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CHAPTER 1

THE PROBLEM

This chapter covers the research problem. This includes the statements of

the problem, the purpose of the study, the scope and limitations of the study, and

the significance of the research.

Introduction

The majority of mothers experience the "baby blues" or emotional ups and

downs that many mothers experience in the first two weeks following childbirth.

The first two to three days after delivery are when baby blues typically start, and

they can linger for up to two weeks. However, this may lead to postpartum

depression, a more severe and pervasive type of depression that some new

mothers experience (Mayo Clinic, 2022). Between 6.5% and 20% of women

experience postpartum depression (Mughal, 2022) or the postpartum depression

rate for these women is 1 in 10 (Bruce, 2022). In the Philippines, postpartum

depression occurs in 19.8% of women who experience depression during

pregnancy and 15.6% of those who do so after giving birth. In extreme

circumstances, mothers run a significant risk of suicide or postpartum psychosis

(World Health Organization, 2015). The prevalence of postpartum depression is

substantially higher than the figures indicate. An estimated 50% of moms who

suffer from postpartum depression are not given a medical diagnosis (Carberg,

2023). The prevalence of the condition, according to medical professionals, may

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be at least twice as high as what has been documented and diagnosed. Postpartum

depression symptoms cannot be included in public health statistics if they are not

recognized and treated.

In underdeveloped nations, an estimated 21 million girls between ages of 15

and 19 get pregnant each year and give birth to 21 million babies. Pregnancy

among teenagers is more common among people with less education or lower

socioeconomic level (WHO, 2023). Compared to girls with higher levels of

education, girls with less education have a 5 times greater chance of becoming

mothers. Girls who are pregnant frequently leave school, which reduces their

chances of finding a job later on and keeps them in a cycle of poverty. Many times,

girls believe that getting pregnant is a better choice than continuing their studies

(Plan International, 2022). With that being said, education really plays a big role

when it comes to pregnancy and motherhood not just because it serves as a bridge

to land a stable job and be able to make a living, but also it provides a sense of

self-awareness among adolescents in terms of decision-making and adulthood.

Considering the fact that the precise cause of postpartum depression is yet

unknown, it is likely that a variety of variables are at play. Postpartum depression

can be influenced by a variety of factors, including shifting family roles, hormonal

changes, stress, marital conflict, and a family history of mental illness (UPMC,

2023). Other factors are emotional and physical changes in women after childbirth.

Social obligations including adhering to customary postpartum care

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practices, financial pressure from a low socioeconomic standing, and social and

sexual relationships with the partner or child's caretaker are other factors that may

contribute to general depression symptoms and stress (Redzuan et al., 2020). Lack

of awareness of depression's warning signs, symptoms, and available treatments

has been cited as a key obstacle to postpartum help-seeking emphasizing the

importance of women's depression literacy in the process of seeking care. Often,

even when treatment is available and offered, most women do not proactively seek

professional assistance for postpartum depression signs and symptoms (Mirsalimi

et al., 2020). Various factors are concerned when it comes to postpartum

depression and there is a certain factor that hinders women to seek professional

help when faced with depression signs and symptoms and that is lack of awareness

about postpartum depression which falls under postpartum depression literacy.

Given that maternal mental health is a vital aspect among mothers, conditions like

depression and anxiety under this aspect should be properly addressed.

Postpartum depression literacy may be viewed as a specific form of mental

health literacy, which is described as the information and attitudes regarding

mental health problems that support their early detection, treatment, and

prevention. The risk of mental health issues is higher during the perinatal period

(Daehn et al., 2022). The findings of Mirsalimi et al., (2020) study indicated that

women throughout the perinatal period lacked sufficient understanding regarding

postpartum depression, highlighting the need for

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research into and development of facilitators like postpartum depression literacy

that influence women's help- seeking behaviors. The aforementioned study just

proves that women during their vulnerability period, which is during and after

pregnancy, are at stake of postpartum depression which is due to lack of adequate

apprehension regarding postpartum depression. Despite the potential advantages

such research could bring for women and their healthcare providers, relatively

little research has addressed postpartum depression within a mental health literacy

framework Mirsalimi et al., (2020). Regarding women's depression literacy during

the perinatal period, there are still many significant concerns to be resolved. These

include how depression literacy is achieved, the involvement of sociodemographic

and clinical correlates, and the mechanisms by which depression literacy is

achieved. More research on this subject is crucial for women's health given the

dearth of literature on postpartum depression literacy.

There is relatively little known about the impact of non-cognitive features

on the health-promoting behaviors of women in reproductive age, despite the fact

that the study of cognitive traits on health-promoting behaviors has gained

prominence over the past few years. While cognition plays a critical role in

learning, making decisions, and processing information, experts believe that other

non-cognitive attributes are also important for achieving better life outcomes.

Non-cognitive qualities encompassed a wide range of characteristics, including the

Big Five personality traits as well as empathy, resilience, locus of control, and

self-esteem (Aikpitanyi et al., 2022). Aside from cognitive traits,

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non-cognitive traits like personality traits, resilience, or locus of control are also

crucial in terms of health-stimulating behaviors especially among reproductive

women.

Actions that promote health include any that help a person or group of

people be healthier and achieve their full potential. The importance of caring for

healthy behaviors and persons' lifestyle depends on its impact on their quality of

life (Pourhoseinzadeh et al., 2017). A person's perception of the factors that

influence their health and its results is known as their health locus of control, or

HLC. The majority of HLC research has concentrated on internal control (i.e.,

personal behaviors), chance control (i.e., fate/luck), and control by influential

others (i.e., health professionals and other people). Individuals that have a strong

IHLC think that their actions determine how well they are doing. They are more

inclined to research health-threatening problems and adopt healthier habits like

disease prevention to keep themselves healthy. An external HLC (EHLC), on the

other hand, is characterized by the conviction that one's health is affected by

supernatural forces, strong people, or fate. Major depression is predicted to

overtake all other diseases as the world's biggest burden of illness by the year

2020. Although the perinatal period is seen as a special time, many women

commonly struggle with adjustment issues and depressive symptoms both during

pregnancy and after giving birth. Despite the uncertain association between HLC

and PPD, HLC has a considerable impact on prenatal depression prediction

(Moshki et al., 2015). According to Abdel -Ati et. al (2022), there is a positive
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correlation between health locus of control and risk factors for maternal mental

health, specifically postpartum depression. An individual’s perception about their

health is at paramount level because how you view certain aspects of life like

decision- making is heavily influenced by how you take things into account.

Health locus of control is just one of the factors that can affect your health, most

especially mental health.

The current study intends to fill in the gaps on the paucity of evidence

relating health locus of control to the level of postpartum depression literacy to

mothers in Batangas City. By analyzing the contributing elements that result in the

certain level of postpartum depression literacy among mothers, this study also

intends to add to the body of knowledge on the subject. The most common factors

impacting health locus of control and postpartum depression literacy will also be

grouped according to the respondents' demographic profiles and correlated with

the learning domains to see if there is a significant difference or relationship.

Finally, this study intends to offer recommendations based on the findings that

will benefit the respondents and have a long-term effect.

Statement of the Problem

This research aims to know the relationship between Level of Postpartum

Depression Literacy and Health Locus of Control to the Maternal Mental Health

of first-time moms in Batangas Province. Specifically, it will seek answers to the

following questions:
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1. What is the demographic profile of the respondents?

1.1 Age

1,2 Educational Attainment

1.3 Monthly Family Income

1.4 Civil Status

1.5 Number of children

1.6 Type of Community

2. How may the postpartum depression literacy of the respondents be

described in terms of:

2.1 Ability to recognize postpartum depression

2.2 Knowledge of risk factors and causes

2.3 Knowledge and beliefs of self-care activities

2.4 Knowledge about professional help available

2.5 Beliefs about professional help available

2.6 Attitudes which facilitate recognition of postpartum depression and

appropriate help seeking

2.7 Knowledge of how to seek information related to postpartum

depression.

3. How may the health locus of control of the respondents be described in

terms of:

3.1 Internal
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3.2 Chance

3.3 Powerful Others

4. Is there significant differences in the respondents level postpartum

depression literacy and health locus of control of the respondents when

grouped according to their demographic profile?

5. Is there a significant difference between health locus of control and

postpartum depression literacy?

6. What course of action may be proposed in light of the findings?

Scope, Delimitation, and Limitation of the Study

The scope of this study will focus on describing the Level of Postpartum

Depression Literacy and Health Locus of Control among the respondents.

Accordingly, the researchers are primarily concerned with determining the

relationship between level postpartum depression literacy and health locus of

control on various fronts. A descriptive correlational research design will be

utilized to investigate the relationship of level postpartum depression literacy and

health locus of control. To assess the levels of the aforementioned variables, two

standardized questionnaires namely The postpartum depression literacy

scale (PoDLiS) and Multidimensional Health Locus of Control (MHLC) Scales

will be used as the main data gathering instrument by the researchers to identify

and measure the existence and strength of a relationship between variables.

