Small Things First: Leveraging Implementation Science to Increase Access to Infant Directed Speech for ALL Infants in Neonatal Intensive Care Units

小事优先：利用实施科学增加新生儿重症监护病房所有婴儿获得婴儿定向语音的机会

• 批准号: 10570336
• 负责人: Melissa Maye
• 金额: $ 13.11万
• 依托单位: HENRY FORD HEALTH SYSTEM
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-23 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10570336
• 关键词: Address; Adult; Affect; Agreement; Behavior; Caring; Child; Child Development; Climate; Clinical Trials; Cognitive; Data; Development; Environment; Environmental Risk Factor; Equity; Face; Frequencies; Gestational Age; Goals; Health; Health Services Research; Hearing; Hospitalization; Hybrids; Individual; Infant; Infant Care; Infant Development; Intervention; Interview; Language; Language Development; Life; Long-Term Effects; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Modeling; National Institute of Child Health and Human Development; Neonatal Intensive Care Units; Nurses; Occupational Therapist; Outcome; Parents; Pattern; Physicians; Premature Infant; Preparation; Professional Role; Psychological Theory; Public Health; Recovery; Research; Research Activity; Resistance; Role; Sales; Site; Speech; Structure; Surveys; Time; Training; Training Activity; United States; Visit; Weight; Work; alertness; causal model; critical developmental period; disorder prevention; effectiveness testing; effectiveness/implementation trial; experience; falls; health care disparity; health care service; health disparity; health equity; high risk; hybrid type 1 trial; implementation framework; implementation research; implementation science; implementation/effectiveness; infant outcome; innovation; language outcome; lexical; meetings; phonology; physical conditioning; pilot test; provider factors; psychologic; routine care; routine practice; routine provider; simulation; skills; theories; therapy design; uptake; verbal; vocalization

Project Summary/Abstract Adequate language input is required for typical language development. However, NICU infants are at particularly high risk for experiencing a language deprived environment and may spend weeks-to-many-months of a critical developmental period in this setting. Importantly, we know that the language environment of the NICU matters: the quantity and quality of language input an infant receives in the NICU has been associated with positive short-and-long-term outcomes (e.g., attentiveness, alertness, vocalizations, conversational turns, language, development). Infant directed speech (IDS), is a highly promising language construct, that is defined as a pattern of speaking adults use with infants and young children that has a simpler phonology, grammatical structure, and fewer lexical items as well as a higher pitch and unusual intonation pattern. Increased use of IDS has been found to be predictive of better language outcomes in typically developing infants. Increasing the quantity of IDS in the NICU may be a simple, low-training, high-impact intervention that could bolster early language outcomes for NICU infants (e.g., verbalizations, conversational turns). For NICU infants, it is imperative that we task both parents and clinicians as co-primary providers of routine IDS due to significant existing barriers to parent visitation. However, tasking clinicians to use IDS during routine care will likely face organizational, innovation, and clinician-level barriers that may impact clinician intentions. To successfully increase all infants’ access to IDS, it is necessary to conduct preliminary implementation research prior to a Hybrid Type 1 (effectiveness- implementation) study to identify and understand: 1) barriers to parent visitation and intentions to use IDS with their hospitalized infant (with semi-structured interviews, surveys); and 2) identify and understand barriers and facilitators to NICU clinician use of IDS (with surveys, video-elicitation interviews; video simulation surveys). To conceptualize this work, we are modifying the Explore Plan Implement Sustain implementation framework to incorporate health equity factors as part of the outer context and use organizational and psychological theories of behavior to explore and refine a possible causal model of contributors to parent and clinician intentions to use IDS with NICU infants. Completing the proposed research will allow us to refine our causal model by identifying an exhaustive list of societal, organizational, innovation, and individual factors (i.e., barriers, facilitators) that may impact or moderate parent intentions to visit and parent and clinician intentions to use IDS in the NICU. Finally, the training and research activities proposed in the K23 application will support the PI in having the data, skills, and experiences necessary to submit a strong application for a multi-site Hybrid Type I (effectiveness- implementation) trial that examines 1) whether we can significantly increase adult use of IDS in the NICU (i.e., parent/visits, clinician/routine care); and 2) whether infants who received higher levels of IDS demonstrated more verbalizations, vocalizations, and conversational turns at discharge (adjusting for gestational age).

项目概要/摘要 典型的语言发展需要足够的语言输入，但新生儿重症监护病房 (NICU) 婴儿的情况尤其如此。 经历语言匮乏的环境的风险很高，并且可能会度过数周至数月的关键时期 重要的是，我们知道 NICU 的语言环境很重要： 婴儿在新生儿重症监护病房 (NICU) 接受的语言输入的数量和质量与积极相关 短期和长期结果（例如，注意力、警觉性、发声、对话轮转、语言、 婴儿定向语音（IDS）是一种非常有前途的语言结构，被定义为一种模式 说话的成人与婴儿和幼儿一起使用，具有更简单的语音、语法结构和 人们发现，IDS 的使用越来越多，词汇量也越来越少，音调越来越高，语调也越来越不寻常。 预测正常发育婴儿中 IDS 数量的增加。 新生儿重症监护病房 (NICU) 可能是一种简单、训练量低、影响力大的干预措施，可以增强儿童的早期语言结果 NICU 婴儿（例如言语、对话）对于 NICU 婴儿，我们必须对两者进行任务。 由于家长和人群存在重大障碍，他们成为常规 IDS 的共同主要提供者 然而，在日常护理期间使用 IDS 的任务可能会面临组织、创新、 以及可能影响临床医生意图的临床医生层面的障碍，以成功增加所有婴儿获得治疗的机会。 IDS，有必要在混合类型1（有效性- 实施）研究以识别和理解：1）家长探视的障碍以及使用 IDS 的意图 住院婴儿（通过半结构化访谈、调查）；2) 识别并了解障碍和 促进 NICU 临床医生使用 IDS（包括调查、视频启发访谈；视频模拟调查）。 概念化这项工作，我们正在修改探索计划实施维持实施框架 将健康公平因素纳入外部背景，并运用组织和心理学理论 行为的探索和完善可能的因果模型，影响父母和临床医生的使用意图 完成 NICU 婴儿的 IDS 将使我们能够通过识别来完善我们的因果模型。 可能会出现的社会、组织、创新和个人因素（即障碍、促进因素）的详尽清单 影响或调节家长探视的意愿以及家长和临床医生在 NICU 中使用 IDS 的意愿。 K23 申请中提出的培训和研究活动将支持 PI 拥有数据、技能、 以及提交多站点混合类型 I 的有力申请所需的经验（有效性- 实施）试验检查 1）我们是否可以显着增加 NICU 中成人对 IDS 的使用（即， 父母/探视、临床医生/日常护理）；以及 2) 接受较高水平 IDS 的婴儿是否表现出更多 出院时的言语、发声和对话（根据胎龄进行调整）。