Children's pre-academic school readiness and home learning activities: a moderated-mediation analysis of home visiting.

Introduction: The current study explores the relation between parent involvement and children's school readiness for 568 families enrolled in the Home Instruction of Preschool Youngsters (HIPPY) program in Texas. Parent involvement in children's learning is a focus of the HIPPY curriculum. Methods: In this analysis, conditional process models were run to examine the relations between children's school readiness and engagement in home learning activities, parents' education level, program language (English or Spanish), both before and after completing a year of the program. Results: At pretest but not posttest, program language moderated the direct relation between parents' education level and children's school readiness and parents with high levels of education were more likely to engage their children in educational activities. Engagement in home learning activities was associated with school readiness regardless of parents' education level and language. Discussion: These findings provide a better understanding of the variables associated with school readiness for HIPPY families, indicating the importance of home learning activities-a variable that may be more amenable to change within intervention programs. Thus, focusing on home learning activities may contribute to decreasing discrepancies in children's preparedness for school entry that are generally identified across language and parent education. Findings may have practical implications for other home visitor programs working with similar populations.

Applying Rasch methodology to examine and enhance precision of the Edinburgh Postnatal Depression Scale.

BACKGROUND: The 10-item Edinburgh Postnatal Depression Scale (EPDS) is a widely used depression measure with acceptable psychometric properties, but it uses ordinal scaling that has limited precision for assessment of outcomes in clinical and research settings. This study aimed to apply Rasch methodology to examine and enhance psychometric properties of the EPDS by developing ordinal-to-interval conversion algorithm. METHODS: The Partial Credit Rasch model was implemented using a sample of 621 mothers of infants (birth to 2 years old) who completed the EPDS as a part of a larger online survey. RESULTS: Initial analysis indicated misfit to the Rasch model attributed to local dependency between individual EPDS items. The best model fit was achieved after combining six locally dependent items into three super-items resulting in non-significant item-trait interaction (χ2(49) = 46.61, p < 0.57), strong reliability (PSI = 0.86), unidimensionality and item invariance across personal factors such as age and mothers' education. This permitted generation of ordinal-to-interval conversion algorithms derived from person estimates of the Rasch model. LIMITATIONS: Ordinal-to-interval conversion cannot be applied for individuals with missing data. CONCLUSIONS: The EPDS met expectations of the unidimensional Rasch model after internal modifications, and its precision can be enhanced by using ordinal-to-interval conversion tables published in this article without the need to alter the original scale format. Scores derived from these conversion tables should decrease error and improve conformity with statistical assumptions in both clinical and research use of the EPDS, making monitoring of clinical status and outcomes more accurate.

Crafting effective messages to enhance safe infant sleep.

BACKGROUND: Health care professionals are continually challenged by the need to provide health information in a way that successfully changes health practices. Research has documented this as a concern in relation to safe infant sleep health campaigns. Often, caregivers' knowledge of recommended practices is not associated with a change in infant sleep choices. PURPOSE: Health campaigns, including most safe infant sleep efforts, often share specific risk factors and steps for avoiding risk, that is, in a verbatim format. Research has shown that caregivers' behavior may be more likely to change when presented with messages based on their general understanding of risk, that is, gist-based format. This research examines caregivers' responses as related to verbatim- and gist-based safe sleep information. METHODS: Five hundred forty-one caregivers of infants were shown 12 images depicting infants in safe or unsafe sleep spaces. Images varied across three commercially available spaces, infant race, and presence/absence of one policy-based risk factor. RESULTS: Differences in caregivers' discernment of safe and unsafe sleep images paralleled reported differences in knowledge of safe sleep recommendations. Discernment of safe/unsafe images was greater for White than Black caregivers, as well as for females in comparison with male caregivers. Gist-based considerations, such as familiarity with the sleeper depicted or infant race, were also associated with caregivers' discernment of safe/unsafe images. IMPLICATIONS FOR PRACTICE: Attending to both gist- and verbatim-based knowledge regarding safe infant sleep campaign information may help to effectively facilitate caregivers' ability to always create safe sleep spaces for their infants.

Validation study showed that ratings on the Welch Emotional Connection Screen at infant age six months are associated with child behavioural problems at age three years.