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Respondents will be chosen using non-probability sampling, specifically

convenience purposive sampling based on needs analysis.

In addition, the respondents that will engage in this study is limited among

mothers who have given birth once, twice or thrice; aged 18 to 49 years old and

without any psychiatric contact. In order to ensure that the respondents are not in a

vulnerable period of their lives. Moreover, the locale of the study shall be limited

to the residence of Batangas City and will go through several months-long

processes beginning in February 2023 until completion.

There are three delimitations in this study. First off, the results of The

Postpartum Depression Literacy Scale (PoDLiS) are described as the respondents'

knowledge of postpartum depression only rather than indicating that they have the

said mental condition and for that reason the research is not conducted at a clinical

level. The result of the Multidimensional Health Locus of Control (MHLC) Scales

indicates specifically what kind of locus of control the respondents has, focusing

in terms of their health. Second, the respondents' feelings and experiences will be

based on their previous pregnancy to serve as the foundation for their level of

postpartum depression literacy and locus of control over their health. Since the

focus of the study is on the literacy and locus of control during the postpartum

period. Lastly, the researcher set parameters for selecting participants for the

study, such as having given birth once, twice, or three times; without any

psychiatric contact; residence within Batangas City; and

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being between the ages of 18 and 49. This study excludes anything that was not

specifically stated.

Hypothesis of the Study

Significance of the Study

This study focuses on the health locus of control and postpartum

depression literacy of mothers in Batangas City. The results of this study could be

highly remarkable and beneficial specifically to the following:

To the Mothers, the direct beneficiary of this study are the first- time

moms. The findings of this study will help them know about the importance of

postpartum depression literacy to their mental health. Moreover, this study will

provide knowledge about how health locus of control is associated and what role it

plays to their mental health. Lastly, it will benefit them by providing knowledge

about certain factors that can possibly put them at risk of postpartum depression.

To the BS Psychology program, as a fundamental sector for promoting

and advocating for mental health, the outcome of the study will be beneficial to

this program. In view of the fact that human mind and behavior is anchored to

psychology, the result of this study shall contribute to the area of study that

concerns conditions like postpartum depression and how various factors like

health locus of control and postpartum depression literacy can be a factor in the

said condition. Furthermore, the findings of this study can also be used for
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clinical purposes and be helpful in the field of clinical psychology and health

psychology, since these fields tackle conditions like postpartum depression.

To Clinical Psychology, as a subspecialty of psychology that offers

ongoing, all-encompassing mental and behavioral health care to individuals, pairs,

families, and groups. The results of the study could be applied to the creation of

psychological exams for the diagnosis of postpartum depression and the creation

of treatment strategies.

To the Health Psychology, as a promoter of wellbeing and healthy

behaviors, especially at population level. The study's findings will be useful to this

program. Given that this area focuses on understanding the psychological and

emotional aspects of health and illness such as postpartum depression and how

various factors such as health locus of control and postpartum depression literacy

can play a role in the condition.

To Batangas State University, the university will benefit from the

findings of this study in regards to research and development. The study might be

used as a framework for the development of research both inside and outside of

the university.

To BatStateU Students, the ideas in this study can pave a way for a better

understanding of students about how various factors like health locus of control be

a contributing factor in the literacy about postpartum depression mothers in

Batangas City. Also, they are of the right age to have a grasp about
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certain aspects of maternal life. Lastly, this paper will serve as a guide and

reference for students undertaking similar studies.

To the Philippine Mental Health Association, the outcome of this study

will provide an understanding about how the level of postpartum depression

literacy among mothers and their health locus of control can possibly affect

mothers in Batangas City. Through this, the aforementioned institution can use

this as a basis for the development of more psychological interventions that will

further promote mental health for mothers.

To the Academe, this study will be of great benefit to the society with

regards to being allies with the school allowing capable and knowledgeable people

who will drive community development in the aspect of postpartum depression

literacy. In lieu of this, the community and the school will work hand- in-hand to

promote education and how it plays a role in the mental health of mothers.

To the Future Researchers, the study aims to serve as a source for future

reference in line with the researches about health locus of control and postpartum

depression literacy. Also, this study will serve as a benchmark for future

researchers who intend to conduct studies related to the topic, providing

background information or an overview of the issue that they might run into when

researching about the topic.

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CHAPTER 2

REVIEW OF LITERATURE

This chapter presents the conceptual and research literature on postpartum

depression literacy, health locus of control and maternal mental health. Further, this

also includes the synthesis, theoretical and conceptual framework, the hypothesis of

the study, and the definition of terms.

Conceptual Literature

A detailed description of the main ideas employed in this study is provided

in this section. This research aims to explain the fundamental concepts, ideas, and

contemporary trends that shape the discourse on Postpartum Depression Literacy

and Health Locus of Control through a careful examination and synthesis of books

and journals that have been published.

Postpartum Depression Literacy. Pregnancy is often seen as a time of pure

happiness, excitement, and emotional well-being. The idea that pregnancy protects

mental health is untrue. As a result, many people who experience mental illness

during pregnancy are hesitant to talk to their healthcare providers about their

condition. This is harmful not only to the mothers health, but also to the health of

their infants. Postpartum depression (PPD) is a complex combination of

behavioral, emotional, and physical changes that affects some women. It is

classified as a type of major depression that begins within four weeks of giving

birth, according to the DSM-5, a manual used to identify mental disorders. If the
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episode begins within 4 weeks of childbirth, the postpartum onset specifier can be

applied to the current or most recent major depressive, manic, or mixed episode of

major depressive disorder, bipolar I disorder, bipolar II disorder, or brief psychotic

disorder. Within each of these disorders, the severity of typical cases varies

significantly. However, it is unclear whether these disorders are three distinct

entities or if they all fall under the umbrella of postpartum mood disorders, in

which symptoms range from little or no disturbance to severe disturbance. Thus,

postpartum depression is diagnosed based on the severity of the depression as well

as the amount of time between delivery and onset.

The postpartum period is arbitrarily divided into three stages: acute phase,

which is the first 24 hours following placenta delivery, the early phase, which lasts

up to 7 days, and the late phase, which lasts up to 6 weeks to 6 months (Gaurav

and Tadi, 2020). Each phase has its own set of clinical considerations and

difficulties. During this time, mothers and newborns are living a critical period in

their lives. Reports have been made of excessive or protracted postpartum

bleeding, breastfeeding difficulties, urinary incontinence, depression, post-

traumatic stress disorder, anxiety, fatigue, and sleep disorders. Even though there

are significant changes and complications that put mothers' and newborns' lives in

danger, there is a lack of appropriate care, which leads to maternal morbidity and

mortality. According to the World Health Organization (2015), early half of

maternal deaths occur within the first 24 hours and 66% within the first week of

giving birth
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Many authors refer to postpartum depression as postpartum "blues." Kripa

Balaram and Raman Marwaha (2023) defined postpartum "blues" as low mood

and mild depressive symptoms that are transient and self-limited and very

prevalent in the perinatal period. Depressive symptoms include sadness, crying,

exhaustion, irritability, anxiety, decreased sleep, impaired concentration, and a

labile mood. These symptoms typically appear two to three days after giving birth,

peak over the next few days, and then fade on their own two weeks later. Which

makes it different from postpartum depression itself, according to Henry Ford

Health Staff (2019), the timeframe in which symptoms appear is frequently the

distinguishing factor of postpartum depression and postpartum blues because

blues fade after a few weeks whereas PPD can last a year or longer. Moreover,

hormonal changes may be the cause of postpartum depression symptoms. During

pregnancy, progesterone and estrogen levels are at their peak. In the first 24 hours

after giving birth, hormone levels quickly return to pre-pregnancy levels.

Researchers believe that this abrupt change in hormone levels may result in

depression. This is similar to the hormonal changes before a woman's period,

despite the fact that the hormone swings are much more extreme during

pregnancy. Even though new mothers frequently experience these emotions, they

are not typical or expected when becoming a parent for the first time.

Postpartum depression has always been stigmatized, according to

Catherine Pearson (2014) in a recent BabyCenter survey of more than 1,400

mothers and pregnant women, 21% of the mothers said they had received a
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diagnosis of postpartum depression or thought they might have it. However, due

to the stigma associated with postpartum depression, 40% of those women chose

not to seek any medical attention. A mother verbatim stated that "the last thing a

new mother wants to do is come out and say, "I'm crying. I'm anxious. I think I'm

failing."

