Assessing Neighborhood Characteristics and Their Association with Prenatal Maternal Stress, Depressive Symptoms, and Well-Being in Eight Culturally Diverse Cities: A Cross-Sectional Study

Despite growing evidence on the influence of neighborhood characteristics on maternal well-being, there is a critical gap in the availability of validated instruments for measuring these constructs across different cultural settings. Existing neighborhood-related scales often lack cross-cultural validation, limiting their applicability in low- and middle-income countries. Understanding the impact of neighborhood characteristics is crucial given its multigenerational impact. We used data from the Evidence for Better Lives dataset to assess the conceptual and measurement equivalence of the community scales of neighborhood cohesion, intergenerational closure, and neighborhood and social disorder, testing for measurement invariance across eight low- and middle-income countries. Secondly, we examined patterns of associations with prenatal maternal stress, well-being, and depressive symptoms through the use of nomological networks. We found that the conceptual and measurement equivalence of the neighborhood domains were comparable across the eight studied countries. Additionally, our results suggest that higher levels of neighborhood and social disorder and lower levels of cohesion and intergenerational closure in the community are associated with adverse maternal outcomes across the included sites. The results of this study stress the importance of exploring the community context when assessing maternal well-being and supports the need to advocate for community-based interventions that promote safer physical and social environments within maternal programs and urban planning.