Development and pilot testing of two behavioural feedback strategies designed to improve maternal self-efficacy.

Background: The aim of this pilot study was to describe the development of, and test the acceptability and feasibility of providing feedback on two behaviours in the context of supportive approaches to improve maternal self-efficacy. We hypothesised that providing individual behavioural feedback to mothers in a socially vulnerable context, when later embedded in supportive intervention approaches, may improve maternal self-efficacy and ultimately promote infant development.

Methods: Feedback was developed following expert consultation with working groups, and included graphical feedback on mother and infant movement behaviours measured using accelerometry, as well as video feedback of mother-infant interactions using first person observation head cameras. Mothers wore the devices for one week, following which individual feedback on movement behaviours and mother-infant interactions was delivered at the Chris Hani Baragwanath Academic Hospital. We adapted an established and published strengths based approach as a guide for health workers to feedback video and accelerometer data. Feasibility and acceptability were tested by conducting focus group discussions with a sample of 8 mothers of infants aged 4-months from South Africa using a semi-structured interview guide.

Results: Mothers included in this study were generally single, unemployed, and less than half had completed formal schooling. Most mothers had two or more children, and lived in informal housing (such as shacks and small, temporary prefabricated structures) with only outdoor toilet facilities available. The feedback was found to be both feasible, and largely acceptable in this context and compliance was 100%.

Conclusion: We have been able to develop feedback with the potential to sensitise mothers to their infants' behaviours. When embedded in a supportive intervention, these feedback modalities have the potential to improve mother's self-efficacy through increasing feelings of competence and reflexive functioning.