In addition, postpartum depression is a serious disease that can last a year

after childbirth. It can impair a mother's ability to care for and bond with her baby,

as well as jeopardize the child's development and safety. If a woman is pregnant,

her literacy when it comes to postpartum depression is an important factor and it

can be measured by her profile to see their knowledge towards it. A woman's

profile, is an evaluation of all the factors that may affect her from developing

postpartum depression, such as the young age of the mother, strained marriages,

educational attainment, the birth of a child who is not of the preferred sex, the

number of children and an increase in environmental stressors like type of

community, war, natural disasters, violence, migration, and a high HIV/AIDS

prevalence. Accordingly, when determining a profile; psychological factors,

biological factors, social factors, and lifestyles are taken into account. When

different factors combine, it can be difficult for women to cope.

Consequently, poor depression literacy, according to Fonseca (2017), was

associated with lower levels of education and income, whereas higher levels of

depression literacy were associated with a history of psychiatric issues or

treatments. Similarly, there is a direct correlation between poverty and maternal

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depression, it is crucial to remember that mothers from all socioeconomic groups

and family types experience depression. As stated by Ibrahim et al. (2020),

poverty is associated with a higher incidence of mental illness making lower

socioeconomic status connected with a lower educational level, which is also

associated with lower levels of mental health literacy. Thus, an individual with

low depression literacy has higher levels of emotional haziness, which has a

negative impact on symptom awareness and recognition. This is an unintended

consequence of emotional competence on the relationship between depression

literacy and symptom awareness/recognition. In light of the fact that a sizable

portion of women displaying clinically significant psychopathological symptoms

did not acknowledge the presence of an emotional problem, it is crucial to

comprehend the mechanisms and factors influencing women's awareness of their

emotional problems, such as the role of depression literacy.

Moreover, another factor that may affect a mother’s literacy towards

postpartum depression is the support they receive from the social environment, it

causes a positive pregnancy and postpartum period, which results in adaptation to

motherhood more quickly, and experience the postpartum period more smoothly.

According to Qi et al (2022), interpersonal relationships in families play an

important role for postpartum women. A lack of support from one's partner has

been identified as a significant risk factor for mental illness. For instance, pregnant

women who were more satisfied with their marriage had a significantly lower risk

of developing maternal mental health issues. While,

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having lack of social support, mismatch between spouses, and stressful living

conditions are among the major causes of postpartum psychiatric disorders. They

are more likely to suffer from stress, anxiety, and depression, which can lead to

health problems for both the mother and child.

Among the lifestyle factors that may affect postpartum period are food

intake patterns, sleep status, exercise, and physical activities. Where a woman’s

knowledge when it comes to this factor would greatly affect an individual's daily

lifestyle. It was discovered that eating enough vegetables, fruits, legumes, seafood,

milk and dairy products, olive oil, and a variety of nutritious foods can help reduce

postpartum depression. However, poverty is a major factor together with mental

illness before achieving the ideal lifestyle. It interacts in a negative cycle in which

people are more likely to develop mental disorders, and people living with mental

disorders are more likely to fall into poverty. According to The Borjen Project

(2022), maternal depression in developing countries concluded that women in

low-income settings are two to three times more likely than women in high-

income settings to suffer from mental health issues. Due to increased exposure to

stressful life events, such as job loss, ongoing difficulties, subpar housing,

dangerous neighborhoods, and partner disputes, poverty increases the stress on

mothers and leads to the most common mental health threat, crippling depressive

symptoms. In general, extended family members play a crucial role in providing

support, frequently helping with daily chores and

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baby care during the postpartum period to give mothers the time they need to

themselves.

Furthermore, infants can also be impacted by the environment and the

quality of their care because they are highly sensitive to these factors, and they are

also likely to be impacted by mothers who suffer from mental illnesses, according

to the World Health Organization. Infants whose mothers are depressed and

unable to give their offspring the strong maternal support they need to overcome

the challenges of poverty or other factors. Infants are mostly at risk for delayed

language, social, and emotional development. But Lähdepuro et al. (2022) pointed

out that not every child is affected negatively by the mother's poor mental health

during pregnancy.

Considering all this, mothers suffer greatly after birth and may fail to

adequately eat, bathe, or care for herself in other ways, the risk of suicide is also a

factor to consider. According to a research article published in the British Journal

of Psychiatry (2022), 4 women out of 1000 are likely to self-harm in a year. While

women with psychiatric disorders had a higher baseline risk of self- harm, their

risk was more than halved when pregnant. Mothers under the age of 30 are more

likely to commit suicide between 3 and 6 months after giving birth. However,

women over the age of 30 have a lower risk of self-harm even after pregnancy.

Public health professionals are becoming more and more interested in the

relatively new concept of health literacy. Personal health literacy can be

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influenced by a variety of things, such as socioeconomic status, education level,

race and ethnicity, age, and disability. It is crucial to remember that having a

traditional education at a high level does not guarantee that a person has a

sufficient level of health literacy. Evidence suggests that women who engage in

prenatal self-care have better health outcomes, so improving pregnant women's

health literacy could be a positive step toward improving maternal health.

Consequently, health literacy is not just about an individual's abilities;

organizations such as doctor's offices and hospitals must also work to improve

health literacy. Health care organizations and providers must be able to

communicate clearly with their patients in order to promote health literacy.

Furthermore, the transition to parenthood is a potentially vulnerable time

for mothers' mental health, around 6.5% to 20% experience postpartum depression

(Saba Mughal et. al., 2022), but only a small percentage of those who meet

diagnostic criteria receive optimal treatment. One reason for this is a lack of

postpartum depression mental health literacy, which is defined as 'knowledge and

beliefs about postpartum depression that aid in its recognition, management, or

prevention'. During the postpartum period, women may be less able to receive the

proper care and make wise decisions about their health and health status due to

low health literacy and health disparities. Therefore, according to Suplee et al.

(2017), they are unaware of or unable to comprehend the warning signs and

symptoms of postpartum complications that require medical attention. Likewise,

according to Cooklin et al., (2018) the psychological changes caused by women's

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rapid physical changes make it difficult to adapt to this process during this critical

postpartum period, and can lead to a variety of problems. Postpartum women face

challenges such as learning new skills and knowledge, meeting the needs of

their newborn and family/community, shifting priorities, and

decreasing social support. Thus, they seek information to help them solve their

problems, and it is claimed that this situation influences health literacy behaviors

After giving birth, a mother's body undergoes major shifts. Some changes

are physical, while others are psychological. As stated by Akwa (2015), others

may experience a sense of loss of self as a result of the changes, some may believe

they don't have time for themselves, that they lack time management skills, and

that they have no control over their body, their image, or their social relationships.

Since, mothers who are aware of obstetric complications are more likely to seek

medical attention before complications arise. According to Sophia Kenward

(2021) having a low health literacy is associated with poorer reported health

status, higher hospitalization rates, and lower use of preventative care. In addition,

inadequate health literacy is more common in socially disadvantage d groups,

such as older adults, immigrant populations, minority populations, and low-

income populations (Kickbusch 2013). Thus, the majority of maternal deaths are

caused by poor health-care seeking behavior after childbirth, but little is done to

improve maternal knowledge of postpartum complications.

When mothers or doctors fail to recognize symptoms, postpartum

depression persists despite obvious warning signs like anxiety, insomnia, and
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confusion, which do not always appear depressed. Because members of racial and

ethnic minorities are more likely to overlook depressive disorders, there is a

greater need to screen for postpartum depression in these groups of women.

Underdiagnoses of this condition can also be brought on by insufficient evaluation

during medical encounters. Even though postpartum depression is easily treatable,

only about 13% of women with symptoms of postpartum depression are under a

doctor's care, and less than 40% of depressed mothers seek help.

Furthermore, despite the fact that treatment is available, few mothers seek

professional help for postpartum depression symptoms. According to Fonseca

(2017), one of the most significant barriers to seeking professional help during the

postpartum period is a lack of knowledge about depression symptoms and

treatment options. Recognizing that new mothers are susceptible to serious, and

occasionally life-threatening, health complications in the days and weeks

following childbirth. According to Dr. Diana Ramos (2023) the crucial fourth

trimester is the period of recovery after giving birth, it provides an opportunity to

lay the groundwork for a new mom's best potential health. Doctors specifically

Ob-gyns conduct a postpartum checkup, a medical checkup performed after

having a baby to ensure that the mother is recovering well from labor and birth.

Even if everything feels fine, a postpartum checkup is recommended to ensure that

the mother is recovering well from labor and delivery, thus, it is a crucial facet of

prenatal care in general.

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In relevance, prior to giving birth, a woman who is not informed about

postpartum depression may mistake her persistent depressive symptoms for the

baby blues and refuse to seek treatment for her depression. When postpartum

depression symptoms appear, it can be difficult to recognize them, and the lack of

treatment that results can have serious consequences. Women who have received

prenatal education will be able to recognize the symptoms of postpartum

depression and seek treatment rather than feeling embarrassed by their feelings.

Without postpartum depression treatment, a woman may experience marital

conflict, increased susceptibility to recurrent mental illness, and even suicidal

thoughts. Consequently, postpartum depression literacy is an important factor in a

woman's self-care and self-efficacy, and the relationship between maternal health

outcomes and health literacy. Improving postpartum depression literacy may

enable women to communicate more effectively with their providers and take

more control over decisions affecting their own and their children's safety.

