Maternal Self-Efficacy, Social Support, and Adaptation to Motherhood in Mothers of Preterm Infants in Neonatal Intensive Care Units
-
Wafaa Ahmed Ameen
,
Maryam Abd Al-Kareem
,
Hayder M. Obaid
,
Abbas Fadhel Jassim
,
Hassanain M. Kadhim AL-Mamoori
,
Ahmed Sh Alzuheri
Abstract
Objective: This cross-sectional study examined maternal role adaptation among mothers of preterm infants in Neonatal Intensive Care Units (NICUs), and assessed whether self-efficacy and social support explain additional variance in adaptation beyond global self-esteem.
Method: A cross-sectional correlational design was employed with a convenience sample of 350 mothers of preterm infants (gestational age < 37 weeks) admitted to the NICU at Imam Al-Sadiq Teaching Hospital in Hilla city, Iraq. Participants completed validated Arabic versions of the Rosenberg Self-Esteem Scale, the Arabic Parental Self-Efficacy Scale (APSES), the Multidimensional Scale of Perceived Social Support (MSPSS), and a Maternal Role Adaptation Questionnaire. Data were analyzed using descriptive statistics, Pearson correlations, and hierarchical linear regression.
Results: Overall maternal role adaptation was poor in 61.4% of mothers (mean score 23.72 ± 5.31). Self-efficacy showed the strongest correlation with adaptation (r = 0.56, P < 0.001), followed by social support (r = 0.51, P < 0.001) and self-esteem (r = 0.44, P < 0.001). Hierarchical regression revealed that after controlling for demographic covariates, self-efficacy (β = 0.41, 95% CI: 0.31-0.50, P < 0.001) and social support (β = 0.33, 95% CI: 0.23-0.42 P < 0.001) were independently associated with adaptation, while self-esteem was not significant in the final model (β = 0.08, 95% CI: -0.03-0.19, P = 0.14). The full model explained 44% of the variance in adaptation scores (R² = 0.44).
Conclusion: Maternal self-efficacy and perceived social support demonstrate stronger associations with adaptation to motherhood than global self-esteem among mothers of preterm infants in NICUs. Interventions to enhance NICU mothers' adaptation should prioritize skill-based self-efficacy building and social support mobilization.
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8. Heydarpour S, Keshavarz Z, Bakhtiari M. Factors affecting adaptation to the role of motherhood in mothers of preterm infants admitted to the neonatal intensive care unit: a qualitative study. J Adv Nurs. 2017;73(1):138-48.
9. Bandura A. Self-efficacy: The exercise of control: Macmillan; 1997.
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16. Karimi M, Bakht R, Tapak L, Refaei M, Basiri B. The effect of empowerment counseling on stress and self-esteem of mothers with hospitalized premature infants. J Reprod Infant Psychol. 2024;42(2):315-26.
17. Maleki M, Mardani A, Harding C, Basirinezhad MH, Vaismoradi M. Nurses' strategies to provide emotional and practical support to the mothers of preterm infants in the neonatal intensive care unit: A systematic review and meta-analysis. Womens Health (Lond). 2022;18:17455057221104674.
18. Xufré Y, Pacheco M, Henriques MR, Gallifa J. Narrative interventions for children and adolescents in foster care: A scoping review. Child Youth Serv Rev. 2026:108853.
19. Rambod M, Pasyar N, Mazarei Z, Soltanian M. The predictive roles of parental stress and intolerance of uncertainty on psychological well-being of parents with a newborn in neonatal intensive care unit: a hierarchical linear regression analysis. BMC Pediatr. 2023;23(1):607.
20. Mohammadi MR, Ahmadi N, Khaleghi A, Mostafavi SA, Kamali K, Rahgozar M, et al. Prevalence and Correlates of Psychiatric Disorders in a National Survey of Iranian Children and Adolescents. Iran J Psychiatry. 2019;14(1):1-15.
21. Tabachnick BG, Fidell LS, Ullman JB. Using multivariate statistics. 1996.
22. Abdel-Khalek AM, Korayem AS, El-Nayal MA. Self-esteem among college students from four Arab countries. Psychol Rep. 2012;110(1):297-303.
23. Naser AY, Al-Shehri H. Parental Self-Efficacy in Managing Pediatrics' Medications and Treatments in Jordan: A Cross-Sectional Study. Healthcare (Basel). 2025;13(18).
24. Fekih-Romdhane F, Fawaz M, Hallit R, Sawma T, Obeid S, Hallit S. Psychometric properties of an Arabic translation of the multidimensional social support scale (MSPSS) in a community sample of adults. BMC Psychiatry. 2023;23(1):432.
