Introduction

Adolescent pregnancy is a major global public health concern, with significant impacts on maternal and child health outcomes. According to the United Nations’ Sustainable Development Goals (SDG) progress report, the global adolescent birth rate declined from 43.3 births per 1,000 women in 2019 to 41.3 in 2023 [1]. In Thailand, the adolescent birth rate declined from 31.3 births per 1,000 women in 2019 to 21.0 in 2022 [2]. This decline can be attributed to improved contraceptive support and increased accessibility to comprehensive sexual education and effective contraceptive methods. Despite the declining statistics of adolescent pregnancy, it remains a critical public health issue for Thailand and worldwide.

Adolescent pregnancy remains a significant health, social, and economic challenge with widespread implications for adolescent mothers’ well-being [3]. Many of these pregnancies are unplanned, with 65.6 percent of adolescent mothers reporting an absence of readiness for the demands of parenting [4]. The transition to motherhood involves substantial physical and psychological changes, often leading to role conflict and difficulties balancing developmental needs with parenting duties [5]. Peer influence and societal norms contribute to the perception of adolescent pregnancy as normal, with many teenage mothers feeling prepared and viewing their decisions positively. It has been shown that teenage mothers tend to have a more positive attitude toward pregnancy and childbirth than a negative one [6]. However, poverty, unemployment, and limited education further complicate their situation [7], contributing to increased parental stress and reduced competence [5,8].

Parental stress involves emotional responses to parenting demands, whereas parental competence reflects a mother’s positive attitude, knowledge, and skills in child-rearing. Among adolescent mothers, high stress and low competence often coexist. This imbalance not only intensifies the challenges of childcare but also undermines their confidence and ability to fulfill the maternal role. These challenges, particularly for adolescent mothers with limited life experience, underscore the critical need for effective interventions that can simultaneously mitigate stress and bolster their confidence and skills in parenting. In this context, the need for support and educational resources to reduce stress and enhance competence for adolescent postpartum women [9], nurses play a crucial role by adopting a supportive attitude and fostering open communication to address the unique needs of this population [10,11].

Evidence shows that maternal stress can be reduced by seeking guidance from family and friends, learning through clinical interactions, consulting with experienced peers, and accessing information online [12]. Therefore, effective care should focus on role adaptation through education, skills training, and counseling via online platforms. A review of the literature, along with observations from the researcher’s experience in postpartum care, reveals that adolescent mothers often receive care similar to that provided to adult mothers, using lectures and skill demonstrations. Adolescent mothers lack convenient and engaging methods to revisit parenting information, as educational materials are frequently presented in less accessible formats, such as manuals, brochures, or CDs. Furthermore, options for timely consultation are limited, presenting barriers to effective support [13–17].

Evidence from research on mobile health (mHealth) interventions has demonstrated promising outcomes in maternal childcare [18–20]. Adolescents increasingly rely on mobile applications and social media for health information, making these tools integral to modern care models [21,22]. Despite the recognized potential of mHealth interventions for maternal childcare and the high prevalence of smartphone use among adolescents, there remains a notable dearth of culturally appropriate, accessible, and engaging digital health interventions and classes specifically tailored for adolescent mothers in low- and middle-income countries (LMICs) like Thailand [23].

Traditional educational methods often fail to resonate with the digital native generation, leading to suboptimal engagement and knowledge retention. Furthermore, existing digital resources, where available, may not always address the unique psychosocial and developmental needs of adolescent mothers effectively. Recent local research highlights that Thai adolescent mothers perceive mobile applications as valuable and easily accessible sources of information [24–26], further affirming the potential of digital platforms in this context. Addressing this critical gap, our study aims to develop and evaluate a novel parental enhancing program leveraging a mobile application to provide targeted and accessible support.

To address this gap, the researchers developed a parental enhancing program with mobile application through ‘Line Official Account™ Parent Paplearn’. The platform delivers information through infographics, e-books, and videos, serving as readily accessible resources for review and offering a reliable platform for ongoing consultation. The program’s objective is to enhance parenting competence and reduce parenting stress, empowering adolescent mothers with the knowledge and confidence of motherhood.

