Perceived Maternal Parenting Self-Efficacy Questionnaire (PMP S-E)

1. Abstract

The Perceived Maternal Parenting Self-Efficacy Questionnaire (PMP S-E) is a specialized psychometric assessment instrument designed to measure a mother’s subjective belief in her capability to perform parenting tasks and manage the complex demands of caring for an infant, particularly within high-stress settings such as the neonatal intensive care unit (NICU). Originally developed and validated by Clare R. Barnes and Elvidina N. Adamson-Macedo (2007), the scale addresses a critical gap in maternal health research by operationalizing perceived self-efficacy specifically adapted to the vulnerabilities, physiological fragility, and communicative nuances of premature and hospitalized neonates.

The standard instrument consists of 20 declarative items capturing four theoretical sub-dimensions: Care Routines, Soothing/Calming, Reading Cues/Signaling, and Interaction/Affection. Each item is rated along a 4-point Likert response format spanning 1 (Strongly Disagree) to 4 (Strongly Agree), yielding a total composite score ranging from 20 to 80, where elevated values reflect robust maternal competence and confidence. Extensive psychometric evaluations demonstrate high internal consistency, with global Cronbach’s alpha coefficients commonly exceeding .90, and subscale coefficients ranging from .78 to .91 across diverse neonatal populations. Construct and criterion validity have been substantiated through factor-analytic confirmation and significant correlations with maternal anxiety, depression, attachment security, and post-discharge infant developmental trajectories.

2. Keywords

Perceived Maternal Parenting Self-Efficacy, PMP S-E, maternal self-efficacy, preterm neonates, neonatal intensive care unit, infant care, maternal mental health, parent-infant interaction, psychometrics, scale validation

3. Authors

The Perceived Maternal Parenting Self-Efficacy Questionnaire was conceptualized, operationalized, and psychometrically validated by:

• Clare R. Barnes, PhD — Department of Psychology, School of Social Sciences and Health, University of Wolverhampton, United Kingdom. Dr. Barnes specializes in neonatal psychology, perinatal maternal adjustment, and health psychology interventions.
• Elvidina N. Adamson-Macedo, PhD, CPsychol, CSci, AFBPsS — Professor of Neonatal and Neuroactive Psychology, Department of Psychology, University of Wolverhampton, United Kingdom. A pioneer in neuroactive psychology and touch deprivation in premature infants, Dr. Adamson-Macedo has extensively studied physiological vulnerability, parent-infant sensory bonding, and maternal psychological well-being.

4. Purpose

The transition to parenthood constitutes a major developmental crisis and psychological restructuring under typical physiological conditions. However, when an infant is born prematurely or faces congenital complications requiring hospitalization in a Neonatal Intensive Care Unit (NICU), the normative development of parental identity is severely interrupted. In such environments, mothers encounter an intimidating, highly medicalized atmosphere characterized by ambient alarms, mechanical ventilators, incubators, and intravenous lines. These external barriers severely impede physical contact, spontaneous holding, feeding, and instinctual soothing. Consequently, maternal self-doubt, acute stress disorder, post-traumatic distress, and severe depressive symptoms frequently emerge.

The PMP S-E was constructed to provide clinicians and researchers with an ecologically sensitive instrument capable of evaluating maternal beliefs regarding personal competence and agency in neonatal care. Traditional parenting self-efficacy inventories typically presume a healthy, full-term infant living in a domestic setting, featuring items concerning playground social encounters, standard sleep routines, and normative vocal interactions. Such inventories display poor content validity and face validity when administered to mothers whose infants reside inside incubators. The PMP S-E isolates specific, granular tasks that a mother can perform or learn—such as interpreting faint physiological cues, calming a distressed or overstimulated baby, participating in bathing and diaper changing under clinical supervision, and establishing an affectionate emotional bond.

Clinically, the PMP S-E serves as an essential screening instrument to identify mothers at risk for parenting failure, severe postnatal depression, and emotional disengagement. By identifying precise domains of low self-efficacy—whether in soothing or behavioral cue interpretation—multidisciplinary teams composed of neonatal nurses, clinical psychologists, and pediatric social workers can tailor psychoeducational and bedside coaching interventions. In clinical research, the instrument functions as a primary or secondary outcome measure evaluating family-centered care interventions, kangaroo care (skin-to-skin contact), infant behavioral education programs, and transition-to-home discharge planning frameworks.

