Monday, March 02, 2009

Good News: SBS Prevention Education, Vancouver

An encouraging report on SBS education for new parents: a study in the March edition of the Canadian Medical Association Journal found the PURPLE campaign materials increased parental awareness of crying behaviors and "walk aways."
Educational materials for new mothers may prevent shaken baby syndrome, CMAJ study shows (Eureka)

Educational materials on how to deal with crying newborns lead to increased knowledge about infant crying and behaviours that are important to preventing shaken baby syndrome, found two new studies being published online March 2 in
CMAJ and Pediatrics.

The CMAJ study involved 1279 mothers in a randomized controlled trial in Greater Vancouver, BC, Canada. Half were provided materials from the Period of PURPLE Crying program and the other half received materials with parent safety tips and sleeping position guidelines. Materials were delivered by public health nurses during routine visits within 2 weeks of birth.

Mothers who received the PURPLE materials scored 5% higher in knowledge about crying compared with mothers who received the control materials. They walked away 1.7 times more frequently from inconsolable infant crying, and were 13% more likely to warn about the danger of shaking infants and to share advice about walking away if frustrated.

The PURPLE materials indicate that the following behaviours are normal but frustrating for parents and suggest coping mechanisms:

Peak pattern, where crying increases, peaks during the second month, then declines
Unexpected timing of prolonged crying
Resistance to soothing
Pain-like look on the face
Long crying bouts
Evening and late afternoon clustering
To help caregivers deal with a crying infant, PURPLE suggests:
* calming responses (carry, comfort, walk and talk)
* put the baby down in a safe place, then walk away to calm yourself
* NEVER shake a crying baby
The researchers suggest that additional communication could result in increased awareness about the dangers of shaken baby syndrome. In this study, the nurses did not know which materials they were delivering. "The intervention may have had stronger effects if the nurses had reinforced the messages, or if the messages were reinforced by multiple exposures through prenatal, maternity and postnatal health care providers, media and community support organizations," write Dr. Ronald Barr and coauthors.

"These findings complement the small number of reports that have reported that practical and contextually relevant materials presented to parents before or shortly after birth can change knowledge and behaviours and perhaps reduce the incidence of shaken baby syndrome," conclude the authors.
It's interesting that the authors conclude that greater impact might result if the nurses giving the information were not "blinded" to the materials being distributed. That seems to tie in with the results previously reported in the Montreal study:

However, there was no doubt as to the relevance of the nurses' participation; the majority (94%) of parents agreed that simply receiving the information cards without the nurses' participation would have been insufficient.

I thought it was good … It wouldn't have been right to say, okay, take the cards and read them, and that's that … I found we weren't left on our own, so there was no risk that we would not read the cards.
Also of note:

1. while the conclusions of the study seem to be couched in terms of mothers who "received" the materials, at one point it is noted that higher effects were observed among mothers who had watched the DVD or read the materials.

That seems to fit with previous research and reinforces the importance of: (1) video education materials; (2) prevention models that do more than just deliver education materials to new parents; and (3) the focus provided by hospital-based education (the study delivered materials by home visits after birth).

2. the study reported that there was already a high awareness of the danger of shaking babies in both study groups. It would be interesting to find out how representative that awareness is across a spectrum of communities in the US and Canada, and whether there is any effect on behavior following high-profile events like the recent maternity tourist incident in Vancouver.

3. the control group got an info set about safe sleep practices, with no mention of whether that information was also given to the intervention group.

It would be interesting to analyze the effect of getting both sets when an "injury prevention" frame is applied to the materials (and to find out whether parents respond differently to "delivery" of "injury prevention" (SIDS) and "child abuse prevention" (SBS) materials.

Even though the Back to Sleep campaign is 15 years old, it's still important to inform new parents. When California evaluated the effectiveness of the First Five materials provided to new parents, one result they found was a significant increase in awareness of safe sleep practices.

UPDATE: Link to abstract for a companion study in the March edition of Pediatrics:
RESULTS. The mean infant crying knowledge score was greater in the intervention group (69.5) compared with controls (63.3). Mean shaking knowledge was greater for intervention subjects (84.8) compared with controls (83.5). For reported maternal behavioral responses to crying generally, responses to unsoothable crying, and for self-talk responses, mean scores for intervention mothers were similar to those for controls. For the behaviors of information sharing, more intervention mothers reported sharing information about walking away if frustrated and the dangers of shaking, but there was little difference in sharing information about infant crying. Intervention mothers also reported increased infant distress. 

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