Using Baby Books to Promote Maternal and Child Health

Study Overview
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Brief Summary
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The Baby Books Project tests whether embedding educational information into baby books can improve the health and wellbeing of first-time mothers and their young children.

Detailed Description
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This study tests the efficacy of embedding educational information (i.e., pediatric anticipatory guidance) into baby books that first-time mothers read to their infants. This 3-group longitudinal study recruited first-time mothers in their third trimester of pregnancy, randomly assigned them to conditions, and followed them until the child was 18 months of age. One group received educational baby books, another group was given the same illustrated books with non-educational text, and the third group was not given any books. Thus, the effects of educational reading could be parsed from the effects of reading alone. The study aimed to test whether embedding pediatric anticipatory guidance in picture books is an effective method for increasing maternal knowledge of child development, parenting strategies, and safety practices, improving parenting beliefs and attitudes (e.g., parenting efficacy, importance of reading, use of corporal punishment), supporting optimal parenting practices (e.g., breastfeeding and nutrition, responsiveness, safety practices), improving maternal health (stress, depression), and supporting children's healthier development (injuries, illness, immunizations, and linguistic, social, and cognitive development). Survey and observational data collection occurred in participants' homes during their third trimester of pregnancy and when their child was 2, 4, 6, 9, 12, and 18 months of age. Twelve phone call interviews were conducted between these home visits. When children were 18 months, a retrospective medical chart audit was conducted.

Official Title
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Using Baby Books to Promote Maternal and Child Health

Conditions
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Condition 1 - Educational Condition (Educational Book Group), Condition 2 - Non-educational Condition (Non-educational Book Group), Condition 3 - Control Condition (No-book Group)

Intervention / Treatment
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* Behavioral: Educational Content/Pediatric Anticipatory Guidance
* Behavioral: Book provision


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Women who are pregnant with first child and able to read in English at a first grade reading level Exclusion Criteria: Women with other children, men, those not able to read in English at a first grade level

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 50 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: educational baby books<br>books embedded with educational information (pediatric anticipatory guidance) | Behavioral: Educational Content/Pediatric Anticipatory Guidance<br>* educational information from Bright Futures Guidelines for Health Supervision for birth to 18 months<br>Behavioral: Book provision<br>* Given free books prenatally and at 2, 4, 6, 9, 12, and 18 months postpartum<br>|
| Active Comparator: non-educational baby books<br>baby books given with same illustrations but no educational information | Behavioral: Book provision<br>* Given free books prenatally and at 2, 4, 6, 9, 12, and 18 months postpartum<br>|
| No Intervention: no books<br>not given any baby books | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in knowledge of child development and parenting | Measured with Opinions about Babies questionnaire | Change from Baseline (pregnancy) to 18 months postpartum | 
| Change in Reading Practices | Self-reported joint reading practices | Change from 2 to 18 months postpartum | 
| Parenting Stress | Measured with the Parenting Stress Index | Change from 2 to 18 months post-partum | 
| Costs | Maternal costs due to their own and their child's illness/injury, use of substances, and purchase of food was measured with the Incurred Cost Questionnaire. | Cumulative costs over study duration | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Safety Practices | Measured with the Home Safety Assessment, an observational and self-report measure of safety practices in the home, car, and outside | 2, 4, 6, 9, 12, and 18 months postpartum | 
| Attitudes about Corporal punishment | Adolescent-Adult Parenting Inventory | 2, 6, 12 and 18 months postpartum | 
| Maternal Depressive Symptoms | Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale. | Change from baseline (pregnancy) to 18 months postpartum | 
| Beliefs about the Importance of Reading to Children | Maternal beliefs about the importance of reading was measured with the Modified Parent Reading Belief Inventory | Change from baseline (prenatal) to 18 months postpartum | 
| Injuries and illnesses | Child illnesses injuries were measured with the Incurred Cost Questionnaire and through a retrospective medical chart audit. | 16 months (from 2 to 18 months postpartum) | 
| Quality of Parent-Child Interaction | Video recording and in-vivo coding of mother-child dyads during play and reading. | Change from 2 to 18 months postpartum | 
| Home environment and parenting | measured with the Home Observation for Measurement of Environment (HOME). | Change from 2 to 18 months postpartum | 
| Receptive and Expressive language | Measured with the Preschool Language Scale - Fourth Edition (PLS4). | Change from 6 to 18 months postpartum | 
| Cognitive and neurological development screening | Measured with the Bayley Infant Neurodevelopmental Screener (BINS) | 4, 6, 9 months postpartum | 
| Infant nutrition | Infant Nutrition Interview measured the introduction of news foods, types of foods, and serving portions at each time point. | 2, 4, 6, 9, 12, and 18 months postpartum | 
| Breastfeeding intentions and practices | measured with the Breastfeeding Intentions and Practices Scale | prenatal and postnatal every visit until no longer breastfeeding | 
| Pregnancy uplifts and Hassles | measured with the Pregnancy Experience Scale | Baselines (pregnancy) | 
| Parenting Satisfaction | measured with the Parenting Satisfaction Scale | Change from 2 to 18 months postpartum | 
| Parenting Self-Efficacy | Measured with the Maternal Self-Efficacy Scale | Change from 2 to 18 months postpartum | 
| Reading self-efficacy | measured with the Reading Self-Efficacy Scale | Change from 2 to 18 months postpartum | 
| Cognitive Development | measured with Exploratory Play Task | 12 and 18 months postpartum | 
| Immunizations, medical visits, and growth status | measured through a retrospective medical chart audit. | 18 months postpartum | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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safety, anticipatory guidance, baby books