Study of Attitudes and Factors Effecting PREterm infant care Practices (SAFE PREP)

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PROJECT SUMMARY The rate of sudden unexpected infant death (SUID) is 2-3-fold higher among preterm infants (born < 37 weeks gestation), compared to term infants (born ≥ 37 weeks gestation). To combat this, the American Academy of Pediatrics (AAP) and US Preventive Services Task Force recommend parental adherence to modifiable SUID reducing infant care practices, including safe sleep practices, breastfeeding, and avoidance of prenatal and postnatal tobacco smoke. Despite the higher risk of SUID among preterm infants and extended opportunities for health-related education during the neonatal hospitalization and early post-discharge period, adherence to these modifiable risk factors is suboptimal. The investigators previously conducted a nationally-representative surveillance study among >3300 mothers of term infants to identify prevalences of infant care practices and characterize the array of factors impacting adherence to these practices, which directly led to a successful interventional trial. The investigators used the Theory of Planned Behavior (TPB) as a framework to study health behavior. The goal of this research plan is to replicate previous qualitative and national surveillance methods among mothers of preterm infants. The focus in the proposed study will be on unique characteristics of mother-preterm infant dyads that may impact adherence to infant care practices, such as the medical complexities of the preterm infant and psychological distress of the mother. This will fill a critical knowledge gap which is needed to inform intervention development to reduce SUID mortality among this vulnerable population. In Aim 1, qualitative methods will be used to explore domains of the TPB (attitudes, perceived subjective norms, and perceived control) and the array of perceived barriers and facilitators of adherence to AAP recommended infant care practices in the home among mothers of preterm infants. Results will inform the development of a nationally representative survey of 1500 mothers of preterm infants discharged from neonatal intensive care units and special care nurseries across the US. The survey will be conducted using a variety of query techniques, including media sources, and will enable completion of Aims 2-4. Aim 2 will determine prevalence of maternal adherence to AAP recommended infant care practices and determine variation in prevalence based on maternal characteristics and degree of infant medical complexity. Aim 3 will determine the extent to which TPB domains are associated with intention to perform and actual performance of AAP recommended infant care practices. Aim 4 will determine the extent to which maternal, infant, and other factors identified in our qualitative analysis are associated with TPB domains and adherence to AAP recommended practices.