Constance H. Keefer

Contributions of Cross-Cultural Psychology to Research and Interventions in Education and Health

Cross-cultural psychology has made important contributions to research and interventions in education and health. In education, cross-cultural research includes the application of Piagetian tests cross-culturally and the discovery of cultural variability in styles of learning. Research using the constructs of individualism and collectivism has shown that a variety of cultural values and parenting styles can be related to school success, and awareness of such differences has been used to enhance the effectiveness of educational intervention. In health, cross-cultural psychology has contributed to the identification of culture-specific patterns of illness and beliefs about illness. Research has shown complicated relationships between cultural expectations of behavior and cross-cultural variability in children’s observed behavior. The role of cultural beliefs and related practices is highlighted in research on temperament. Theoretical models derived from cross-cultural research are shown to be useful in creating a framework for systematic consideration of education and health in cultural context.

Perinatal circumstances and newborn outcome among the Gusii of Kenya: Assessment of risk*

Twenty-four Kenyan Gusii newborn infants and their mothers were studied in order to examine the interrelationships of newborn behavioral organization, and biomedical and biosocial factors as they are affected by culture. African mothers were found to be of high parity, had low third trimester weight gains, suffered anemia and parasitic infestation, and delivered under unmonitored stressful circumstances. Neonatal assessments of biomedical and behavioral factors were done two or more times during the first two weeks of life. The infants were large, vigorous, and showed little behavioral or physiologic signs of stress. They performed in every assessment within the normal range for American infants born under optimat conditions. Factors of birth weight, length, gestational age, and postpartum weight gain were positively related to behaviors demonstrating good organization in the control of the state of consciousness. Infants born of older mothers of high parity demonstrated poorer social interactive skills, particularly in the third exam period.

Child care and infectious respiratory disease during the first two years of life in a rural Kenyan community

Recent research in the U.S. has demonstrated the health risks accompanying the increase in use of day care centers for infants and young children, a trend that reflects large-scale social and economic changes. The present study reports increased risk of respiratory disease in rural Kenyan children, resulting from increased exposure to unrelated young children. The shift in risk patterns accompanies sociocultural and economic trends during the 1970s: maternal participation in work groups for cash cropping and increased school attendance by other family members. Thus as in the American case, participation in modern patterns of household economics significantly influences the pattern of illness for infants and young children.

Selective affective response to a parent in a 6-month-old infant.

CASE. At her 6-month health supervision visit, Julie is accompanied by both her mother and father. Their main concern is persistent colicky behavior with uncontrollable episodes of crying and night wakening every 2 to 3 hours. The pediatrician discussed persistent crying and various soothing techniques at each previous health supervision visit. Julies mother could not hold back tears as she described the babys behavior and her own sleep deprivation. The parents portrayed the crying as an off/on switch without variations in volume. They read a book on sleep problems in infants and followed the advice. For a week, they allowed Julie to cry when she awakened. She cried for 1 to 3 hours each time without being able to settle herself. When her mother breast-feeds, Julie settles and then sleeps for a few hours before awakening in a crying state. However, her mother is unable to return to sleep quickly. As the pediatrician explored the family and home environment, a new behavior, beginning about 1 month before the office visit, emerged. Both parents were concerned that when Julie looked at her mother, she became agitated and anxious. The pediatrician, somewhat doubtful, then saw Julie smiling while in her fathers arms. When she was turned toward her mother, Julies facial features became tense and she appeared anxious. This was followed by what the pediatrician described as fussy vocalizations ... as if she was stressed. Later in the office visit, the pediatrician deliberately repeated the same event and the baby had a similar response when turning to her mother. When she was transferred to her mothers arms, she did not console immediately but only after about 3 minutes. Julies mother expressed loving feelings for her child alternating with hating her and counting the days until she grows up. The father and maternal grandmother, who helps during the day with child care, are supportive but frustrated as the crying persists and the mothers sleep deteriorates. Along with Julies mother, they are concerned about what they perceive to be a negative relationship between Julie. and her mother. The parents are in their early thirties and this is their first child. The prenatal and perinatal history is normal. During the first 2 weeks of life, Julie was described as cuddly and easy to feed at breast. Frequent crying and night awakening began after the second week. Both parents work in sales in small retail stores. Julies mother was planning to return to work 3 months after the birth of the baby, but sleep deprivation altered her plan. The father attends a community college two nights each week. The parents state that they have a good marriage.

The Early Mother-Child Relationship: A Developmental View of Woman as Mother

The process of becoming a mother is a complex developmental sequence involving a search for a particular identity as a woman. Helene Deutsch gave us a framework for understanding this process. She pointed out its biological and psychological nature and the unique experience it provides, “in which a woman is given the opportunity of experiencing a real sense of immortality and of the victory of life over death.”1 The successful search means a movement from the diffusion of youth to the completeness and reality of adulthood. Interrelationships between the mother and her child, her mate, and her parents must undergo expansion and clarification. Success in this process is made possible by the fact that these relationships, particularly that with her child, will fuel the mother’s own growth.

Use of the Behavioral Observation of the Newborn Educational Trainer for Teaching Newborn Behavior

Nurses who work with families in the postnatal period teach parents about their newborns and facilitate emotional bonds between parents and infants. This article describes a newborn behavior training that incorporates the Behavioral Observation of the Newborn Educational Trainer (BONET), a learning aid that educates clinicians about newborn behavioral organization, self-regulation skills, and interactive capabilities. Nurses may apply this training to help parents understand and respond to newborn cues.

