use program readiness, strength of scientific base, and empirical
evidence of program effectiveness. Better programs included parenting skills, strengthening
families and infant training for their health.
There are similar programs that assist in improving the health and well-being of mothers
and child. This portion of the essay will list and inform on educational programs that use
program readiness, strength of scientific base, and empirical evidence of program effectiveness.
This study will also inform on better programs included parenting skills, strengthening families
and infant training for their health. These programs are used as a cross-sectional study due to that
findings were found inconclusive for this undergoing study.

Healthy Mommy and Me

Make Parenting a Pleasure (MPAP) was developed to empower individual parents


experiencing stress, low income, isolation, and a lack of parenting information and social
support. MPAP, Intentional Harmony and Triple P-Positive Parenting Program was designed to
reduce parental stress and increase parenting skills, social support, and parents' sense of
competence, all of which have been validated with empirical data as increasing successful
parenting and decreasing risk factors related to child abuse and neglect (Saks, Hyman, Reilly, &
Rusch, 2006).
The Nurturing Parenting Program emphasizes the following seven principles from which
to build warm and caring environments for children: feelings of attachment, empathy, nurturing
oneself, gentle touch, discipline, expressing feelings, expectations, and self-worth (Bavolek,
2007). Nurturing Parenting Programs were designed on the basis of the prevention of empirically
validated parental risk factors for abuse and neglect. The program's design also utilizes the
following building blocks of parenting: bonding and attachment, empathy, self-awareness, touch,
discipline, unconditional love and respect, and developmental knowledge.
Active Parenting and Promising programs are based on strong theoretical perspectives
that undergird activities and materials. Research has been done over a long period of time, but
primarily utilizes single group, pre-test-post-test designs.
Common Sense Parenting (CSP) programs are grounded in social learning principles and
have years of empirical, well-designed research with positive results. STAR Parenting attempts
to help parents of young children respond instead of react to challenging behavior programs
curriculum is grounded in developmental and cognitive-behavioral theories and also draws upon
principles of authoritative parenting.

Healthy Mommy and Me

Strengthening Families Program for Parents and Youth 10-14 (SFP 10-14) and Systematic
Training for Effective Parenting (STEP) program, the program was designed to foster: a healthy
future orientation within youth; an increased appreciation of youth for their parents/caregivers;
and gains in valuable skills for coping with stress and peer pressure and parents are asked to
identify the goal of their children's misbehavior and respond in a way that encourages more
positive behaviors and future interactions.
These similar programs lead to wanting to improve the health and well-being of mothers
and child. they all assist with implementing Healthy Mommy and Me.

Description of program components and their theoretical significance

The Health Belief Model (HMB) helps to explain why people participate in health related
behaviors or why they choose not to participate in health behaviors. The HBM hypothesizes that
the likelihood of an individual to participate in a health behavior depends on a persons
motivation to change to enable them to perform a particular health behavior, their thoughts on
how susceptible they are to a health problem(s), and how likely is this health problem to harm
them or disrupt their lives- perceived threat. In the HBMs perceived severity states that if a
person does not see a specific health problem or behavior as a problem that can endanger their
lives then the individual will not find a reason to change or be motivated to change their habits.
The Healthy Mommy and Me Program address perceived severity through a 60 minute
workshops with activity the experimental group will increase their knowledge to improve their
health and wellness afterbirth. The participants will increase their knowledge by being able to
identify three health risks that put their infants at risk for fatality. Being able to identify the
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Healthy Mommy and Me

