Feasibility of a Transdisciplinary Mixed Methods Study Examining Barriers and Facilitators to Maternal Engagement in Colorado Neonatal Intensive Care Units (NICUs)

Background and Purpose: Because preterm and low birthweight infants are hospitalized in NICUs, they are likely to be separated from their mothers for weeks or months during a critical developmental period. Research suggests that maternal engagement is critical to infants’ health and development. However, little is currently known about what factors influence maternal engagement, which barriers are most salient for mothers of color and mothers from historically underserved populations, and how these barriers may contribute to later disparities in infant health. The aim of this pilot study was to assess the feasibility of a multi-site, multi-institution, transdisciplinary research project examining barriers and facilitators to maternal engagement in two Colorado NICUs.

Methods: A research team with researchers from three universities and two hospitals launched a transdisciplinary pilot project in May 2017 to test study procedures and data collection instruments in two NICUs. Enrollment team members identified eligible mothers through daily NICU census reviews and tracked the consents and refusals of mothers who were asked to participate. Participants completed an initial survey and daily dairies to record maternal engagement activities in the NICU. Research assistants within the hospital system extracted infant discharge data from electronic medical records and entered them into a HIPAA-compliant database. Social work research team members then collected 6-week post-discharge survey data via phone calls or emailed links sent to participants. Attrition was tracked in the project database. Pilot data from the initial survey, 6-week post-discharge survey, maternal engagement diaries, and qualitative interviews were reviewed to assess response quality.

Results: Since the research project started in May 2017, 93 mothers were eligible for study participation. Sixty-three (67.7%) enrolled in the project, and 5 (7.9%) subsequently withdrew. Thirty-two mothers were ineligible for study participation due to several factors, including maternal age (less than 18 years old), severity of infant medical condition, reported illicit substance use, infant death, maternal incarceration, and maternal language. Of those enrolled in the study, 43 reported the number of paid days of leave available to them during the maternity period with an average of 20 paid days. However, 53.5% (n = 23) reported access to zero paid days of leave during their maternity period. Approximately a quarter (n = 16) of the participants reported that they sometimes have difficulty paying their bills, while 17.5% (n = 11) reported difficulty paying their bills very often. Thirty-one of the 44 participants (70.5%) eligible for the 6-week post-discharge survey completed the survey. Pilot data allowed the research team to identify and address limitations in survey questions, maternal engagement time-use diaries, and the qualitative interview protocol.

Conclusions and Implications: Findings demonstrate procedural feasibility of a multi-site, multi-institution transdisciplinary study examining barriers and facilitators to maternal engagement in Colorado NICUs. Evidence from this pilot study can inform social work researchers seeking to launch multi-site, multi-institution transdisciplinary research projects in hospital settings. This pilot study demonstrates the effectiveness of social work researchers in developing transdisciplinary research partnerships that seek to address social injustices, particularly health disparities, through research-informed policy and clinical interventions.