Improving Care Giver Adherence to Recommended Infant Care Practices

项目摘要/摘要 此续订应用程序的重点是利用我们成功启动的平台 社交媒体和降低风险培训(SMART)研究，一项使用移动医疗的随机试验 (MHealth)提高照顾者对美国儿科学会(AAP)依从性的战略-推荐 与安全睡眠有关的婴儿护理做法，并通过增加对文化敏感的产前检查来加强覆盖范围 教育组成部分，并专门针对睡眠相关风险最高的低收入人群 婴儿死亡。SMART被提议设计、实施和评估干预措施的有效性 预防婴儿猝死综合征(SID)和与意外伤害相关的婴儿死亡 睡眠环境。这些死亡，我们将称之为与睡眠有关的死亡，仍然是主要原因。 在美国，每年约有3500人死于新生儿死亡。其中许多死亡是可以预防的- 改善了对AAP婴儿安全睡眠指南的遵守。 SMART的一个关键发现是，仅以幼儿园为基础的教育并不有效，而是一种技术- 基于mHealth消息的干预是-收到安全睡眠mHealth消息的母亲每- 百分位数越高，遵循安全睡眠做法的比率就越高。我们推荐的Smarter(社交媒体和风险 简化教学-增强伸展能力)研究是通向全面转化为实践的自然下一步 聪明的人。这项更聪明的研究计划进行一项四臂实用随机对照试验，招募2500名孕妇参加 妇女、婴儿和儿童特别补充营养计划(WIC)在2个州(MA和 VA)被随机分配到产前安全睡眠和母乳喂养mHealth干预的组合中 出生后：1)产前和产后母乳喂养安全睡眠；2)产前母乳喂养安全 产后睡眠；3)产前和产后安全睡眠；4)产前和产后母乳喂养。这 研究条件的组合将使我们能够评估信息内容、时间和摄取剂量以及 在出生后6个月内保持安全睡眠和母乳喂养。主要目的是为了- 确认旨在促进安全睡眠实践的产前和产后mHealth干预措施的有效性。 奶嘴和母乳喂养。第二个目标是评估潜在的调解因素，这些因素可能解释 预防对婴儿护理实践的影响，并为改进未来的干预方法提供信息。

Project Summary/Abstract The focus of this renewal application is to leverage the platform from which we successfully launched the Social Media and Risk Reduction Training (SMART) study, a randomized trial using mobile health (mHealth) strategies to improve caregiver adherence to American Academy of Pediatrics (AAP)-recommended infant care practices related to safe sleep, and to enhance the reach by adding a culturally-sensitive prenatal education component and specifically targeting low-income populations who are most at risk for sleep-related infant deaths. SMART was proposed to design, implement, and assess the effectiveness of interventions to prevent Sudden Infant Death Syndrome (SIDS) and unintentional injury-related infant deaths associated with the sleep environment. These deaths, which we will refer to as sleep-related deaths, remain the leading cause of postneonatal death in the United States, with ~3500 deaths each year. Many of these deaths are preventa- ble with improved adherence to AAP safe infant sleep guidelines. A key finding from SMART was that nursery-based education alone was not effective, but a technology- based mHealth messaging intervention was – mothers receiving safe sleep mHealth messages had ~10 per- centage point higher rates of following safe sleep practices. Our proposed SMARTER (Social Media and Risk Reduction Teaching- Enhanced Reach) study is the natural next step towards the full translation into practice of SMART. The SMARTER study plans a 4-arm pragmatic RCT in which 2500 pregnant mothers recruited at Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) programs in 2 states (MA and VA) are randomly assigned to a combination of safe sleep and breastfeeding mHealth interventions prenatally and postnatally: 1) Safe Sleep Prenatal and Breastfeeding Postnatal; 2) Breastfeeding Prenatal and Safe Sleep Postnatal; 3) Safe Sleep Prenatal and Postnatal; and 4) Breastfeeding Prenatal and Postnatal. This combination of study conditions will allow us to evaluate message content, timing, and dose of uptake and maintenance of safe sleep and breastfeeding practices through 6 months after birth. The primary aim is to as- sess the effectiveness of the mHealth prenatal and postnatal interventions aimed at promoting safe sleep prac- tices and breastfeeding. The secondary aim is to assess potential mediating factors that may explain the inter- vention effects on infant care practices and inform areas for improving future intervention approaches.