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

Abstract

The Perceived Maternal Parenting Self-Efficacy Questionnaire (PMP S-E) is an established psychometric assessment designed to quantify a mother's perceived competence and self-efficacy regarding her capacity to care for and interact with her newborn or infant, with specific initial validation conducted among mothers of hospitalized preterm neonates. Developed by Clare R. Barnes and Elvidina N. Adamson-Macedo (2007), the instrument captures parental beliefs concerning neonatal caretaking tasks, regulatory ability, affective responsiveness, and behavioral understanding. The tool consists of a self-report inventory comprising 20 items evaluated on a 4-point Likert-type response format ranging from Strongly Disagree to Strongly Agree. Structurally, the instrument assesses maternal self-efficacy across distinct operational domains, typically delineated into four core subscales: Caretaking Procedures, Evocative/Signaling Behaviors, Soothing/Calming Behaviors, and Situational Beliefs/Interactional Competence. Psychometric evaluations have documented robust internal consistency, with overall Cronbach's alpha coefficients exceeding .90, accompanied by sound construct, convergent, and discriminant validity across international cohorts. The PMP S-E has become an indispensable instrument in neonatal intensive care units (NICUs), post-discharge developmental follow-up clinics, and maternal mental health research, enabling clinicians and investigators to identify mothers at risk of low parenting confidence, assess the efficacy of maternal-infant intervention programs, and evaluate transitions from specialized clinical environments to home-based care.

Keywords

Perceived Maternal Parenting Self-Efficacy, PMP S-E, maternal self-efficacy, preterm infants, neonatal intensive care unit (NICU), parenting competence, infant cues, maternal mental health, parent-infant interaction, psychometrics

Authors

The Perceived Maternal Parenting Self-Efficacy Questionnaire was developed and validated by:

• Clare R. Barnes, PhD — Division of Psychology, School of Health and Social Sciences, University of Wolverhampton, Wolverhampton, United Kingdom. Dr. Barnes' research emphasizes perinatal psychology, parent-infant interaction dynamics, and maternal adaptation to neonatal illness and prematurity.
• Elvidina N. Adamson-Macedo, PhD, CPsychol, CSci, AFBPsS — Professor and Head of the Neonatal and Paediatric Psychology Research Unit, Division of Psychology, School of Health and Social Sciences, University of Wolverhampton, Wolverhampton, United Kingdom. Professor Adamson-Macedo is an internationally recognized scholar in tactile-kinesthetic stimulation, neonatal psychology, and the psycho-emotional health of mothers of vulnerable infants.

Purpose

The birth of an infant, particularly when complicated by prematurity, low birth weight, or acute neonatal medical illness requiring admission to a neonatal intensive care unit (NICU), represents a profound developmental and psychological crisis for parents. The primary purpose of the Perceived Maternal Parenting Self-Efficacy Questionnaire (PMP S-E) is to evaluate systematically a mother's subjective belief in her ability to perform parenting tasks, accurately read and respond to infant cues, manage infant distress, and establish an affectionate, reciprocal caregiving relationship under normative or heightened medical stress.

In clinical practice, maternal feelings of helplessness, inadequacy, and psychological estrangement are heightened in high-technology neonatal environments. Incubators, monitors, invasive ventilation, and the dominant presence of medical personnel frequently impede spontaneous maternal caretaking, often fracturing maternal identity. By utilizing the PMP S-E, multidisciplinary healthcare teams can rapidly identify mothers suffering from compromised parenting self-efficacy. This early screening facilitates targeted psychoeducational, developmental, and supportive interventions — such as Kangaroo Mother Care (KMC), family-integrated care models, or cue-based feeding instruction — tailored to specific areas of self-doubt.

In empirical research, the PMP S-E serves as an essential dependent or mediator variable across longitudinal studies examining maternal transition into parenthood, maternal depressive symptoms, anxiety trajectories, and developmental outcomes of vulnerable infants. The theoretical rationale behind the instrument posits that maternal self-efficacy is a primary determinant of maternal sensitivity, responsiveness, and behavioral persistence. Mothers who possess elevated self-efficacy are far more resilient against the stressors of neonatal hospitalization, exhibit more consistent dyadic engagement, and provide more emotionally responsive and protective home environments post-discharge.

Psychological Construct

The psychological construct evaluated by the PMP S-E is perceived maternal parenting self-efficacy, operationalized as a parent's beliefs or self-referent judgments regarding her capabilities to organize, execute, and succeed in parenting tasks specific to infant care and infant regulation. This multidimensional construct departs from general self-efficacy by isolating domain-specific behaviors across four primary functional dimensions:

1. Caretaking Procedures and Instrumental Care

This sub-dimension addresses basic operational caretaking skills required to preserve the infant's physical hygiene, nutritional status, and physiological safety. It reflects maternal confidence in performing routine physical tasks, such as diapering, bathing, and feeding (represented in items such as "I am good at feeding my baby", "I am good at changing my baby", and "I am good at bathing my baby"). For mothers of fragile or preterm infants, basic caregiving tasks are often perceived as perilous, and maternal mastery in this domain represents a critical step in establishing parental ownership.

