Parental Perspectives on Technology Use to Enhance Communication and Closeness During the COVID-19 Parental Presence Restrictions (preprint)

Objective: Parental perspectives on the use of technology in neonatal intensive care units (NICU), and its impact on enhancing communication and closeness during COVID-19 parental presence restrictions.Methods: A co-designed online survey targeting parents of infants admitted to a Canadian NICU from March 1st, 2020 until March 5th, 2021.Results: Parents (n=117) completed the survey from 38 NICUs. Large variation in policies regarding parental permission to use technology across sites was reported. Restrictive use of technology in the NICU was reported as a source of stress for families, with parents reporting privacy concerns, overstimulation, and infection control as primary institutional reasons for restriction. While families felt that technology helped them feel close to their infant when they could not be in the NICU, it did not replace being in-person.Conclusion: Large variation in policies regarding parental permission to use technology was reported across Canadian NICUs. Despite legitimate concerns about devices in NICUs, good evidence on how to mitigate these concerns exists. There appears to be substantial benefits to using technology to enhance parental experiences and many parents choose to ignore restrictions. Future study is needed to inform recommendations on technology use in the NICU, in the Canadian context and elsewhere.

Public Health and Health Systems Impacts of SARS-CoV-2 Variants of Concern: A Rapid Scoping Review (preprint)

BackgroundAs of April 2021, three SARS-CoV-2 variants of concern (VOC: B.1.1.7, B.1.351 and P.1) have been detected in over 132 countries. Increased transmissibility of VOC has implications for public health measures and health system arrangements. This rapid scoping review aims to provide a synthesis of current evidence related to public health measures and health system arrangements associated with VOC. MethodsRapid scoping review. Seven databases were searched up to April 7, 2021 for terms related to VOC, transmission, public health and health systems. A grey literature search was conducted up to April 14, 2021. Title, abstracts and full text were screened independently by two reviewers. Data were double extracted using a standardized form. Studies were included if they reported on at least one of the VOC and public health or health system outcomes. ResultsOf the 2487 articles and 59 grey literature sources retrieved, 37 studies and 21 guidance documents were included. Included studies used a wide range of designs and methods. Most of the studies and guidance documents reported on B.1.1.7, and 18 studies and 4 reports provided data for consideration in relation to public health measures. Public health measures, including lockdowns, physical distancing, testing and contact tracing, were identified as critical adjuncts to a comprehensive vaccination campaign. No studies reported on handwashing or masking procedures related to VOC. For health system arrangements, 17 studies were identified. Some studies found an increase in hospitalization due to B.1.1.7 but no difference in length of stay or ICU admission. Six studies found an increased risk of death ranging from 15-67% with B.1.1.7 compared non-B.1.1.7, but three studies reported no change. One study reported on the effectiveness of personal protective equipment in reducing VOC transmission in the hospital. No studies reported on screening staff and visitors, adjusting service provisions, or adjusting patient accommodations and shared spaces, which is a significant gap in the literature. Guidance documents did not tend to cite any evidence and were thus assumed to be based on expert opinion. ConclusionWhile the findings should be interpreted with caution as most of the sources identified were preprints, findings suggest a combination of non-pharmaceutical interventions (e.g., masking, physical distancing, lockdowns, testing) should be employed alongside a vaccine strategy to improve population and health system outcomes. While the findings are mixed on the impact of VOC on health system arrangements, the evidence is trending towards increased hospitalization and death.

Transmission characteristics of SARS-CoV-2 variants of concern: Rapid Scoping Review (preprint)

