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Am J Perinatol 2023; 40(13): 1413-1420
DOI: 10.1055/s-0041-1736294
Original Article

Parent Activation in the Neonatal Intensive Care Unit

Ryan Skeens
1   Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
,
Kerri L. Cavanaugh
2   Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
3   Vanderbilt Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee
,
Robert Cronin
4   Department of Medicine and Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
5   Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
,
QinGxia Chen
6   Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
7   Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
,
Yuhan Liu
6   Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
,
Hannah Huth
8   College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
,
Gretchen P. Jackson
5   Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
9   Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
10   IBM Watson Health, Cambridge, Massachusetts
› Author Affiliations
Funding This study was funded through the Center for Effective Health Communication Mini Grant Program, Vanderbilt University Medical Center, Nashville, TN.
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Abstract

Objective Patient activation is the knowledge, skills, and confidence to manage one's health; parent activation is a comparable concept related to a parent's ability to manage a child's health. Activation in adults is a modifiable risk factor and associated with clinical outcomes and health care utilization. We examined activation in parents of hospitalized newborns observing temporal trends and associations with sociodemographic characteristics, neonate characteristics, and outcomes.

Study Design Participants included adult parents of neonates admitted to a level-IV neonatal intensive care unit in an academic medical center. Activation was measured with the 10-item Parent version of the Patient Activation Measure (P-PAM) at admission, discharge, and 30 days after discharge. Associations with sociodemographic variables, health literacy, clinical variables, and health care utilization were evaluated.

Results A total of 96 adults of 64 neonates were enrolled. The overall mean P-PAM score on admission was 81.8 (standard deviation [SD] = 18), 88.8 (SD = 13) at discharge, and 86.8 (SD = 16) at 30-day follow-up. Using linear mixed regression model, P-PAM score was significantly associated with timing of measurement. Higher P-PAM scores were associated with higher health literacy (p = 0.002) and higher in mothers compared to fathers (p = 0.040). There were no significant associations of admission P-PAM scores with sociodemographic characteristics. Parents of neonates who had a surgical diagnosis had a statistically significant (p = 0.003) lower score than those who did not. There were no associations between discharge P-PAM scores and neonates' lengths of stay or other indicators of illness severity.

Conclusion Parental activation in the NICU setting was higher than reported in the adult and limited pediatric literature; scores increased from admission to discharge and 30-day postdischarge. Activation was higher in mothers and parents with higher health literacy. Additional larger scale studies are needed to determine whether parental activation is associated with long-term health care outcomes as seen in adults.

Key Points

  • Little is known about activation in parents of neonates.

  • Activation plays a role in health outcomes in adults.

  • Larger studies are needed to explore parent activation.

Keywords

activation - parent activation - P-PAM - neonatal intensive care unit - health care outcomes - health literacy


Publication History

Received: 24 March 2021

Accepted: 27 August 2021

Article published online:
12 October 2021

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