Supporting parents of premature infants transitioning from the NICU to home: A pilot randomized control trial of a smartphone application

“Therefore, the Parenting Sense of Competence Scale (PSOC;α=0.807), a well-validated 17-item scale created to assess satisfaction of parenting and parental self-efficacy in a variety of populations (Johnston and Mash, 1989; Gilmore and Cuskelly, 2009).”

“While the admission experiences of parents of VLBW infants have been studied (Singer and Ryff, 1999; Singer et al., 1999; Singer et al., 2003; Singer et al., 2010), the needs of parents transitioning home has received less attention (Bruder and Cole, 1991; Fowlie and McHaffie, 2004).”

“Therefore, the Parenting Sense of Competence Scale (PSOC;α=0.807), a well-validated 17-item scale created to assess satisfaction of parenting and parental self-efficacy in a variety of populations (Johnston and Mash, 1989; Gilmore and Cuskelly, 2009).”

“Debate surrounds mhealth initiatives in part due to regulatory concerns (Cortez et al., 2014) and a lack of scientific evidence for improved care, outcomes, or cost savings, especially around newborn health (Agarwal and Labrique, 2014).”

“This is an open access article under hospitalization in the first year (Escobar et al., 1999; Underwood et al., 2007).”

“While the admission experiences of parents of VLBW infants have been studied (Singer and Ryff, 1999; Singer et al., 1999; Singer et al., 2003; Singer et al., 2010), the needs of parents transitioning home has received less attention (Bruder and Cole, 1991; Fowlie and McHaffie, 2004).”

“While the admission experiences of parents of VLBW infants have been studied (Singer and Ryff, 1999; Singer et al., 1999; Singer et al., 2003; Singer et al., 2010), the needs of parents transitioning home has received less attention (Bruder and Cole, 1991; Fowlie and McHaffie, 2004).”

“This is an open access article under hospitalization in the first year (Escobar et al., 1999; Underwood et al., 2007).”

“To date, several reports of specific NICU discharge programs exist in the literature (Smith et al., 2013; Forsythe and Willis, 2008), but to our knowledge no studies have tested an intervention using technology and employing a randomized trial approach with specific outcomes focusing on primary…”

“…policy statement on the importance of involving parents from admission through discharge (Committee on Fetus and Newborn, 2008), parents desire more information and frequently report feeling unprepared for discharge (Sneath, 2009; De Rouck and Leys, 2009; Brazy et al., 2001; Smith et al., 2012).”

“While the admission experiences of parents of VLBW infants have been studied (Singer and Ryff, 1999; Singer et al., 1999; Singer et al., 2003; Singer et al., 2010), the needs of parents transitioning home has received less attention (Bruder and Cole, 1991; Fowlie and McHaffie, 2004).”

“Low parenting efficacy has also been associated with parental depression (Gauthier et al., 2010; Demontigny et al., 2013) and children with overly concerned parents due to a real or perceived vulnerabilitymay have restricted social development and behavioral problems (Pearson and Boyce, 2004).”

“…policy statement on the importance of involving parents from admission through discharge (Committee on Fetus and Newborn, 2008), parents desire more information and frequently report feeling unprepared for discharge (Sneath, 2009; De Rouck and Leys, 2009; Brazy et al., 2001; Smith et al., 2012).”

“While the admission experiences of parents of VLBW infants have been studied (Singer and Ryff, 1999; Singer et al., 1999; Singer et al., 2003; Singer et al., 2010), the needs of parents transitioning home has received less attention (Bruder and Cole, 1991; Fowlie and McHaffie, 2004).”

“NICU-2-Homewas designed with a theoretical underpinning using Bandura's Self-Efficacy Theory (Bandura, 1995) and was developed with Motorola Mobility specifically for this project based on findings of the needs of VLBW parents who had transitioned home (Garfield et al., 2014).”

“NICU-2-Homewas designed with a theoretical underpinning using Bandura's Self-Efficacy Theory (Bandura, 1995) and was developed with Motorola Mobility specifically for this project based on findings of the needs of VLBW parents who had transitioned home (Garfield et al., 2014).”

“Low parenting efficacy has also been associated with parental depression (Gauthier et al., 2010; Demontigny et al., 2013) and children with overly concerned parents due to a real or perceived vulnerabilitymay have restricted social development and behavioral problems (Pearson and Boyce, 2004).”

