Adaptation to High-Risk Childbearing: Extension of a Preliminary Situation-Specific Theory with Focus on Psychological State and Functional Status*

Introduction: Little is known about expectant and new parents’ psychological experiences of high-risk childbearing. Objective: The paper is a report analyses of data from a Roy Adaptation Model-guided pilot study of women’s and their male partners’ adaptation to high-risk childbearing and thereby extends a preliminary situation-specific theory of adaptation to high-risk childbearing. Materials and methods: A previous paper was a comprehensive report of the results of the pilot study except for psychological state, measured by the Multiple Affect Adjective Checklist-Revised. The additional data analyses reported in this paper are for effect sizes of correlations between the Multiple Af-fect Adjective Checklist-Revised subscales and maternal and paternal functional status inventories. Results: Correlations of small ( r = 0.1), medium ( r = 0.3), and large ( r = 0.5) effect sizes were found for the measures of psychological state and functional status for both women and their male partners except for psychological state positive affect and maternal functional status during the postpartum, and psychological state anxiety and paternal functional status during the postpartum. Conclusions: Overall, no substantial differences were found in psychological state and functional status for women and their male partners during pregnancy and the postpartum. The findings of this secondary data analysis constitute an extension of the preliminary situation-specific theory reported in a previously published paper.

Adaptación a la maternidad de alto riesgo: ampliación de una teoría preliminar de situación específica con enfoque en la condición psicológica y el estado funcional* * Financiación: los análisis de datos y escritura de este artículo fueron apoyadas por el Ann Kibrick Research Award concedido a Jacqueline Fawcett por Theta Alpha Chapter of Sigma Theta Tau International.

Introduction
The purpose of this paper is to report an extension of a Roy Adaptation Model (RAM) (1)-guided preliminary situation-specific theory of correlates (physical and psychological symptoms, physical energy, relationship quality) of maternal and paternal functional status during high-risk childbearing (2). The content of this paper adds correlations between already collected data for psychological state and maternal and paternal functional status, as measured by maternal and paternal functional status inventories, to the theory.
The RAM depicts people as adaptive systems that adapt to focal and contextual environmental stimuli (1). Adaptation occurs in physiological, self-concept, role function, and interdependence adaptive modes, which are thought to be interrelated. This paper presents the results of data analyses for the relation between the self-concept mode, represented by the psychological state as measured by three Multiple Affect Adjective Checklist-Revised (MAACL-R) subscales (anxiety, depression, positive affect) (3), and the role function mode, represented by functional status during high-risk childbearing, as measured by maternal and paternal functional status inventories (4,5,6). The definitions for the relevant RAM concepts (self-concept mode, role function mode), the theory concepts (psychological state, functional status), and the empirical indicators used to measure the theoretical concepts are given in Table 1.

Materials and Methods
Psychological state was not included in data analysis for the preliminary theory (2)

Results
The results for correlational analyses of the measures of psychological state and maternal and paternal functional status are given in Table 2   Based on the analysis of MACCL-R subscale scores with scores for inventories of maternal and paternal functional status (see Table 2), the preliminary theory can now be extended to assert these propositions:

During pregnancy, for women:
z There is a negative relation of low magnitude (small effect size) between psychological state anxiety and maternal functional status; so, the lower the psychological state anxiety, the higher the maternal functional status.
z There is a negative relation of low magnitude (small effect size) between psychological state depression and maternal functional status; so, the lower the psychological state depression, the higher the maternal functional status.
z There is a positive relation approaching moderate magnitude (small to medium effect size) between psychological state positive affect and maternal functional status; so, the higher the psychological state positive affect, the higher the maternal functional status.

During pregnancy, for male partners:
z There is a positive relation of high magnitude (large effect size) between psychological state anxiety and paternal functional status; so, the higher the psychological state anxiety, the higher the paternal functional status.
z There is a positive relation of low magnitude (small effect size) between psychological state depression and paternal functional status; so, the higher the psychological state depression, the higher the paternal functional status.
z There is a negative relation of low magnitude (small effect size) between psychological state positive affect and paternal functional status; so, the lower the psychological state positive affect, the higher the paternal functional status.

During the postpartum, for women:
z There is a negative relation of low magnitude (small effect size) between psychological state anxiety and maternal functional status; so, the lower the psychological state anxiety, the higher the maternal functional status.
z There is a negative relation of moderate magnitude (medium effect size) between psychological state depression and maternal functional status; so, the lower the psychological state depression, the higher the maternal functional status.

During the postpartum, for male partners:
z There is a negative relation of low magnitude (small effect size) between psychological state depression and paternal functional status; so, the lower the psychological state depression, the higher the paternal functional status.
z There is a positive relation of low magnitude (small effect size) between psychological state positive affect and paternal functional status; so, the higher the psychological state positive affect, the higher the paternal functional status.
The data indicate that the effect sizes for the relations between psychological state positive affect and maternal functional status during the postpartum, and psychological state anxiety and paternal functional status during the postpartum were too low to consider (see Table 2).

Discussion
The direction of the relations between psychological state anxiety, depression, and positive affect and paternal functional status during pregnancy are inconsistent with expectations. Expected would have been negative relations between psychological state anxiety and depression and paternal functional status; so, the higher the anxiety and depression, the lower the functional status. Similarly, expected would have been a positive relation between psychological state positive affect and paternal functional status; so, the higher the positive affect, the higher the paternal functional status. The reason for these unexpected results is elusive. Inasmuch as effect size tends to be stable regardless of sample | AÑO 23 -VOL. 23 Nº 1 -CHÍA, COLOMBIA -ENERO-MARZO 2023 | e2318 size, it is unclear whether obtaining a larger sample of male partners from the same population would yield different results.
As seen in Table 2, there is no substantial difference in effect sizes for MAACL-R measured psychological state and functional status for women and their male partners during pregnancy and the postpartum. Overall, there is a significant effect size for the positive relation between the male partner's psychological state anxiety and paternal functional status during pregnancy. Perhaps feelings of anxiety motivate the male partner to perform a high level of activities that comprise paternal functional status. Furthermore, there is a medium effect size for the positive relation between the women's psychological state depression and maternal functional status during the postpartum, for if a woman feels depressed, she probably will decrease the level of her performance of activities that comprise maternal functional status.
A review of related literature revealed a few relevant journal articles for this study.
Regarding women, Maloni and colleagues (10)  Regarding male partners, Sevil and Özkan (16) found that the paternal functional status of 155 expectant and 93 fathers residing in Turkey was related to sociodemographic factors but did not study the relation between any measures of mood and paternal functional status. McVeigh, St. John, and Cameron (17) reported that of the 165 Australian fathers who participated in their study of the postpartum, most appeared to engage in a balancing act that required them to relinquish some personal activities to be an involved parent. They did not, however, report any correlates of paternal functional status in their descriptive study.
No studies of the relation between positive affect and maternal or paternal functional status during pregnancy or the postpartum were located.

Conclusion
The study findings support the utility of the Roy Adaptation Model (1) as a guide for research and indicate, as proposed in the model, that the modes of adaptation (self-concept mode and role function mode in this study) are interrelated. As the Fawcett and Tulman's (2) paper indicate, the theory is too preliminary to recommend application in nursing practice. More research with participants of diverse cultures is needed to determine whether the effect sizes are stable across diverse populations and which relations contribute to an empirically adequate situation-specific theory.

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