Mothers who are adequately educated about health issues are more likely

to adopt behaviors that improve health outcomes. As stated by, Solhi et al. (2019)

health literacy education increased participation in physical and mental self-care

during pregnancy. Mothers who participated in health literacy education sessions

demonstrated improvements in their physical activity, prenatal care, dietary

supplement use and habits. Increasing pregnant women's health literacy

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may be a step in the right direction toward enhancing maternal health because

prenatal self- care practices improve health outcomes for women.

Health Locus of Control. Health is a complete state of physical, mental, and

social well-being, rather than simply the absence of disease or infirmity (World

Health Organization). Similar to that, it is influenced by a variety of variables,

including social factors, awareness, and even personality traits. Locus of control,

on the other hand, according to Wright et al. (2013) is a psychological term that

describes how strongly people feel control over the events and encounters that

have an impact on their lives. Behavioral scientists, refer to locus of control as a

psychological construct, which is a theory about human behavior that has been

developed to characterize a collectionof attitudes and behaviors. For a very long

time, many individuals have researched the idea that there is a locus, or "location,"

of control, and that this view has an impact on people's lives.

Combining locus of control and health has a significant impact on health-

related behaviors and beliefs because it acts as a mediator or a link between

personal status, social standing, and health outcomes. According to Nazareth et

al., (2016) it is referred to as a health locus of control when individuals' decisions

about who or what is responsible for managing their health condition are reflected

in their perception. Thus, it may also influence a person's health behaviors and

health outcomes.

One of the World Health Organization's priorities is behavior modification

to promote health and healthy lifestyles. People's lifestyles can be

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improved by encouraging healthy eating, exercise, stress reduction, and spiritual

development, as well as eliminating elements that are harmful to human health. If

health-related behaviors are encouraged, people will perform better, live better,

and spend less money on healthcare. Thus, one of the elements that can control a

person's health- related behaviors is the health locus of control. As stated by M

Dogonchi (2022) individual perceptions of the health locus of control influence

the formation of a precise understanding of one's attention to the development and

maintenance of various health-promoting and preventive behaviors. In effect, the

term 'locus' refers to the location where control is thought to reside - either

internally to the individual or externally.

The concept of locus of control arose from looking both outside and inside

the organism, taking into account both external reinforcements and internal

cognitive processes (Duane Schultz, 2016). An extensive research program

discovered that some people believe reinforcers are influenced by their own

actions, while others believe they are controlled by other people and outside

forces. The source of our locus of control can have a significant impact on our

behavior. People with an internal locus of control believe that their behaviors and

abilities control the reinforcement they receive. They have a firm grip on their own

lives and act accordingly, reporting less anxiety, higher self-esteem, and greater

happiness. As a result, according to Saric & Pahic (2013) they have better mental

and physical health than those who have a high level of external control. While the

rewards received, according to those with an external locus

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of control, are determined by other people, fate, or luck. They firmly believe that

external forces have no power over them. Additionally, they see little point in

making any effort to change their circumstances because they think that their own

actions and abilities have no bearing on the reinforcers they receive.

In terms of people's health locus of control beliefs, several articles and

journals have discovered that an individual's reflect on who or what is responsible

for managing their health condition. The health locus of control is formed by past

experiences in health issues and having external or internal control over affect

health. The health behaviors are predicted by the degree to which an individual

believes they can perform the behavior and that it will be effective. People who

have an internal health locus of control (HLOC) are more likely to take action to

manage their symptoms than those who have a more external HLOC, who think

their symptoms are accidental and turn to other people, like their doctor, to

manage them. Thus, those with a high internal HLC ought to be more likely to

partake in activities that support and promote good health. People who have higher

external HLC, on the other hand, think that they have no control over their health

are likely to be less likely to follow through with suggested healthy behaviors.

In regards to an individual, their health and how much they want to be

involved in making medical decisions may be also influenced by their health locus

of control. According to Dr. Federick Navarro (2107), the health locus of control

decision-making is associated with a wide range of health-related

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dispositions and behaviors that those attempting to influence are unaware of. The

health locus of control decision-making is not limited to the choice of doctor,

hospital, or health insurance, but is influenced by habits, preferences, and physical

abilities, which are frequently reflected in past behavior. Nevertheless, decision-

making control over one's health is determined by who makes the decisions: the

person itself or someone else. When someone else is in charge, the locus of

control is external. While, when a person himself makes health decisions, the

locus of control is internal. From the perspective of personalized medicine, a

precise assessment of the patient's locus of control over their health could aid in

customizing the decision-making process within the clinical context.

Health locus of control predicts health in a variety of ways, including social

capital and risky behaviors like drinking, smoking, and not exercising enough. As

cited by Kesavayuth et. al, (2020), people who have an internal locus of control

have better physical and mental health as well as better self-reported health. Less

of them depend on both curative and preventive medical care. Therefore, those

with an internal locus of control may experience better health for a variety of

reasons, including maintaining healthy habits. On the contrary, individuals who

display an external locus of control, have a tendency to move in the exact opposite

direction from those exhibiting internality, according to Flores (2020). These

people frequently exhibit higher levels of depression, psychopathology, low self-

esteem, and poor academic performance.

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Several publications have consistently found that locus of control is

associated with psychological well-being. It was determined that indicators of

good psychological well-being came from reports of lower indices of stress and

depression, linking it to high internal locus of control, and reports that stress is

frequently the result of feeling powerless in a given situation, suggesting it is

linked to having an external locus of control. Similarly, according to Ashley L.

Peterson (2018), depression is linked to having an external locus of control, which

can also be accompanied by a feeling of helplessness. Since they think they can

affect their outcomes, those with a stronger internal locus of control might have an

easier time inspiring themselves. Taken together, preventative health measures

and an internal locus of control may be more correlated.

Correspondingly, according to the case put forth by Khumalo (2019),

higher levels of internal locus of control would be linked to lower levels of

depression, while higher levels of external locus of control, which includes both

powerful others and chance, would be linked to higher levels of depression. In line

with this Baitina et al. (2018) affirm that people with an internal locus of control

are less likely to experience depression and will work hard to achieve success,

whereas people with an external locus of control are found to be depressed,

anxious, and less able to adjust themselves well to the environment and to the

problems faced.

There is much debate about whether females are more likely to be internal

or external in terms of prevalence. However, it is crucial to evaluate a woman's

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health locus of control especially during pregnancy because it is linked to her

health behaviors, psychosocial problems, and her sense of control over her body.

A woman's health locus control beliefs may help determine whether she is at risk

for postpartum depression. (PPD). Thus, according to Kordi et al. (2017), pregnant

women with an internal health locus of control are more likely to change their

lifestyles and adopt positive health behaviors than those with an external health

locus of control, who take more risks. As a result, mothers who have an internal

locus of control strongly believe in making decisions about their own health, and

they take more responsibility for doing so. They find effective ways to manage

stress and are more likely to engage in health-promoting behaviors.

Research Literature

The research literature used in this study was compiled from a wide range

of academic articles, research papers, theses, and published dissertations, as well as

from other reliable sources that add to the body of knowledge in the area of Level

of Postpartum Depression Literacy and Health Locus of Control.

In a conducted study, HS Galal (2022), they assess the relationship of health

locus of control and risk factors for postpartum depression among primi- para

mothers. For the study, they employed a descriptive correlational research design,

and they carried out in different governmental hospitals to collect some

respondents with the use of three tools: interview schedule questionnaire,

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Edinburgh postnatal depression scales, multidimensional health locus of control

scales. According to the findings, it has a significant relationship between the

depression scale they used and the demographic profile of the respondents.

Furthermore, in helping the respondents in overcoming challenges, they

recommended that women who are at risk of developing postpartum depression

participate in an awareness program proposed in accordance with the study's result.

However, M Moshki (2015) investigates the Relationship of Postpartum

Depression to Health Control Beliefs and Demographic Factors. In this study, the

correlation coefficients were used to investigate the pattern of causal links using

path analysis. The study used a convenience sampling in recruiting the

participants. To analyze data, Pearson correlation and path analysis were applied to

examine the relationships between variables using SPSS 20 and LISREL

8.50software. According to the results, it showed that a positive correlation exists

between predisposing (knowledge, internal HLC, powerful others HLC, chance

HLC) enabling and reinforcing factors with postpartum depression by GHQ score

(GFI = 1, RSMEA = 000). The findings of the study showed that postpartum

depression was significantly predicted by three factors: inner assurance, acceptance

of successful people, and faith in chance. These factors had significant negative,

positive, and favorable effects, respectively.