health risks will allow a person understand the potential fatality Participants will also change
their behavior by increasing their bonding techniques, in doing so this be in engaging in various
activity with their infant (singing, dancing, music) at least 4 times a week for 60 minutes a day
outside of the program.
The HBM is perceived threat, thus if an individual may know that that certain behaviors
are not healthy but may not change because they do not feel that their negative health choices
will result in negative health consequences. The individual does not feel like the disease could
happen to them- they feel invisible. Allowing mother to be educated on the possible
consequences of risks after birth could happen to them will help them think about the threat.
Those in a low socio-economical community seem to not be aware of the treat.
The HBM perceived benefit, the individual will be more likely to change their negative
health habits if they believe that they will succumb to the negative consequences of their
unhealthy habits. Healthy Mommy and Me addresses perceived benefit, first by educating
participants on the benefits of bonding. The main benefits will be emphasized: to improve health
and wellness- to prevent and reduce infant mortality and diseases. The maintenance of a health
will not only prevent risks but allow confidence to the mother of ensuring she is doing all that is
possible to improve their life.
The HBM is perceived barriers that an individual feels are keeping them from performing
the healthy behaviors. Perceived barriers that Healthy Mommy and Me target population faces
is not having efficient transportation, participants come from a low socio-economic background
and can lack resource as to get from one location to the next. This will stop them from getting
important useful information that can help improve their health and wellness.

Healthy Mommy and Me

Self-efficacy, this an individuals belief in themselves that they can or are capable of
performing a new behavior or action that will allow them to change old behaviors. Education on
health and wellness of the mother and child prevention mentioned in previous components will
be used as a method to allow participants to believe they have the power to change their habits.
Hypothesis

By June 2017 mother of the experimental group will increase their knowledge by 30% by
being able to identify at least 3 health behaviors to stay calm with their crying baby. By
completion of the program the experimental group participants will have a knowledge change of
20% by being able to identify three health risks that put their infants at risk for fatality. By the
completion of the program participants in the experimental group will change their behavior by
increasing their bonding techniques by 20% by engaging in various activity with their infant
(singing, dancing, painting,) at least 4 times a week for 60 minutes a day. All three of these
objectives will be measure through pretest and posttest.

Methods
Description of the population and method of sample selection

Healthy Mommy and Me will consist of women participants who are first time
mothers. Their age will range from 18 and over. This program will be held in the community of
Santa Ana, California at the Community college. This would be center of resource of the local
for the participants. Women from all backgrounds will be welcomed, however the program will
be focused towards Hispanics and Latinos within Santa Ana. Also again women must fall under

Healthy Mommy and Me

of first time mothers and single. There is a large community of 78.2% of Hispanics and Latinos
in Santa Ana (U.S. Census, 2015). In this population, there are about 47.8 % in which the
population is foreign born (U.S. Census, 2015). There is an estimated of median household
income of $47,335 (U.S. Census, 2015). Residents in Santa Ana there are 21.5% who fall under
the poverty line (U.S. Census, 2015). The estimated persons per household is 4.45 (U.S. Census,
2015).The city covers 27.27 square miles, yet has over 11,900.6 residents per square mile (U.S.
Census, 2015).
For Healthy Mommy and Me the method of sampling that will be used will be
clustering sampling. The recruitment will be to invite those at a local hospital in Santa Ana,
Coastal Community hospital to mothers. This would offered at the time of registration or before
the mother and child are discharged.
In participating in the program they will be receiving an intervention. Within the
invitation, it is to provide knowledge to mothers to improve the wellbeing of their health as well
as their newborn up to one year. They will be different workshops offered on health and
wellness, newborn care, child development, breastfeeding, home safety and additional special
health needs. These workshops will be 60 minutes in length. In addition to workshops there will
be activities that will engage both mother and infant. This will be to assist with bonding, early
brain stimulation, mother will learn games, songs, and dance with their infant.
Healthy Mommy and Me is an intervention-based behavioral program. In order to
calculate sample size, for statistical analysis purposes, the alpha level () is set at 0.05 and the
beta () is set at 0.80 (1-4 ). Using the statistical power analysis program, G*Power, the value
received for sample size by inputting the alpha level, and beta level, and effect size of 0.10 was

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100. However, 20% of 100 will be added to the sample size calculation in order to account for
participants who drop out from the program, refuse to participate, or are unable to be located at
post-test. The experimental group will have 100 participants, with an overall sample size of
n=120. Since there is a control group there will be a total of n=240.
Design of experimental methodology

