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Pediatric Care -- On Your Cell Phone and In Your Neighborhoods

Posted: 4/26/2010

Having a baby is a very exciting time for new parents, with all the preparation and anticipation that comes with it. But how do parents find help and assistance -- from prenatal care to parenting tips?  Researchers at the Johns Hopkins University School of Nursing (JHUSON) have come up with innovative ways to provide parenting tips to new parents of all demographics.

Providing Pregnancy and Newborn Information Via Text Messages

Each year, more than 500,000 babies are born prematurely, and about 28,000 children die before their first birthday. Getting evidence-based educational information into the hands of pregnant women and new mothers is a critical element in the effort to reduce premature births across the country.

A new program, Text4Baby, brings free, educational messages right to women's fingertips via text messages. "Because of the number of young women of childbearing age that we want to reach, text messages make sense to really target this audience," says Elizabeth Jordan, DNSc, RNC, assistant professor at the JHUSON and a board member for the National Healthy Mothers, Healthy Babies Coalition, which developed the nationwide program. About 90 percent of Americans have cell phones, Jordan says, and a vast majority of those between the ages of 18 and 29 are sending and receiving text messages. Texting is also a successful way to reach low income and minority women, those most in need for educational information about pregnancy and newborn care.

Through 51-character texts three times a week, Text4Baby delivers messages about topics such as seasonal flu, prenatal vitamins, breastfeeding, and immunizations. Jordan, who has dedicated her career to improving maternal and infant health, helped review the text messages, which were developed by the Centers for Disease Control and Prevention and adapted with texting and young women in mind. "It's something that really got me excited," says Jordan, who represents the Association of Womens Health, Obstetric and Neonatal Nurses (AWHONN) on the coalition board." I have dedicated my career to taking care of moms and having healthy baby outcomes".

Since January 2010, more than 25,000 women in 41 states have registered for the free text messaging service which  is made possible through support from academic, private, government, and nonprofit organizations, including the Wireless Foundation, Johnson & Johnson, and technology company Vioxia. The effectiveness of the program nationwide is now being evaluated by researchers at George Washington University to determine whether text messages are affecting behavior change.

Supporting and Empowering Minority Parents

Navigating parenthood can be hard and many parents seek support of parenting education programs. But too many programs fail to take into account parents diverse cultural and economic backgrounds and some lack the social context that can really make them effective. The approaches often don't resonate with minority groups, leaving parents feeling powerless and unsupported.
 
To fill this need, Deborah Gross, DNSc, RN, FAAN, the JHUSON Leonard and Helen Stulman Professor in Mental Health and Psychiatric Nursing helped develop the Chicago Parent Program. The program focuses on an overlooked population and aims to have a positive impact on parents and young children. "It was designed in collaboration with African American and Latino parents to address the issues parents raising young children face," says Gross. "One of the biggest differences is that most programs were designed for white, middle class parents and are being adapted [for other groups]. This  Program, which can be used in any city, was designed with a diverse community in mind" she says.
 
Gross is now expanding the Program to other cities, including Baltimore and New York. With the support of the Robert Wood Johnson Foundation, Harlem Children's Zone in New York recently started using the Program with parents of three year-olds in Head Start programs.   The Zone is the national model for the president's Promise Neighborhoods initiative which funds communities providing comprehensive, integrated services designed to improve the lives of families living in poverty.  "To date, the parent groups are going very well and parent satisfaction scores are consistently high," Gross reports.

The 12-session Program is conducted in group sessions, where parents can discuss common issues, struggles, and solutions. To encourage those discussions, the program includes about 160 vignettes showing scenes familiar to most parents, such as getting children up and ready for school or handling bored children while at the laundry mat. The scenes cast real families, mostly ethnic minorities, in real situations, which is unique to this parenting program and provides the relevant social context, Gross explains. 

Parents are taught predictable, effective options for discipline, with the overall goal of ensuring the discipline is controlled and done without humiliation or rage. The Program gives parents options for encouraging their children's good behavior, and discouraging poor behavior, such as ignoring or time out. "We're trying to give parents a bag of tricks," Gross says. "What most parents have in their bag is about one or two tricks, and neither usually works very well. The program helps them to be clear about the behaviors they like and to encourage those, as well as what they don't like and want to discourage." Parents feel more in control, which builds their confidence.
 
Evaluations of the Program have proven its success.  In one evaluation, Chicago parents who participated in at least half of the Program sessions reported greater improvements in parenting self-efficacy, used less corporal punishment, and used more positive and consistent discipline strategies. Further, children whose parents attended the program reported their children had fewer behavioral problems up to one year later. Parents' satisfaction with the program is also quite high, Gross says. "They find it very supportive, and they learn a lot," she says. "They can see the differences in their kids, as well as themselves."