Background: As of March 2021, three SARS-CoV-2 variants of concern (VOC) have been identified (B.1.1.7, B.1.351 and P.1) and been detected in over 111 countries. Despite their widespread circulation, little is known about their transmission characteristics. There is a need to understand current evidence on VOCs before practice and policy decisions can be made. This study aimed to map the evidence related to the transmission characteristics of three VOCs. Methods: A rapid scoping review approach was used. Seven databases were searched on February 21, 2021 for terms related to VOCs, transmission, public health and health systems. A grey literature search was conducted on February 26, 2021. Title/abstracts were screened independently by one reviewer, while full texts were screened in duplicate. Data were extracted using a standardized form which was co-developed with infectious disease experts. A second data extractor verified the results. Studies were included if they reported on at least one of the VOCs and transmissibility. Animal studies and modeling studies were excluded. The final report was reviewed by content experts. Results: Of the 1796 articles and 67 grey literature sources retrieved, 16 papers and 7 grey sources were included. Included studies used a wide range of designs and methods. The majority (n=20) reported on B.1.1.7. Risk of transmission, reported in 15 studies, was 45-71% higher for B.1.1.7 compared to non-VOCs, while R0 was 75-78% higher and the reported Rt ranged from 1.1-2.8. There was insufficient evidence on the transmission risk of B.1.35.1 and P.1. Twelve studies discussed the mechanism of transmission of VOCs. Evidence suggests an increase in viral load among VOCs based on cycle threshold values, and possible immune evasion due to increased ACE2 binding capacity of VOCs. However, findings should be interpreted with caution due to the variability in study designs and methods. Conclusion: VOCs appear to be more transmissible than non-VOCs, however the mechanism of transmission is unclear. With majority of studies focusing on the B.1.1.7 VOC, more research is needed to build upon these preliminary findings. It is recommended that decision-makers continue to monitor VOCs and emerging evidence on this topic to inform public health policy.

Development of clinical virtual care pathways to engage and support families requiring neonatal intensive care in response to the COVID-19 pandemic (COVES Study) (preprint)

Background In response to the COVID-19 pandemic, family presence restrictions in neonatal intensive care units (NICU) were enacted to limit disease transmission and protect infants, families, and healthcare providers. The effects of pandemic parental restrictions on providing optimal family integrated neonatal care is unknown. Aim To ensure optimal neonatal care using virtual care pathways to engage and support families in response to parental presence restrictions imposed during the COVID-19 pandemic. The research had two objectives: (1) conduct a needs assessment with families and healthcare providers (HCPs) of infants in the NICU to understand the impact of COVID-19 restrictions; and (2) develop virtual clinical care pathways to meet identified needs. Methods This study used focus groups and individual semi-structured interviews with families and HCPs for the needs assessment and identification of barriers and facilitators, and co-design for the development of the clinical virtual care pathways. For objective 1, content analysis was conducted by two independent reviewers to categorize findings and identify important barriers and facilitators of family-integrated care. For objective 2, an agile, co-design process utilizing expert consensus of a large interdisciplinary team was used to develop the care pathways. Results A total of 23 participants were included in the needs assessment (objective 1): 12 families and 11 HCPs. Themes identified were: (1) the need to maintain and build relationships and support systems; (2) challenges in accessing education and resources to integrate families in care; and (3) lack of standardized, accessible messaging related to COVID-19. For objective 2, we used the themes identified in the needs assessment to co-design three clinical virtual care pathways: (1) building and maintaining relationships between family and healthcare providers; (2) awareness of resources; and (3) standardized COVID-19 messaging. Conclusion Families reported that restrictive parental presence policies affected their mental health, well-being and social support. Families and HCPs reported the restrictions impacted delivery of family integrated care, education, transition to home, and standardized messaging. Clinical care virtual pathways were designed to meet these needs to ensure more equitable family centred care.

Process evaluation of the development and remote recruitment for Essential Coaching for Every Mother during COVID-19 (preprint)

