Improving Care Giver Adherence to Recommended Infant Care Practices

项目总结/摘要 此次续约申请的重点是利用我们成功推出的平台 社交媒体和降低风险培训（SMART）研究，一项使用移动的健康的随机试验， （mHealth）策略，以提高护理人员遵守美国儿科学会（AAP）-建议 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保健， 教育部分，特别针对低收入人群谁是最有风险的睡眠有关的 婴儿死亡。SMART旨在设计、实施和评估干预措施的有效性， 预防婴儿猝死综合症（SIDS）和与意外伤害相关的婴儿死亡 睡眠环境。这些死亡，我们将称为睡眠相关死亡，仍然是主要原因 在美国，新生儿后期死亡率高达3500人，每年约有3500人死亡。其中许多死亡是可以预防的- 改善对AAP安全婴儿睡眠指南的遵守。 SMART的一个关键发现是，仅以托儿所为基础的教育并不有效，而是一种技术- 基于移动健康信息干预的母亲接受安全睡眠移动健康信息的比例为10%- 遵循安全睡眠做法的比例高出一个百分点。我们提出的SMARTER（社交媒体和风险） 减少教学-提高达到）研究是自然的下一步充分转化为实践 的SMART。SMARTER研究计划进行一项4臂实用RCT，其中2500名孕妇在 2个州（马萨诸塞州和马萨诸塞州）的妇女、婴儿和儿童特别补充营养方案（WIC） VA）被随机分配到产前安全睡眠和母乳喂养mHealth干预措施的组合 产前和产后：1）安全睡眠产前和产后母乳喂养; 2）产前和产后母乳喂养 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消息内容、时间和摄取剂量， 在出生后6个月内保持安全睡眠和母乳喂养。主要目标是- 评估旨在促进安全睡眠实践的移动健康产前和产后干预措施的有效性， 标签和母乳喂养。第二个目的是评估可能解释相互作用的潜在中介因素。 干预对婴儿护理实践的影响，并为改善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.