Effectiveness of a psycho-educational intervention to prevent postpartum parental distress and enhance infant well-being: study protocol of a randomized controlled trial

Supporting Disclosure of Unmet Mental Health Needs among Parents of Critically Ill Infants

OBJECTIVE

To characterize (1) the prevalence of mental health discussion and (2) facilitators of and barriers to parent disclosure of mental health needs to clinicians.

STUDY DESIGN

Parents of infants with neurologic conditions in neonatal and pediatric intensive care units participated in a longitudinal decision-making study from 2018 through 2020. Parents completed semi-structured interviews upon enrollment, within 1 week after a conference with providers, at discharge, and 6 months post-discharge. We used a conventional content analysis approach and NVIVO 12 to analyze data related to mental health.

RESULTS

We enrolled 61 parents (n = 40 mothers, n = 21 fathers) of 40 infants with neurologic conditions in the intensive care unit. In total, 123 interviews were conducted with 52 of these parents (n = 37 mothers, n = 15 fathers). Over two-thirds of parents (n = 35/52, 67%) discussed their mental health in a total of 61 interviews. We identified two key domains when approaching the data through the lens of mental health: (1) self-reported barriers to communicating mental health needs: parents shared uncertainty about the presence or benefit of support, a perceived lack of mental health resources and emotional support, and concerns about trust; (2) self-reported facilitators and benefits of communicating mental health needs: parents described the value of supportive team members, connecting to peer support, and speaking to a mental health professional or neutral third party.

CONCLUSIONS

Parents of critically ill infants are at high risk of unmet mental health needs. Our results highlight modifiable barriers and actionable facilitators to inform interventions to improve mental health support for parents of critically ill infants.

Maternal post-natal depressive symptoms at 2 months: Effects of French antenatal preventive measures in the E.L.F.E. cohort

BACKGROUND

Given the high incidence of perinatal maternal depression, implementation of preventive actions is crucial. In France, two prenatal preventive measures are available to the general population: early prenatal interview (EPI) and antenatal classes (ANC).

OBJECTIVE

To explore the independent associations between EPI and / or ANC and maternal depressive symptoms at 2 months postpartum.

METHOD

We used data from the Etude Longitudinale Française depuis l'Enfance (ELFE), a French national representative cohort of children and their parents, followed-up from birth to early adulthood. Data concerning characteristics were collected from the mothers during the maternity stay and between 6/8 weeks' post-partum. The level of depressive symptoms was scored by the French version of the Edinburgh Postnatal Depression Scale (EPDS) between 6/8 weeks' post-partum. We considered EPDS score ≥10 indicative of postnatal psychological distress (PPD) and EPDS ≥12 for postnatal depressive symptoms (PNDS). After data imputation, multivariate logistic regression analysis was performed.

RESULTS

Among the 16,411 mothers included in our sample, 26% benefited both from EPI and ANC, 31.1 % of ANC, 7.7% of an EPI and 35% of neither; 20,1% presented PPD and 12,1% PNDS. The likelihood of presenting PPD was significantly higher in mothers who had neither had EPI nor ANC (OR = 1.15 (95% CI : 1.01-1.30). There was no association between receiving or not an EPI and/or ANC and presenting PNDS.

CONCLUSIONS

Antenatal preventive measures may be helpful to prevent PPD at 2 months' post- partum, while PNDS do not seem to be influenced by these actions.

The role of mothers' self-compassion on mother-infant bonding during the COVID-19 pandemic: A longitudinal study exploring the mediating role of mindful parenting and parenting stress in the postpartum period

The current COVID-19 pandemic is a challenging time for postpartum mothers, and associated challenges may have a negative impact on their parenting and, consequently, on mother-infant bonding. This study aimed to longitudinally explore whether mothers' self-compassion was associated with mother-infant bonding and whether this relationship was mediated by mindful parenting and parenting stress. A total of 125 Portuguese mothers of infants aged between 0 and 12 months completed an online survey at two assessment points during the first wave of the COVID-19 pandemic (T1: April-May 2020; T2: June-July 2020). The survey included several questionnaires assessing sociodemographic, clinical, and COVID-19 information; self-compassion; mindful parenting; parenting stress; and mother-infant bonding. Mothers presented significantly higher levels of self-compassion, less impaired mother-infant bonding, and lower levels of depressive symptoms at T2 than T1. Higher levels of self-compassion at T1 predicted less impaired mother-infant bonding at T2, and this relationship was mediated by higher levels of mindful parenting and lower levels of parenting stress (both assessed at T1). These results highlight the relevance of mothers' self-compassion to establishing mother-infant bonding in the postpartum period, particularly during the COVID-19 pandemic, and the important role of mindful parenting and parenting stress in determining this relationship.

