Reich IMHJ 2005-1
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INFANT MENTAL HEALTH JOURNAL, Vol. 26(2), 143156 (2005)
2005 Michigan Association for Infant Mental Health
Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/imhj.20038
A R T I C L E
WHAT DO MOTHERS KNOW? MATERNAL
KNOWLEDGE OF CHILD DEVELOPMENT
STEPHANIE REICH
Vanderbilt University
ABSTRACT: Maternal knowledge of child development has been shown to affect how mothers raise their
children and the environments they provide. This study examines maternal knowledge of child devel-
opment and whether level of knowledge varies by content area. Additionally, this study explored maternalcharacteristics that predict knowledge levels globally and by content area. Low-income women (N
203) in the waiting room of an obstetric clinic (n 97) and pediatric clinic (n 106) in a southern state
were asked to complete questionnaires on typical child development and demographic characteristics.
Overall, women correctly answered 65% of the criterion-referenced knowledge questions. Mothers lacked
the most knowledge about infant sleep patterns and developmental ability of 6-month-old infants. Ma-
ternal education, race, number of children, and assistance with childcare were significantly related to
maternal knowledge. Identifying gaps in maternal knowledge and characteristics that correspond to
knowledge deficits provides insight into how best to tailor educational interventions for mothers.
RESUMEN: Se ha demostrado que el conocimiento materno sobre el desarrollo del nino afecta la manera
como las madres cran a sus ninos y el ambiente que ellas les proveen a sus hijos. Este estudio examina
el conocimiento materno sobre el desarrollo del nino y si el nivel de ese conocimiento vara de acuerdo
a las distintas areas de contenido. Adicionalmente, se exploran las caractersticas maternales que predicen
los niveles de conocimiento, globalmente y segun area de contenido. Se les pidio a unas mujeres (N203)
de bajos recursos economicos, que estaban en la sala de espera de una clnica de obstetricia (n97) y
una clnica pediatrica (n106), en un estado del sur, que completaran cuestionarios sobre el t pico de-
sarrollo del nino y las caractersticas demograficas. En general, las mujeres respondieron correctamente
el 65% de aquellas preguntas de conocimiento que tienen criterio de referencia. Las madres no ten an
suficiente conocimiento de los patrones de dormir del infante ni de las habilidades de desarrollo de los
infantes a los seis meses de edad. La educacion materna, la raza, el numedo de hijos, as como la asistencia
con el cuidado infantil fueron significativamente relacionados con el conocimiento materno. Los vac os
que se identificaron en el conocimiento materno y las caractersticas que corresponden a los deficits deconocimiento nos dan una base sobre la cual podemos moldear mejor las intervenciones educativas para
las madres.
RESUME: Il a deja ete demontre que les connaissances maternelles du developpement de lenfant affectent
la maniere dont les meres elevent leurs enfants et lenvironnement quelles creent. Cette etude examine
les connaissances maternelles du developpement de lenfant et la facon dont le niveau de connaissances
varie suivant le contenu. De plus, cette etude a explore les caracteristiques maternelles qui predisent les
Direct correspondence to: Stephanie Reich, Department of Psychology and Human Development, Vanderbilt Univer-
sity, CEPI-1212 21st Avenue South, Nashville, TN 37203; e-mail: [email protected].
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144 S. Reich
niveaux de connaissance globalement et par domaine de contenu. On a demande a des meres issues de
milieux defavorises (N203) dans la salle dattente dune clinique obstetrique (n97) et dune clinique
pediatrique (n106) dans un etat du sud des Etats-Unis de remplir des questionnaires sur le developpe-
ment typique de lenfant et des caracteristiques demographiques. Dans lensemble, les femmes ont re-
pondu correctement a 65% des questions de connaissances sur des criteres de reference. Les meres ontfait etat de connaissances bien moindres sur les patterns de sommeil du nourrisson et les capacites
developpementales des bebes de 6 mois. Leducation maternelle, la race, le nombre denfants, et laide
a la garde des enfants etaient sensiblement lies aux connaissances maternelles. Lidentification des fosses
entre les connaissances maternelles et les caracteristiques qui correspondent aux deficits de connaissances
aide a comprendre comment adapter au mieux les interventions educationnelles pour les meres.