Materials and methods

Data collection procedure

All participants were recruited between 14 February 2023 and 21 June 2024, with each participating in the study for a duration of six weeks. Data collection for the final participant was completed on 2 August 2024. The study was conducted sequentially, beginning with the control group, which was recruited from 14 February to 11 August 2023. The final follow-up for this group was completed on 22 September 2023. Subsequently, the intervention group was recruited from 26 August 2023 to 21 June 2024, with the final follow-up completed on 2 August 2024. Participants were matched based on gravidity, desire for children, marital status, experience in childcare, and childcare support. Matched participants were then assigned to the intervention group accordingly.

A sequential design was employed in this study, with participants recruited and assigned to groups in a time-ordered manner. This approach aimed to reduce the influence of external confounding variables that may vary over time, such as staffing changes or institutional policies. By separating group recruitment periods, the investigators sought to minimize overlap and potential contamination between groups. However, it is acknowledged that this design does not eliminate all sources of bias, and the lack of randomization remains a limitation.

The researcher collaborated with nurses to identify eligible participants who met the inclusion criteria and obtained permission to meet them after 24 hours postpartum. During these meetings, the researcher explained the study objectives, procedures, and participants’ rights. Informed consent forms were then obtained from the participants. Before the intervention, the researcher administered several assessment tools to collect baseline data, including the demographic characteristics questionnaire, the Edinburgh Postnatal Depression Scale [28], the Parenting Stress Index Fourth Edition Short Form [29], and the Parenting Sense of Competence Scale [30]. After that, all participants were scheduled for intervention, while the control group had standard postpartum care. This process will continue until the required sample size is reached, with 30 participants in each group.

At one week postpartum, participants in both the intervention and control groups completed the Edinburgh Postnatal Depression Scale [28] to screen for postpartum depression, ensuring that appropriate emotional and psychological support could be provided based on the findings. In cases where no baseline differences were detected between groups, the researchers planned to adjust for variable variance using appropriate statistical methods.

Then, the researcher sent weekly messages via a mobile application through the Line Official Account™ Parent Paplearn for a duration of five weeks. These messages were designed to address any questions or concerns regarding the challenges participants faced in child-rearing and parenting responsibilities after discharge, based on postpartum problem and advice records. At the conclusion of the study, six weeks postpartum, participants in both groups were administered the Parenting Stress Index Fourth Edition Short Form [29] and the Parenting Sense of Competence Scale [30]. Details of the study as shown in Fig 1.

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Fig 1. Flow diagram of study.

https://doi.org/10.1371/journal.pone.0324318.g001

Results

In the study 30 adolescent postpartum women in each group. In the intervention group, one participant had an APGAR score of 6 at one minute but a normal score at five minutes without complications; thus, all participants met the inclusion criteria. Tests of homogeneity revealed no significant differences between the intervention and control groups in all demographics and obstetric characteristics, except for the significant difference in EPDS at 1 week postpartum (2.63 ± 4.21 vs 6.57 ± 5.82, p < .05). The baseline imbalance in EPDS scores at 1 week was carefully addressed in the ANCOVA to control for baseline differences. The details are shown in Table 1.

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Table 1. Participant demographics and obstetric characteristics (N = 60).

https://doi.org/10.1371/journal.pone.0324318.t001

The paired t-test revealed a statistically significant difference in the intervention group after the parental enhancing program with mobile application through ‘Line Official Account™ Parent Paplearn’. Parental stress significantly decreased (p < .01), while parental competence increased (p < .001). In contrast, the control group showed no statistically significant differences in either parental stress (p > .05) or competence (p > .05), as detailed in Table 2.

