Assessing maternal postnatal depression, bonding and practices in mothers of preterm and low birth weight infants in Indonesia

Preterm and low birth weight (LBW) infants face elevated health risks and require specialized care. Maternal postnatal depression (PND) and the quality of mother-infant bonding are critical determinants of caregiving practices and neonatal outcomes. However, practical, validated methods for assessing these constructs remain limited within the Indonesian clinical and research context. This study presents a protocol for assessing PND and bonding among mothers of preterm and LBW infants in Indonesia. A community-based cross-sectional design was implemented across three districts in West Sumatra. A total of 255 mothers of preterm or LBW infants were selected using multistage random sampling. PND was measured using the validated 10-item Edinburgh Postnatal Depression Scale (EPDS), with a cut-off score of 12/13 indicating significant depression. Mother-infant bonding was assessed with a culturally adapted 10-item bonding questionnaire. Maternal practices were evaluated using an 8-item checklist covering breastfeeding, Kangaroo Mother Care, immunization, and use of maternal-child health records. Instruments underwent expert review, translation and back-translation, and pilot testing to ensure validity and reliability (Cronbach's α: 0.75-0.90). The primary endpoints included the identification of maternal PND, the quality of bonding, and maternal adherence to essential infant care practices. Data collection followed a standardized interviewer protocol, and data were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). The protocol proved feasible in community settings and provides a replicable method to evaluate maternal PND and bonding, with potential to inform interventions that enhance neonatal care outcomes.