236 - Empowering Parents: Using Targeted Journals to Improve Parental Stress and Engagement in the NICU

Publication Number: 236.4589

Erik VerHage, University of Florida College of Medicine, Gainesville, FL, United States; Meredith C. Joseph, University of Florida College of Medicine, Gainesville, FL, United States; Leslie Parker, University of Florida College of Medicine, Gainesville, FL, United States; Celine Cattier, UF Health Shands Children's Hospital, Gainesville, FL, United States; Marie T. Berg, University Of Florida, University Of Florida College Of Medicine, FL, United States

Background: Parental mental health and engagement can improve infant behavioral and clinical outcomes. Parents of preterm infants are subject to increased stress and mental health disorders, which can lead to decreased engagement. Previous studies have demonstrated journaling can decrease stress but those journals did not use prompts targeting the most common stressors and barriers to engagement.

Objective: To design a journal targeted to mitigate stress and promote engagement in NICU parents, evaluate the impact of the journal on parental stress and engagement, and determine the feasibility of a future larger scale trial.

Design/Methods: In this single-center pilot RCT, parents of very preterm infants (280/7 - 336/7 wks gestational age) were randomized to either receive the journal or routine NICU care. The journal has prompts to track medical progress, encourage daily bonding, support emotional processing and gratitude, and balance home-life responsibilities. Primary outcomes included parental engagement (PREEMI score) and parental stress (PSS:NICU score). Secondary outcomes included length of stay, infant receipt of maternal breastmilk, satisfaction, visitation frequency, and journal use.

Results: We enrolled 21 family units (25 individuals) with 11 family units (14 individuals) randomized to the journal group and 10 family units (11 individuals) to the control group. There was no difference in the primary outcomes PREEMI and PSS:NICU scores). There was a trend toward increase in visitation frequency (median 7.0 d per wk journal [IQR 6.2-7.0] vs 6.0 d per wk control [4.5-7.0]; p = 0.11) and decreased infant length of stay in the journal group (median 25 d [IQR 24-38] journal vs 55 d [IQR 36-67] control; p = 0.01). There was an increase in parental comfort taking their child home in the journal group (Fig. 1 [Q4]; p = 0.03) and trend toward increased receipt of maternal breastmilk at discharge (p = 0.15). Most parents in the journal group stated the journal enhanced various aspects of their NICU stay and all recommended that any parent with a child in the NICU should use the journal (Fig. 2).

Conclusion(s): To our knowledge, this is the first study that assesses the impact of a journal specifically designed to reduce stress and promote engagement. Limitations include high loss-to-follow up, lack of blinding, and small sample size. The intervention was well-received and feasible for larger-scale study. It enhanced several dimensions of parental engagement (Fig. 2), which may not have been fully captured by the primary outcome due to limitations of survey-based assessments.

Figure 1. Satisfaction questions for the journal (J) and control (C) group respectively.
Question 1: I am satisfied with the general NICU experience
Question 2: I am satisfied with the medical care my child received
Question 3: I am satisfied with my interactions with the medical staff (providers, nurses, therapists, etc...)
Question 4: I feel comfortable taking my child home

Figure 2. Intervention group only responses regarding journal use.
Q1: Using the journal enhanced your understanding of your child's medical condition.
Q2: Using the journal has enhanced your communication with medical providers, nurses, and other staff.
Q3: Using the journal has promoted participation in your child's care and other bonding activities.
Q4: Using the journal has helped me process through the difficult emotions of having a baby in the NICU.
Q5: Using the journal has enhanced my relationship with my child
Q6: I would recommend for any parent with a child in the NICU to use this journal

Figure 1. Satisfaction questions for the journal (J) and control (C) group respectively.
Question 1: I am satisfied with the general NICU experience
Question 2: I am satisfied with the medical care my child received
Question 3: I am satisfied with my interactions with the medical staff (providers, nurses, therapists, etc...)
Question 4: I feel comfortable taking my child home

Figure 2. Intervention group only responses regarding journal use.
Q1: Using the journal enhanced your understanding of your child's medical condition.
Q2: Using the journal has enhanced your communication with medical providers, nurses, and other staff.
Q3: Using the journal has promoted participation in your child's care and other bonding activities.
Q4: Using the journal has helped me process through the difficult emotions of having a baby in the NICU.
Q5: Using the journal has enhanced my relationship with my child
Q6: I would recommend for any parent with a child in the NICU to use this journal