ZUSAMMENFASSUNG: Es konnte gezeigt werden, dass wenn Mutter Kenntnisse uber die kindliche Ent-
wicklung haben es ihre Art die Kinder zu erziehen ebenso beeinflusst, wie die Umgebung, die sie fur
das Kind herstellen. Diese Studie untersucht die mutterlichen Kenntnisse kindlicher Entwicklung und ob
das Ausma an Kenntnissen in unterschiedlichen Gebieten variiert. Zusatzlich untersuchte diese Studie
mutterliche Charakteristika, die das Ausma der Kenntnisse vorhersagbar machen im Uberblick und inden verschiedenen Gebieten. Mutter mit geringem Einkommen (n 203) im Warteraum einer Schwan-
gerenambulanz (n 97) und einer padiatrischen Ambulanz (n 106) in einem sudlichen Staat wurden
gebeten einen Fragebogen uber die typischen Entwicklung des Kindes gemeinsam mit demographischen
Details, auszufullen. Insgesamt wurden 65% der Teilbereiche der Kenntnissen zugeordneten Fragen rich-
tig beantwortet. Die Mutter wussten am wenigsten uber die Schlafmuster eines Kindes und den Entwick-
lungsstand eines sechsmonatigen Kindes. Die mutterliche Ausbildung, Rasse, Anzahl der Kinder und
Hilfestellungen durch Betreuung waren signifikant mit mutterlichen Kenntnissen korreliert. Wenn man
Mangel bei den mutterlichen Kenntnissen und Charakteristika identifiziert, die mit Mangeln in ihren
Kenntnissen korrelieren, so erlaubt das einen tiefen Einblick wie man am besten Fortbildungen fur Mutter
nach Ma anfertigt.
* * *
Research in child development suggests parents beliefs and knowledge strongly affect themanner in which they rear their child; however, little is known about the level of knowledge
parents possess about typical child development, and even less is known about the factors that
influence such levels of knowledge. This article describes the findings of a brief survey of low-
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Maternal Knowledge 145
income mothers knowledge and how individual demographic characteristics predicted such
knowledge.
Interventions designed to increase parental knowledge of typical child development and
effective parenting strategies have been associated with reduced parental stress, lowered childmaltreatment, and overall better child outcomes (Culp, Culp, Blankemeyer, & Passmark, 1998;
Honig & Wittmer, 1991). In an educational intervention targeted to young mothers (1120
years), Britner and Reppucci (1997) found that increases in parental knowledge of child de-
velopment and parenting practices significantly decreased reported child maltreatment 3 to 5
years later. In a study of extremely low birth weight infants, Dichtelmiller et al. (1992) found
that maternal knowledge accounted for 13 to 15% of the variance of Bayley scores at 8 months
of age, with infants of mothers with above-average knowledge scores performing 1 SD higher
than those of parents with average or less than average knowledge. A systematic review of
randomized controlled trials of parenting programs found that increases in maternal knowledge
and parenting ability were related to improvements in behavior problems in children (Barlow,1997) and reduced maternal anxiety and depression (Barlow & Coren, 2000). These results
suggest that more knowledgeable parents are more likely to create an environment appropriate
to a childs emerging abilities and promote childrens healthy development (Benasich &
Brooks-Gunn, 1996; Miller, 1988).
Conversely, parents with inappropriate expectations of typical child development often
overestimate the rate of development of their children. This overestimation contributes to im-
patience and intolerance of their childs behavior (Cowen, 2001; de Lissovay, 1973). In extreme
cases, inappropriate beliefs about child development have been associated with child maltreat-
ment (Peterson, Gable, Doyle, & Ewigman, 1997). Additionally, parenting behaviors and strat-
egies greatly affect infant attachment (Schmidt & Eldridge, 1986; Ward, Kessler, & Altman,1993), with harsh, inconsistent parenting behavior correlating highly with poor attachment and
child psychopathology (Carter, Garrity-Rokous, Chazan-Cohen, Little, & Briggs-Gowan, 2001;
Erickson, Sroufe, & Egeland, 1985; Greenberg, Speltz, & DeKlyen, 1993).
While parental knowledge has been shown to be important to child development, few
studies have assessed the degree of knowledge most parents have regarding typical child de-
velopment. The bulk of the research on parental knowledge thus far has focused on adolescent
rather than adult mothers.
ADOLESCENT MOTHERS KNOWLEDGE OF CHILD
DEVELOPMENT
Children born to adolescent parents have an increased risk of experiencing behavioral and
developmental problems (Barrat, 1991; Hubbs-Tait, Osofsky, Hann, & Culp, 1994). A 20-year
longitudinal study of children of adolescent parents found these children to be significantly
more likely to experience early school dropout, unemployment, violent offending, and early
parenthood (Jaffee, Caspi, Moffitt, Belsky, & Silva, 2001).
Studies that explore the level of adolescent mothers knowledge have focused predomi-
nately on low-income and minority women (Bavolek, 1989; Parks & Smeriglio, 1983; Stern
& Alvarez, 1992; Tamis-Lemonda, Shannon, & Spellman, 2002). These studies have identifiedincome, race, and education as strong predictors of maternal knowledge of child development;
however, little research has investigated what adult mothers know and what characteristics
influence their knowledge.
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ADULT MOTHERS KNOWLEDGE OF CHILD
DEVELOPMENT
Daniel Yankelovich and DYG, Inc. (2000) conducted a national survey of parents, elderly
adults, and childless adults to assess their knowledge of development of children 0 to 3 yearsold and policies that affect children (e.g., childcare, parental leave). Although the study asked
about elements of development, questions were limited to intellectual, emotional, and social
development. Of these topics, scores ranged from 60 to 77% correct. This study was large in
sample size (N 3,000), but contained a disproportionate number of affluent, White, married,
and well-educated respondents. Although a contribution to the field, this study does not provide
much information on knowledge of other developmental areas (e.g., safety practices, physical
development, nutrition, crying) or levels of knowledge in lower income, less educated, or non-
White populations.