Furthermore, Z Zahmatkesh (2020), they aim to determine the relationship

between mental health and self-efficacy and postpartum depression. The

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researchers used a descriptive cross-sectional study to evaluate the relationship

between mental health literacy and self-efficacy and depression. Also, in choosing

their participants, they used a simple random sampling method and the instruments

used in the study were parenting self-efficacy questionnaires, mental health literacy

questionnaire, and depression questionnaire (BECK). The total data were analyzed

using SPSS 16 software and paired t-test. P value. According to the study’s

findings, there is a significant relationship between the postpartum depression and

self-efficacy in which the study results recommended to prevent the said problem,

it suggested educational programs and support groups can be implemented to help

the respondents to prevent it.

Another study which was conducted by Mirsalimi et al., (2020), aimed to

develop a specific measure for assessing postpartum depression literacy and

consequently evaluate its psychometric properties among a sample of perinatal

women. The method of the study consisted of two studies: developing the measure

and evaluating psychometric properties of the developed questionnaire. Then a

basic questionnaire was then created using the criteria of mental health literacy and

a preliminary assessment. According to the study’s results, some of the item pools

were removed and subjected to the content and face validity. Also, in the second

stage, they used a Postpartum Depression Literacy Scale (PoDLis) to evaluate. The

factors designated the following constructs: ability to recognize postpartum

depression, knowledge of risk factors and causes, knowledge and belief of self-

care activities, knowledge about professional help available, beliefs

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about professional help available, attitudes which facilitate recognition of

postpartum depression and appropriate help-seeking, and knowledge of how to

seek information related to postpartum depression. In this study, the findings

demonstrated that women with postpartum depression were not sufficiently

understood throughout the perinatal period, indicating the need for research and

development of facilitators such as postpartum depression literacy that influence

women's help-seeking behaviors. The study suggested that community initiatives

should be used to raise awareness, and mental health should be discussed in

childbirth classes throughout pregnancy.

From the study conducted by KH Law (2018), it stated that postpartum

mental illness is likely due to an interaction of genetic vulnerability and adjustment

difficulties, it may be possible to prevent the onset of postpartum mental illness if

factors causing psychological distress are addressed. In this study, they used semi-

structured interviews with 32 first-time mothers and thematic content analysis.

Also, in this study, they give sustained research effort toward the development of

interventions designed to prevent or reduce maternal psychological distress. In

general, these interventions have frequently centered on giving women postpartum

care and/or education. Maternal distress has been targeted by education-focused

programs that give moms the information and abilities to handle postpartum

difficulties. The results from the study indicate that societal norms, often

propagated through social media platforms, may place undue pressure on even

relatively well-adjusted new mothers. According to the

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findings, they highlight the issues related to the notion of common humanity and

emphasize the role of this factor in normalizing the postpartum experience and

reducing psychological distress.

In addition, Sangsawang (2019) further stated that postpartum depression

(PPD) is a major public health problem affecting 10–57% of adolescent mothers

which can affect not only adolescent mothers but also their infants. Thus, there is a

need for interventions to prevent PPD in adolescent mothers. In the study, they

used systematic review that was conducted by using the PRISMA as a guideline.

Furthermore, it was also stated by this study that the evidence from this systematic

review suggests that 6 of 13 studies from both psychological and psychosocial

interventions including (1) home-visiting intervention, (2) prenatal antenatal and

postnatal educational program, (3) CBT psycho-educational, (4) the REACH

program based on interpersonal therapy, and (5) infant massage training is

successful in reducing rates of PPD symptoms in adolescent mothers in the

intervention group than those mothers in the control group. The findings of the

study stated that the said intervention might be considered for adolescent pregnant

womens, but the review of the study indicates the most or a possible effective

intervention that these interventions might be considered for incorporation in

antenatal care interventions for adolescent pregnant women.

On the other hand, E Mollard ( 2015), specified that women's health locus

of control during pregnancy may predict risk for postpartum depression. In the

study, it says that PPD is a serious issue for moms and their newborns, yet there
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are few treatment options and strategies to predict or prevent it. The methods used

in the study was a pre/post-test experimental design. Two hundred and thirty

pregnant women in Iran were given the Multidimensional Health Locus of Control

Scale (MHLCS) and randomly divided into the control group or the experimental

group. The experimental group received an educational intervention about

pregnancy, childbirth and the postpartum period targeted to HLC. At 4 weeks

postpartum, participants were retested with the MHLCS and given the Edinburgh

Postnatal Depression Scale. Multiple statistical methods were applied. As a result

of the study, the findings showed that those who have a higher IHLC are less likely

to have PPD and those with a high CHLC have higher levels of PPD.

Furthermore Gupta S., et al., (2013), added an existing knowledge about

postpartum depression and the risk factors among the respondents. The methods

used in the cross-sectional study that was designed to assess the prevalence of

postpartum depression among women. According to the findings of the study, the

socio-demographic factors among women with or without depression are more

likely to be less educated and they belong to low socio-economic class. It was also

38 stated that poor relationship with the partner, his alcohol intake as well as poor

relationship and support from in-laws were significantly associated. Furthermore

T. Beydokhti (2014), aims to determine the effectiveness of application of health

locus of control in pregnant women for prevention of postpartum depression. This

study investigates a pre-post experimental design

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methodology. With this method, two hundred and thirty volunteer women were

randomly divided into experimental and control groups. The data collectiontools

included a demographic questionnaire, the Multidimensional Health Locus of

Control Scale, and the Edinburgh Depression Scale. Based on the associations

found in the pretest, an intervention program was planned and carried out in the

focused group discussion method. Data were collected after the end of scheduled

sessions, immediately and one month later. The data were analyzed with SPSS- 16

using statistical methods including Anova, chi-square test, student's t-test and

paired t-test. As a result of the study, immediately following intervention, the

chance health locus of control decreased dramatically while internal health locus of

control improved significantly. A month following intervention, there was also a

significant difference in postpartum depression reduction between the two groups.

According to the findings of the study, the chance of health locus of control

significantly reduced and internal health locus of control significantly increased,

immediately after intervention. Also, they also suggest that a month after

intervention, a significant difference was observed between the two groups in

reducing postpartum depression.

Sharing the view of YN Wang (2021), stated that pregnant women may be

more vulnerable to stress, which may cause them to have psychological problems.

In this study, a total of 2232 subjects were recruited from three cities in China and

through online surveys, information on demographic data and health status during

pregnancy were collected. Insomnia severity index generalized

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anxiety disorder 7-item scale, patient health questionnaire-9, somatization subscale of the symptom c

Synthesis

The study aims to know the Level of postpartum depression literacy and

health locus of control of mothers in Batangas city. The researchers synthesized

the ways in which the current study differs from and resembles the earlier studies

that are mentioned in the research literature.

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This part shows similarities of the previous studies and present study based

on the presented research literature. The study of HS Galal and M Moshki, is

focused on the relationship between the health locus of control and risk factors
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of postpartum depression which had correlates in accordance with the

respondent’s demographic factors which had linked similarities between the two

studies that also connects on the present study. Meanwhile, the study of Z

Zahmatkesh which aimed to determine the relationship between mental health and

self-efficacy and postpartum depression. Like the present study’s goal on what

plan of action may be proposed in the study to prevent the said problem. In line

with this, in the study of Galal they used a multidimensional health locus of

control scales (MHLC) which had the same scale used in this present study, to

determine the health locus of control of the respondents. Furthermore, this

literature reviews from Galal, M Moshki and Z Zahmatkesh, have the similarities

in terms of analyzing the risk factors of postpartum depression to the women and

how they prevent it using the suggested programs or interventions in which the

present study needed it to support the study's goals.

In the line of the knowledge about postpartum depression, YN Wang, KH

Law, and Mirsalimi shared a similar view about the health risk factors of

postpartum depression literacy including that postpartum mental illness is likely

due to an interaction of genetic vulnerability and adjustment difficulties, it may be

possible to prevent the onset of postpartum mental illness if factors causing

psychological distress are addressed. In contrary, Mirsalimi used a scale using the

PODLIS in which the present study had the same scale in assessing the factors

designated the following constructs: ability to recognize postpartum depression,

knowledge of risk factors and causes, knowledge and belief of self-

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care activities, knowledge about professional help available, beliefs about

professional help available, attitudes which facilitate recognition of postpartum

depression and appropriate help-seeking, and knowledge of how to seek

information related to postpartum depression. However, given on the risk factors,

KH Law stated that women may be more vulnerable to stress which may cause

them to have psychological problems. Concerning on the presents study,

postpartum depression literacy can help the more women to prevent the health risk

factors of the said illness or distress that may occur on the woman’s mental health.

Some of the previous studies used a quantitative approach, which had the present

study use the same to quantify a broader perspective in collecting data of the

respondents. In reference, Abdel-At and Beydokhti used similar questionnaires to

the present study in terms of measuring health locus of control. Some of the

previous studies used T-test, and a nova to statistically analyze the gathered data.