AIM: The emotional connection between mothers and infants born preterm has been associated with positive behaviour. The aim of this study was to examine the longitudinal association between emotional connection at six months of age and behavioural problems at three years. METHODS: This study was carried out by the University of North Texas, USA and comprised 49 mothers and infants from a longitudinal investigation of family interaction and infant development conducted in 1994-1997. Face-to-face interaction and toy-based play were videotaped and coded at six months of age using the Welch Emotional Connection Screen (WECS), a brief screening tool for relational health. When the children were three years of age, the mothers reported on child behavioural problems. RESULTS: The children from dyads that were rated as emotionally connected at six months of age had fewer externalising and internalising behavioural problems at the age of three. No links were found between emotional connection during toy-based play at six months and later child behavioural problems. CONCLUSION: We showed that when the WECS was used at six months of age it was a promising and valid relational screening tool for infants at risk of adverse behavioural outcomes at the age of three.

The practical utility of the Welch Emotional Connection Screen for rating parent-infant relational health.

Emotional Connection (EC) measured by the Welch Emotional Connection Screen (WECS) was related to the Parent-Infant Interaction Rating System (PIIRS), a 5-point adaptation of the rating system developed for the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (e.g., NICHD Early Child Care Research Network, 1999, Developmental Psychology, 35, 1399). Parent-infant dyads (n = 49 mothers; 43 fathers) were videotaped during face-to-face interaction at infant age 6 months; interactions were coded with both the WECS and PIIRS. At age 3, mothers completed the Child Behavior Checklist. WECS ratings of EC were associated with PIIRS rating items for both mother-infant and father-infant dyads. Mother-infant EC related positively to maternal sensitivity and positive regard for child, child positive mood and sustained attention, and dyadic mutuality, and negatively with maternal intrusiveness. Father-infant EC related positively to fathers' positive regard for child, child positive mood and sustained attention, and dyadic mutuality. Mother-infant EC predicted child behavior problems at age 3 better than mother-infant PIIRS ratings of dyadic mutuality. With fathers, neither EC nor dyadic mutuality ratings predicted mother-reported child behavior problems. Findings highlight the practical utility of the WECS for identifying potentially at-risk dyads and supporting early relational health.

Supporting lower-income working women to initiate breastfeeding: Learning who is breastfeeding and what helps.

BACKGROUND AND PURPOSE: Based on the Women, Work, and Wee Ones longitudinal study, mothers' likelihood of breastfeeding is examined across demographic and health variables. METHODS: Frequencies of breastfeeding and cosleeping by 285 mothers from the Women, Work, and Wee Ones cohort are reported as related to mothers' work schedule, marital status, or mother or infant health. CONCLUSIONS: Breastfeeding rates were about 30% across most maternal characteristics. The frequency of mothers' breastfeeding was higher when mothers were both breastfeeding and cosleeping (breastfeeding-cosleeping), in comparison with breastfeeding only, as evident for mothers with nonstandard work schedules. Cosleeping was common across all mothers. Breastfeeding rates were low, perhaps reflecting challenges of early care. Premature infants were more likely to be cosleeping than breastfeeding. Approximately 30% of mothers breastfed across the different factors examined. IMPLICATIONS FOR PRACTICE: The information may help nurse practitioners in addressing early care needs and supporting breastfeeding across groups. Younger mothers were least likely to breastfeed and reported higher frequency of cosleeping. Overall breastfeeding frequency was higher when mothers were cosleeping. Nurse practitioners may find it important to provide clear information about safe infant sleep and safe approaches to protecting infants.

Translating research-based knowledge about infant sleep into practice.

PURPOSE: Review infant sleep research with a focus on understanding the elements related to infant safety and infant and maternal well-being during nighttime care. DATA SOURCES: This review summarizes current research and addresses the controversies and conflicting outcomes reported in infant nighttime care. This review addresses current literature on infant sleep patterns, as well as factors that influence infant sleep and are consequences of different care routines. Conversation points are provided to help nurse practitioners (NPs) address safety and practice concerns. CONCLUSIONS: Shared information can help parents provide a safe and healthy environment for infants and help to facilitate communication ties between the healthcare providers and the families. IMPLICATIONS FOR PRACTICE: NPs need to help parents understand infant sleep patterns norms, what is current knowledge about infant nightwakings and parental presence, as well as about approaches to altering infant sleep patterns. Integrating this knowledge with parent preferences that are influenced by cultural practices and individual differences is crucial in helping parents develop a strong sense of competence and comfort with their choices and behaviors.