25. Frese BJ, Nguyen MHT. The Evolution of Maternal Role Attainment: A Theory Analysis. ANS Adv Nurs Sci. 2022;45(4):323-34.
26. Khalesi ZB, Mirzaii S, Rad EH, Panjalipour S, Kazemi S. Determinants of maternal role adaptation in mothers with preterm neonates. JBRA Assist Reprod. 2021;25(3):434-8.
27. Khaleghi A, Pirzad Jahromi G, Zarafshan H, Mostafavi SA, Mohammadi MR. Effects of transcranial direct current stimulation of prefrontal cortex on risk-taking behavior. Psychiatry Clin Neurosci. 2020;74(9):455-65.
28. van Wyk L, Majiza AP, Ely CSE, Singer LT. Psychological distress in the neonatal intensive care unit: a meta-review. Pediatr Res. 2024;96(6):1510-8.
29. Govindaswamy P, Laing S, Waters D, Walker K, Spence K, Badawi N. Needs and stressors of parents of term and near-term infants in the NICU: A systematic review with best practice guidelines. Early Hum Dev. 2019;139:104839.
30. Shetty AP, Halemani K, Issac A, Thimmappa L, Dhiraaj S, K R, et al. Prevalence of anxiety, depression, and stress among parents of neonates admitted to neonatal intensive care unit: a systematic review and meta-analysis. Clin Exp Pediatr. 2024;67(2):104-15.
31. Poluektova O, Kappas A, Smith CA. Using Bandura's self-efficacy theory to explain individual differences in the appraisal of problem-focused coping potential. Emotion Review. 2023;15(4):302-12.
32. Bandura A. On the functional properties of perceived self-efficacy revisited. Sage publications Sage CA: Los Angeles, CA; 2012. p. 9-44.
33. Alinejad-Naeini M, Shoghi M, Peyrovi H. Exploration of the process of maternal role attainment in Iranian mothers with preterm neonate: A grounded theory. J Hum Behav Soc Environ. 2023;33(1):44-63.
34. Zhang R, Dong Q. Effectiveness of Supportive Nursing Care Interventions to Reduce the Stress of the Mothers in the Neonatal Intensive Care Unit: A Systematic Review and Meta-Analysis. Adv Neonatal Care. 2026;26(2):166-76.
35. Chen S, Shen H, Jin Q, Zhou L, Feng L. Family-centered care in the neonatal intensive care unit: a meta-analysis and systematic review of outcomes for preterm infants. Transl Pediatr. 2025;14(1):14-24.
36. McDermott KA, Louis CC, Rochon EA, Grunberg VA. Which support matters when? Relational functioning and posttraumatic stress in NICU parents. J Reprod Infant Psychol. 2026:1-17.
37. Vega-Vega P, Miranda-Castillo C, Urrutia-Soto MT. Construct of self-efficacy in mothers of highly complex chronic children: A qualitative study. J Pediatr Nurs. 2025;85:639-45.
38. Heidary S, Heidari H, Choopani R, Sedehi M. The effect of the supportive care program based on Bandura's self-efficacy on stress and participation of the mothers of the neonates admitted to neonatal intensive care unit. J Educ Health Promot. 2023;12:265.
39. Bagheri M, Ramezani M, Vaghee S, Sadeghi T. The Effect of Applying Problem-solving Skills on Stress Coping Styles and Emotional Self-efficacy in Mothers of Preterm Neonates: A Randomized Clinical Trial. Int J Community Based Nurs Midwifery. 2024;12(4):254-66.
40. Białas A, Kamecka K, Rasmus P, Timler D, Kozłowski R, Lipert A. Anxiety, Coping, and Self-Efficacy as a Psychological Adjustment in Mothers Who Have Experienced a Preterm Birth. J Clin Med. 2025;14(12).
41. Konukbay D, Vural M, Yildiz D. Parental stress and nurse-parent support in the neonatal intensive care unit: a cross-sectional study. BMC Nurs. 2024;23(1):820.
42. Xu F, Shi LL, Gao L. Analysis of anxiety and depression status and related factors among mothers of children in neonatal intensive care unit. World J Psychiatry. 2025;15(3):101748.
2. Ohuma EO, Moller AB, Bradley E, Chakwera S, Hussain-Alkhateeb L, Lewin A, et al. National, regional, and global estimates of preterm birth in 2020, with trends from 2010: a systematic analysis. Lancet. 2023;402(10409):1261-71.
3. Metwally MH, Awad H, Samy G, Ayed M, Swanson J, Al-Nemri A, et al. Current enteral feeding practices for premature infants in neonatal intensive care units in the Middle East and North Africa. JPGN Rep. 2026;7(1):150-8.