Healthy Mommy and Me This would be a quasi-experimental design will use a


nonequivalent comparison design with the experimental and control group. This design is being
used because there will be no random assignment and will not be based on individual
characteristics, but instead, based on similar group characteristics. Participants at Western
Medical Santa Ana will be in the control (comparison) group and participants at Coastal
Community hospital will be in the experimental group.
Since Healthy Mommy and Me will have a nonequivalent comparison group study
design, not all threats of to internal validity can be controlled. However, Healthy Mommy and
Me will have two groups and a pre and post-test with the same instruments. This design will
control for four different threats to internal validity: history, maturation, testing and
instrumentation. Threats that remain due to the absence of random assignment are: regression to
the mean effect, selection, attrition, interaction, diffusion, compensation, compensatory rivalry,
and demoralization.
Regression of the mean effect cannot be controlled in this design since participants are
not selected through individual characteristics. However, outliers will be taken into consideration
when analyzing the data. The threat of selection will be controlled because participants will not
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have a choice of receiving the program or not. Participants from western medical Santa Ana
will be the in control (comparison) group and participants at Coastal Community will be in the
experimental group.
Minimizing barriers and providing incentives will control the threat of attrition.
Incentives will be given at both sites to both the control and experimental group; this will include
treats, water, toys for infants or even coupon for diapers. Transportation might be a barrier and
that why it was calculated to the dropout rate of 20%. Interaction will only occur if regressions to
the mean effect, selection, or attrition occur simultaneously. By controlling each threat
individually, interaction will also be controlled.
Diffusion of information will be addressed by geographical isolation of the two groups.
Both of these schools are on opposite ends of the city of Santa Ana. Regularly meeting with staff
and monitoring sessions to make sure standard treatment of the control group is occurring will
control compensation, demoralization, and compensatory rivalry.
Operationalization of concepts

Healthy Mommy and Me will collect data through self-administered questionnaires.


These questionnaires will be in both Spanish and English and serve as both the pre-test, to
establish a baseline and as a post-test, to assess change.
The risk factors for the health issue are known; therefore, the purpose of the program is to
increase and raise further awareness among the target population regarding risks. The programs
purpose is to reach a large number of mothers who deliver in establish a method of sustainability.

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The independent variable is the program itself and the dependent variables will be the
hypothesized impacts and outcomes that will result from implementing the program. In order to
determine whether the program is impacting the population, pretests, posttests and attendance
sheets will be used as instruments of measurements.
Questionnaires are an appropriate approach because participants of this age group are
more likely to give an honest answer on a paper response than in a face-to-face interview. Also,
bias can occur in face-to-face interviews. The main disadvantage of using a self-administered
questionnaire Healthy Mommy and Me is that ability to understand the questions and be able
to answer them accordingly. However, this will be taken into the consideration and the
questionnaires will be developmentally appropriate. Mother would take this pre/post test at the
location of the program (Santa Ana College) Demographic questions will be asked at the
beginning of the pre-test and post-test. The participants age will be collected in interval form.
Participants gender and race will be collected through nominal data. Participants grade levels
will be collected through ordinal level data.
Sign in will be determine whether the program is impacting the target population enough
to continuously attend every lesson and workshop. The pre and post tests will assist with
determining whether the participants are actively learning. The feedback forms will also assist
with determining whether the participants found the program effective and impactful.

Formative evaluation methods


For this program Pilot testing will be necessary. This will be used to assess, feasibility of
Healthy Mommy and Me. Formative evaluation will be used as a form of feedback to identify

