The Effect of Nursing Quality Improvement and Mobile Health Interventions on Infant Sleep Practices A Randomized Clinical Trial
The Effect of Nursing Quality Improvement and Mobile Health Interventions on Infant Sleep Practices A Randomized Clinical Trial
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DOI：
10.1001/jama.2017.8982
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发表时间：
2017-07-25
影响因子：
120.7
通讯作者：
Corwin, Michael J.
中科院分区：
文献类型：
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作者：
Moon, Rachel Y.;Hauck, Fern R.;Corwin, Michael J.
重要性：对已知可降低婴儿猝死风险的建议依从性不足，导致此类死亡下降速度放缓。
目的：与对照干预措施相比，分别评估两种干预措施以及联合干预措施在促进婴儿安全睡眠实践方面的有效性。
设计、地点和参与者：对健康足月新生儿的母亲进行的四组整群随机临床试验，于2015年3月至2016年5月在美国16家每年分娩量超过100例的医院招募参与者。数据收集于2016年10月结束。
干预措施：所有参与者均受益于婴儿安全睡眠实践（干预组）或母乳喂养（对照组）的护理质量改进活动，然后接受一项为期60天的移动健康项目，在此项目中，母亲们会频繁收到包含有关婴儿安全睡眠实践（干预组）或母乳喂养（对照组）教育内容短视频的电子邮件或短信，并收到有关婴儿护理实践的询问。
主要结果和测量指标：主要结果是母亲自我报告对4种婴儿安全睡眠实践的依从性，包括睡眠姿势（仰卧）、睡眠位置（同室不同床）、软床垫使用（无）和安抚奶嘴使用（任何情况）；在婴儿60至240天龄时通过母亲调查问卷收集数据。
结果：1600名母亲被随机分配到4组中的一组（每组400人），其中1263人完成了调查（78.9%）。母亲的平均（标准差）年龄为28.1岁（5.8岁），32.8%的受访者为非西班牙裔白人，32.3%为西班牙裔，27.2%为非西班牙裔黑人，7.7%为其他种族/族裔。婴儿的平均（标准差）年龄为11.2周（4.4周），51.2%为女性。在校正分析中，接受安全睡眠移动健康干预的母亲与接受对照移动健康干预的母亲相比，将婴儿仰卧放置的比例更高（分别为89.1%对80.2%；校正风险差为8.9%[95%置信区间，5.3% - 11.7%]），同室不同床的比例更高（82.8%对70.4%；校正风险差为12.4%[95%置信区间，9.3% - 15.1%]），不使用软床垫的比例更高（79.4%对67.6%；校正风险差为11.8%[95%置信区间，8.1% - 15.2%]），使用安抚奶嘴的比例更高（68.5%对59.8%；校正风险差为8.7%[95%置信区间，3.9% - 13.1%]）。护理质量改进干预的独立效应在所有结果中均不显著。两种干预措施之间的相互作用仅在仰卧睡眠姿势方面显著。
结论和相关性：在健康足月新生儿的母亲中，与对照干预措施相比，移动健康干预措施（而非护理质量改进干预措施）提高了对婴儿安全睡眠实践的依从性。广泛实施是否可行以及是否能降低婴儿猝死率仍有待研究。
IMPORTANCE Inadequate adherence to recommendations known to reduce the risk of sudden unexpected infant death has contributed to a slowing in the decline of these deaths.OBJECTIVE To assess the effectiveness of 2 interventions separately and combined to promote infant safe sleep practices compared with control interventions.DESIGN, SETTING, AND PARTICIPANTS Four-group cluster randomized clinical trial of mothers of healthy term newborns who were recruited between March 2015 and May 2016 at 16 US hospitals with more than 100 births annually. Data collection ended in October 2016.INTERVENTIONS All participants were beneficiaries of a nursing quality improvement campaign in infant safe sleep practices (intervention) or breastfeeding (control), and then received a 60-day mobile health program, in which mothers received frequent emails or text messages containing short videos with educational content about infant safe sleep practices (intervention) or breastfeeding (control) and queries about infant care practices.MAIN OUTCOMES AND MEASURES The primary outcome was maternal self-reported adherence to 4 infant safe sleep practices of sleep position (supine), sleep location (room sharing without bed sharing), soft bedding use (none), and pacifier use (any); data were collected by maternal survey when the infant was aged 60 to 240 days.RESULTS Of the 1600 mothers who were randomized to 1 of 4 groups (400 per group), 1263 completed the survey (78.9%). The mean (SD) maternal age was 28.1 years (5.8 years) and 32.8% of respondents were non-Hispanic white, 32.3% Hispanic, 27.2% non-Hispanic black, and 7.7% other race/ethnicity. The mean (SD) infant age was 11.2 weeks (4.4 weeks) and 51.2% were female. In the adjusted analyses, mothers receiving the safe sleep mobile health intervention had higher prevalence of placing their infants supine compared with mothers receiving the control mobile health intervention (89.1% vs 80.2%, respectively; adjusted risk difference, 8.9%[95% CI, 5.3%-11.7%]), room sharing without bed sharing (82.8% vs 70.4%; adjusted risk difference, 12.4%[95% CI, 9.3%-15.1%]), no soft bedding use (79.4% vs 67.6%; adjusted risk difference, 11.8%[95% CI, 8.1%-15.2%]), and any pacifier use (68.5% vs 59.8%; adjusted risk difference, 8.7%[95% CI, 3.9%-13.1%]). The independent effect of the nursing quality improvement intervention was not significant for all outcomes. Interactions between the 2 interventions were only significant for the supine sleep position.CONCLUSIONS AND RELEVANCE Among mothers of healthy term newborns, a mobile health intervention, but not a nursing quality improvement intervention, improved adherence to infant safe sleep practices compared with control interventions. Whether widespread implementation is feasible or if it reduces sudden and unexpected infant death rates remains to be studied.