The evolution of parental self-efficacy in knowledge and skill in the home care of preterm infants

Background: The American Academy of Pediatrics recommends the consideration of the ability and confidence of a caregiver to take care of a preterm infant before discharge (D/C). Objective: To identify how parental self-efficacy as measured by the Infant Care Survey (ICS) evolves during their preterm child’s Neonatal Intensive Care Unit (NICU) admission, and to identify conditions associated with caregiver confidence. Methods: Prospective cohort study involving parents of infants ≤ 32 weeks gestation who were enrolled between 10-20 days of their infant’s life. Parent/infant demographic, pregnancy, NICU, and D/C data was collected. Parents responded to the ICS at enrollment and D/C. Enrollment and D/C ICS scores were compared to one another using a Paired Samples t-test to assess the change in scores over time. Further, conditions which are thought to affect self-efficacy were compared to enrollment, D/C, and the change in total ICS scores to assess for correlations. Results: Total ICS scores showed significant improvement from enrollment to D/C: (188.3 ± 60.5 vs. 235.9 ± 20.9). When comparing caregivers who did not have other children in the home to parents who did, caregivers without previous children had significantly lower ICS scores at enrollment (149.8 ± 64.0 vs. 221.7 ± 31.2); however, D/C ICS scores were similar (228.7 ± 23.1 vs. 242.1 ± 17.2). This was the result of a more profound improvement in self-efficacy amongst first time parents during their child’s NICU admission (79.0 ± 68.1 vs. 20.3 ± 35.2). Conclusion: Despite the stress and anxiety of having a child in the NICU, parental self-efficacy is likely to significantly improve during their child’s hospitalization. This was most evident amongst first time parents. We suspect that parental participation in their infant’s care and formal educational opportunities contribute to improvement in confidence over time.