Hughes, Anita J.
(2017)
Development and evaluation of a multi-media intervention to enhance the motor development of premature infants.
PhD thesis, University of Nottingham.
Abstract
Background: Pregnancy is defined as lasting 40 weeks and birth that occurs before 37 weeks of gestation are classed as preterm, with neonates from as early as 22 weeks gestation surviving, although this is rare. Prematurity is associated with a range of long-term morbidities which negatively influence health and well-being. Infants born at less than 33 weeks gestation are at significantly increased risk for impaired motor development compared with their term peers (Allen, 2008). Deficits in motor skills such as balance, eye-hand co-ordination and manual dexterity have been well documented and are evident in infancy (Wood et al., 2000; Bracewell and Marlow, 2002). Early interventions have demonstrated some success in improving motor skills, but the effective elements were unclear. In addition, interactions between parent and infant can be problematic.
Aims: The aim was to develop and evaluate an interactive multimedia parenting intervention, which focuses of motor development of their preterm infant, and to compare parental perceptions of infant capability, parental confidence and parental stress.
Methods: The design of the intervention incorporated Social learning theory (Bandura, 1977) as the basis for the parenting intervention. The development of the intervention incorporated findings from a systematic review and a focus group with feedback from relevant healthcare, education professionals and parents of preterm infants. A randomised controlled trial was designed and conducted to evaluate the effectiveness and acceptability of the intervention. In total 168 preterm infants were recruited from five NHS neonatal intensive care units and randomly allocated to an intervention or control arm. The intervention arm consisted of the Helping Our Premature infant ON to better motor skills (HOP-ON) programme and Sharing My Infant’s Learning Experiences (SMILES) programme alongside treatment as usual. The control arm received the SMILES programme alongside treatment as usual. The primary outcome was motor scores on from AIMS and Bayley III developmental assessment. The secondary outcomes were parental perceptions of infant capability, parental confidence and parental stress. Evaluation of the study was conducted following the 12 month assessment.
Findings: The primary outcomes of motor scores on the AIMS and Bayley III were not significantly different between the intervention and control groups. Parental perceptions of infant capability were measured with IPIQ and no statistically significant differences were found at 3-4 months corrected age. In relation to parental confidence and stress, these were measured at 3-4 months corrected age and 12 months corrected age using the Parenting Stress Index (PSI) short form. At 12 months corrected age there was a difference between the intervention and control group, with the control group showing significantly higher levels of stress than the intervention group (p<0.038).
Conclusion: The need for interventions with parents and their preterm infants is well established, and although the HOP-ON programme did not significantly improve the motor skills of the preterm infants, the evaluation suggests that parents found the information valuable. HOP-ON is an easy to use intervention, which would benefit from further exploration, along with the reduction on reported stress levels at 12 months.
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