The effects of infant abdominal massage on the first year parental stress level among Chinese parents in Hong Kong

Abstract

Maternal psychological distress is one of the most common perinatal complications that affects up to 25% of pregnant and postpartum women. Parenting stress encompasses how fathers and mothers experience their parental role, their perceptions of how difficult parenting an infant is, and the quality of parent–child interactions. Abdominal massage is a low-cost and accessible intervention that does not require additional support. Infant massage performed by parents has been shown to be beneficial for parental distress and maternal mood. This thesis aimed to examine the effects of infant abdominal massage on first-year parental stress levels among Chinese parents in Hong Kong, as well as to explore parents’ perception of the intervention and the relationship between compliance with the intervention and changes of parental stress levels. This was achieved through a cluster randomized controlled trial with qualitative evaluation. Between November 2021 and March 2022, 160 parents were recruited from 10 mother groups, which were randomized into either a waitlist control or the intervention group. An infant abdominal massage class was given to those in the intervention group by a certified International Association of Infant Massage instructor. The Chinese Parenting Stress Index (PSI-SF) was used to measure parental stress levels of parents at baseline and 4 weeks after the intervention. Parents from the intervention group were interviewed about their perceptions of receiving infant abdominal massage training and performing infant abdominal massage on their babies. In the quantitative phase of the study, the mean total PSI-SF score was 80.7 (SD=19.25), with the highest mean score observed in the Parental distress (PD) subscale, which had a mean score of 30.2 (SD=8.03). The overall compliance with the intervention was 66%, and it was found to have a statistically significant effect on PSI-SF (p<0.001). Interestingly, the total PSI-SF among fathers was slightly higher than that among mothers. The intervention group exhibited significantly lower PSI-SF total score compared to the control group, with a mean difference of -5.46 (95% CI=0.72 to 10.2, p=0.049). Furthermore, no moderating factors were found to have a significant intervention effect on PSI-SF (p<0.05). In the qualitative phase, we identified an overarching theme of infant abdominal massage bringing a positive experience despite uncertainties affecting compliance. Four themes were identified: receiving clear infant abdominal massage classes, the influence of uncertain conditions on compliance, improving parental satisfaction and feeling it was a worthwhile experience. This thesis provides a deeper and broader understanding of the effectiveness of abdominal massage on parental stress levels through quantitative and qualitative data. It also provides a cost-effective method for parents to tackle their parental stress, which is not widely used in Chinese countries. Further exploration of how abdominal massage could help Chinese parents is recommended. The findings of this thesis can aid in the planning or adjustment of current postpartum depression screening while also helping to lower the risk of postpartum mood disorders.