Zepeda and Espinosa (1988) surveyed 139 Hispanic, Black, and White mothers of pre-
school children about their knowledge of developmental milestones from birth to age seven.These milestones centered on knowledge of self-help skills, motor skills, and language devel-
opment. The authors found mothers years of residency in the United States and years of
education completed were significantly associated with maternal knowledge about child de-
velopment. Unfortunately, this survey did not explore other areas of knowledge (e.g., nutrition,
cognitive development) or other maternal characteristics (e.g., number of children, income)
that might be related to knowledge.
PREDICTORS OF MATERNAL KNOWLEDGE
Few researchers have explored what adult parents know, and even fewer have investigatedwhat factors are related to parental knowledge. Studies to date suggest parental knowledge is
related to socioeconomic status (Tamis-Lemonda, Chen, & Bornstein, 1998), maternal edu-
cation (Richman, Miller, & LeVine, 1992), and culture (Bornstein et al., 1996). Little is known
about whether the level of knowledge parents possess is influenced by such things as parenting
experience (i.e., number of children), age, support with childcare, financial support through
public assistance, or living situations.
The goal of the current study is to (a) describe what low-income and ethnically diverse
mothers know about typical child development, (b) determine whether the level of knowledge
varies by content area (e.g., cognitive development, nutrition, safety), and (c) discover if in-
dividual characteristics of mothers (e.g., number of children, annual income, education) predictthe level of knowledge they possess.
METHOD
A total of 203 women were recruited from a pediatric (n 106) and an obstetric (n 97)
residency continuity clinic at a university hospital in the South. A researcher in street clothes
approached women in the waiting room of each clinic and invited them to complete a ques-
tionnaire. All data were collected anonymously, with no payment given to respondents. A
university institutional review board approved the procedures.
Participants
The women were 18 to 52 years of age (M 27.12, SD 7.77) and sought medical services
either for their child or themselves in regards to their pregnancy. Fifty-two percent were White,
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(i.e., lacking knowledge). A percentage correct was calculated from the number of correct
responses divided by the number of items completed. Missing items were not scored to avoid
falsely concluding a lack of knowledge of items that were unintentionally skipped. Therefore,
scores on the knowledge survey are conservative estimates.The second part of the measure contains three questions about developmental timing, one
question about responding to infant crying, and one question about warning signs of potential
health problems. For each question, respondents are presented five response options and asked
to check all that apply. The first three questions ask what a child is capable of at 3 months, 6
months, and 1 year of age. Response options to these three items described physical and
cognitive milestones (e.g., change an object from one hand to another, say first word).
The fourth question states, When babies cry the best things to do are: Response options
describe such things as checking the diaper and checking if anything is hurting the baby such
as clothing pinching their skin. The last question asks, Which of the following in a 6 month-
old baby can be a sign of a health problem? Response options describe such potential signs
as avoids eye contact and does not smile or make sounds. Each question in the second section
was scored as a percentage correct.
To ensure face validity and readability, cognitive interviews with target respondents were
conducted during the creation of the questionnaire. This process occurred 1 month prior to the
start of the survey study. Fifteen women (8 in an obstetric clinic and 7 in a pediatric clinic)
were asked to read the questionnaire and paraphrase each item. The respondents then were
asked to discuss what they thought the question addressed, if each item was readable, and what
cognitive processes they used to answer each question. All items were interpreted as intended,
and respondents described the measure as easy to understand.
Demographics. A demographic questionnaire also was created for this study. Items include
questions regarding age, ethnicity, education, income, number of children, living and childcare
arrangements, types of public assistance utilized, and for pregnant women, due date and deliv-
ery plans. See Table 1 for responses to the demographic questionnaire.
Analysis
Simple descriptive statistics provide information on the overall level of knowledge the mothers
possess. Comparisons of the relationship between individual characteristics to overall knowl-
edge and domain-specific knowledge were tested through linear regression methods. Although
the two groups (pediatric clinic and obstetric clinic) significantly differed on only two variables
(number of children and amount of public assistance received), a group variable was included
in all regression analyses to control for potential heterogeneity between clinic samples. The
inclusion of a number of children variable allowed comparisons of women who were preg-
nant with their first child to those with children. Finally, the race variable was dichotomized
into White/non-White since the number of minority groups other than African American was
insufficient for comparison. The following variables were included in each regression analysis
to determine which variables best predict knowledge.
Y 4raceo 1group 2age 3education 5income 6pub asst 7# of children
8live al one 9help w/c hil d
For each analysis, Y corresponded to the total score or a subscale score on knowledge of
each of the following: Cognitive and Physical Development, Safety, Discipline, Nutrition,
Establishing Routines, Sleep Patterns, Maternal Health after Birth, Responding to Crying,
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Maternal Knowledge 149
Warning Signs of Developmental Problems, and Developmental Ability at 3 Months, 6 Months,
and 1 Year of Age.