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the areas of the program that need to improve from community and experts. Experts within the
field of the health and wellness of the mother and infant (Primary Physicians, Health Educators),
as well as focus group of families in the Santa Ana community to gauge their input on the
program. The experts will provide constructive criticism on which areas to improve or alter in
order to get improve the outcome from the target population. Criticism will measure the
programs components and method of approach, on its effectiveness and whether the material is
appropriate at a cognitive level of the participants. The families of the Santa Ana community will
provide feedback on the materials that are being presented to the participants to allow
inclusiveness. They will have the ability to rank the activities and lessons to insure effectiveness
of the program. Families will provide insight on their community, bringing up issues and
addressing possible solutions that they think will be more effective. This feedback will provide
the necessary adjustments for the program to better serve the target population.
Process evaluation methods
Oversight and evaluation are necessary to insure that Healthy Mommy and Me is
reaching the target population; the program being implemented as outlined in the
curriculum, and that resources are rightfully allocated. Pre-survey data will be entered and
looked at immediately to determine if the program has in fact targeted primarily Latinos who are
first time mothers. To make sure participants are attending the program an attendance sheet will
be used, to check-in and check-out. Activities will be implemented to involve participating, such
as bonding activities with their infant for an hour. Incentives will be offered to participants, like
water, diaper coupon, infant books, and toys.
To evaluate if the program is being implemented as outlined in the curriculum, bi-

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monthly staff meetings will be held. This will allow staff to provide feedback to the program
coordinator about any potential changes that should be made to the curriculum. It will give
the coordinator an opportunity to stress the importance of adherence to the outlined curriculum,
in order to effectively assess change at post-test. The bi-monthly meetings will also give an
opportunity to staff members to assess the budget allocation. If staffs believe funding should go
towards different components of the program, necessary changes will made. Staff will also
inform the program coordinator if materials and incentives are effective at adhering participants
to the program. If they are not, suggestions will made to redirect budget allocation.
Rationale for choice of statistical techniques:
The statistical techniques used by Healthy Mommy and Me will be univariate analysis and
bivariate analysis.

Descriptive StatisticsUnivariate Analysis


A univariate analysis will include demographic data. Gender, age, race, and grade-level,
will be collected through the pre-test. Gender and race will be collected through nominal data
and the mode will be calculated for both. Gender of participants will be presented on a pie chart,
while race of participants will be presented on a bar graph. Grade-level of participants will be
collected during the pre-test using ordinal level of measurement. Thus, the median grade-level be
presented and this will be through a bar graph. Age will be collected during the pre-test as well
using interval level of measurement. The mean age will be calculated and presented through a
histogram.
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Inferential StatisticsBivariate Analysis


A Bivariate analysis will be conducted at a significance level of alpha () =0.5

Objective 1
By June 2017 mother of the experimental group will increase their knowledge by 30% by
being able to identify at least 3 health behaviors to stay calm with their crying baby. As measured
by questions 1-16 on posttest. The dependent variables are questions 1-16, which are nominal.
The independent variable is group membership (experimental group versus control), a nominal
level variable with two categories. A summative index will be created by assigning codes to
questions 1-16. A code of 1 will be assigned to the correct answer and a code of 0 will be
assigned to all the incorrect answer. The summative index is an interval level variable ranging
from 0-16 and will be used as the independent test variable for an independent sample t-test.
Objective 2
By completion of the program the experimental group participants will have a knowledge
change of 20% by being able to identify three health risks that put their infants at risk for
mortality rate. Questions 17-32 on posttest. The dependent variables are questions 17-32, which
are ordinal. The independent variable is group membership (experimental group versus control),
a nominal level variable with two categories. A summative index will be created by assigning
codes to questions 17-32. A code of 3 will be assigned to the most desired answer and a code
of 0 will be assigned to the least desired answer. Answers with decreasing scores will be
assigned decreasing values such as 2 and 1. The summative index is an interval level
variable ranging from 0-36 and will be used as the independent test variable for an independent
sample t-test.

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Healthy Mommy and Me

Objective 3
By the completion of the program participants in the experimental group will change
their behavior by increasing their bonding techniques by 20% by engaging in various activity
with their infant (singing, dancing, painting,) at least 4 times a week for 60 minutes a day.
The variables are questions 25-26, which are interval. The independent variable is group
membership (experimental group versus control), a nominal level variable with two categories. A
summative index will be created to serve as the interval level variable.