“Low parenting efficacy has also been associated with parental depression (Gauthier et al., 2010; Demontigny et al., 2013) and children with overly concerned parents due to a real or perceived vulnerabilitymay have restricted social development and behavioral problems (Pearson and Boyce, 2004).”

“NICU parents are already using the internet as a resource (De Rouck and Leys, 2011), however, with most agreeing there is useful information available on premature infants (Gabbert et al., 2013).”

“VLBW infants' survival becomes directly proportional to gestational age and birth weight (Stephens et al., 2010), with parents providing all care after successful discharge.”

“NICU parents are already using the internet as a resource (De Rouck and Leys, 2011), however, with most agreeing there is useful information available on premature infants (Gabbert et al., 2013).”

“While the admission experiences of parents of VLBW infants have been studied (Singer and Ryff, 1999; Singer et al., 1999; Singer et al., 2003; Singer et al., 2010), the needs of parents transitioning home has received less attention (Bruder and Cole, 1991; Fowlie and McHaffie, 2004).”

“To date, several reports of specific NICU discharge programs exist in the literature (Smith et al., 2013; Forsythe and Willis, 2008), but to our knowledge no studies have tested an intervention using technology and employing a randomized trial approach with specific outcomes focusing on primary…”

“Of the 11 studies found, eight described the design and evaluation of a mobile application for caregivers [3,9,17,20,21,23,24,27], whereas one evaluated a previously designed mobile application [22].”

“This is consistent with other studies that have found parents who received education and communication interventions while in the NICU had shorter length of stays than those who did not, due to improved confidence and knowledge in caring for their infant.(47,48) Further studies on eHealth interventions should consider…”

“Recruitment occurred through flyers and posters at hospital-based parenting education, antenatal clinics, and ultrasound services and at postnatal services such as Neonatal Intensive Care Unit (NICU) and home visits by Child and Family Health Nurses.”

“A randomised study using a smartphone application showed promising results in increasing the sense of parenting competence (self-efficacy) during early in-home care.(18) Further studies are needed to determine whether the use of telecommunication supports mothers to continue breastfeeding and increases mother-infant i…”

“…problems, Enebrink et al., 2012; or anxiety, Morgan et al., 2017; and parents with mental health problems, Jones et al., 2014), outcomes (e.g., parent and child mental health; Thongseiratch et al., 2020), and delivery modes (e.g., websites, Enebrink et al., 2012; apps, Garfield et al., 2016).”

“These tools are mainly used to provide information such as neonatal information [32], parental education [17,32] and ad hoc communication in the NICU [19].”

“Study design and participants This report is a prospective cohort analysis of data collected for a randomized controlled trial using a smartphone technology application designed to support parents of VLBW NICU infants during the transition to home.(23) The sample size from the original data collection was computed to…”

“Consistent with the results of other researchers (Garfield et al., 2016; Granero- Molina et al., 2019), we found that the parents of preterm infants reported negative emotions and sleep disorders.”

“…in perinatal care [70]; smoking cessation and mothers’secondhand smoking exposure [96]; parenting self-efficacy and satisfaction [72,74,104]; breastfeeding self-efficacy, knowledge, and infant feeding attitudes [89,92]; parental depression and child sadness [75]; and parental anxiety,…”

“…access to on- demand information and resources that were provided in many formats, instructional videos, links to go deeper on topics, and pages they could ‘favourite’ for reading later (Danbjørg et al., 2015; Garfield et al., 2016; Isetta et al., 2013; Shorey et al., 2018; Strand et al., 2021).”

“Mobile applications for facilitating the transition from the NICU to home have already proven to be a promising strategy for improving parental preparation for discharge [15], yet the availability of apps specifically created with consideration for the unique desires and needs of caregivers and providers at safety-net…”

“More promising results were found when using novel technologies such as smartphone applications designed around the needs of VP parents for the NICU and discharge period [19-22].”

“The PSOC is a 17-item measure that assesses change in the parent’s sense of competence in caring for their infant (Gibaud-Wallston & Wandersman 1978; Garfield et al., 2016).”

“Parents of neonates undergoing enterostomy have different concerns as they were transferred from the NICU to home (Garfield et al., 2016; Li et al., 2019).”

“They face risks of long-term developmental problems (Kilpatrick et al., 2017) and high costs after NICU discharge, which are often associated with medical treatment, hospital readmissions, and outpatient visits (Garfield et al., 2016).”