RESULTS
Both samples were comparable in their total level of knowledge, with a mean score of 65%
(SD 0.16). Table 2 shows the means and SDs for each subscale as well as the total score.
Subscale scores were equivalent between groups, except for knowledge about Discipline and
Developmental Ability at 1 Year of Age, in which the pediatric sample scored significantly
higher (p .05).
Several participant characteristics predicted scores on the total knowledge questionnaire
and subscales. Education was the most consistent predictor for the total score ( 0.001,
p 0.05) as well as scores on Safety ( 0.076, p 0.05), Nutrition ( 0.069, p 0.05),
and Establishing Routines ( 0.077, p 0.05). This relationship was positive, with higher
educational levels corresponding to higher scores on the knowledge survey. After controlling
for other factors, Whites scored higher than non-Whites on knowledge of effective discipline
strategies ( 0.137, p 0.05) and 3-month-olds ( 0.095, p 0.05) and 1-year-olds
( 0.057, p 0.05) developmental ability. Interestingly, women with more children scored
lower on the Establishing Routines subscale (0.041, p 0.05) while mothers with more
childcare help scored higher on the Cognitive and Physical Development subscale ( 0.03,
p 0.01). Table 3 provides parameter estimates for each of the respondent characteristics on
the models that were significant.
DISCUSSION
Although this was a convenience sample, the findings are consistent with previous research.
Overall, women answered 65% of the questions correctly. Mothers and mothers-to-be had high
levels of knowledge about establishing routines (86% correct) and promoting maternal health
after childbirth (82%); however, these same women lacked knowledge about how much sleep
infants need (26%) and what 6-month-old infants are capable of doing (53%). Incorrect answers
on the survey tended to err on the side of overestimating infant ability, with many women
endorsing abilities beyond babies developmental capability. For example, incorrect answers
tended to overestimate when babies could crawl, speak their first word, share with others, and
show anxiety around strangers. On average, women overestimated development by 3 months
or more. This is a disturbing finding, as research in child maltreatment suggests that abusiveparents tend to overestimate their childs abilities (Azar & Rohrbeck, 1986; Lowenthal, 1986;
Perry, Wells, & Doran, 1983).
Differences Between Clinics
The mothers surveyed in the pediatric clinic scored significantly higher than those in the ob-
stetric clinic on two subscales: Discipline and Developmental Ability at 1 Year of Age. A
possible explanation for these differences is that the pediatric clinic sample had more children
and therefore more parenting experience. As 51% of the obstetric clinic sample was pregnant
with their first child, these women may not have considered or researched child developmentbeyond 1 year of age (a time when discipline becomes more necessary). In a study of infor-
mation-seeking practices of women during pregnancy and postpartum, Deutsch, Ruble, Flem-
ing, Brooks-Gunn, and Stangor (1988) found that women sought more information about the
phase they were approaching soonest. For example, women entering their third trimester so-
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TABLE2.
MeanProportionCorrectforTotalK
nowledgeSurveyandEachSubscale
Group
Total
Score
M(SD)
Development
M(SD)
Safety
M(SD)
Discipline
M(SD)
Nutrition
M(SD)
Routine
M(SD)
Maternal
Health
M(SD)
Sleep
M(SD)
3-month
Developmen
t
M(SD)
6-month
Development
M(SD)
1-year
Development
M(SD)
Crying
M(SD)
Warning
Signs
M(SD)
TotalSample
(n
203)
0.6
5
(0.1
6)
0.6
1
(0.2
0)
0.6
9
(0.2
1)
0.6
8
(0.3
0)
0.6
3
(0.2
8)
0.8
6
(0.2
7)
0.8
2
(0.2
5)
0.2
6
(0.3
1)
0.7
0
(0.2
1)
0.5
3
(0.1
6)
0.7
4
(0.2
4)
0.7
4
(0.2
3)
0.7
5
(0.2
3)
Pediatric
Mothers
(n
106)
0.6
4
(0.1
6)
0.6
0
(0.2
1)
0.6
9
(0.2
2)
0.7
1
(0.3
4)
0.6
2
(0.2
7)
0.8
4
(0.3
0)
0.7
9
(0.2
6)
0.2
9
(0.3
1)
0.6
9
(0.2
0)
0.5
4
(0.1
6)
0.7
7
(0.2
2)
0.7
6
(0.2
2)
0.7
6
(0.2
2)
Pregnant
Women
(n
97)
0.6
6
(0.1
6)
0.6
3
(0.1
9)
0.6
6
(0.1
6)
0.6
4
(0.2
5)
0.6
4
(0.2
9)
0.8
8
(0.2
4)
0.8
6
(0.2
2)
0.2
4
(0.3
1)
0.7
0
(0.2
2)
0.5
2
(0.1
7)
0.7
2
(0.2
6)
0.7
1
(0.2
4)
0.7
4
(0.2
3)
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Maternal Knowledge 151
TABLE 3. Significant Parameter Estimates of Respondent Characteristics on Total Knowledge and
Subscales
Total
Score
(SD)
Development
(SD)
Safety
(SD)
Discipline
(SD)
Nutrition
(SD)
Routine
(SD)
3-month
Development
(SD)
1-year
Development
(SD)
Group 0.413
(0.09)
0.092
(0.06)
0.056
(0.06)
0.151*
(0.09)
0.008
(0.08)
0.108
(0.08)
0.012
(0.06)
0.030*
(0.05)
Age 0.027
