# Study of Attitudes and Factors Effecting PREterm infant care Practices (SAFE PREP)

> **NIH NIH R01** · BOSTON MEDICAL CENTER · 2021 · $611,244

## Abstract

PROJECT SUMMARY
The rate of sudden unexpected infant death (SUID) is 2-3-fold higher among preterm infants (born < 37 weeks
gestation), compared to term infants (born ≥ 37 weeks gestation). To combat this, the American Academy of
Pediatrics (AAP) and US Preventive Services Task Force recommend parental adherence to modifiable SUID
reducing infant care practices, including safe sleep practices, breastfeeding, and avoidance of prenatal and
postnatal tobacco smoke. Despite the higher risk of SUID among preterm infants and extended opportunities
for health-related education during the neonatal hospitalization and early post-discharge period, adherence to
these modifiable risk factors is suboptimal. The investigators previously conducted a nationally-representative
surveillance study among >3300 mothers of term infants to identify prevalences of infant care practices and
characterize the array of factors impacting adherence to these practices, which directly led to a successful
interventional trial. The investigators used the Theory of Planned Behavior (TPB) as a framework to study
health behavior. The goal of this research plan is to replicate previous qualitative and national surveillance
methods among mothers of preterm infants. The focus in the proposed study will be on unique characteristics
of mother-preterm infant dyads that may impact adherence to infant care practices, such as the medical
complexities of the preterm infant and psychological distress of the mother. This will fill a critical knowledge
gap which is needed to inform intervention development to reduce SUID mortality among this vulnerable
population. In Aim 1, qualitative methods will be used to explore domains of the TPB (attitudes, perceived
subjective norms, and perceived control) and the array of perceived barriers and facilitators of adherence to
AAP recommended infant care practices in the home among mothers of preterm infants. Results will inform the
development of a nationally representative survey of 1500 mothers of preterm infants discharged from
neonatal intensive care units and special care nurseries across the US. The survey will be conducted using a
variety of query techniques, including media sources, and will enable completion of Aims 2-4. Aim 2 will
determine prevalence of maternal adherence to AAP recommended infant care practices and determine
variation in prevalence based on maternal characteristics and degree of infant medical complexity. Aim 3 will
determine the extent to which TPB domains are associated with intention to perform and actual performance of
AAP recommended infant care practices. Aim 4 will determine the extent to which maternal, infant, and other
factors identified in our qualitative analysis are associated with TPB domains and adherence to AAP
recommended practices.

## Key facts

- **NIH application ID:** 10159752
- **Project number:** 5R01HD095060-04
- **Recipient organization:** BOSTON MEDICAL CENTER
- **Principal Investigator:** Sunah S Hwang
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $611,244
- **Award type:** 5
- **Project period:** 2018-08-17 → 2022-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10159752

## Citation

> US National Institutes of Health, RePORTER application 10159752, Study of Attitudes and Factors Effecting PREterm infant care Practices (SAFE PREP) (5R01HD095060-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10159752. Licensed CC0.

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