NURSING INTERVENTIONS TO PROMOTE CHILD DEVELOPMENT THROUGH BRONFENBRENNER'S BIOECOLOGICAL THEORY

ABSTRACT Objective: to analyze the benefits and limitations of nursing interventions for the promotion of child development, according to the Bioecological Theory of Human Development, by Bronfenbrenner. Method: an integrative review, from the databases PubMed, Lilacs, CINAHL, Web of Science and Scopus, using the descriptors: "child development" AND "nurses" OR "nursing". No time limit was set for publications. The search was perfomed in September 2019 and update in March 2020. Results: 24 studies were selected for the final sample. The predominant type of study design was the clinical trial (60%). The home visit was the most used strategy (60%). Seven main themes emerged from the outcomes of the interventions: the child, maternal health, parenting skills, relationship between nurse and mother/father, use of social benefits, professional practice, and family violence. The process component was present in all studies, portraying the relevance of proximal interactions in the home environment. Only two interventions had no impact on any outcome. Conclusion: nursing interventions showed benefits in all outcomes, especially in outcomes related to children and parental practices, and improved situations of interaction between caregivers and children, reducing punitive practices and violence against children. It is essential to consider the bioecological perspective, so that nursing interventions, in promoting child development, are more effective.

Screening and Support for Infant Safe Sleep: A Quality Improvement Project

Infant sleep is an anticipatory guidance topic that is discussed frequently at well child checks, starting with the newborn visit. It is challenging to cover a large amount of information in a short visit. This article describes a quality improvement project implemented at a pediatric primary care practice to improve screening for infant safe sleep. The screening form was updated to include questions from the Pregnancy Risk Assessment Monitoring System (PRAMS). This updated screening better captured actual sleeping practices, allowing for more targeted education.

Effectiveness of a psycho-educational intervention for expecting parents to prevent postpartum parenting stress, depression and anxiety: a randomized controlled trial

BACKGROUND

The first months postpartum can be challenging for parents, leading to elevated symptoms of parenting stress, depression and anxiety. In turn, distressed parents are at higher risk for providing suboptimal quality of caregiving. As psychoeducational interventions can be effective in reducing psychological distress, the goal of this randomized controlled trial was to examine the effectiveness of low-intensity universal psychoeducational program to prevent postpartum parenting stress, and to enhance parental well-being and caregiving quality.

METHOD

Between 26 and 34 weeks of pregnancy, 138 pregnant women and 96 partners were randomized to the intervention or a waitlist control group. The intervention consisted of a booklet, a video, a home visit, and a telephone call. Information was provided on (1) sensitive responsiveness, adapting to the parental role, and attending to own needs; (2) crying patterns; (3) feeding (arrangements); and (4) sleeping (arrangements). The primary outcome was parenting stress postpartum. Secondary outcomes were additional measures of distress (depression and anxiety), parental well-being, and caregiving quality.

RESULTS

Both groups showed a rise in distress after birth. No between-group differences were observed on parenting stress, nor on the secondary outcomes. The intervention was rated as useful and of added value by the parents.

CONCLUSION

This study offered no evidence that our universal prevention program was effective in decreasing parental distress or in increasing caregiving quality. However, parents found aspects of the intervention useful. More research is needed, including a longer period of follow-up as well as observational measures of parents' responsiveness.

TRIAL REGISTRATION

This trial has been registered on 15 September 2016 in the Netherlands National Trial Register, ID: NTR6065, https://www.trialregister.nl/trial/5782 .

Tracker-Based Personal Advice to Support the Baby's Healthy Development in a Novel Parenting App: Data-Driven Innovation

BACKGROUND

The current generation of millennial parents prefers digital communications and makes use of apps on a daily basis to find information about child-rearing topics. Given this, an increasing amount of parenting apps have become available. These apps also allow parents to track their baby's development with increasing completeness and precision. The large amounts of data collected in this process provide ample opportunity for data-driven innovation (DDI). Subsequently, apps are increasingly personalized by offering information that is based on the data tracked in the app. In line with this, Philips Avent has developed the uGrow app, a medical-grade app dedicated to new parents for tracking their baby's development. Through so-called insights, the uGrow app seeks to provide a data-driven solution by offering parents personal advice that is sourced from user-tracked behavioral and contextual data.

OBJECTIVE

The aim of this study was twofold. First, it aimed to give a description of the development process of the insights for the uGrow app. Second, it aimed to present results from a study about parents' experiences with the insights.

METHODS

The development process comprised 3 phases: a formative phase, development phase, and summative phase. In the formative phase, 3 substudies were executed in series to understand and identify parents' and health care professionals' (HCPs) needs for insights, using qualitative and quantitative methods. After the formative phase, insights were created during the development phase. Subsequently, in the summative phase, these insights were validated against parents' experience using a quantitative approach.

RESULTS

As part of the formative phase, parents indicated having a need for smart information based on a data analysis of the data they track in an app. HCPs supported the general concept of insights for the uGrow app, although specific types of insights were considered irrelevant or even risky. After implementing a preliminary set of insights in a prototype version of the uGrow app and testing it with parents, the majority of parents (87%) reported being satisfied with the insights. From these outcomes, a total of 89 insights were implemented in a final version of the uGrow app. In the summative phase, the majority of parents reported experiencing these insights as reassuring and useful (94%), as adding enjoyment (85%), and as motivating for continuing tracking for a longer period of time (77%).

CONCLUSIONS

Parents experienced the insights in the uGrow app as useful and reassuring and as adding enjoyment to their use of the uGrow app and tracking their baby's development. The insights development process we followed showed how the quality of insights can be guaranteed by ensuring that insights are relevant, appropriate, and evidence based. In this way, insights are an example of meaningful DDI.