# Leveraging Health Literacy-informed Technology-based Approaches to Support Safe Medication Use By Parents After Discharge of Infants from the Neonatal Intensive Care Unit

> **NIH NIH R21** · NEW YORK UNIVERSITY SCHOOL OF MEDICINE · 2020 · $339,000

## Abstract

PROJECT SUMMARY
Infants discharged from the neonatal intensive care unit (NICU) are at high risk for medication-related adverse
events. These medically complex infants are often under treatment for multiple conditions conditions, with ~50%
discharged home with >1 medication. Two-thirds of parents make medication errors post-NICU discharge,
increasing the risk of morbidity. Underdosing/non-adherence can lead to therapeutic failure; overdosing can
cause serious adverse effects. The small size/relative physiologic immaturity of these infants renders them less
tolerant of even small dosing errors. These errors may be compounded by low health literacy and limited English
Proficiency; in addition, stress associated with having a preterm infant contributes to a reduced capacity to
manage the cognitive load associated with executing complex post-dischage instructions. The FDA and
American Academy of Pediatrics have recognized the complexity of liquid medication administration and the
potentially serious implications of errors. Addressing these issues in NICU graduates is important given the high
prevalence and potential morbidity associated with errors. Incorporating key health literacy-informed
communication strategies (dose demonstration, pictures, teachback) into provider counseling leads to sizeable
improvements in medication knowledge, dosing errors, and adherence in the general pediatric population. To
date, these strategies have not been studied in the NICU setting. The complexity of medication management in
this high risk group may also require more intensive strategies; studies have shown that technology-based
strategies can support patient adherence to provider instructions at home, but there has been limited study with
NICU graduates. The primary objective of this application is to promote safe medication use/adherence for high
risk infants, by leveraging health literacy-informed approaches and mobile health technology to reinforce provider
medication counseling and support parent medication management after NICU discharge. We will study HELPix,
adapted for NICU graduates, and determine if there is added benefit of HELPix enhancement with TECH
(Technology Enhanced Communication in the Home). Existing HELPix components include: 1) low literacy
patient-/regimen-specific instruction sheets with optimized instructions [metric-only (mL), doses appropriately
rounded, pictographic dose diagram, explicit dosing intervals], 2) dose demonstration, 3) teachback/showback,
4) provision of dosing tool. TECH components include: parent access to health literacy-informed instructions via
smartphones post-discharge (i.e. pictographic dose diagrams, animated dose demos, `virtual' teachback/
showback) and automated dosing reminders. The study will utilize a 3-arm RCT (HELPix+TECH vs. HELPix vs.
usual care alone) in the NICU, with these aims: 1) Examine the degree to which HELPix and HELPix+TECH
improve parent medication dosing and adherence compared to usual care...

## Key facts

- **NIH application ID:** 9873575
- **Project number:** 1R21HD100804-01
- **Recipient organization:** NEW YORK UNIVERSITY SCHOOL OF MEDICINE
- **Principal Investigator:** Hsiang Yin
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $339,000
- **Award type:** 1
- **Project period:** 2020-03-12 → 2022-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9873575

## Citation

> US National Institutes of Health, RePORTER application 9873575, Leveraging Health Literacy-informed Technology-based Approaches to Support Safe Medication Use By Parents After Discharge of Infants from the Neonatal Intensive Care Unit (1R21HD100804-01). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9873575. Licensed CC0.

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