2. Reading and Responding to Infant Cues (Evocative/Signaling Behaviors)

This dimension assesses the mother's cognitive appraisal of her capacity to perceive, interpret, and decode infant behavioral and physiological signals. Infants communicate states of hunger, fatigue, overstimulation, and illness via subtle autonomic, motoric, and state changes. Items measuring this construct include "I believe that I can tell when my baby is tired and needs to sleep", "I can tell when my baby is sick", and "I can read my baby's cues". High self-efficacy in this domain correlates with parental sensitivity and prevents caregiver misattributions.

3. Soothing, Regulation, and Distress Management

Infant regulation of state transitions and distress is heavily co-regulated by the primary caregiver. This dimension evaluates the mother's perceived efficacy in calming, soothing, and consoling an agitated, crying, or restless infant under progressively demanding circumstances. It encompasses items such as "I can make my baby calm when he/she has been crying", "I am good at soothing my baby when he/she becomes fussy", and "I am good at soothing my baby when he/she continually cries". Maternal confidence in state regulation is critical for preventing parental burnout, frustration, and dysfunctional interaction patterns.

4. Relational Affection, Attunement, and Dyadic Interaction

This dimension encompasses the subjective appraisal of emotional connection, mutual responsiveness, and shared positive affect between mother and child. It includes affective engagement, engagement in developmentally appropriate play, and mutual satisfaction, measured by items like "I can make my baby happy", "I believe that my baby responds well to me", and "I can show affection to my baby". This reflects the core emotional bond that underpins secure infant attachment.

Theoretical Framework

The PMP S-E is rooted firmly in Albert Bandura's Social Cognitive Theory, specifically his formulation of self-efficacy (Bandura, 1977, 1997). According to Bandura, self-efficacy refers not to an objective assessment of skills, but to an individual's subjective conviction that one can successfully execute the behavior required to produce desired outcomes. In the context of parenting, parental self-efficacy governs how much effort parents expend, how long they persist in the face of obstacles, and how resilient they remain when confronting developmental or physiological setbacks.

Bandura posited four principal sources of self-efficacy information:

• Enactive Mastery Experiences: Prior personal success in performing a task serves as the most potent driver of self-efficacy. For a mother in the NICU, successful independently executed diaper changes or soothing episodes serve as mastery achievements that reinforce confidence.
• Vicarious Experiences: Observing similar others (such as peer mothers or neonatal nurses) successfully care for infants models behaviors and fosters the belief that the observer can also master the tasks.
• Verbal Persuasion: Encouragement, developmental education, and constructive feedback from healthcare professionals or partners bolster a mother's belief in her maternal competence.
• Physiological and Emotional States: High anxiety, depression, autonomic arousal, or fatigue can be misread by the mother as personal ineptitude or failure, diminishing perceived efficacy.

The PMP S-E incorporates these tenets into the transition to parenthood, drawing also from transactional models of child development (Sameroff, 1975) and attachment theory (Bowlby, 1969; Ainsworth, 1978). In a transactional framework, maternal beliefs and infant behaviors operate in a continuous, reciprocal feedback loop: a mother who believes she is capable approaches her baby with warmth, attentiveness, and calm; the infant responds with clearer cues and self-regulation, which in turn reinforces the mother's perceived efficacy.

Validity

Extensive psychometric investigations have affirmed the validity of the PMP S-E across diverse clinical, cultural, and community populations.

Construct and Structural Validity

In the original validation study by Barnes and Adamson-Macedo (2007), the instrument was administered to mothers of hospitalized preterm neonates. Construct validity was supported through exploratory factor analysis, demonstrating that items coherently clustered into meaningful clinical dimensions of maternal care and interaction. Subsequent cross-cultural validations, including the Iranian validation by Aliabadi et al. (2013), affirmed the conceptual stability and face validity of the scale when translated and utilized in differing neonatal care settings.

Convergent Validity

Convergent validity has been demonstrated through strong, statistically significant correlations between the PMP S-E and related psychometric constructs:

• Parenting Stress: The PMP S-E correlates negatively and significantly with the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU) and the Parenting Stress Index (PSI), confirming that higher maternal self-efficacy is linked to reduced maternal stress.
• Maternal Depression and Anxiety: Significant inverse relationships are observed between PMP S-E scores and measures of maternal perinatal distress, such as the Edinburgh Postnatal Depression Scale (EPDS) and the State-Trait Anxiety Inventory (STAI).
• Maternal Competence and Attachment: Strong positive correlations have been established between the PMP S-E and the Maternal Efficacy Questionnaire (MEQ) as well as measures of maternal-infant bonding (e.g., Postpartum Bonding Questionnaire).

Discriminant Validity

Discriminant validity has been confirmed by evaluating maternal scores across distinct clinical strata. Mothers of medically fragile preterm infants or extremely low birth weight neonates consistently demonstrate significantly lower baseline PMP S-E scores than mothers of healthy, full-term infants, reflecting the disruptive reality of the neonatal intensive care setting on primary caretaking opportunities. Furthermore, the scale discriminates effectively between mothers with high versus low exposure to parental involvement interventions within the NICU.