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Table 2. Mean scores of parental stress and parental competence before and after the intervention within each group (N = 60).

https://doi.org/10.1371/journal.pone.0324318.t002

At 6-weeks postpartum, after controlling for baseline EPDS scores, the intervention group demonstrated significantly lower adjusted mean scores of parental stress (Adjusted Mean = 32.95, SE = 1.66) compared to the control group (Adjusted Mean = 42.15, SE = 1.66), F(1, 57) = 14.40, p < .001, with a large effect size (partial η² = 0.20, 95% CI for adjusted mean difference = [−14.05, −4.34). Similarly, adjusted mean scores of parental competence were significantly higher in the intervention group (Adjusted Mean = 69.64, SE = 1.35) than in the control group (Adjusted Mean = 63.79, SE = 1.35), F(1, 59) = 8.79, p < .01, with a moderate-large effect size (partial η² = 0.13, 95% CI for adjusted mean difference = 1.90, 9.80). These detailed results are presented in Table 3.

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Table 3. Adjusted parental stress and parental competence scores between intervention groups and control groups after intervention (6 weeks postpartum), when controlling for baseline EPDS score at 1 week postpartum (N = 60).

https://doi.org/10.1371/journal.pone.0324318.t003

Discussion

The findings of this quasi-experimental study indicated that participants in the intervention group reported lower parental stress and higher parental competence compared with the control group. While these results are promising and consistent with the research hypothesis, they should be interpreted cautiously as preliminary evidence of the program’s potential benefits, rather than conclusive proof of effectiveness. Future randomized controlled trials with larger and more diverse samples are needed to validate these findings.

The parental enhancing program with mobile application through ‘Line Official Account™ Parent Paplearn’, was developed based on Belsky’s “A Process Model of Competent Parental Functioning” [27]. The program was designed to address contextual sources of stress and support, with nurses providing adolescent mothers with childcare knowledge, skill training, and ongoing support through the Line platform. The observed improvements are consistent with previous evidence. For instance, the study by Léniz-Maturana et al. [31] demonstrated that maternal role confidence is associated with reduced stress levels. Similarly, Flaherty et al. [32] found that parental competence and perceived social support play a critical role in moderating stress levels. These converging findings suggest that structured support may assist adolescent mothers during their transition to parenthood.

The findings are consistent with previous studies on parental programs that demonstrated improvements in maternal outcomes. For example, Saleh et al. [17] reported that parenting coaching interventions for teenage mothers reduced stress and enhanced knowledge, attitudes, behaviors, and self-efficacy. Similarly, Kordi et al. [14] emphasized the importance of maternal role training in fostering role fulfillment and satisfaction, while Moudi et al. [15] found that even brief face-to-face parenting skills training significantly improved perceived self-efficacy and mother–infant bonding. In addition, Polgaya et al. [16] highlighted the benefits of continuous support, including repeated skills training, regular assessments, and follow-up consultations, can strengthen maternal attitudes and performance. While the present program incorporates ongoing support through the Line platform, the extent to which it replicates or exceeds the benefits of these interventions requires further investigation.

This study also contributes to the growing literature on mobile technology–based interventions for parenting support. Prior research has demonstrated the potential of such approaches. Shorey et al. [19] demonstrated that telephone-based interventions and mobile health app follow-up enhance parenting self-efficacy, bonding, perceived social support, and satisfaction, while also reducing postnatal depression. Chua et al. [18] indicated that mobile applications improved parenting self-efficacy, anxiety, depression, social support, and bonding. Additionally, Nuampa et al. [33] indicated that adolescent mothers perceive mobile applications as accessible sources, with nurses acknowledging that these applications can reduce their workload, improve preparedness, and enhance the standard of support provided. The current findings suggest that integrating mobile technology may improve accessibility and engagement for adolescent mothers, though further studies are needed to confirm this modernizing health promotion.

Conclusion

The parental enhancing program with a mobile application demonstrates promise in supporting postpartum adolescent mothers by reducing parental stress and improving parental competence. However, as this study used a quasi-experimental design, future studies employing randomized controlled designs are warranted to confirm these findings and strengthen the evidence base for practice.

Supporting information

Acknowledgments

The authors would like to thank all the participants who contributed to this study, and Assoc. Prof. Dr. Nittaya Sinsuksai for suggesting the study.