Impact of PRECEDE-PROCEED model on enhancing neonatal sleep safety practices

The neonatal period is the most vulnerable stage of life, and safe sleep practices are crucial in preventing asphyxia and sudden infant death syndrome. The PRECEDE-PROCEED model is a comprehensive evaluation framework for assessing health needs for designing and implementing health programs. This study aimed to explore the application and effectiveness of an intervention based on the PRECEDE-PROCEED model in improving neonatal sleep safety caregiving behaviors.

In this randomized controlled trial, neonatal caregivers from the obstetrics department of a tertiary hospital in Jiangsu Province, China, were recruited between May and August 2024. Using the PRECEDE-PROCEED model as a guiding framework, the study assessed caregivers' baseline knowledge and practices concerning neonatal sleep safety and identified barriers to effective neonatal sleep safety. In the PRECEDE phase, the current state of neonatal caregivers' knowledge, behaviors, and barriers was analyzed. These barriers were categorized into predisposing factors (e.g., caregivers' knowledge, awareness, and motivation), enabling factors (e.g., access to resources and external support), and reinforcing factors (e.g., feedback from others). Targeted interventions were then implemented accordingly. In the PROCEED phase, the effectiveness of the intervention was evaluated, feedback was collected, and the intervention strategy was continuously adjusted and optimized. Lastly, data were gathered through questionnaires and direct on-site observations, and a comparative analysis was conducted to evaluate changes in caregivers' knowledge, practices, and perceived self-efficacy before and after the intervention.

Following the intervention, neonatal caregivers exhibited a significant improvement in their knowledge of neonatal sleep safety compared to the control group (P < 0.05). Their caregiving practices became more standardized, with notably higher accuracy rates in sleep posture selection and sleep environment arrangement, in contrast to the control group (P < 0.05). Additionally, caregivers also exhibited a significant increase in self-efficacy scores after the intervention (P < 0.05).

The PRECEDE-PROCEED model proved effective in identifying barriers to caregiving practices and facilitated the development of targeted interventions, resulting in substantial improvements in caregivers' knowledge and adherence to best practices for neonatal sleep safety. Additionally, the model contributed to enhancing caregivers' self-efficacy. These outcomes are crucial for the ongoing improvement of caregiving practices and the promotion of neonatal sleep safety. Lastly, the use of this model may contribute to a decrease in the risk of sudden infant death syndrome.