4. Pavlyshyn Н, Sarapuk I, Saturska U. Maternal Stress Experience in the Neonatal Intensive Care Unit after Preterm Delivery. Am J Perinatol. 2024;41(9):1155-62.
5. Pavlyshyn Н, Sarapuk I, Saturska U. Maternal Stress Experience in the Neonatal Intensive Care Unit after Preterm Delivery. Am J Perinatol. 2024;41(9):1155-62.
6. Doheny KK, Gardner FC, Ali S, Fronheiser BJ, Miller CJ, Brelsford GM. Maternal Stress Responses and Coping Following a NICU Experience. Children (Basel). 2025;12(6).
7. Mercer RT. Becoming a mother versus maternal role attainment. J Nurs Scholarsh. 2004;36(3):226-32.
8. Heydarpour S, Keshavarz Z, Bakhtiari M. Factors affecting adaptation to the role of motherhood in mothers of preterm infants admitted to the neonatal intensive care unit: a qualitative study. J Adv Nurs. 2017;73(1):138-48.
9. Bandura A. Self-efficacy: The exercise of control: Macmillan; 1997.
10. de la Fuente J, Kauffman DF, Boruchovitch E. Editorial: Past, present and future contributions from the social cognitive theory (Albert Bandura). Front Psychol. 2023;14:1258249.
11. Nouri F, Jamalimoghadam N, Edraki M, Mirshah E. The Effect of Virtual Education in Parenting Skills on the Parenting Sense of Competence in First-time Mothers with a 0-2-year-old Baby: A Quasi-experimental Study. Int J Community Based Nurs Midwifery. 2023;11(4):270-7.
12. Vaziri MH, Merghati-Khoei E, Tabatabaei S. Moral Distress among Iranian Nurses. Iran J Psychiatry. 2015;10(1):32-6.
13. Fang Y, Boelens M, Windhorst DA, Raat H, van Grieken A. Factors associated with parenting self-efficacy: A systematic review. J Adv Nurs. 2021;77(6):2641-61.
14. Wittkowski A, Garrett C, Calam R, Weisberg D. Self-Report Measures of Parental Self-Efficacy: A Systematic Review of the Current Literature. J Child Fam Stud. 2017;26(11):2960-78.
15. Tajalli S, Parvizy S, Ebadi A, Zamaniashtiani F, Kenner C. Understanding the experience of the mothers' ability to take care of their preterm infants related to in-hospital and post-discharge: a qualitative content analysis. BMC Pediatr. 2025;25(1):72.
16. Karimi M, Bakht R, Tapak L, Refaei M, Basiri B. The effect of empowerment counseling on stress and self-esteem of mothers with hospitalized premature infants. J Reprod Infant Psychol. 2024;42(2):315-26.
17. Maleki M, Mardani A, Harding C, Basirinezhad MH, Vaismoradi M. Nurses' strategies to provide emotional and practical support to the mothers of preterm infants in the neonatal intensive care unit: A systematic review and meta-analysis. Womens Health (Lond). 2022;18:17455057221104674.
18. Xufré Y, Pacheco M, Henriques MR, Gallifa J. Narrative interventions for children and adolescents in foster care: A scoping review. Child Youth Serv Rev. 2026:108853.
19. Rambod M, Pasyar N, Mazarei Z, Soltanian M. The predictive roles of parental stress and intolerance of uncertainty on psychological well-being of parents with a newborn in neonatal intensive care unit: a hierarchical linear regression analysis. BMC Pediatr. 2023;23(1):607.
20. Mohammadi MR, Ahmadi N, Khaleghi A, Mostafavi SA, Kamali K, Rahgozar M, et al. Prevalence and Correlates of Psychiatric Disorders in a National Survey of Iranian Children and Adolescents. Iran J Psychiatry. 2019;14(1):1-15.
21. Tabachnick BG, Fidell LS, Ullman JB. Using multivariate statistics. 1996.
22. Abdel-Khalek AM, Korayem AS, El-Nayal MA. Self-esteem among college students from four Arab countries. Psychol Rep. 2012;110(1):297-303.
23. Naser AY, Al-Shehri H. Parental Self-Efficacy in Managing Pediatrics' Medications and Treatments in Jordan: A Cross-Sectional Study. Healthcare (Basel). 2025;13(18).
24. Fekih-Romdhane F, Fawaz M, Hallit R, Sawma T, Obeid S, Hallit S. Psychometric properties of an Arabic translation of the multidimensional social support scale (MSPSS) in a community sample of adults. BMC Psychiatry. 2023;23(1):432.