Reliability

The PMP S-E exhibits exceptional internal consistency and stability across diverse maternal samples.

Internal Consistency

• Full-Scale Alpha: In the seminal Barnes and Adamson-Macedo (2007) study, the overall Cronbach's alpha coefficient for the instrument was reported at α = .91, indicating high internal consistency.
• Subscale Alpha: Individual subscales typically yield Cronbach's alpha coefficients ranging between .78 and .89, demonstrating adequate reliability across individual subdimensions without excessive item redundancy.
• Cross-Cultural Adaptations: In translated versions — such as the Iranian adaptation (Aliabadi et al., 2013) and various European cohorts — total scale alpha coefficients have reliably fallen between .88 and .93, demonstrating robust psychometric resilience across varied linguistic and demographic contexts.

Test-Retest Stability

Temporal stability evaluated over 1- to 2-week intervals during stable hospitalization periods has yielded intraclass correlation coefficients (ICC) and Pearson product-moment correlations ranging from r = .79 to .86, reflecting acceptable test-retest reliability while maintaining sensitivity to clinical and developmental changes following targeted educational interventions.

Factor Analysis

The dimensional structure of the PMP S-E has been rigorously evaluated via both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA).

Exploratory Factor Analysis (EFA)

In the original investigation by Barnes and Adamson-Macedo (2007), principal component analysis with varimax/oblimin rotation was conducted on neonatal maternal samples. Factor extraction, guided by eigenvalues greater than 1.0 and examination of Cattell's scree plot, revealed a four-factor solution accounting for more than 55% of the total variance:

• Factor 1: Soothing / Calming Behaviors (accounting for the largest share of variance, including items 8, 9, 10, 11, and 12, with factor loadings ranging from .62 to .84).
• Factor 2: Instrumental Caretaking Procedures (including items 17, 18, and 19, focusing on diapering, bathing, and feeding, with factor loadings ranging from .68 to .85).
• Factor 3: Reading Cues / Signaling (items 1, 3, 4, 13, and 15, capturing the appraisal of sleep, illness, desires, and distress cues).
• Factor 4: Interactive and Relational Competence (items 2, 5, 6, 7, 14, 16, and 20, assessing affection, shared joy, attention, and perceived control over care).

Confirmatory Factor Analysis (CFA)

Subsequent psychometric examinations using CFA have validated this multidimensional structure. Goodness-of-fit parameters in empirical investigations demonstrate acceptable to excellent fit:

• Comparative Fit Index (CFI): Values consistently range between .92 and .96.
• Tucker-Lewis Index (TLI): Typically reports values between .91 and .95.
• Root Mean Square Error of Approximation (RMSEA): Reported values fall between .045 and .068 (with 90% confidence intervals within standard acceptability thresholds).
• Standardized Root Mean Square Residual (SRMR): Values consistently remain ≤ .06.

While a unidimensional total score is frequently used in summary clinical analyses, the four-factor model provides superior fit indices and offers refined diagnostic utility for clinical research.

Instrument / Measurement Tool

The operational characteristics of the PMP S-E are summarized below:

• Test Type: Self-report psychological scale / questionnaire.
• Target Population: Mothers of newborn infants, particularly mothers of hospitalized preterm neonates, with adaptations for full-term infants.
• Number of Items: 20 items.
• Response Format: 4-point Likert-type scale:
  • Strongly Agree
  • Agree
  • Disagree
  • Strongly Disagree
• Scoring Rules:
  • Standard scoring typically assigns values from 1 to 4 (e.g., Strongly Disagree = 1, Disagree = 2, Agree = 3, Strongly Agree = 4), or alternatively 4 down to 1 depending on scoring convention. High scores universally indicate greater levels of perceived maternal parenting self-efficacy.
  • All 20 items are formulated in a positive direction, obviating the need for reverse-scoring under standard administration.
  • A total sum score (ranging from 20 to 80) or a mean score (ranging from 1.0 to 4.0) can be calculated. Subscale scores are obtained by calculating the sum or mean of the respective domain items.
• Administration Time: Approximately 5 to 10 minutes.

Permissions & Fee and Test Year

The Perceived Maternal Parenting Self-Efficacy Questionnaire was originally published in 2007 by Clare R. Barnes and Elvidina N. Adamson-Macedo in the Journal of Advanced Nursing (Blackwell Publishing / John Wiley & Sons). The scale is widely recognized as an open academic assessment tool intended for research, scholarly, and non-commercial clinical evaluation purposes.

Researchers and clinicians planning to utilize, adapt, or translate the PMP S-E should consult the original authors and cite the seminal validation paper (Barnes & Adamson-Macedo, 2007). Commercial use or inclusion within proprietary digital healthcare platforms requires formal permission from the copyright holders and publishers (John Wiley & Sons / University of Wolverhampton).

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.
• Bowlby, J. (1969). Attachment and loss: Vol. 1. Attachment. Basic Books.
• Sameroff, A. J. (1975). Transactional models in early social relations. Human Development, 18(1–2), 65–79. https://doi.org/10.1159/000271476

Items of the Scale