Get Social Media and Risk-Reduction Training (GET SMART)

项目摘要 婴儿猝死和意外死亡(SUID)，包括婴儿猝死综合症和 与意外伤害相关的婴儿死亡仍然是美国新生儿后死亡的主要原因，约为3400人 死亡人数/年。如果更多地遵守婴儿安全睡眠指南，许多猪油中毒是可以预防的。确实有 遵守这些指导方针的种族和社会经济差异以及SUID率。我们进行了 针对婴儿护理实践的成功的社交媒体和降低风险培训(SMART；1R01HD072815) 在这项研究中，美国16家产科医院的1600名母亲被随机安排接受教育短片， 在前两个月，通过电子邮件或短信提供，重点是安全睡眠(TodaysBabyTM)与控制 出生后。与收到注意力匹配控制信息的母亲相比，那些收到这一信息的母亲 干预措施使遵循安全睡眠做法的比率高出约10个百分点。重要的是，种族和 在研究人群中，安全睡眠实践中的社会经济差异被消除。鉴于我们 已经证明了智能干预的有效性，我们现在建议使用智能(获取社交媒体 和降低风险培训)，这是一项由20人组成的3型混合实施-有效性集群随机试验 医院确定在现实条件下实施这一干预的最佳策略。我们会 比较SMART(医院工作人员介绍方案， 获得知情同意，与他们一起观看了2个视频)，而且是低接触(LT，即较少的资源密集型) 战略，将利用社会营销技术，以直接面向消费者的方式接触母亲 在产后住院期间，通过二维码很容易在医院环境中看到母亲 将用于注册TodaysBabyTM计划。考虑到SUID和安全睡眠实践的差异，获得 SMART将出现在以低收入人口为主的县的医院中，这些县的 全国SUID费率。我们将使用实施研究的Proctor概念模型来告知我们的 实施战略和成果。我们将比较以医院为基础的HT和LT的影响 关于渗透率差异的战略(符合条件的母亲报名参加 TodaysBabyTM)，根据收入和种族/民族进行渗透的公平性，以及每名母亲的计划成本 报名吧。次级执行成果将是可行性、可接受性、可持续性和忠于 干预(观看的视频数量)。有效性结果将是坚持4项安全睡眠实践 (睡眠姿势、睡眠部位、不使用柔软被褥、使用安抚奶嘴)。之后 完成这项执行效果研究后，我们将能够产生有价值的政策相关数据 对于易于复制的移动提供的视频，公众决策所需的安全睡眠干预 卫生组织和卫生保健系统，为历史上最高的群体提供广泛的可扩展性信息 SUID的比率。

Project Summary Sudden and Unexpected Infant Deaths (SUID), which include Sudden Infant Death Syndrome and unintentional injury-related infant deaths, remains a leading cause of US postneonatal mortality, with ~3400 deaths/year. Many SUIDs are preventable with greater adherence to safe infant sleep guidelines. There are racial and socioeconomic disparities in adherence to these guidelines and in SUID rates. We conducted the successful Social Media and Risk-Reduction Training for Infant Care Practices (SMART; 1R01HD072815) study in which 1600 mothers at 16 US birth hospitals were randomized to receive short educational videos, delivered by email or text message, focused on safe sleep (TodaysBabyTM) vs. control, in the first 2 months after birth. Compared to mothers receiving attention-matched control messages, those receiving this intervention had ~10 percentage point higher rates of following safe sleep practices. Importantly, racial and socioeconomic disparities in safe sleep practices were eliminated among the study population. Given that we have demonstrated effectiveness in the SMART intervention, we now propose GET SMART (Get Social Media and Risk-Reduction Training), a type 3 hybrid implementation-effectiveness cluster randomized trial of 20 hospitals to determine optimal strategies to implement this intervention in real-world conditions. We will compare the “high touch” (HT) implementation strategy used in SMART (hospital staff introduced the program, obtained informed consent, watched 2 videos with them) with a “low touch” (LT, i.e., less resource-intensive) strategy, which will leverage social marketing techniques in a direct-to-consumer approach to reach mothers during the postpartum hospitalization through QR codes easily visible in the hospital environment that mothers will use to sign up for the TodaysBabyTM program. Given the disparities in SUID and safe sleep practices, GET SMART will occur in hospitals serving predominantly low-income populations in counties with >1.5 times the national SUID rate. We will use the Proctor Conceptual Model of Implementation Research to inform our implementation strategies and outcomes. We will compare the impact of the hospital-based HT and LT strategies with regards to differences in penetration (proportion of eligible mothers who sign up for TodaysBabyTM), equity of penetration according to income and race/ethnicity, and the program cost per mother sign up. Secondary implementation outcomes will be feasibility, acceptability, sustainability; and fidelity to the intervention (number of videos watched). Effectiveness outcomes will be adherence to 4 safe sleep practices (sleep position, sleep location, nonuse of soft bedding, pacifier use) after the 2-month intervention. After completion of this implementation-effectiveness study, we will be able to generate valuable policy-relevant data for an easily replicated mobile-delivered video safe sleep intervention needed for decision-making by public health organizations and health care systems to inform broad scalability among groups with historically high rates of SUID.