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Designing and implementing an intervention to improve maternal social support in the postpartum period: A mixed study
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Foruzan Sharifipour    , Zahra Behboodi Moghadam , Zahra Abbaspoor * |
| Faculty of Nursing and Midwifery, Reproductive Health Promotion Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran , Abbaspour-z@ajums.ac.ir |
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| Keywords: social support, postpartum care, qualitative research |
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| Abstract (HTML) (120 Views)
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Type of Study: Original |
Subject:
Sub-aquatic Medicine
Received: 2024/12/25 | Revised: 2025/02/26 | Accepted: 2025/03/17 | Published: 2025/04/5
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Extended Abstract: (35 Views) |
Introduction
The postpartum period is a critical transitional phase during which mothers are expected to assume new maternal responsibilities while simultaneously fulfilling their established roles within the family. Balancing these roles often presents significant challenges, leading to increased stress and pressure for many women [2]. Studies consistently show that a majority of mothers experience a variety of physical and psychological issues in the weeks following childbirth. These problems range from fatigue, back pain, breast soreness, constipation, hemorrhoids, to sexual dysfunction [3]. Despite these difficulties, many women tend to place their own health needs secondary to those of their newborns during this vulnerable period. Particularly, primiparous mothers often feel unprepared to cope with these demands and require substantial support from family members, friends, and healthcare providers [5].
One crucial factor that can significantly reduce mothers' vulnerability and alleviate their stress in the postpartum period is social support [9]. While interventions aimed at preventing postpartum depression have sometimes focused on enhancing social support [15], relatively little attention has been paid to how mothers actually perceive support resources during this time [16]. Understanding these perceptions and experiences is key to designing effective interventions.
Accordingly, this study employed a mixed-methods design aimed at first elucidating mothers’ experiences of social support in the postpartum period through a qualitative approach. Next, the qualitative findings, along with expert opinions, informed the design of an intervention to improve social support for postpartum mothers. Finally, the proposed intervention was quantitatively evaluated for effectiveness. The overall purpose of this research was to provide a foundation for national health policies and strategies by generating evidence-based documentation and enhancing the body of knowledge in maternal postpartum support.
Methods
This research was conducted as a multi-stage mixed-method study at Jundishapur University of Medical Sciences in Ahvaz, Iran. Data collection, analysis, and integration were performed over several stages utilizing both qualitative and quantitative methodologies, divided into three phases: qualitative investigation, intervention design, and quantitative evaluation.
In the first phase, using a qualitative conventional content analysis approach, 22 postpartum mothers were interviewed to explore their perceptions and experiences related to social support during the postpartum period. The interviews provided rich data, which were analyzed to extract themes related to sources of support, barriers, and strategies for enhancing maternal support.
In the second phase, the findings from the qualitative study, along with results from a systematic review, were used to develop an intervention aimed at improving perceived social support among postpartum women. The development process included a nominal group technique session involving experts to prioritize and finalize the components of the intervention. The resulting intervention comprised a group training program specifically created for husbands, recognizing the critical role spouses play in supporting mothers postpartum.
The third phase involved a randomized clinical trial to test the effectiveness of the designed intervention. One hundred pregnant women, along with their spouses, were randomly assigned to intervention and control groups. Social support was assessed at baseline, immediately post-intervention, and one month after the intervention ended, allowing for evaluation of both immediate and sustained impacts on maternal perceptions of social support.
Results
The qualitative phase yielded three principal categories: “support resources,” “support barriers,” and “support promotion strategies.” Support resources included spouses, family members, health professionals, and community networks. Barriers were identified as lack of knowledge, cultural taboos, and inadequate support systems that hinder the receipt of social assistance. Mothers suggested several strategies to improve support, emphasizing the need to enhance spousal involvement, improve healthcare communication, and expand community support networks.
During the nominal group session, experts confirmed that educating husbands was essential for boosting social support postpartum. As a result, a group training intervention for husbands was designed based on the qualitative findings and systematic review prioritizations.
In the randomized clinical trial phase, the intervention group exhibited significantly higher social support scores immediately after the program (79.42 ± 7.15) and one month later (84.40 ± 5.91), compared to the control group (37.26 ± 7.99 and 37.14 ± 6.63, respectively), with these differences highly statistically significant (p< 0.001).
Discussion and Conclusion
This multi-stage mixed-method study was designed to deepen understanding of mothers’ perceptions and experiences of postpartum social support and to develop an evidence-based intervention to enhance such support. The qualitative phase identified three main themes capturing participants’ views: available support resources, barriers to obtaining support, and strategies to promote support. These findings parallel previous research showing that comprehensive support reduces perceived stress in postpartum women, facilitates adaptation to maternal demands, and strengthens mother-infant bonding [34, 35].
A particularly important finding of the study was the central role of spousal support. The presence of a supportive husband was shown to increase maternal self-confidence, ease acceptance of the maternal role, and promote successful breastfeeding. These results align with prior studies demonstrating that spousal support is a vital source of coping for mothers dealing with postpartum stress [36].
The quantitative phase confirmed the effectiveness of a husband-focused educational intervention designed to increase perceived social support in primiparous mothers during the early postpartum period. The significant improvements seen four and eight weeks after delivery underscore the value of educating spouses about postpartum challenges and support strategies. This suggests that enhancing husbands’ knowledge and involvement can positively influence couples’ attitudes and practices related to postpartum health, contributing to better maternal well-being [20].
Notably, numerous studies endorse that structured educational programs for spouses have a beneficial impact on mothers’ mental health by providing emotional and practical support [46, 47]. The positive outcomes of the group education intervention in this study offer a strong recommendation for integrating such programs into routine postpartum care delivered by midwives and maternal health care providers.
Ethical Considerations
Participation in this study was entirely voluntary. All participants signed informed consent forms after the research objectives and procedures were explained. Confidentiality of their responses was assured, and participants were informed that their involvement would not influence their healthcare or treatment. To minimize bias, participants were also made aware that the study outcomes would not affect their selection or services. This study was approved by the Research Ethics Committees of Ahvaz Jundishapur University of Medical Sciences under code IR.AJUMS.REC.1399.401. Additionally, the clinical trial phase was registered with the clinical trial number IRCT20240213060991N1.
Funding
This study is part of the first author’s PhD dissertation in midwifery and was financially supported by Ahvaz Jundishapur University of Medical Sciences, Iran.
Authors’ Contribution
All authors equally contributed to conceptualizing the study and drafting the manuscript. The final content was reviewed and approved by all authors, who agreed on every aspect of the research work.
Conflict of Interest
The authors declared no conflict of interest pertinent to this study.
Acknowledgments
We sincerely thank the research team and all participants, including mothers, spouses, and healthcare staff, who generously contributed their time and experiences for this study.
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Ethics code: IR.AJUMS.REC.1399.401 Clinical trials code: IRCT20160427027633N8
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