Kang R, Barnard K, Hammond M, Oshio S, Spencer C, Thibodeaux B, Williams J
University of Washington School of Nursing SM-24, Department of Community Health Care Systems, Seattle 98195, USA.
Public Health Nurs. 1995 Jun;12(3):171-80. doi: 10.1111/j.1525-1446.1995.tb00006.x.
This study was designed as a multi-site field experiment to test the efficacy of hospital and home visit interventions to improve interaction between mothers and preterm infants. Hospital intervention consisted of State Modulation (SM) treatment, which focused on teaching mothers to read the behavioral cues and modulate the states of consciousness of preterm infants during feedings. Home visit intervention was a field-tested program, Nursing Systems for Effective Parenting-Preterm (NSTEP-P), implemented during the first five months after the infant's hospital discharge. A hospital program on car seats (CS) and standard public health nursing home visits (PHN) served as comparison treatments. The sample consisted of 327 mothers and their preterm infants who were less than 36 weeks of gestational age at hospital discharge. Mothers were randomly assigned to intervention groups on the basis of their education. High education (HE) was > or = 13 years of education, while low education (LE) was < or = 12 years of education. HE mothers were only assigned to hospital programs, while LE mothers were assigned to combinations of hospital and home visit programs. Evaluations were conducted at 40 weeks conceptual age (expected date of birth), at 46 weeks conceptual age (1.5-months-corrected age), and 60 weeks conceptual age (5-months-corrected age). Comparisons were made within each educational group. For HE groups, SM infants gave significantly more clear cues during observations of feeding interactions at 1.5-months-corrected age and teaching interactions at 5-months-corrected age than infants in the CS group. During the teaching interaction, well-educated SM mothers provided significantly more social-emotional and cognitive stimulation than CS mothers. For LE groups, infants in the SM group combined with either PHN or NSTEP-P exhibited significantly more responsive behavior during feeding observations than those infants in the CS/PHN group at 1.5-months-corrected age. LE mothers in the SM/NSTEP-P group demonstrated more sensitivity and more stimulation during teaching interactions at 5-months-corrected age than mothers in the SM/PHN or CS/PHN groups. Findings suggest that State Modulation treatment is effective in influencing positive social interaction of infants regardless of the level of maternal education. State modulation treatment combined with NSTEP-P is most effective in improving the social interaction between preterm infants and mothers with limited formal education. Such treatment-specific programs suggest avenues for providing cost-effective care that complements the changing transactional needs of mothers and preterm infants.
本研究设计为一项多中心现场试验，以测试医院干预和家访干预对改善母亲与早产婴儿之间互动的效果。医院干预包括状态调节（SM）治疗，其重点是教导母亲在喂奶期间解读行为线索并调节早产婴儿的意识状态。家访干预是一个经过现场测试的项目，即出院后前五个月实施的早产有效育儿护理系统（NSTEP-P）。一个关于汽车座椅（CS）的医院项目和标准公共卫生家访（PHN）作为对照治疗。样本包括327名母亲及其早产婴儿，这些婴儿出院时胎龄小于36周。母亲们根据其教育程度被随机分配到干预组。高学历（HE）是指受教育年限大于或等于13年，而低学历（LE）是指受教育年限小于或等于12年。高学历母亲仅被分配到医院项目组，而低学历母亲则被分配到医院和家访项目的组合组。在矫正年龄40周（预产期）、矫正年龄46周（矫正1.5个月龄）和矫正年龄60周（矫正5个月龄）时进行评估。在每个教育组内进行比较。对于高学历组，在矫正1.5个月龄时观察喂奶互动以及矫正5个月龄时观察教学互动期间，接受SM治疗的婴儿比CS组婴儿给出的明确线索明显更多。在教学互动期间，受过良好教育的接受SM治疗的母亲比CS组母亲提供了明显更多的社会情感和认知刺激。对于低学历组，在矫正1.5个月龄时观察喂奶互动期间，接受SM治疗并结合PHN或NSTEP-P的组中的婴儿比CS/PHN组中的婴儿表现出明显更多的反应性行为。在矫正5个月龄时观察教学互动期间，SM/NSTEP-P组中的低学历母亲比SM/PHN或CS/PHN组中的母亲表现出更高的敏感性和更多的刺激行为。研究结果表明，无论母亲教育水平如何，状态调节治疗都能有效影响婴儿的积极社交互动。状态调节治疗与NSTEP-P相结合对于改善早产婴儿与正规教育有限的母亲之间的社交互动最为有效。此类特定治疗项目为提供具有成本效益的护理提供了途径，以满足母亲和早产婴儿不断变化的互动需求。