This part shows the difference of the previous studies to the present study

of the researchers. In the study of Galal, they used an interview schedule

questionnaire and Edinburgh postnatal depression scales which in the present

study has different tools used in assessing the participants. Also, in terms finding

the participants, they carried out in different governmental hospitals to collect

some respondents but in the present study, since the main purpose of the study is

to know the level of postpartum depression literacy and health locus of control,

instead of going into different hospitals to gather some respondents, we decided

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to limit on the specific location. However, M Moshki, using the Pearson

correlation and path analysis were applied to examine the relationships between

variables using SPSS 20 and LISREL 8.50software. Concurrently, from the study

of Z Zahmatkesh used parenting self-efficacy questionnaires, mental health

literacy questionnaires, and depression questionnaires (BECK). And based on the

previous study, the total data analyzed using SPSS 16 software which in the

present study used a different scale to determine the variables.

KH Law stated that postpartum mental illness is likely due to an interaction

of genetic vulnerability and adjustment difficulties while Galal stated that risk for

postpartum depression is due to inadequate social support and poor mental health.

Mollard found out that those who have a higher IHLC are less likely to have PPD

and those with a high CHLC have higher levels of PPD however, Moshki stated

that postpartum depression was significantly predicted by three factors: inner

assurance, acceptance of successful people, and faith in chance in which these

factors had significant negative, positive, and favorable effects, respectively. Galal

utilized descriptive cross-sectional design while Mollard used pre/post-test

experimental design to statistically treat their data. Some of the previous data used

convenience sampling and chi-square as a statistical tool of their data. In contrast,

the present study will be utilizing purposive Quota sampling to properly select the

needed participants of the study. In summary, the previous and present are similar

in considering the correlation between the two variables. Both previous and

present study used T-

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test, Pearson correlation and multidimensional health locus of control scale. Also,

both previous and present studies aim to know what intervention or plan of action

may be proposed for the respondents. However, there may be similarities in some

methods used, specifically in using the quantitative approach, some previous

studies used different ways of gathering the data. In relation, the present study

only focused on the level of postpartum depression literacy and health locus of

control which is not discussed in the previous studies.

Theoretical Framework

This part of the study explains pertinent theories based literature review

and defines the major concepts in the study as well as the linkages that might exist

between them.

Beck’s Postpartum Depression Theory. In the 1970s, clinical psychologist

Aaron Beck initially put forth his cognitive behavioral theory of depression, from

which his theory of postpartum depression developed. According to Beck's

hypothesis, depressive disorders, including postpartum depression, grow and are

maintained as a result of negative automatic thoughts, attitudes, and beliefs. As

Beck and his colleagues continued to develop the theory, risk factors and

vulnerabilities such as hormonal changes, life stresses, and irrational expectations

of motherhood were only a few (Beck, 2022). Beck's theory has evolved and been

improved via empirical study and clinical practice. Beck

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theorizes that postpartum depression is caused by a complex interaction of

biological, psychological, and social factors.

According to the theory, postpartum depression goes through four stages:

encountering terror, dying of oneself, battling for survival, and regaining control.

While dying of oneself can seem like "alarming unreality, isolation of oneself, and

contemplation of self-destruction," experiencing horror can manifest as

"horrifying anxiety attacks, obsessive pondering, and encompassing fogginess"

(McEwen & Wills, 2019). While regaining control entails "making transitions,

mounting lost time, and reaching a guarded recovery," trying to survive can be

depicted in "battling the system, praying for relief, and seeking solace" (McEwen

& Wills, 2019).

Prenatal depression, prenatal anxiety, life stress, marital satisfaction, social

support, parenting stress, child temperament, self-esteem, economic position, and

whether the pregnancy was pla nned are among the predictors of postpartum

depression that Beck also created (McEwen & Wills, 2019). Other signs include

eating and sleeping problems, emotional instability, worry, insecurity, perplexity,

guilt and humiliation, loss of identity, and suicide thoughts.

Beck’s Postpartum Depression Theory seeks to describe and make clear the

cognitive processes and harmful thought processes that contribute to the formation

of postpartum depression. The theory doesn't forecast how postpartum depression

will progress or turn out, nor does it recommend any specific therapies
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to be utilized in its treatment. Instead, it aims to identify the psychological

mechanisms and elements that underlie this disease and create a framework for

understanding it. Instead, it offers a model that is explanatory and descriptive and

can direct future study and treatment.

The theory's fundamental ideas therefore encompass four stages of

balancing on the verge. These ideas are described using the symptoms unique to

each stage. The possibility of developing symptoms and disease states is

simultaneously increased by predictors or risk factors when they are present in

combination. The most crucial element and aim of the theory is to comprehend the

mechanisms underlying postpartum depression, as doing so enables you to alter

the way that millions of women view their postpartum mood and well- being.

Postpartum depression literacy covers the predictors of postpartum

depression in this theory. Postpartum depression is predicated by a number of

factors, including prenatal depression, prenatal anxiety, life stress, marital

satisfaction, social support, parenting stress, child temperament, self-esteem,

financial situation, and if the pregnancy was planned, according to this theory.

Knowledge with regards to postpartum depression plays a huge role to be aware of

these predictors which will help in making ways to take care of one’s well- being

especially the affected sector, the mothers.

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Attribution Theory. The focus of attribution theory is on people's interpretations

of events and how their actions and thoughts are affected. Heider (1958) was the

first to put up a psychological theory of attribution, but Weiner and his associates

(such as Jones et al. in 1972; Weiner, 1974, and 1986) created a theoretical

framework that has grown to be a significant social psychology research

paradigm. According to the notion of attribution, people try to understand the

motivations behind others' actions, or they assign reasons to conduct. When trying

to comprehend another person's actions, a person may assign one or several causes

to that action. An attribution is a three-step process that begins with perception or

observation of the behavior, is followed by a belief that the behavior was

performed on purpose, and is finally followed by a belief about whether or not the

other person was coerced into performing the behavior (in which case the situation

is attributed as the cause) (in which case the cause is attributed to the other

person).

Weiner emphasized achievement in his attribution theory (Weiner, 1974).

He determined that the most significant variables influencing attributions for

achievement are talent, effort, task complexity, and luck. Three causal dimensions

—locus of control, stability, and controllability—are used to categorize attributes.

The internal vs the exterior locus of control are the two poles of the locus of

control dimension. The stability dimension identifies whether or not causes alter

over time. For instance, effort can be categorized as an unstable external cause and

ability as an internal, stable cause. Controllability

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distinguishes between factors that one can influence, such as competence or

efficacy, and factors that one cannot influence, including aptitude, mood, the

behavior of others, and luck.

Locus of control, or whether one believes that one's own actions or external

circumstances are what caused events, is a key idea in the study of attribution

theory. A person who has an "internal," or internal locus of control, will think that

her ability or level of effort will determine how well she does on a job endeavor.

An "external" will determine whether a project was easy or difficult, the boss was

helpful or unhelpful, or some other factor as the cause of success or failure.

Generally, optimism and physical health are related to an internal center of control.

Delaying pleasure is often easier for those who have an internal locus of control.

Locus of control is one of the three causal dimensions in this theory. Locus

of control highlights a person’s belief about a certain situation and how it is

supposed to happen. This dimension of attribution theory basically covers how a

person is going to take in regards to one's situation, for example is, one’s health.

Internality or externality of locus of control plays a role in how a person will take

actions with regards to his or her health which includes awareness about mental

health conditions like postpartum depression.

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Figure 1. Theoretical Framework of the Study

This study has three main variables; postpartum depression literacy, health

locus of control, and maternal mental health, which are all focused on first-time

moms. Figure 1 further explains and elaborates how each variable is supported by

theories respectively.

Beck’s Postpartum Depression Theory includes four stages of depression,

in which these stages have predictors. These predictors are under the coverage of

postpartum depression literacy. The arrow that points the Beck’s Postpartum

Depression Theory to postpartum depression indicates that this theory mainly

tackles postpartum depression. The arrow that connects the predictors to the four

stages of postpartum depression indicates that these predictors fall under the

category of postpartum depression literacy and are present in all four stages of

postpartum depression.

Attribution theory has three causal dimensions; locus of control, stability,

and controllability. The arrow that points the attribution theory to postpartum
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depression indicates that this theory supports the relationship of locus of control

and postpartum depression since locus of control concerns the belief of an

individual or how a person will react in light of their circumstances, such as their

health, in which includes mental health conditions like postpartum depression.

Conceptual Framework

The researchers developed a conceptual framework that will serve as a guide

in this study. This study will focus on the factors of postpartum depression literacy

and health locus of control among selected mothers in Batangas City. The conceptual

framework paradigm depicts the input-process-output (IPO) model, which serves as

the research paradigm for the study. The paradigm explains how the researchers will

be able develop, collect data, and evaluate the study. The input determined the

students' profile in terms of age, educational attainment, monthly family incomes,

civil status, number of children, and type of community. It also identified the

prevalent factors influencing level of postpartum depression literacy and health locus

of control.