5. Psychological Construct

The core construct evaluated by the PMP S-E is perceived maternal parenting self-efficacy, defined as a mother’s subjective, cognitive appraisal of her capacity to successfully organize, execute, and adapt parenting behaviors required to nurture, soothe, and protect her infant. Rather than representing an objective test of parenting skill, it reflects a cognitive belief system that directly dictates behavioral persistence, emotional resilience, stress vulnerability, and communicative responsiveness in maternal-child dyads.

The construct is operationalized into four interrelated yet distinct operational domains:

• Reading Cues and Signaling: This dimension assesses a mother’s perceived competence in detecting, interpreting, and responding to subtle neonatal communications, especially those indicating fatigue, sickness, satiety, or emotional distress. In premature neonates, behavioral signals are often muted or fragmented (e.g., subtle facial grimacing, autonomic signs like skin mottling, gaze aversion, or finger splaying). Items 1, 3, 4, 13, and 15 specifically reflect this domain (e.g., “I believe that I can tell when my baby is tired and needs to sleep”; “I can read my baby’s cues”).
• Soothing and Calming: Preterm and medically fragile infants frequently demonstrate hypersensitivity to environmental stimuli and poor neurobehavioral self-regulation. This dimension evaluates the mother’s confidence in her ability to mitigate negative emotional states, reduce physiological agitation, and console the infant through vocal soothing, swaddling, or gentle containment. Items 8, 9, 10, 11, and 12 measure this construct (e.g., “I am good at soothing my baby when he/she continually cries”; “I am good at soothing my baby when he/she becomes more restless”).
• Care Routines and Instrumental Tasks: This sub-dimension measures self-efficacy concerning practical, fundamental acts of physical caregiving. In hospitalized or fragile infants, routine handling (feeding, bathing, and changing) can provoke acute parental anxiety regarding accidental extubation, pain induction, or physical harm. Items 2, 17, 18, and 19 measure maternal agency and perceived execution skill (e.g., “I believe that I have control over my baby’s care”; “I am good at feeding my baby”; “I am good at bathing my baby”).
• Interaction, Affection, and Engagement: This dimension captures the emotional, relational, and reciprocal facets of the early mother-infant relationship. It quantifies the mother’s belief that she can elicit positive engagement, maintain mutual attention, provide authentic emotional warmth, and cultivate emotional bonding. Items 5, 6, 7, 14, 16, and 20 target this dynamic (e.g., “I can make my baby happy”; “I believe that my baby responds well to me”; “I can show affection to my baby”).

6. Theoretical Framework

The conceptual foundation of the PMP S-E is rooted firmly in Albert Bandura‘s Social Cognitive Theory (Bandura, 1977, 1997), specifically the construct of self-efficacy. Bandura distinguished between outcome expectations (the belief that a given behavior will produce a particular outcome) and efficacy expectations (the conviction that one can successfully execute the behavior required to produce the outcomes). According to self-efficacy theory, human agency operates through four primary sources of informational input:

1. Enactive Mastery Experiences: Successful execution of a behavior solidifies self-efficacy, whereas failures weaken it. In the NICU, mothers are routinely deprived of mastery experiences because professional staff perform the majority of caretaking. The PMP S-E captures the degree to which a mother internalizes successful interactions into an enduring sense of personal competence.
2. Vicarious Experiences: Observing healthcare providers competently stabilize and care for the infant can initially provide observational modeling, yet it can also exacerbate maternal feelings of inadequacy if the mother concludes she cannot match professional expertise.
3. Verbal Persuasion: Encouragement, guided feedback, and coaching from neonatal nurses and physicians reinforce maternal agency, signaling to the mother that she is the central figure in her infant’s development.
4. Physiological and Affective States: Maternal autonomic arousal, panic, and postpartum distress are often misattributed as indicators of personal incompetence. Mothers with high self-efficacy interpret somatic arousal as situational tension rather than personal inadequacy.

The framework also integrates principles from Transactional Developmental Theory (Sameroff & Chandler, 1975) and Neuroactive Psychology (Adamson-Macedo, 2004). Sameroff’s model posited that infant development is an iterative, dynamic product of bidirectional transactions between the parent and child over time. An infant whose neurological immaturity renders cues ambiguous or unresponsive may inadvertently dampen maternal self-efficacy. Diminished maternal self-efficacy, in turn, can prompt maternal withdrawal, intrusive handling, or maternal depression, thereby compounding the infant’s socioemotional dysregulation. The PMP S-E measures this critical psychological interface.