(0.04)
0.004
(0.00)
0.004
(0.00)
0.005
(0.00)
0.001
(0.00)
0.000
(0.00)
0.000
(0.00)
0.000
(0.00)
Education 0.001*
(0.00)
0.047
(0.02)
0.076**
(0.02)
0.039
(0.03)
0.069*
(0.03)
0.077*
(0.03)
0.045
(0.02)
0.021
(0.02)
Race 0.049
(0.02)
0.028
(0.04)
0.084
(0.04)
0.137*
(0.06)
0.062
(0.06)
0.000
(0.05)
0.095*
(0.04)
0.057*
(0.03)
Income 0.057(0.03)
0.008(0.02)
0.007(0.01)
0.004(0.03)
0.014(0.03)
0.012(0.02)
0.020(0.01)
0.004(0.01)
Public
Assistance
0.001
(0.01)
0.052
(0.06)
0.033
(0.06)
0.157
(0.09)
0.003
(0.08)
0.002
(0.08)
0.101
(0.06)
0.004
(0.05)
Number of
Children
0.041
(0.05)
0.002
(0.01)
0.022
(0.01)
0.003
(0.02)
0.013
(0.02)
0.041*
(0.02)
0.001
(0.01)
0.031
(0.04)
Live Alone 0.005
(0.01)
0.065
(0.05)
0.018
(0.05)
0.041
(0.07)
0.002
(0.06)
0.059
(0.06)
0.068
(0.04)
0.009
(0.01)
Childcare
Help
0.019
(0.04)
0.030**
(0.01)
0.012
(0.01)
0.038
(0.01)
0.007
(0.01)
0.003
(0.01)
0.014
(0.01)
0.001
(0.01)
F value
R2
Adjusted R2
2.74**
0.2380.151
2.71**
0.2360.149
2.66**
0.2350.147
2.74**
0.240.152
2.45*
0.1490.046
2.47*
0.1450.046
2.17*
0.0150.036
2.17*
0.190.103
*p .05. **p .01.
licited information on labor and delivery while women 1-month postpartum researched par-
enting and child development more than related topics. Similarly, research on incoming fresh-
man, pregnant women, and doctoral students have found information-seeking practices to be
greatest prior to a transition or a new demand (e.g., Chan & Schmitt, 2000; La Ferle, 2000).
Predictors of Knowledge
As with previous surveys of parental knowledge, maternal education was highly predictive of
knowledge scores; however, this relationship did not hold for each of the subscales. A possible
explanation for the inconsistency of education as a predictor of knowledge could be that public-
service campaigns and public-assistance programs (e.g., WIC) focus on educating parents about
child safety and development. Thus, more women may know about this type of information
without having to read or seek out additional sources while higher educated women may
actively solicit information about development, leading to more knowledge in the less often
presented areas. Research has shown that higher educated mothers tend to seek information
more from formal sources such as print sources (e.g., books, magazines) and experts (e.g.,pediatricians, nurses) than less educated women (e.g., Vukelich & Kliman, 1985). In a study
of well-educated womens information-seeking practices during pregnancy and after birth,
physicians and books were found to be the most common sources of information (Deutsch et
al., 1988). Conversely, in a study of low-income mothers with, at most, a high-school education,
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152 S. Reich
advice from friends and family was the most common source of information (Keller & McDade,
2000). Additionally, research in internal medicine has found that physicians tend to provide
more factual information to university-educated patients (e.g., Stewart, 1984). Since pediatri-
cians are a common source of information on child development, it is possible that well-educated mothers discuss more with their childs provider.
Non-White racial groups scored lower than Whites on knowledge of child developmental
ability at ages 3 months and 1 year and on knowledge of discipline. A potential explanation
for a lack of knowledge of developmental ability may be due to fewer interactions with the
childs pediatrician and, therefore, less provision of anticipatory guidance. Research has shown
that non-White families tend to have less continuous care and poorer interpersonal relationships
with their provider (Stevens & Shi, 2002; Taira et al., 2001). For example, in a survey by
Cooper-Patrick and colleagues (1999) of over 1,800 adults about their interaction with their
physician, African American patients rated their relationship with their provider to be less
participatory than Caucasians. In the area of pediatrics, Stevens, Shi, and Cooper (2002) also
found poorer relationships with pediatricians reported by minority parents. Questions in the
Discipline subscale focused on the efficacy of spanking and the use of noncorporal punishment
strategies such as redirecting and reinforcing prosocial behavior. Research on the relationship
of race and corporal punishment suggests that racial minorities, especially African Americans,
tend to endorse corporal punishment techniques (e.g., Flynn, 1996, 1998). Since the knowledge
questionnaire was derived from pediatric guidelines that reject corporal punishment as an ef-
fective discipline strategy for children less than 18 months of age, mothers who endorse this
type of discipline would score lower on the subscale.