NEWBORN ASSESSMENTS IN AN AFRICAN POPULATION

This study describes the behavior of 24 healthy full-term newborn Gusii infants of Kenya, using the Brazelton Neonatal Assessment Scale. The Scale defines the infants motor and social behavior and state and physiological organization. This behavior was then correlated with biomedical assessments done during the antecedent pregnancies and during the newborn period. Findings included: a)the quality of the infants motor performance was unique in our experience in its synthesis of increased yet balanced tone with slow, smooth, large-arced movement; overshooting, startles or tremors were rarely sacn; b)state changes were slow and gradual leading to long periods of alertness; c)performances on all items were stable over the first ten days; this is in marked contrast to American samples which show a characteristic “recovery curve”; d)pre- and perinatal, biomedical and cultural factors placed these infants at high-risk for poor neonatal outcome; this made their organized and stable behavior all the more impressive. A comparison is made to an American sample of low risk infants. On all scale items, the Gusii infants performed at least as well as the American group, and scored significantly higher in three areas: motor maturity (p < .001), general tone (p < .001) and startles (p < .05). These findings will be discussed in three contexts: 1)the cultural variations in pregnancy risk factors, 2)the question of differences in motor development between black and white infants, and 3)the contribution of the infants behavior to his caregiver within a specific cultural milieu.

Selective Affective Response to a Parent in a 6-Month-Old Infant

CASE At her 6-month health-supervision visit, Julie is accompanied by both her mother and father. Their main concern is persistent “colicky” behavior with “uncontrollable” episodes of crying and night wakening every 2 to 3 hours. The pediatrician discussed persistent crying and various soothing techniques at each previous health-supervision visit. Julie’s mother could not hold back tears as she described the baby’s behavior and her own sleep deprivation. The parents portrayed the crying as “an off/on switch” without variations in volume. They read a book on sleep problems in infants and followed the advice. For a week, they allowed Julie to cry when she awakened. She cried for 1 to 3 hours each time without being able to settle herself. When her mother breastfeeds, Julie settles and then sleeps for a few hours before awakening in a crying state. However, her mother is unable to return to sleep quickly. As the pediatrician explored the family and home environment, a new behavior, beginning about 1 month before the office visit, emerged. Both parents were concerned that when Julie looked at her mother, she became agitated and anxious. The pediatrician, somewhat doubtful, then saw Julie smiling while in her father’s arms. When she was turned toward her mother, Julie’s facial features became tense and she appeared anxious. This was followed by what the pediatrician described as “fussy vocalizations . . . as if she was stressed.” Later in the office visit, the pediatrician deliberately repeated the same event, and the baby had a similar response when turning to her mother. When she was transferred to her mother’s arms, she did not console immediately but only after about 3 minutes. Julie’s mother expressed loving feelings for her child alternating with “hating her and counting the days until she grows up.” The father and maternal grandmother, who helps during the day with child care, are supportive but frustrated as the crying persists and the mother’s sleep deteriorates. Along with Julie’s mother, they are concerned about what they perceive to be a negative relationship between Julie and her mother. The parents are in their early thirties and this is their first child. The prenatal and perinatal history is normal. During the first 2 weeks of life, Julie was described as cuddly and easy to feed at breast. Frequent crying and night awakening began after the second week. Both parents work in sales in small retail stores. Julie’s mother was planning to return to work 3 months after the birth of the baby, but sleep deprivation altered her plan. The father attends a community college 2 nights each week. The parents state that they have a good marriage.

An innovative curriculum for primary care neonatology.

ABSTRACT. This article describes the design of an innovative curriculum for pediatric residency newborn nursery rotation. In 1989, the Accreditation Committee for Graduate Medical Education added the requirement of newborn care to pediatric residency training; in 1996, the Accreditation Committee for Graduate Medical Education expanded that requirement. Specifically, certification required 4 weeks of newborn care, separate from any neonatal intensive care experience, and with at least 2 weeks in a newborn nursery. In response, we designed a structured newborn nursery curriculum for our pediatric residency training program. Three areas of focus were identified, from which the content and the strategies for teaching were derived. The areas of focus were (1) primary care, (2) confluence of levels of care that arise in newborn care, and (3) limitations and advantages of the structure and the environment of the rotation. The curriculum was implemented on a pediatric level 1 (PL-1) rotation entitled “primary care neonatology.”

Child care and Culture: Infant care: Cultural norms and interpersonal environment

This chapter concerns how Gusii mothers define infant care – their shared assumptions about the tasks and standards involved – and examines the infants interpersonal environment over the first 30 months of life. Age trends in the infants social ecology are analyzed in relation to family characteristics and to developmental patterns measured by the Bayley Infant Scales. THE CULTURAL MODEL OF INFANT CARE Despite their socioeconomic and religious differences, our sample families in Morongo varied little in how they defined the maternal role and its primary responsibilities. Their model of infant care largely replicated that of the preceding generation, whose norms and practices were recorded in the 1950s. The practices of mothers had been affected by new scarcities as well as new resources. The new resources included blankets, which made it unnecessary to keep the cooking fire going all night, thus reducing the risks of burns; more clothing, keeping children warmer during the rainy season; bottles with nipples, making it unnecessary for child caregivers to force-feed babies from a calabash when the mother was absent; and the use of water from wells instead of streams. In other words, greater access to cash, imported consumer goods, and household improvements had brought a higher level of material welfare that reduced some of the risks to infants observable in the earlier study. Novel scarcities included firewood, still used for cooking but more difficult to obtain in densely inhabited settlements, and children to look after babies, now attending school during the years they formerly spent at home.