The procedure explains data collection, analysis, and interpretation. Thus,

this study will employ two standardized questionnaires: the Multidimensional

Health Locus of Control (MHLC) Scales, specifically Form A, develope d by

Wallston et al. (1978), and the Postpartum Depression Literacy Scale (PoDLiS)

developed by Mirsalimi et al (2020). Moreover, this study will begin with the

development of the scoring and the interpretation of the questionnaire and once
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they have been developed it will be given to the validators to validate. The study

will begin by administering a needs analysis with the assistance of a licensed

psychologist, and then it will proceed with the study by distributing questionnaires

to the participants. The collected data will be analyzed and interpreted once the

researchers have completed the study. Furthermore, based on the study's findings,

a mental health program can be conducted to address the gaps that will be discover

in this study.
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INPU
T
Demographic Profile of
the respondents
1.1 Age
1,2 Educational
Attainment
1.3 Monthly
Family Income
1.4 Civil Status
1.5 Number of children
1.6 Type of Community ● Formulation of
Level of pospartum
Question
depression literacy of the Scoring and
respondents in terms of: Interpretation Proposed
2.1 Ability to Mental Health
recognize postpartum ● Validation of
depression Activity/
2.2 Knowledge of risk Question Program for the
factors and causes Scoring and participants
2.3 Knowledge and beliefs Interpretatio
of self-care activities
2.4 Knowledge about ● Pilot Study
professional help available
2.5 Beliefs about
professional help available ● Needs Analysis
2.6 Attitudes which
facilitate recognition of ● Conducting the
postpartum depression and
Study
appropriate help seeking
2.7 Knowledge of how to ● Analyzing and
seek information related to
postpartum depression. Interpretation of
Health locus of control of
Data
the respondents be
described in terms of:
3.1 Internal
3.2 Chance
3.3 Powerful Others

Figure 2. Conceptual Paradigm of the Study

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Hypotheses of the Study

1. Ho1- there is no significant differences between postpartum depression

literacy and health locus of control when grouped according to

demographic profile

2. Ho2- there is no significant relationship between postpartum depression

literacy and health locus of control

Definition of Terms

The researchers extensively describe the following concepts used

conceptually and operationally in order to provide a simple and easy

understanding of the flow of thinking in this study.

Motherhood- Motherhood is the cultural process of locating women's

identities in their capacity to nurture infants and children. (Ellen Ross, 2018). In

accordance with this study, Motherhood is defined as a state of being a mother and

a gender-specific version of the term parenthood. In this study, mothers are the

participants in the study and the ones to benefit most and the whole motherhood

community to improve their mental health.

Postpartum- The postpartum period begins soon after the delivery of the

baby and usually lasts six to eight weeks and ends when the mother’s body has

nearly returned to its pre-pregnant state. (Lopez-Gonzalez, 2020). In this study,

postpartum is defined as a type of depression suffered by a mother after giving

birth, often resulting from a confluence of hormonal changes, postpartum

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depression, and exhaustion that affect the lives of a mother. Also, it will benefit in

the present study because it can help the participants to be aware of how it will

affect their maternal mental health with regards to when the symptoms of

postpartum depression may occur.

Depression literacy- Depression literacy is defined as “knowledge about

depression as a psychiatric disorder and about the epidemiology, etiology,

symptomatology, treatment and prognosis of depression” (Nijam et al., 2013). In

this study, Depression literacy is a specific type of mental health literacy and is

defined as the ability to recognize depression and make informed decisions about

treatment. Through discovering the benefits of depression literacy to the role of

maternal mental health, it can help the respondents to be more aware of the factors

and suggest possible intervention programs to solve the said problem.

Locus of control - Locus of control is how much control you feel you

have over a situation. (Natalie Boyd, 2021). In this study, the locus of control is

how much you believe you have influence over the things that happen in your life.

A belief about whether the results of our actions depend on what we do (internal

control orientation) or on circumstances beyond our personal control (external

control orientation) is what it is described as. In lieu of the present study, it will

benefit the respondents' maternal mental health. It also influences the response to

events and gives motivation to what will take action to the specific events of life.
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C
HAPTER 3

RESEARCH METHOD AND PROCEDURE

This chapter contains the research design, respondents of the study, data

gathering instruments, data gathering procedures, ethical considerations and statistical

treatment of data.

Research Design

This present study aims to assess the level of postpartum depression

literacy and health locus of control of mothers in Batangas city, specifically 100

from a rural community and another 100 for an urban community. The study will

use a descriptive correlational design in a quantitative method. In this design, it is

most suitable for the study to demonstrate the relationship of the two variables

namely, health locus of control and postpartum depression literacy. Using this

method, researchers can make logical connections between the two variables.

According to Fisher and Bloomfield (2019), quantitative research focuses

on the objective measurement of statistical data processed statistically. It is

comprehensive in its intent since it seeks results that can be extrapolated to a

larger population to quantify the issue and understand how prevalent it is.

However, A descriptive correlational method refers to a type of study in which

information is collected without making any changes to the study subject.

Descriptive research cannot make predictions or determine causality. It simply

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identifies behaviors and describes the behavior and the participants. (J Brown,

2021)

Therefore, this design will also be utilized to determine what course of

action may be proposed based on the result of this study. Also, it attempted to

understand the various effects on their way of life.

Respondents of the Study

In selecting respondents for the study, the researchers will employ

purposive sampling, which is a type of non-probability sampling known as

judgmental, selective, or subjective sampling is one in which researchers use their

own judgment to select people from the population to take part in their surveys.

Purposive sampling is used by researchers when they want to reach a specific

subset of people, as all survey participants are chosen because they fit a specific

profile.

To determine which respondents would be good candidates for inclusion in

the study's sample, the researchers developed selection criteria when examining

the target respondents. A large population should be needed for the study using a

sampling quota in gathering the respondents, specifically 100 respondents for

urban and 100 for rural, totalling to 200 respondents. Likewise, respondents are

limited to mothers who have no psychiatric contact, between the ages of 18 and

49, and currently reside around Batangas City in order to determine if they have

met the requirements. Additionally, prior to participating

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in the study and answering the questionnaire, the respondents who just gave birth

are excluded, based on the literature they are vulnerable or can have more chances

of acquiring the said illness. The respondents will based on the past feelings or

recalling what they experienced during the times they just gave birth. To make

sure that the respondents are not affected by the baby blues or the early phase of

Postpartum Depression.

Moreover, the respondents' profile, including their age, educational level,

monthly family income, civil status, number of children, and type of community

are another factor taken into account by the researchers.

Data Gathering Instruments

The researcher utilizes one research made and two standardized

questionnaires namely Postpartum Depression Literacy Scale (PoDLiS) and

Multidimensional Health Locus of Control (MHLC) Scales which will be used as

a data-gathering tool for this research in order to ascertain the data needed from

the respondents.

To obtain the demographic profile of the respondents, the researchers

constructed a self-made questionnaire which will determine the necessary

information from the participants' age, level of education, monthly family income,

civil status, number of children and type of community. This section of the

questionnaire will consist of multiple-choice and fill-in-the-blank questions.

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Multidimensional Health Locus of Control (MHLC) Scales . To determine the

respondents' type of health locus of control a scale made by Wallston et al. (1978)

entitled Multidimensional Health Locus of Control (MHLC) Scales specifically Form

A will be utilized, which include eighteen (18) items with 6-items for each of its three

subscales: Internal, Chance and Powerful Others, to determine a person's degree of

health locus either internal or external control. The six items Internal subscale focuses

on a stable disposition differentiating between individuals believing that they can

determine what happens to them and includes items such as “If I get sick, it is my own

behavior which determines how soon I get well again”. Likewise, the two types of

external health locus of control: Chance subscale focuses on attributing life's

outcomes to fate or luck and includes items such as “Luck plays a big part in

determining how soon I will recover from an illness.”, on the other hand Powerful

Other subscale focuses on believing that life's outcomes are determined by powerful

others and includes items such as “Health professionals control my health”. The

Cronbach's alpha of the internal health locus of control (0.68), powerful others health

locus of control (0.72), and chance health locus of control (0.66) subscales.
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Subscales No. of items Items Cronbach’s

alpha
Internal 6 1, 6, 8, 12, 0.68
13,
17
Chance 6 2, 4, 9, 11, 0.72
15,
16
Powerful 6 3, 5, 7, 10, 0.66
Others 14,
18

Table 1 Items and Reliability of MHLC

The type of respondents' locus of control over their health was assessed using a

6-point Likert scale in the questionnaire. Six options are available for responding to

the statements: (1) strongly disagree, (2) moderately disagree, (3) slightly disagree,

(4) slightly agree, (5) moderately agree, and (6) strongly agree. The results of the

scale will enable the researchers to ascertain the respondents' locus of control over

their health. The test's interpretation will be based on the factor mean because it

identifies and measures three interest domains. The following is how the scores are

interpreted: 1.00 - 2.00 (Very Low); 2.01 - 3.01 (Low); 3.02 - 4.02 (Moderate);

4.03 - 5.03 (High); and 5.04 - 6.00 (Very High).