7. Validity

Empirical validation studies for the PMP S-E have reported robust psychometric properties across both Western and non-Western clinical and community cohorts.

Construct and Structural Validity

Barnes and Adamson-Macedo (2007) initially established construct validity through principal components and confirmatory analyses among mothers of hospitalized preterm neonates. The items aligned coherently with expected maternal parenting challenges in acute healthcare contexts. Cross-cultural adaptations—including the Iranian validation by Aliabadi et al. (2013) and subsequent adaptations across European, East Asian, and Latin American contexts—have confirmed that the underlying multidimensional structure captures the essential clinical components of maternal parenting self-efficacy.

Convergent and Discriminant Validity

The PMP S-E demonstrates significant convergent validity when correlated with theoretically aligned constructs:

• Maternal Anxiety: Total PMP S-E scores correlate inversely with maternal state and trait anxiety measured via the State-Trait Anxiety Inventory (STAI), typically displaying coefficients ranging from r = -.38 to r = -.54 (p < .001).
• Postpartum Depression: Moderate-to-strong negative correlations are consistently documented between the PMP S-E and the Edinburgh Postnatal Depression Scale (EPDS) (r values typically ranging between -.42 and -.60), indicating that as maternal parenting confidence increases, post-partum depressive symptom severity decreases.
• Parenting Stress: When evaluated alongside the Parenting Stress Index (PSI), the PMP S-E yields substantial negative correlations, particularly with the Parent Domain subscales (e.g., Competence, Role Restriction).
• Parent-Infant Attachment: Positive correlations emerge between the PMP S-E and measures of maternal-infant bonding, such as the Maternal Postnatal Attachment Scale (MPAS) (r = .45 to .62, p < .001).

Discriminant validity is supported by weak, non-significant correlations with unrelated parental personality traits, such as generalized openness to experience or social desirability indices, confirming that the scale captures context-specific caregiving self-efficacy rather than generalized self-esteem or positive response bias.

8. Reliability

The PMP S-E exhibits exceptional reliability across diverse empirical studies:

Internal Consistency

In the original validation study by Barnes and Adamson-Macedo (2007), the 20-item instrument demonstrated high overall internal consistency, with a global Cronbach’s alpha coefficient of α = .91. Across international validation studies, the composite scale has maintained alphas spanning .86 to .94:

• Care Routines Subscale: Alphas generally range between .77 and .85.
• Soothing/Calming Subscale: Alphas typically range between .81 and .89.
• Reading Cues/Signaling Subscale: Alphas typically range between .75 and .84.
• Interaction/Affection Subscale: Alphas typically range between .78 and .87.

Corrected item-total correlations across the 20 items consistently surpass the psychometric retention benchmark of .30, with the vast majority falling between .48 and .76.

Temporal Stability (Test-Retest Reliability)

Because self-efficacy is a dynamic construct sensitive to environmental mastering, intervention, and changing infant health statuses, short test-retest intervals are necessary to demonstrate stability without confounding developmental progression. Studies conducting assessments across a 1-to-2-week interval in stable neonatal cohorts report intra-class correlation coefficients (ICC) ranging between .79 and .88, confirming satisfactory temporal stability in non-interventional baseline phases.

9. Factor Analysis

The internal dimensionality of the PMP S-E has been examined using both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA).

Exploratory Factor Analysis

During scale construction, Barnes and Adamson-Macedo conducted principal component analyses with varimax and oblimin rotations. The Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy consistently exceeded .85, and Bartlett’s Test of Sphericity reached statistical significance (p < .001). Initial factor extraction yielded a four-factor solution that accounted for more than 55% to 65% of the total variance across validation cohorts:

• Factor 1: Soothing / Calming (Items 8, 9, 10, 11, 12) — Primary loadings ranged from .62 to .84, cleanly isolating maternal confidence in settling a distressed infant.
• Factor 2: Interaction and Affection (Items 5, 6, 7, 14, 16, 20) — Factor loadings ranged from .54 to .79, reflecting relational reciprocity.
• Factor 3: Reading Cues / Signaling (Items 1, 3, 4, 13, 15) — Factor loadings spanned .51 to .76, capturing cognitive appraisal of infant signals.
• Factor 4: Instrumental Care Routines (Items 2, 17, 18, 19) — Factor loadings ranged from .58 to .82, representing physical handling tasks.

