Protocol for implementation of an evidence based parentally administered intervention for preterm infants
Abstract Background Multi-sensory behavioral interventions for preterm infants have the potential to accelerate feeding, growth, and optimize developmental trajectories and increase parents’ interactive engagement with their infants. However, few neonatal intensive care units (NICUs) provide evidenc...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-03-01
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| Series: | BMC Pediatrics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12887-021-02596-1 |
| _version_ | 1818415564997001216 |
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| author | Rosemary White-Traut Debra Brandon Karen Kavanaugh Karen Gralton Wei Pan Evan R. Myers Bree Andrews Michael Msall Kathleen F. Norr |
| author_facet | Rosemary White-Traut Debra Brandon Karen Kavanaugh Karen Gralton Wei Pan Evan R. Myers Bree Andrews Michael Msall Kathleen F. Norr |
| author_sort | Rosemary White-Traut |
| collection | DOAJ |
| description | Abstract Background Multi-sensory behavioral interventions for preterm infants have the potential to accelerate feeding, growth, and optimize developmental trajectories and increase parents’ interactive engagement with their infants. However, few neonatal intensive care units (NICUs) provide evidence-based standardized early behavioral interventions as routine care. Lack of implementation is a major gap between research and clinical practice. H-HOPE, is a standardized behavioral intervention with an infant- directed component (Massage+) and a parent-directed component (four participatory guidance sessions that focus on preterm infants’ behaviors and appropriate responses). H-HOPE has well documented efficacy. The purpose of this implementation study is to establish H-HOPE as the standard of care in 5 NICUs. Methods The study employs a Type 3 Hybrid design to simultaneously examine the implementation process and effectiveness in five NICUs. To stagger implementation across the clinical sites, we use an incomplete stepped wedge design. The five participating NICUs were purposively selected to represent different acuity levels, number of beds, locations and populations served. Our implementation strategy integrates our experience conducting H-HOPE and a well-established implementation model, the Consolidated Framework for Implementation Research (CFIR). The CFIR identifies influences (facilitators and barriers) that affect successful implementation within five domains: intervention characteristics, outer setting (the hospital and external events and stakeholders), inner setting (NICU), implementers’ individual characteristics, and the implementation process. NICUs will use the CFIR process, which includes three phases: Planning and Engaging, Executing, and Reflecting and Evaluating. Because sustaining is a critical goal of implementation, we modify the CFIR implementation process by adding a final phase of Sustaining. Discussion This study builds on the CFIR, adding Sustaining H-HOPE to observe what happens when sites begin to maintain implementation without outside support, and extends its use to the NICU acute care setting. Our mixed methods analysis systematically identifies key facilitators and barriers of implementation success and effectiveness across the five domains of the CFIR. Long term benefits have not yet been studied but may include substantial health and developmental outcomes for infants, more optimal parent-child relationships, reduced stress and costs for families, and substantial indirect societal benefits including reduced health care and special education costs. Trial registration ClinicalTrials.gov registration number NCT04555590 , Registered on 8/19/2020. |
| first_indexed | 2024-12-14T11:37:00Z |
| format | Article |
| id | doaj.art-6817fc8abe6e43d3a65e182d30036012 |
| institution | Directory Open Access Journal |
| issn | 1471-2431 |
| language | English |
| last_indexed | 2024-12-14T11:37:00Z |
| publishDate | 2021-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pediatrics |
