Using Baby Books to Promote Maternal and Child Health

The Baby Books Project tests whether embedding educational information into baby books can improve the health and wellbeing of first-time mothers and their young children.

Study Overview

• Status: Completed
• Conditions: Condition 1 - Educational Condition (Educational Book Group); Condition 2 - Non-educational Condition (Non-educational Book Group); Condition 3 - Control Condition (No-book Group)
• Intervention / Treatment: Behavioral: Educational Content/Pediatric Anticipatory Guidance; Behavioral: Book provision

Detailed Description

This study tests the efficacy of embedding educational information (i.e., pediatric anticipatory guidance) into baby books that first-time mothers read to their infants. This 3-group longitudinal study recruited first-time mothers in their third trimester of pregnancy, randomly assigned them to conditions, and followed them until the child was 18 months of age. One group received educational baby books, another group was given the same illustrated books with non-educational text, and the third group was not given any books. Thus, the effects of educational reading could be parsed from the effects of reading alone. The study aimed to test whether embedding pediatric anticipatory guidance in picture books is an effective method for increasing maternal knowledge of child development, parenting strategies, and safety practices, improving parenting beliefs and attitudes (e.g., parenting efficacy, importance of reading, use of corporal punishment), supporting optimal parenting practices (e.g., breastfeeding and nutrition, responsiveness, safety practices), improving maternal health (stress, depression), and supporting children's healthier development (injuries, illness, immunizations, and linguistic, social, and cognitive development).

Survey and observational data collection occurred in participants' homes during their third trimester of pregnancy and when their child was 2, 4, 6, 9, 12, and 18 months of age. Twelve phone call interviews were conducted between these home visits. When children were 18 months, a retrospective medical chart audit was conducted.

• Study Type: Interventional
• Enrollment (Actual): 198
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • California
    • Irvine, California, United States, 92697
      • University of California, Irvine
  • Tennessee
    • Nashville, Tennessee, United States, 37212
      • Vanderbilt University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 50 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

• Women who are pregnant with first child and able to read in English at a first grade reading level

Exclusion Criteria:

• Women with other children, men, those not able to read in English at a first grade level

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Single Group Assignment
• Masking: Double

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: educational baby books; books embedded with educational information (pediatric anticipatory guidance)	Behavioral: Educational Content/Pediatric Anticipatory Guidance; educational information from Bright Futures Guidelines for Health Supervision for birth to 18 months; Behavioral: Book provision; Given free books prenatally and at 2, 4, 6, 9, 12, and 18 months postpartum
Active Comparator: non-educational baby books; baby books given with same illustrations but no educational information	Behavioral: Book provision; Given free books prenatally and at 2, 4, 6, 9, 12, and 18 months postpartum
No Intervention: no books; not given any baby books

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in knowledge of child development and parenting	Measured with Opinions about Babies questionnaire	Change from Baseline (pregnancy) to 18 months postpartum
Change in Reading Practices	Self-reported joint reading practices	Change from 2 to 18 months postpartum
Parenting Stress	Measured with the Parenting Stress Index	Change from 2 to 18 months post-partum
Costs	Maternal costs due to their own and their child's illness/injury, use of substances, and purchase of food was measured with the Incurred Cost Questionnaire.	Cumulative costs over study duration