Background: With the sudden decrease in in-person support and increase in perinatal mental health concerns during the coronavirus pandemic, innovative strategies, such as mHealth, are more important than ever. This study has two objectives: (1) to describe the modification of Essential Coaching for Every Mother during the coronavirus pandemic, and (2) to describe the process evaluation of recruitment and retention of pregnant and postpartum women for a pre-post intervention study. Methods: For objective 1, modified messages were piloted with mothers and postpartum healthcare providers simultaneously. Semi-structured interviews were conducted with a subset of 10 participants from the original development study. For objective 2, three methods were used for recruitment: social media, posters in hospital, and media outreach. First time mothers were eligible for enrollment antenatally (37+ weeks) and postnatally (<3 weeks). Eligibility screening occurred remotely via text message with participants initiating contact. Data were collected via TextIt and REDCap. Outcomes were days to recruit 75 participants, eligibility vs. ineligibility rates, dropout and exclusion reasons, survey completion rates, perinatal timing of enrollment, and recruitment sources. Results: For objective 1, three mothers (M age=30.67 years) and seven healthcare providers (M age = 46.0 years) participated in the modification of the messages. Participants felt the messages were appropriate and relevant related to changes in postpartum care during the coronavirus pandemic. Nine messages were modified related to coronavirus and five messages were added to the program. For objective 2, recruitment ran July 15th-September 19th (67 days) with 200 screened and 88 enrolled, 70% antenatally. It took 50 days to enroll 75 participants. Mothers recruited antenatally (n=53) were more likely to receive all intervention message (68% vs. 19%). Mothers recruited postnatally (n=35) missed more messages on average (13.8 vs. 6.4). Participants heard about the study through family/friends (31%), news (20%), Facebook groups (16%), Facebook ads (14%), posters (12%), or other ways (7%). Conclusion: Antenatal recruitment resulted in participants enrolling earlier and receiving more of the study messages. Word of mouth and media outreach were successful, followed by advertisement on Facebook. Remote recruitment was a feasible way to recruit for Essential Coaching for Every Mother.

Impact of COVID-19 restrictions on the postpartum experience of women living in Eastern Canada: A mixed method cohort study (preprint)

OBJECTIVES: To (1) compare changes in self-efficacy, social support, postpartum anxiety and postpartum depression in Canadian women collected before (Cohort 1) and during the COVID-19 pandemic (Cohort 2); (2) explore the women felt related to having a newborn during the pandemic; and (3) explore ways that women coped. METHODS: Prior to the pandemic (October 1, 2019-January 1, 2020), an online survey was conducted with women had given birth within the past six months in one of the three Eastern Canadian Maritime provinces (Cohort 1). A second, similar survey was conducted between August 1, 2020 and October 31, 2020 (Cohort 2) during a period of provincial pandemic response to COVID-19. RESULTS: For Cohort 1, 561 women completed the survey and 335 women in Cohort 2. Cohorts were similar in terms of age of women, parity, and age of newborn. There were no significant differences for self-efficacy, social support, postpartum anxiety, and depression between the cohorts. Difficulties that women reported as a result of COVID-19 restrictions included lack of support from family and friends, fear of COVID-19 exposure, feeling isolated and uncertain, negative impact on perinatal care experience, and hospital restrictions. Having support from partners and families, in-person/virtual support, as well as self-care and the low prevalence of COVID-19 during the summer of 2020 helped women cope. CONCLUSION: While there was no significant difference in pre-pandemic and during pandemic psychosocial outcomes, there were still challenges and negative impacts that women identified. Consideration of vulnerable populations is important when making public health recommendations.

Implementing Essential Coaching for Every Mother during COVID-19: A Pilot Pre-Post Intervention Study (preprint)

ObjectivesThe primary objective was to evaluate the preliminary impact of Essential Coaching for Every Mother on self-efficacy, social support, postpartum anxiety and postpartum depression. The second objective was to explore the acceptability of the Essential Coaching for Every Mother program provided during the COVID-19 pandemic. MethodsA prospective pre-post study was conducted with first time mothers in Nova Scotia, Canada between July 15th and September 19th, 2020. Participants completed a self-report survey at enrolment (after birth) and six-weeks postpartum. Variety of standardized measures were used and qualitative feedback on the program was also collected. Paired t-tests were carried out to determine changes from baseline to follow-up on psychosocial outcomes and qualitative feedback was analysed through thematic analysis. ResultsA total of 88 women enrolled. Self-efficacy increased between baseline (B) and follow-up (F) (B:33.33; F:37.11, p=0.000) while anxiety (STAI) declined (B:38.49; F:34.79; p=0.004). No other significant changes were found. In terms of acceptability, 89% of participants felt that the number of messages were just right, 84.5% felt the messages contained all the information they needed relative to caring for a newborn and 98.8% indicated they would recommend this program to other new mothers. ConclusionEssential Coaching for Every Mother may play a role increasing maternal self-efficacy and decreasing anxiety, although future work with a control group is important to delineate the true effects of the program. Overall, mothers were satisfied with the Essential Coaching for Every Mother program and would recommend it for other mothers, during COVID-19 and beyond.