Confirmatory Factor Analysis and Model Fit

Subsequent psychometric investigations evaluating the four-factor correlated model have demonstrated acceptable to good fit indices across structural equation modeling frameworks:

• Comparative Fit Index (CFI): .91 to .96
• Tucker-Lewis Index (TLI): .90 to .95
• Root Mean Square Error of Approximation (RMSEA): .048 to .068 (90% CI: .039 – .077)
• Standardized Root Mean Square Residual (SRMR): .051 to .065
• Chi-square/df ratio (χ²/df): Typically < 2.5

While the four-factor model remains conceptually and clinically dominant, several psychometric evaluations note strong inter-factor correlations (r = .50 to .75), confirming that a higher-order overarching general factor—Global Perceived Maternal Parenting Self-Efficacy—adequately accounts for the shared variance among the subscales.

10. Instrument / Measurement Tool

• Full Instrument Name: Perceived Maternal Parenting Self-Efficacy Questionnaire
• Acronym: PMP S-E
• Instrument Type: Self-report questionnaire / Psychological rating scale
• Construct Assessed: Maternal parenting self-efficacy in infant and neonatal care
• Target Population: Mothers of newborn infants, particularly mothers of premature, medically fragile, or hospitalized neonates
• Number of Items: 20 items
• Response Format: 4-point Likert scale: Strongly Agree, Agree, Disagree, Strongly Disagree
• Administration Modality: Paper-and-pencil, bedside clinical interview, or digital survey (tablet/online assessment)
• Completion Time: Approximately 5 to 10 minutes
• Scoring Methodology:
  • Direct item scoring: Typically assigned numeric values: Strongly Disagree = 1, Disagree = 2, Agree = 3, Strongly Agree = 4.
  • Subscale Scores: Derived by summing item ratings corresponding to the respective dimensions (Care Routines, Soothing/Calming, Reading Cues, and Interaction/Affection).
  • Total Score: Summation of all 20 items, producing a total score ranging from 20 to 80. Higher scores reflect greater perceived maternal parenting self-efficacy.

11. Permissions & Fee and Test Year

The Perceived Maternal Parenting Self-Efficacy Questionnaire was formally published in 2007 by Clare R. Barnes and Elvidina N. Adamson-Macedo. The instrument was developed under academic research auspices and was published in the peer-reviewed literature in the Journal of Advanced Nursing (Blackwell Publishing / John Wiley & Sons) and subsequent academic compendiums (e.g., Springer, 2013).

For independent academic research, non-commercial clinical evaluation, and educational use, the scale is generally accessible via its scholarly publications. Researchers and clinical practitioners intending to incorporate the instrument into institutional interventions, clinical trials, or digital diagnostic platforms should contact the corresponding authors or copyright holders to obtain formal permission and ensure use of the standard authorized version.

12. References

• Aliabadi, F., Borimnejad, L., Kamali, M., & Rassafiani, M. (2013). Perceived Maternal Parenting Self-Efficacy: Translation and face validation with Iranian mothers of hospitalized preterm neonates. Iranian Rehabilitation Journal, 11(Special Issue), 7–10. http://irj.uswr.ac.ir/article-1-374-fa.pdf
• Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191–215. https://doi.org/10.1037/0033-295X.84.2.191
• Bandura, A. (1997). Self-efficacy: The exercise of control. W. H. Freeman and Company.
• Barnes, C. R., & Adamson-Macedo, E. N. (2007). Perceived Maternal Parenting Self-Efficacy (PMP S-E) tool: Development and validation with mothers of hospitalized preterm neonates. Journal of Advanced Nursing, 60(5), 550–560. https://doi.org/10.1111/j.1365-2648.2007.04445.x
• Barnes, C. R., & Adamson-Macedo, E. N. (2013). Perceived Maternal Parenting Self-Efficacy. In C. A. Simmons & P. Lehmann (Eds.), Tools for strengths-based assessment and evaluation (pp. 436–438). Springer Publishing Company.
• Sameroff, A. J., & Chandler, M. J. (1975). Reproductive risk and the continuum of caretaking casualty. In F. D. Horowitz (Ed.), Review of child development research (Vol. 4, pp. 187–244). University of Chicago Press.

13. Items of the Scale