| spelling | doaj.art-6817fc8abe6e43d3a65e182d300360122022-12-21T23:02:59ZengBMCBMC Pediatrics1471-24312021-03-0121111310.1186/s12887-021-02596-1Protocol for implementation of an evidence based parentally administered intervention for preterm infantsRosemary White-Traut0Debra Brandon1Karen Kavanaugh2Karen Gralton3Wei Pan4Evan R. Myers5Bree Andrews6Michael Msall7Kathleen F. Norr8Department of Nursing Research and Evidence-Based Practice, Children’s WisconsinSchool of Nursing, Duke UniversityDepartment of Nursing Research and Evidence-Based Practice, Children’s WisconsinDepartment of Nursing Research and Evidence-Based Practice, Children’s WisconsinSchool of Nursing and Department of Population Health Sciences, Duke University School of MedicineDivision of Women’s Community and Population Health, Department of Obstetrics & Gynecology, Duke University School of Medicine, Duke UniversityCollege of Medicine, Department of Pediatrics, University of ChicagoCollege of Medicine, Department of Pediatrics, University of ChicagoDepartment of Nursing Research and Evidence-Based Practice, Children’s WisconsinAbstract Background Multi-sensory behavioral interventions for preterm infants have the potential to accelerate feeding, growth, and optimize developmental trajectories and increase parents’ interactive engagement with their infants. However, few neonatal intensive care units (NICUs) provide evidence-based standardized early behavioral interventions as routine care. Lack of implementation is a major gap between research and clinical practice. H-HOPE, is a standardized behavioral intervention with an infant- directed component (Massage+) and a parent-directed component (four participatory guidance sessions that focus on preterm infants’ behaviors and appropriate responses). H-HOPE has well documented efficacy. The purpose of this implementation study is to establish H-HOPE as the standard of care in 5 NICUs. Methods The study employs a Type 3 Hybrid design to simultaneously examine the implementation process and effectiveness in five NICUs. To stagger implementation across the clinical sites, we use an incomplete stepped wedge design. The five participating NICUs were purposively selected to represent different acuity levels, number of beds, locations and populations served. Our implementation strategy integrates our experience conducting H-HOPE and a well-established implementation model, the Consolidated Framework for Implementation Research (CFIR). The CFIR identifies influences (facilitators and barriers) that affect successful implementation within five domains: intervention characteristics, outer setting (the hospital and external events and stakeholders), inner setting (NICU), implementers’ individual characteristics, and the implementation process. NICUs will use the CFIR process, which includes three phases: Planning and Engaging, Executing, and Reflecting and Evaluating. Because sustaining is a critical goal of implementation, we modify the CFIR implementation process by adding a final phase of Sustaining. Discussion This study builds on the CFIR, adding Sustaining H-HOPE to observe what happens when sites begin to maintain implementation without outside support, and extends its use to the NICU acute care setting. Our mixed methods analysis systematically identifies key facilitators and barriers of implementation success and effectiveness across the five domains of the CFIR. Long term benefits have not yet been studied but may include substantial health and developmental outcomes for infants, more optimal parent-child relationships, reduced stress and costs for families, and substantial indirect societal benefits including reduced health care and special education costs. Trial registration ClinicalTrials.gov registration number NCT04555590 , Registered on 8/19/2020.https://doi.org/10.1186/s12887-021-02596-1Preterm infantBehavioral interventionParent engagementNICU implementationCFIR |
| spellingShingle | Rosemary White-Traut Debra Brandon Karen Kavanaugh Karen Gralton Wei Pan Evan R. Myers Bree Andrews Michael Msall Kathleen F. Norr Protocol for implementation of an evidence based parentally administered intervention for preterm infants BMC Pediatrics Preterm infant Behavioral intervention Parent engagement NICU implementation CFIR |
| title | Protocol for implementation of an evidence based parentally administered intervention for preterm infants |
| title_full | Protocol for implementation of an evidence based parentally administered intervention for preterm infants |
| title_fullStr | Protocol for implementation of an evidence based parentally administered intervention for preterm infants |
| title_full_unstemmed | Protocol for implementation of an evidence based parentally administered intervention for preterm infants |
| title_short | Protocol for implementation of an evidence based parentally administered intervention for preterm infants |
| title_sort | protocol for implementation of an evidence based parentally administered intervention for preterm infants |
| topic | Preterm infant Behavioral intervention Parent engagement NICU implementation CFIR |
| url | https://doi.org/10.1186/s12887-021-02596-1 |
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