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.

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.