Evaluation of The Period of PURPLE Crying A

Evaluation of The Period of PURPLE Crying, A Shaken Baby Syndrome Prevention Program Laura Schwab Reese, MA 1, 2 Kimberly Kim, MPH 3 Erin O. Heiden, MPH 1, 2 Jingzhen Yang, Ph. D, MPH 4 1 University Introduction § Shaken Baby Syndrome (SBS) is a leading cause of death in children less than one year old. § The estimated annual incidence of SBS is 25 -30 cases per 100, 000 infants. § The Period of PURPLE Crying is an evidencebased SBS prevention program. § Study aims: o Evaluate The Period of PURPLE Crying as implemented in five local hospitals. o Measure program impact on mothers’ knowledge about normal infant crying, the dangers of shaking an infant, and techniques to soothe and cope with infant crying. Materials and Methods § A post-test only design. § Prior to discharge, all mothers who gave birth between March 15 – August 15, 2011 in five participating hospitals received the Period of PURPLE Crying education session from a trained nurse and were given a booklet and DVD to take home. § § § Mothers and nurses completed a survey following the intervention. Phone interviews were conducted with enrolled mothers two months after discharge. Process Measures: mother/nurse agreement on five evaluation domains o Attitude towards the education session o Normal infant crying o Dangers of shaking an infant o Soothing and copying techniques o Motivation to share information Outcome Measures: mothers’ o Knowledge of normal infant crying and dangers of shaking an infant o Techniques to soothe and cope with infant crying of Iowa Injury Prevention Research Center, 2 Department of Community & Behavioral Health, University of Iowa, 3 Planned Parenthood of the Heartland, 4 Department of Social and Behavioral Sciences, Kent State University Table 1. Characteristics of mothers who received The Period of PURPLE Crying education All Mother’s agea ≤ 25 26 -30 31 -35 >35 Education High school or less Some college College degree Graduate studies Paritya First child Not first child Watched DVD Watched in hospital Did not watch in hospital Watched before, during, or after the hospital Did not watch video a Sums Baseline Follow-up n (%) 211 n (%) 68 53 (25. 6) 91 (43. 9) 48 (23. 2) 15 (7. 3) 12 (18. 5) 28 (43. 1) 17 (26. 2) 8 (12. 3) 53 (25. 1) 36 (17. 1) 81 (38. 4) 41 (19. 4) 10 (14. 7) 13 (19. 1) 35 (51. 5) 10 (14. 7) 97 (46. 9) 110 (53. 1) 32 (47. 1) 36 (52. 9) 53 (26. 4) 148 (73. 6) 9 (13. 2) 59 (86. 7) n/a 40 (58. 8) n/a 28 (41. 2) Figure 1. Mother’s rating of the usefulness of the Period of PURPLE Crying (Scaled 1 to 10 with 1 as “Not Useful” and 10 as “Very Useful”) 9% 10 15% 56% 8 20% 7 or less Figure 2. Mother’s Knowledge (Percent correct of 10 items) 24% 21% 55% § Three-quarters (76%) of mothers rated The Period of PURPLE Crying program as very useful. § More nurses (92%) perceived mothers as motivated to share program content than mothers who reported intent to share (89%). § Only one-quarter (26%) of mothers watched the DVD while in the hospital, but more than half (59%) of mothers had viewed the DVD by two months post-discharge. § Over half (55%) of mothers received a perfect score on a knowledge test of normal infant crying and the dangers of shaking an infant. Missed 1 item § More than half of mothers recalled (52%) or reported trying (59%) at least one soothing technique. However, fewer mothers recalled (38%) or reported trying (27%) at least one coping technique. Figure 3. Consistency between mother and nurse survey answers for five evaluation domainsa Exact Match Close Match 13% 80% 14% 11% 12% Discussion and Conclusions 14% 60% 84% 81% 84% 80% Attitudes Normal Crying Dangers Soothing 40% 70% 20% 0% a. For § Of 211 baseline participants, 47% were first-time mothers and 58% had a college degree or more. Follow-up participants were demographically similar to the baseline sample. All correct Missed 2+ items not equal to sample size due to missing numbers. 100% 9 Results Sharing each domain, consistency was assessed by matched ratings of “mostly agree” or “strongly agree” Table 2. Survey Questions by Evaluation Domain Program Domain Attitudes Normal Crying Mother Survey Item(s) • I felt comfortable talking with the nurse about the Period of PURPLE Crying. • I understand how to prevent shaken baby syndrome. Nurse Survey Item • I felt confident educating this mother about the Period of PURPLE Crying. • The nurse taught me about normal infant crying. • This mother seemed to understand what I told her about normal infant crying. Dangers • The nurse taught me about the dangers of shaking an infant. • This mother seemed to understand the dangers of shaking an infant. Soothing • The nurse taught me ways to help soothe my infant’s crying. • The nurse taught me ways to cope when I am feeling frustrated or overwhelmed by my infant’s crying. • I plan to try the soothing and coping techniques that the nurse explained. • I taught this mother ways to soothe her baby’s crying and/or cope with her own frustration. Sharing • I plan to talk to my child’s other caretakers about the Period of PURPLE Crying and the dangers of shaking an infant. • This mother seemed motivated to tell her child’s other caretakers about the Period of PURPLE Crying and the danger of shaking an infant. § Overall, the Period of PURPLE Crying intervention was successfully implemented and well-received by both mothers and nurses. o Regardless of education, age, and parity, mothers felt it was important to talk about SBS. o With limited time and resources, nurses were able to implement the program. § The successful implementation, combined with results from randomized control trial evaluations, support wide-spread dissemination of the program. § Future programs should encourage mothers to share content with their child’s other caregivers.