Small Things First: Leveraging Implementation Science to Increase Access to Infant Directed Speech for ALL Infants in Neonatal Intensive Care Units

小事优先：利用实施科学增加新生儿重症监护病房所有婴儿获得婴儿定向语音的机会

• 批准号: 10570336
• 负责人: Melissa Maye
• 金额: $ 13.11万
• 依托单位: HENRY FORD HEALTH SYSTEM
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-23 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10570336
• 关键词: Address; Adult; Affect; Agreement; Behavior; Caring; Child; Child Development; Climate; Clinical Trials; Cognitive; Data; Development; Environment; Environmental Risk Factor; Equity; Face; Frequencies; Gestational Age; Goals; Health; Health Services Research; Hearing; Hospitalization; Hybrids; Individual; Infant; Infant Care; Infant Development; Intervention; Interview; Language; Language Development; Life; Long-Term Effects; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Modeling; National Institute of Child Health and Human Development; Neonatal Intensive Care Units; Nurses; Occupational Therapist; Outcome; Parents; Pattern; Physicians; Premature Infant; Preparation; Professional Role; Psychological Theory; Public Health; Recovery; Research; Research Activity; Resistance; Role; Sales; Site; Speech; Structure; Surveys; Time; Training; Training Activity; United States; Visit; Weight; Work; alertness; causal model; critical developmental period; disorder prevention; effectiveness testing; effectiveness/implementation trial; experience; falls; health care disparity; health care service; health disparity; health equity; high risk; hybrid type 1 trial; implementation framework; implementation research; implementation science; implementation/effectiveness; infant outcome; innovation; language outcome; lexical; meetings; phonology; physical conditioning; pilot test; provider factors; psychologic; routine care; routine practice; routine provider; simulation; skills; theories; therapy design; uptake; verbal; vocalization

Project Summary/Abstract Adequate language input is required for typical language development. However, NICU infants are at particularly high risk for experiencing a language deprived environment and may spend weeks-to-many-months of a critical developmental period in this setting. Importantly, we know that the language environment of the NICU matters: the quantity and quality of language input an infant receives in the NICU has been associated with positive short-and-long-term outcomes (e.g., attentiveness, alertness, vocalizations, conversational turns, language, development). Infant directed speech (IDS), is a highly promising language construct, that is defined as a pattern of speaking adults use with infants and young children that has a simpler phonology, grammatical structure, and fewer lexical items as well as a higher pitch and unusual intonation pattern. Increased use of IDS has been found to be predictive of better language outcomes in typically developing infants. Increasing the quantity of IDS in the NICU may be a simple, low-training, high-impact intervention that could bolster early language outcomes for NICU infants (e.g., verbalizations, conversational turns). For NICU infants, it is imperative that we task both parents and clinicians as co-primary providers of routine IDS due to significant existing barriers to parent visitation. However, tasking clinicians to use IDS during routine care will likely face organizational, innovation, and clinician-level barriers that may impact clinician intentions. To successfully increase all infants’ access to IDS, it is necessary to conduct preliminary implementation research prior to a Hybrid Type 1 (effectiveness- implementation) study to identify and understand: 1) barriers to parent visitation and intentions to use IDS with their hospitalized infant (with semi-structured interviews, surveys); and 2) identify and understand barriers and facilitators to NICU clinician use of IDS (with surveys, video-elicitation interviews; video simulation surveys). To conceptualize this work, we are modifying the Explore Plan Implement Sustain implementation framework to incorporate health equity factors as part of the outer context and use organizational and psychological theories of behavior to explore and refine a possible causal model of contributors to parent and clinician intentions to use IDS with NICU infants. Completing the proposed research will allow us to refine our causal model by identifying an exhaustive list of societal, organizational, innovation, and individual factors (i.e., barriers, facilitators) that may impact or moderate parent intentions to visit and parent and clinician intentions to use IDS in the NICU. Finally, the training and research activities proposed in the K23 application will support the PI in having the data, skills, and experiences necessary to submit a strong application for a multi-site Hybrid Type I (effectiveness- implementation) trial that examines 1) whether we can significantly increase adult use of IDS in the NICU (i.e., parent/visits, clinician/routine care); and 2) whether infants who received higher levels of IDS demonstrated more verbalizations, vocalizations, and conversational turns at discharge (adjusting for gestational age).

项目总结/摘要 适当的语言输入是典型的语言发展所必需的。然而，NICU婴儿尤其 经历语言剥夺环境的高风险，可能会花费数周至数月的关键时间， 在这个发展阶段。重要的是，我们知道NICU的语言环境很重要： 婴儿在NICU中接受的语言输入的数量和质量与积极的 短期和长期结果（例如，注意力，警觉性，发声，会话，语言， 发展）。婴儿定向言语是一种非常有前途的语言结构，它被定义为一种模式 成年人与婴儿和幼儿使用的语音，语法结构， 词汇量少，音调高，语调不正常。IDS的使用越来越多， 在正常发育的婴儿中预测更好的语言结果。增加入侵检测系统的数量 NICU可能是一种简单，低培训，高影响的干预措施，可以加强早期语言结果， NICU婴儿（例如，言语化、会话转向）。对于新生儿重症监护室的婴儿，我们必须同时 父母和临床医生作为常规IDS的共同主要提供者，因为父母存在重大障碍， 探视然而，在常规护理期间，要求临床医生使用IDS可能会面临组织，创新， 以及可能影响临床医生意图的临床医生级别的障碍。为了成功地增加所有婴儿获得 IDS，有必要在混合型1（有效性- 实施）研究，以确定和理解：1）父母探视的障碍和使用IDS的意图， 他们的住院婴儿（半结构化访谈，调查）;和2）识别和理解障碍， 协助NICU临床医生使用IDS（调查，视频诱导访谈;视频模拟调查）。到 为了使这项工作概念化，我们正在修改探索计划实施持续实施框架， 将健康公平因素作为外部环境的一部分，并使用组织和心理学理论 探索和完善一个可能的因果模型的贡献者父母和临床医生的意图使用 新生儿重症监护室婴儿的IDS。完成拟议的研究将使我们能够通过识别 社会、组织、创新和个人因素的详尽清单（即，障碍、促进者）， 影响或缓和父母的访视意愿以及父母和临床医生在NICU中使用IDS的意愿。最后， K23申请中提出的培训和研究活动将支持PI拥有数据，技能， 和必要的经验，以提交一个强有力的申请，多地点混合I型（有效性- 实施）试验，其检查1）我们是否可以显著增加NICU中IDS的成人使用（即， 父母/访问，临床医生/常规护理）;以及2）接受较高水平IDS的婴儿是否表现出更多 出院时的语言表达、发声和会话（根据胎龄调整）。