Protocol for implementation of an evidence based parentally administered intervention for preterm infants

Area of Science:

• Neonatal care
• Developmental psychology
• Implementation science

Background:

• Multi-sensory behavioral interventions like H-HOPE can improve feeding, growth, and development in preterm infants.
• Few neonatal intensive care units (NICUs) routinely use evidence-based behavioral interventions, creating a gap between research and practice.
• H-HOPE is a standardized intervention with infant-directed (Massage+) and parent-directed components, proven effective.

Purpose of the Study:

• To implement the H-HOPE intervention as standard care in five NICUs.
• To examine the implementation process and effectiveness of H-HOPE in diverse NICU settings.
• To identify facilitators and barriers to successful H-HOPE implementation and sustainability.

Main Methods:

• A Type 3 Hybrid design with an incomplete stepped wedge approach across five purposively selected NICUs.
• Utilizing the Consolidated Framework for Implementation Research (CFIR) to guide the implementation strategy.
• Employing a mixed-methods analysis to identify implementation facilitators and barriers across CFIR domains.

Main Results:

• The study systematically identified key facilitators and barriers to H-HOPE implementation success and effectiveness.
• Implementation was staggered across sites using an incomplete stepped wedge design.
• The CFIR process guided NICUs through Planning, Executing, Reflecting, Evaluating, and Sustaining phases.

Conclusions:

• Establishing H-HOPE as standard care in NICUs has the potential to significantly improve infant health and developmental outcomes.
• The study's findings will inform broader implementation of evidence-based behavioral interventions in neonatal care.
• Long-term benefits may include improved parent-child relationships, reduced family stress, and decreased healthcare costs.