Women with more children scored lower on the Establishing Routines subscale, even when
controlling for other characteristics such as income, education, and race. Perhaps a home with
many children is not conducive to establishing routines such as naptime and dinnertime. It islikely that more children in the home creates more competing demands on womens time (Knox
& Wilson, 1978), making the establishment of routines difficult.
Mothers who receive more assistance with childcare scored higher on the Cognitive and
Physical Development subscale. There are several possible explanations for this finding. First,
additional caregivers may provide the opportunity for discussions with mothers about the
childs current developmental abilities as well as anticipated future abilities. This heightened
awareness could lead to increased knowledge of these topics. Another possible explanation is
that the people assisting with the care of the child also might play a role in teaching mothers
what is typical cognitive and physical child development. In the adolescent literature, childcare
assistance from family members has been shown to contribute to new mothers knowledge ofparenting (Schilmoeller & Baranowski, 1985). It also is feasible that additional caregivers
provide social support and additional free time in which mothers are able to seek out infor-
mation about their childs development. Research on adolescent parenting has found assistance
with childcare, especially from family, contributes to continued education for teen mothers
(e.g., Unger & Cooley, 1992). Unfortunately, this survey did not question if the adults assisting
with childcare were family members.
Age, income, public assistance, and number of people in the home did not predict total
knowledge scores or subscale scores. These four demographic variables may be measuring
similar constructs. For example, women with low incomes are more likely to receive public
assistance and live in more crowded households. Additionally, women who become mothersat a young age tend to have lower incomes. Although amount of assistance with childcare
predicted scores on the Cognitive and Physical Development subscale, the number of people
in the house did not. Possible explanations for this could be that those assisting with childcare
do not live in the house with the child or that adults in less crowded houses tend to help more.
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Maternal Knowledge 153
Household crowding could be an indicator of having many children in the home, resulting in
less free time to discuss or research child development, even when being assisted.
Limitations. This study surveyed low-income women at one medical center (two clinics) inone southern state. Although overall knowledge scores were comparable to other studies, the
relationship between knowledge scores and demographic information may not generalize to
populations with higher incomes or in other geographic areas. The participants in this study
were predominately Caucasian and African American (91%), and therefore findings may not
extend to other racial and ethnic groups. Finally, the method of calculating the knowledge score
as the percentage correct given the number answered was conservative. If a woman did not
know the answer to a question and chose to not answer that item, her score would not be
penalized for this lack of knowledge. Therefore, it is possible that the level of knowledge found
in this survey was somewhat inflated. Even with these limitations, this study adds information
to the underresearched area of adult mothers knowledge of child development.
Future directions. Research strongly supports that what parents know about child development
affects how they raise their children. This study sheds light onto the topics mothers know the
most and the least about as well as demographic characteristics that predict knowledge in each
area. What is needed now are ways to educate mothers about typical child development.
Publications such as Bright Futures Guidelines for Health Supervision (Green & Palfrey, 2002)
and provision of pediatric anticipatory guidance as recommended by the Academy of Pediatrics
(1997) aim at improving maternal knowledge; however, this study suggests that such methods
are not sufficient for ensuring high levels of knowledge. This could be due to mothers not
receiving the information or the information not being retained once it is presented. Identifi-
cation of knowledge gaps and characteristics that correspond to them is an essential step to-wards creating educational interventions that increase maternal knowledge. This awareness will
enable the tailoring of educational interventions to women with specific characteristics (e.g.,
teaching women with numerous children how to establish daily routines). Attention to which
topics mothers and mothers-to-be are most familiar with help those providing educational
interventions prioritize which content areas to emphasize.
Some preliminary research has identified promising ways to educate parents about typical
child development. For instance, parenting classes have proven effective in teaching parents
about typical child development. Research has shown benefits to home-based, hospital-based,
and group-based educational programs (e.g., Cowen, 2001; Parush & Hahn-Markowitz, 1997).
Reading materials also have proven effective in increasing maternal knowledge. For example,Showers (1989) use of behavioral management cards on such topics as toilet training, bed-
wetting, and temper tantrums has shown posttest knowledge gains at the 1-week and the 1-
month follow-up. The use of a childrens book embedded with information about typical de-
velopment by Reich, Bickman, and Worley (2004) also resulted in increases in mothers
knowledge.