Timeline of activities to be accomplished

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August
2016

SeptemberDec
2016

Jan-May June
2017
2017

Implementation

Process
Evaluation

Activity

Jan-May
2016

Needs
Assessment

Program
development

Pilot testing

June
2016

July
2016

July
2017

Sampling

Pretest

Posttest

Data Analysis

Report Writing

Questionnaire:
Please read the questions carefully and answer honestly. Your answers will be kept confidential
Name:______________________

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Demographics
1. Sexual Orientation .

A. FEMALE
B.Other (please write)________________

2. How old are you?

write specific age________________

3. What is your race/ethnicity?

A. Asian/Pacific Islander

(Circle all that apply)

B. African American/Black
C. White/Caucasian
D. Hispanic or Latino
E. Native American
F. Other (please write)____________________

4. What is your educational background?

A.Non High school graduate


B.High school graduate
C. College (2 year)
D. University (4 year)

Knowledge
Please circle the best answer:

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1.It is reported that infants to one year of age die suddenly and unexpectedly each year (CDC,
2015)
A. True
A. False
2. Which of the following would lead to mortality of an infant?
A.sleeping on their tummy
B. sleeping with stuffed toy or blankets
C. sleeping in their mother's bed
D. all the above

3. An infant CAN die when they are sleeping with no reason to support why?
A. True
B. False
4. An infant can sleep safely on,
A.
B.
C.
D.

Its back
swaddled
clear environment (nothing in the crib)
All the Above

5. Does Postpartum depression occur to the mother


A. True
B. False
6. Postpartum depression is
A.
B.
C.
D.

sadness
Anxiety
Hopeless
All the above

7. Mothers CAN Seek support, counseling with Postpartum depression

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A.True
B.False
8. It is best to ______ when you feel frustrated while your infant is crying.
A. Shack the infant so it becomes dizzy
B. hit the infant, so it has a reason to cry
C. take a deep breath, place the infant in a safe restful place while you try to relax.
9. Leaving a child to cry in a safe place(swing, crib, playpen)while you are trying to relax is
child abuse?
A. True
B. False
10. Infant continues to cry for 30 min or longer you should
A.
B.
C.
D.
E.

Ensure diaper is not dirt/wet


ensure they have had eaten (drank breastmilk/milk)
check if its their nap time
check to see if there is a fever
all the above
11.True or False, bonding activity improves brain functioning?
A. true
B. false
12.Which of the following is NOT a bonding Technique?

A. singing to your infant


B. dancing with infant
C. leaving infant in their walker
13. True or False, Bonding can be done anywhere?
A. true
B. false
14. True or False, leaving your infant in a playpen is bonding time?
A. true
B. false
15.Which of the following would be the best way to improve your sleeping?

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A. nap when infant is napping


B. nap when you infant is awake
C. nap when infant is feeding
16. it is important to ____ with your child so they can develope skills
A.
B.
C.
D.

Ignore
Leave unattended
Spank
Talk

Attitudes
There is no right or wrong answer in this section. After reading each sentence, please check the
box that you feel best represents how much you agree or disagree with the statement.

Strongly Disagree 1

Disagree 2

Agree 3

Strongly Agree 4

2. Singing, dancing, music helps my infant develop skills.

3. Bonding with my infant is fun.

4. I would rather leave my infant in the playpen while I watch tv.

5. The presenter encouraged me to bond with my infant

6. Asking for resources is helpful

1. Bonding with my infant keeps us both healthy.

7. Talking to my Dr. about issues in regard to my health and infant is easy. 1

2 3

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8. Postpartum Depression can be cured through therapy

9. Understanding postpartum depression is important.

10. Knowing the symptoms of postpartum depression is useful

11. I would rather smoke or drink then acknowledge my infant when crying

12. I am detached from my infant I am a horrible mom. 1

13. Talking to a support group will help reduce anxiety. 1

14. Attending to the program will help me build confidence 1

15. I will be able to self reduce my stress when I am at home with my infant 1

16. I am able to seek additional help at home if needed.

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f

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General citation

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Healthy Mommy and Me

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