"I Need to Pay Attention to Everything": Perspectives of Low-income Parents of Preterm Children on Early Relational Health.

Abstract

Objective: Supporting early relational health (ERH) positively affects lifelong health. We investigated perspectives of low-income parents of preterm children regarding child factors and parenting behaviors (defined as responsive parenting, structure/routines, and warm parent-child relationship) associated with ERH and factors associated with these behaviors.

Methods: We conducted in-depth, semi-structured interviews with low-income parents of children born preterm between Neonatal Intensive Care Unit (NICU) discharge and age 3 years. We examined perceptions of ERH and used the PRECEDE framework to identify predisposing, enabling, and reinforcing factors affecting parenting behaviors associated with ERH. We developed codes and themes iteratively using a deductive qualitative approach.

Results: We interviewed 22 parents of children born 24 to 34 weeks' gestation at 1 to 35 months corrected age. Regarding perspectives on ERH, parents shared that the NICU hospitalization heightens attention to children after discharge and that they feel an intense, sometimes overwhelming, bond with children born preterm. Parents both make accommodations for their preterm children and treat them the same as children born full term. Medical vulnerability affects how they spend time with their children. Regarding predisposing, enabling, and reinforcing factors of parenting behaviors associated with ERH, parents noted that developmental professionals can support relationships, that perceptions of preterm birth affect parents' relationships with their children, and that prior experience parenting preterm and full-term children affects confidence and knowledge of how to form relationships.

Conclusion: Adaptation of existing ERH interventions should incorporate ways that NICU hospitalization and views of prematurity inform low-income parents' perceptions and use of parenting behaviors associated with ERH.