Table 2 Scoring of MHLC

Scoring Verbal
Interpretation
1 Strongly Disagree
2 Moderately Disagree

3 Slightly Disagree
4 Slightly Agree

5 Moderately Agree
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6 Strongly Agree.
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Table 3 Interpretation and Characteristics based on MHLC Scores

Sco Verbal Characteristi

re Interpretatio cs
n
1.00 - 2.00 Very Internal: Does not believe that they can
Low determine what happens to them.

Chance: Does not attribute life's outcomes to

fate or luck.

Powerful: Does not believe that life's

outcomes are determined by powerful others.

2.01 - 3.01 Low Internal: May have believed that they can
determine what happens to them.

Chance: May have attributed life's outcomes

to fate or luck.

Powerful: May have believed that life's

outcomes are determined by powerful others.

3.02 - 4.02 Moderat Internal: Believe that they can determine what
e happens to them.

Chance: Attribute life's outcomes to fate or luck.

Powerful: Believe that life's outcomes are

determined by powerful others.

4.03 - 5.03 High Internal: Often believe that they can determine
what happens to them.

Chance: Often attribute life's outcomes to fate or

luck.

Powerful: Often believe that life's outcomes

are determined by powerful others.
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5.04 – 6. 00 Very High Internal: Extremely believe that they can

determine what happens to them.

Chance: Extremely attribute life's outcomes to

fate or luck.

Powerful: Extremely believe that life's outcomes

are determined by powerful others.

Postpartum Depression Literacy Scale (PoDLiS)

To assess participants' knowledge of postpartum depression a scale developed

by Mirsalimi et al. (2020) entitled Postpartum Depression Literacy Scale (PoDLiS)

will be utilized. It is made up of 31 items that are now used to assess knowledge of

the signs and symptoms of postpartum depression as well as attitudes toward mental

health and seeking help.

The scale is composed of 7 sub factors namely (1) the ability to recognize

postpartum depression which contains six items characterized by statement such as

“Sleeping too much or too little may be a sign of postpartum depression”, (2)

knowledge of risk factors and causes which contains 5 items and includes statements

like “How likely is it that postpartum depression might be caused by a hormonal

imbalance?”, (3) knowledge and belief in self-care which contains 5 items and has

statements like “Good sleep is helpful in prevention or management of postpartum

depression”, (4) knowledge about professional help available which contains 2 items

and characterized by statement like “Treatment for postpartum depression, provided

by a mental health professional, can be effective”, (5) beliefs about professional help

available which has 2 items and contain statement like

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“Antidepressants are addictive”, (6) attitudes toward postpartum depression which has

6 items and includes statement such as “ If I had postpartum depression I would not

tell anyone” , and lastly (7) knowledge of how to seek postpartum depression

information which has five items and characterized by statement like “I can appraise

the accuracy of information about postpartum depression on the Internet”. Each

subscale has a Cronbach’s alpha of 0.77; 0.76; 0.78; 0.83; 0.78; 0.70; 0.73; and 0.78

Table 4 Items and Reliability of PoDLiS

Sub factors No. Range Cronbach’s

of of alpha
ite Items
ms
Ability to recognize postpartum 6 1-6 0.
depression 77

Knowledge of risk factors and causes 5 7- 0.

11 76
Knowledge and beliefs of self-care 5 12- 0.
activities 16 78

Knowledge about professional help 2 22- 0.

available 23 83

Beliefs about professional help 2 24- 0.

available 25 78
Attitudes which facilitate recognition 6 18, 26, 0.
of postpartum depression and 30-32, 70
appropriate help-seeking 34

Knowledge of how to seek information 5 35- 0.

related to postpartum depression 39 73

The level of postpartum depression literacy among the respondents was

assessed using a 5-point Likert scale with a range of 1 to 5. There are five possible

responses for the various statements: 1-strongly disagree, 2-disagree, 3-neutral, 4-

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agree, and 5-strongly agree. To calculate each subscale or total score for the PoDLiS,

first add raw scores and then divide into the number of items for each subscale.

While, the factor mean, which is defined as follows, is used to interpret the score: 1-

1.80 (Very Low); 1.81-2.61 (Low); 2.62-3.42 (Moderate); 3.43-4.23 (High); and 4.24-

5.00 (Very High)

Table 5 Scoring of PoDLiS

Score Verbal
Interpretation
1 Strongly Disagree

2 Disagree
3 Neutral

4 Agree

5 Strongly Agree
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Table 6 Range and Characteristics based on PoDLiS Scores

Range Verbal Characteristics

Interpretation
1-1.80 Very Low Level The statements does not describes the
of Postpartum participants in terms of their assessment
Depression on postpartum depression literacy
Literacy

1.81- Low Level The statements rarely describes the

2.61 of participants in terms of their assessment
Postpartum on postpartum depression literacy
Depression
Literacy
2.62- Moderate Level The statements moderately describes the
3.42 of Postpartum participants in terms of their assessment
Depression on postpartum depression literacy
Literacy

3.43- High Level The statements highly describes the

4.23 of participants in terms of their assessment
Postpartum on postpartum depression literacy
Depression
Literacy
4.24- Very High The statements extremely describes the
5.00 Level of participants in terms of their assessment
Postpartum on postpartum depression
Depression Litera
Literacy cy

Data Gathering Procedures

The following actions must be taken in the correct order in order to

complete the data collection process for this study. First, respondents will be

chosen using non-probability sampling, specifically purposive sampling based on

needs analysis. Social media platforms will be utilized for crowdsourcing. The

researchers will conduct a pre-survey to find and complete the needed

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respondents for the study. This will take place within Batangas City. The

researcher will use two adopted standardized questionnaires in finding the needed

data in the study. First, is the Multidimensional Health Locus of Control (MHLC)

and then the Postpartum Depression Literacy Scale (PoDLiS).

After obtaining the needed number of respondents for the study, the

researchers will provide informed consent to the respondents which will ensure

the voluntary participation of the respondents as well as their rights in this study.

The researchers will briefly discuss the nature and purpose of conducting the

study. After the respondents gave their consent, the data collection will formally

commence.

The questionnaires will be disseminated using Google Forms or through

printed material. The data from the respondents will be totaled, tabulated,

analyzed, and translated with the aid of statistical tools after all the required

components of the questionnaire have been completed by the respondents. Finally,

the findings will be discussed, along with conclusions and recommendations

drawn from the data obtained.

Ethical Considerations

This research certifies that the study’s purpose is to determine the level of

postpartum depression literacy and health locus of control of first-time moms and

its role on maternal mental health as part of the requirements of Bachelor of

Science in Psychology program at Batangas State University. The researchers

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will include a written explanation to the participants of the purpose of the

research, their right to refuse to participate, the understanding of the boundaries of

confidentiality of this study, and their right to have a copy of the results of the

study if they so wish. The participants will sign a consent form as proof of their

willingness to cooperate, and that they are not coerced in any way.

Statistical Treatment of Data

The researchers will treat the data they have gathered using acceptable statistical

procedures in order to assess and interpret it as objectively as possible. The collected

data will be evaluated to ascertain the postpartum depression literacy, health locus of

control, and maternal mental health assessment outcomes. The statistical tools to be

used are as follows: Frequency Distribution, Percentage, Weighted Mean, Pearson

Correlation, Independent T-test, and One-way ANOVA

Frequency Distribution. It will be used to figure out how many people fall into each

demographic profile classification and how many respondents answered a specific

question.

Percentage. It will be used to find out how many responded to each category in the

demographic profile of the respondents as well as the items provided in each

questionnaire. To get the percentage of a sample, dividing the total number by the

given number will be applied. This is used to assess the respondents profile by their

age, gender, status, address, socioeconomic status, number of Individuals who are

first-time moms.
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Weighted mean. This will be used to interpret data according to a point of scale that

was used to analyze the response. This will also be used to get the average ratings for

each scale of the respondents’ questionnaire.

Pearson Correlation. To ascertain whether there is a statistically significant link

between the contributing elements influencing postpartum depression literacy and

health locus of control when they are grouped according to their demographic profile.

This will also establish whether there is a causal link between the respondents'

postpartum depression literacy and health locus of control and the role on the

maternal mental health of the respondents.

Independent T-test. This will be used to analyze the mean and significant difference

between the levels of postpartum depression literacy, health locus of control, and

maternal mental health when grouped according to civil status

One-way ANNOVA. This will be used to test whether there is a significant

difference between the levels of postpartum depression literacy, health locus of

control, and maternal mental health when grouped according to age, educational

attainment, family income and number of households.

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