In addition to designing novel ways to educate mothers about child development, research-
ers should collect demographic information to assess which strategies work best for whom and
if certain maternal characteristics mediate knowledge gain. Thus, greater insight into what low-
income mothers currently know about child development and which characteristics contribute
to their knowledge will enable future studies to determine whether some types of educationalinterventions (e.g., parenting classes, behavior cards) are more effective for some types of
mothers and/or particular educational topics. Since maternal knowledge affects how mothers
raise their children, increasing their knowledge about typical child development would be
beneficial.
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154 S. Reich
REFERENCES
American Academy of Pediatrics. (1997). Guidelines for Health Supervision III. Elk Grove Village, IL:
Author.
Azar, S.T., & Rohrbeck, C.A. (1986). Child abuse and unrealistic expectations: Further validation of the
parent opinion questionnaire. Journal of Consulting and Clinical Psychology, 54, 867868.
Barlow, J. (1997). Systematic review of the effectiveness of parent training programmes in improving
the behaviour of 3 7 year old children. Oxford, England: Health Services Research Unit.
Barlow, J., & Coren, E. (2000). Parenting programmes for improving maternal psychosocial health (Issue
3). Oxford, England: Cochrane Library.
Barrat, M. (1991). School-age offspring of adolescent mothers: Environment and outcomes. Family, 40,
442447.
Bavolek, S. (1989). Assessing and treating high-risk parenting attitudes. Early Child Development and
Care, 42, 99112.Benasich, A., & Brooks-Gunn, J. (1996). Maternal attitudes and knowledge of child rearing: Associations
with the family and child outcomes. Child Development, 67, 11861205.
Bornstein, M., Tamis-LeMonda, C., Pascual, L., Haynes, O.M., Painter, K., Galperin, C., & Pecheux, M.
(1996). Ideas about parenting in Argentina, France, and the United States. International Journal of
Behavioral Development, 19, 347367.
Britner, P., & Reppucci, N.D. (1997). Prevention of child maltreatment: Evaluation of a parent education
program for teen mothers. Journal of Child and Family Studies, 6, 165 175.
Carter, A., Garrity-Rokous, F., Chazan-Cohen, R., Little, C., & Briggs-Gowan, M. (2001). Maternal
depression and comorbidity: Predicting early parenting, attachment security, and toddler social-
emotional problems and competencies. Journal of the American Academy of Child and AdolescentPsychiatry, 40, 1826.
Chan, D., & Schmitt, N. (2000). Interindividual differences in intraindividual changes in proactivity
during organizational entry: A latent growth modeling approach to understanding newcomer adap-
tation. Journal of Applied Psychology, 85, 190 210.
Cooper-Patrick, L., Gallo, J., Gonzales, J., Vu, H., Powe, N., Nelson, C., & Ford, D. (1999). Race, gender,
and partnership in the patientphysician relationship. Journal of the American Medical Association,
282, 583589.
Cowen, P.S. (2001). Effectiveness of a parent education intervention for at-risk families. Journal of the
Society of Pediatric Nurses, 6, 7382.
Culp, A., Culp, R., Blankemeyer, M., & Passmark, L. (1998). Parent Education Home Visitation Program:Adolescent and nonadolescent mother comparison after six months of intervention. Infant Mental
Health Journal, 19, 111123.
de Lissovay, (1973). Childcare by adolescent parents. Children Today, 4, 2225.
Deutsch, F., Ruble, D., Fleming, A., Brooks-Gunn, J., & Stangor, C. (1988). Information-seeking and
maternal self-definition during the transition to motherhood. Journal of Personality and Social Psy-
chology, 55, 420431.
Dichtelmiller, M., Meisels, S., Plunkett, J., Bozynski, M., Claflin, C., & Mangelsdorf, S. (1992). The
relationship of parental knowledge to the development of extremely low birth weight infants. Journal
of Early Intervention, 16, 210 220.
Erickson, M., Sroufe, L., & Egeland, B. (1985). The relationship between quality of attachment andbehavior problems in preschool in a high-risk sample. Monographs of the Society for Research in
Child Development, 50(12), 147166.
Flynn, C. (1996). Normative support for corporal punishment: Attitudes, correlations, and implications.
Aggression and Violent Behavior, 1, 47 55.
-
8/3/2019 Reich IMHJ 2005-1
13/14
Maternal Knowledge 155
Flynn, C. (1998). To spank or not to spank: The effects of situation and age of child on support for
corporal punishment. Journal of Family Violence, 13, 21 37.
Green, M., & Palfrey, J. (2002). Bright Futures: Guidelines for Health Supervision of Infants, Children,
and Adolescents (2nd ed., Rev.). Arlington, VA, National Center for Education in Maternal and
Child Health.
Greenberg, M., Speltz, M., & DeKlyen, M. (1993). The role of attachment in the early development of
disruptive behavior problems. Development and Psychopathology, 5, 191213.
Honig, A., & Wittmer, D. (1991). Socialization and discipline for infants and young children. Early Child
Development and Care, 66, 6573.
Hubbs-Tait, L., Osofsky, J., Hann, D., & Culp, A. (1994). Predicting behavior problems and social
competence in children of adolescent mothers. Family Relations, 43, 439446.