“These are factors that may have an impact on the mother’s learning and infant readiness for the discharge and transition from hospital to home(27-29).”

“The use of application resulted in an improved general level of parenting self-efficacy in the mothers of the intervention (7%) compared to the control group (less than 1%) (30).”

“, 2012); describing the development, implementation and evaluation of discharge programs or interventions (Brodsgaard et al., 2015; Garfield et al., 2016; ToralLopez et al., 2016), and documenting parental perspectives, experiences, or emotional responses related to discharge and transition-home both qualitatively and…”

“Improving parents’ MH is shown to allow greater parent-child bonding [32] and more sensitive responsiveness of mothers to their infants’ cues [33].”

“…control intervention based on a mobile healthcare application on the growth and development of premature infants [24], a study on the development of a smartphone education app for premature infants’ parents [25,26], and a study on an intervention program for premature infants’ parents [27–29].”

“Garfield et al.(33) designed a smartphone application called NICU-2-Home, in order to make the transition from hospital to home easier for parents with prematurely born infants.”

“While there are some online modalities (Bahmanpour et al., 2023; Benzies et al., 2020; Collette et al., 2023; Garfield et al., 2016; Hägi-Pedersen et al., 2022; Huang et al., 2024), the primary delivery method for these interventions is in-person sessions, ranging from three sessions (Bernard et…”

“Therefore, additional supports to optimize outcomes during this period can have a large impact during the early foundational time period for both parent and infant (DiBari & Rouse, 2023; Garfield et al., 2016).”

“18 NICU-2-Home smartphone applications 19 and Estrellita are information technology with special designations to distinguish them from other existing products.”

“In addition, practically all young parents now own a smartphone and have considerable skills in using the device [14-16].”

“Smartphones are accessible and practical to be used by caregivers during childcare (Gar fi eld et al., 2016), allowing quick access to virtual information.”

“A study on the NICU2HOME app (CF Garfield) [31,36] showed that parental self-efficacy and satisfaction with care improved in parents of preterm infants.”

“15 Raines, in a study in 2017, prepared the parents of babies to be discharged from the NICU by simulation method and determined that when parents perform their own care practices with the simulation method, their feelings of trust increase.”

“Two studies 12 , 13 showed that the length of stay in patients in the experimental group was slightly shorter than that in the control group, but the difference was not significant, with the number of days in the study conducted by Gray et al 12 (68.5 ± 28.3 vs. 70.6 ± 35.6 days; P ≥ .05) and…”

“Furthermore, the work of Garfield et al [23] with infants with very low birth weight showed that parents who received an app-based support program improved parental self-efficacy and discharge preparedness compared with the control group.”

“Mothers also use smartphone apps for information, interaction, medical tools, and social media [15,16].”

“Dazu gehören auch Reminder- und Kontrollfunktion für Aufgaben, die andere übernehmen (wie z. B. in Brown et al. 2016 oder Garfield et al. 2016).”

“This component was explicitly reported in eight trials (Colditz et al., 2019; Garfield et al., 2016; Gund et al., 2013; Huang et al., 2024; Mobbs et al., 2022; Phagdol et al., 2023; Robinson et al., 2016; Yan et al., 2022), and was commonly supported by video-based modelling, guided parent-infant…”

“…and specific to maternal stress responses in the NICU setting; [29, 50] and (2) The Parenting Sense of Competence Scale (PSOC), a well-validated measure created to assess satisfaction of parenting and parental self-efficacy in a variety of populations, including parents of preterm infants [51].”

“Recently, technological advances, such as eHealth tools, have been explored to strengthen parental care and facilitate remote monitoring of these newborns, which may represent a promising strategy for regions with physical and logistical barriers [21].”

“These approaches have been associated with improvements in parental engagement, perceived support, and self-efficacy during the transition from hospital to home (Garfield et al., 2016; Gund et al., 2013; Nayak et al., 2019; Hägi-Pedersen et al., 2022).”

“The studies were conducted across different regions of the world: one in America (The United States) [28], two in Asia (Singapore) [29,31] and one study in Oceania (Australia) [30].”

“Garfield et al. (2016)16 RCT 90 parents VLBW IG: 46 CG: 44 NICU-2-Home smartphone application a. Parents’ selfefficacy b. Ready to go home c. Length of stay (LOS) A smartphone application used by parents of VLBW infants during the transition home from the NICU can improve parenting self-efficacy,…”