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Safety Practices	Measured with the Home Safety Assessment, an observational and self-report measure of safety practices in the home, car, and outside	2, 4, 6, 9, 12, and 18 months postpartum
Attitudes about Corporal punishment	Adolescent-Adult Parenting Inventory	2, 6, 12 and 18 months postpartum
Maternal Depressive Symptoms	Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale.	Change from baseline (pregnancy) to 18 months postpartum
Beliefs about the Importance of Reading to Children	Maternal beliefs about the importance of reading was measured with the Modified Parent Reading Belief Inventory	Change from baseline (prenatal) to 18 months postpartum
Injuries and illnesses	Child illnesses injuries were measured with the Incurred Cost Questionnaire and through a retrospective medical chart audit.	16 months (from 2 to 18 months postpartum)
Quality of Parent-Child Interaction	Video recording and in-vivo coding of mother-child dyads during play and reading.	Change from 2 to 18 months postpartum
Home environment and parenting	measured with the Home Observation for Measurement of Environment (HOME).	Change from 2 to 18 months postpartum
Receptive and Expressive language	Measured with the Preschool Language Scale - Fourth Edition (PLS4).	Change from 6 to 18 months postpartum
Cognitive and neurological development screening	Measured with the Bayley Infant Neurodevelopmental Screener (BINS)	4, 6, 9 months postpartum
Infant nutrition	Infant Nutrition Interview measured the introduction of news foods, types of foods, and serving portions at each time point.	2, 4, 6, 9, 12, and 18 months postpartum
Breastfeeding intentions and practices	measured with the Breastfeeding Intentions and Practices Scale	prenatal and postnatal every visit until no longer breastfeeding
Pregnancy uplifts and Hassles	measured with the Pregnancy Experience Scale	Baselines (pregnancy)
Parenting Satisfaction	measured with the Parenting Satisfaction Scale	Change from 2 to 18 months postpartum
Parenting Self-Efficacy	Measured with the Maternal Self-Efficacy Scale	Change from 2 to 18 months postpartum
Reading self-efficacy	measured with the Reading Self-Efficacy Scale	Change from 2 to 18 months postpartum
Cognitive Development	measured with Exploratory Play Task	12 and 18 months postpartum
Immunizations, medical visits, and growth status	measured through a retrospective medical chart audit.	18 months postpartum

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Community Conditions	measured with the observational Community Conditions Checklist and self-report Community Conditions Interview	4 months postpartum and following a move to a new residence

Collaborators and Investigators

• Sponsor: Vanderbilt University
• Collaborators: University of California, Irvine
• Investigators: Study Director: Stephanie M Reich, PhD, University of California, Irvine; Principal Investigator: Leonard Bickman, PhD, Vanderbilt University

Publications and helpful links

General Publications

• Khalessi A, Reich SM. A Month of Breastfeeding Associated with Greater Adherence to Pediatric Nutrition Guidelines. J Reprod Infant Psychol. 2013 Jul 1;31(3):299-308. doi: 10.1080/02646838.2013.784898.
• Reich SM, Penner EK, Duncan GJ, Auger A. Using baby books to change new mothers' attitudes about corporal punishment. Child Abuse Negl. 2012 Feb;36(2):108-17. doi: 10.1016/j.chiabu.2011.09.017. Epub 2012 Mar 3.
• Reich SM, Penner EK, Duncan GJ. Using baby books to increase new mothers' safety practices. Acad Pediatr. 2011 Jan-Feb;11(1):34-43. doi: 10.1016/j.acap.2010.12.006.
• Reich SM, Bickman L, Saville BR, Alvarez J. The effectiveness of baby books for providing pediatric anticipatory guidance to new mothers. Pediatrics. 2010 May;125(5):997-1002. doi: 10.1542/peds.2009-2728. Epub 2010 Apr 12.

Study record dates

Study Major Dates

• Study Start: April 1, 2005
• Primary Completion (Actual): June 1, 2009
• Study Completion (Actual): July 1, 2010

Study Registration Dates

• First Submitted: July 18, 2014
• First Submitted That Met QC Criteria: July 28, 2014
• First Posted (Estimate): July 30, 2014

Study Record Updates

• Last Update Posted (Actual): April 14, 2017
• Last Update Submitted That Met QC Criteria: April 13, 2017
• Last Verified: April 1, 2017

More Information

Terms related to this study

• Keywords: safety; anticipatory guidance; baby books
• Additional Relevant MeSH Terms: Pathologic Processes; Disease
• Other Study ID Numbers: R01HD447749