Jaffee, S., Caspi, A., Moffitt, T., Belsky, J., & Silva, P. (2001). Why are children born to teen mothers
at risk for adverse outcomes in young adulthood? Results from a 20-year longitudinal study. De-
velopment and Psychopathology, 13, 377397.Keller, J., & McDade, K. (2000). Attitudes of low-income parents towards seeking help with parenting:
Implications for practice. Child Welfare, 79, 285312.
Knox, D., & Wilson, K. (1978). The differences between having one and two children. Family Coordi-
nator, 27, 2325.
La Ferle, C. (2000). Consumer role transitions: Understanding advertisings place in self-concept change,
information seeking, and consumption. Dissertation Abstracts International Section A: Humanities
and Social Sciences, 60, 2274.
Lowenthal, E. (1986). Changing expectations: A challenge for parents and professionals. Exceptional
Parents, 16, 4850.
Miller, S. (1988). Parents beliefs about childrens cognitive development. Child Development, 59, 259285.
Nunnally, J., & Bernstein, I. (1994). Psychometric theory. New York: McGraw-Hill.
Parks, P., & Smeriglio, V. (1983). Parenting knowledge among adolescent mothers. Journal of Adolescent
Health Care, 4, 163167.
Parush, S., & Hahn-Markowitz, J. (1997). The efficacy of an early prevention program facilitated by
occupational therapists: A follow-up study. American Journal of Occupational Therapy, 51, 247
251.
Perry, M.A., Wells, E.A., & Doran, L.D. (1983). Parent characteristics in abusing and nonabusing fam-
ilies. Journal of Clinical Child Psychology, 12, 329336.
Peterson, L., Gable, S., Doyle, C., & Ewigman, B. (1997). Beyond parenting skills: Battling barriers and
building bonds to prevent child abuse and neglect. Cognitive and Behavioral Practice, 4, 53 74.
Reich, S., Bickman, L., & Worley, K. (2004, June). Preventing child injury and promoting better child
outcomes through the use of childrens books. Poster presented at the Society for Prevention Re-
search Annual Conference. Quebec City, Canada.
Richman, A., Miller, P., & LeVine, R. (1992). Cultural and educational variations in maternal respon-
siveness. Developmental Psychology, 28, 614621.
Schilmoeller, G., & Baranowski, M. (1985). Childrearing of firstborns by adolescent and older mothers.
Adolescence, 20, 805 822.
Schmidt, E., & Eldridge, A. (1986). The attachment relationship and child maltreatment. Infant MentalHealth Journal, 7, 264273.
Showers, J. (1989). Behaviour management cards as a method of anticipatory guidance for parents. Child:
Care, Health, and Development, 15, 401 415.
Stern, M., & Alvarez, A. (1992). Knowledge of child development and caretaking attitudes: A comparison
-
8/3/2019 Reich IMHJ 2005-1
14/14
156 S. Reich
of pregnant, parenting, and nonpregnant adolescents. Family Relations: Interdisciplinary Journal of
Applied Family Studies, 41, 297 302.
Stevens, G., & Shi, L. (2002). Racial and ethnic disparities in the quality of primary care for children.
Journal of Family Practice, 51(6), 573 578.
Stevens, G., Shi, L., & Cooper, L. (2002). Patient-provider racial and ethnic concordance and parent
reports of the primary care experiences of children. Annals of Family Medicine, 1, 105112.
Stewart, M. (1984). Patient characteristics which are related to the doctorpatient interaction. Family
Practice, 1, 3036.
Taira, D., Safran, G., Seto, T., Rogers, W., Inui, J., Montgomery, J., & Tarlov, A. (2001). Do patient
assessments of primary care differ by patient ethnicity? Health Services Research, 36, 10591072.
Tamis-Lemonda, C., Chen, L., & Bornstein, M. (1998). Mothers knowledge about childrens play and
language development: Short-term stability and interrelations. Developmental Psychology, 34(1),
115124.
Tamis-Lemonda, C., Shannon, J., & Spellman, M. (2002). Low-income adolescent mothers knowledgeabout domains of child development. Infant Mental Health Journal, 23, 88 103.
Unger, D., & Cooley, M. (1992). Partner and grandmother contact in Black and White teen parentfamilies.
Journal of Adolescent Health, 13, 546552.
Vukelich, C., & Kliman, D. (1985). Mature and teenage mothers infant growth expectations and use of
child development information sources. Family Relations, 34, 189196.
Ward, M., Kessler, D., & Altman, S. (1993). Infantmother attachment in children with failure to thrive.
Infant Mental Health Journal, 14, 208 220.
Yankelovich, D., & DYG, Inc. (2000). What grown-ups know about child development: A national
benchmark survey. Washington, DC: Civitas Corporation, Zero to Three, and Brio Corporation.
Zepeda, M., & Espinosa, M. (1988). Parental knowledge of childrens behavioral capabilities: A studyof low income parents. Hispanic Journal of Behavioral Sciences, 10, 149 159.