25. Frese BJ, Nguyen MHT. The Evolution of Maternal Role Attainment: A Theory Analysis. ANS Adv Nurs Sci. 2022;45(4):323-34.
26. Khalesi ZB, Mirzaii S, Rad EH, Panjalipour S, Kazemi S. Determinants of maternal role adaptation in mothers with preterm neonates. JBRA Assist Reprod. 2021;25(3):434-8.
27. Khaleghi A, Pirzad Jahromi G, Zarafshan H, Mostafavi SA, Mohammadi MR. Effects of transcranial direct current stimulation of prefrontal cortex on risk-taking behavior. Psychiatry Clin Neurosci. 2020;74(9):455-65.
28. van Wyk L, Majiza AP, Ely CSE, Singer LT. Psychological distress in the neonatal intensive care unit: a meta-review. Pediatr Res. 2024;96(6):1510-8.
29. Govindaswamy P, Laing S, Waters D, Walker K, Spence K, Badawi N. Needs and stressors of parents of term and near-term infants in the NICU: A systematic review with best practice guidelines. Early Hum Dev. 2019;139:104839.
30. Shetty AP, Halemani K, Issac A, Thimmappa L, Dhiraaj S, K R, et al. Prevalence of anxiety, depression, and stress among parents of neonates admitted to neonatal intensive care unit: a systematic review and meta-analysis. Clin Exp Pediatr. 2024;67(2):104-15.
31. Poluektova O, Kappas A, Smith CA. Using Bandura's self-efficacy theory to explain individual differences in the appraisal of problem-focused coping potential. Emotion Review. 2023;15(4):302-12.
32. Bandura A. On the functional properties of perceived self-efficacy revisited. Sage publications Sage CA: Los Angeles, CA; 2012. p. 9-44.
33. Alinejad-Naeini M, Shoghi M, Peyrovi H. Exploration of the process of maternal role attainment in Iranian mothers with preterm neonate: A grounded theory. J Hum Behav Soc Environ. 2023;33(1):44-63.
34. Zhang R, Dong Q. Effectiveness of Supportive Nursing Care Interventions to Reduce the Stress of the Mothers in the Neonatal Intensive Care Unit: A Systematic Review and Meta-Analysis. Adv Neonatal Care. 2026;26(2):166-76.
35. Chen S, Shen H, Jin Q, Zhou L, Feng L. Family-centered care in the neonatal intensive care unit: a meta-analysis and systematic review of outcomes for preterm infants. Transl Pediatr. 2025;14(1):14-24.
36. McDermott KA, Louis CC, Rochon EA, Grunberg VA. Which support matters when? Relational functioning and posttraumatic stress in NICU parents. J Reprod Infant Psychol. 2026:1-17.
37. Vega-Vega P, Miranda-Castillo C, Urrutia-Soto MT. Construct of self-efficacy in mothers of highly complex chronic children: A qualitative study. J Pediatr Nurs. 2025;85:639-45.
38. Heidary S, Heidari H, Choopani R, Sedehi M. The effect of the supportive care program based on Bandura's self-efficacy on stress and participation of the mothers of the neonates admitted to neonatal intensive care unit. J Educ Health Promot. 2023;12:265.
39. Bagheri M, Ramezani M, Vaghee S, Sadeghi T. The Effect of Applying Problem-solving Skills on Stress Coping Styles and Emotional Self-efficacy in Mothers of Preterm Neonates: A Randomized Clinical Trial. Int J Community Based Nurs Midwifery. 2024;12(4):254-66.
40. Białas A, Kamecka K, Rasmus P, Timler D, Kozłowski R, Lipert A. Anxiety, Coping, and Self-Efficacy as a Psychological Adjustment in Mothers Who Have Experienced a Preterm Birth. J Clin Med. 2025;14(12).
41. Konukbay D, Vural M, Yildiz D. Parental stress and nurse-parent support in the neonatal intensive care unit: a cross-sectional study. BMC Nurs. 2024;23(1):820.
42. Xu F, Shi LL, Gao L. Analysis of anxiety and depression status and related factors among mothers of children in neonatal intensive care unit. World J Psychiatry. 2025;15(3):101748.
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How to Cite
1.
Ahmed Ameen W, Abd Al-Kareem M, M. Obaid H, Fadhel Jassim A, M. Kadhim AL-Mamoori H, Sh Alzuheri A. Maternal Self-Efficacy, Social Support, and Adaptation to Motherhood in Mothers of Preterm Infants in Neonatal Intensive Care Units. Iran J Psychiatry. 2026;:1-9.
