Interventions to improve quantitative measures of parent satisfaction in neonatal care: a systematic review

Abstract

ObjectiveInterventions improving parent satisfaction can reduce parent stress, may improve parent-infant bonding and infant outcomes. Our objective was to systematically review neonatal interventions relating to parents of infants of all gestations where an outcome was parent satisfaction.MethodsWe searched the databases MEDLINE, EMBASE, PsychINFO, Cochrane Central Register of Controlled Trials, CINAHL, HMIC, Maternity and Infant Care between 1 January 1946 and 1 October 2017. Inclusion criteria were randomised controlled trials (RCT), cohort studies and other non-randomised studies if participants were parents of infants receiving neonatal care, interventions were implemented in neonatal units (of any care level) and ≥1 quantitative outcome of parent satisfaction was measured. Included studies were limited to the English language only. We extracted study characteristics, interventions, outcomes and parent involvement in intervention design. Included studies were not sufficiently homogenous to enable quantitative synthesis. We assessed quality with the Cochrane Collaboration risk of bias tool (randomised) and the ROBINS-I tool (Risk Of Bias In Non-randomised Studies - of Interventions) (non-randomised studies).ResultsWe identified 32 studies with satisfaction measures from over 2800 parents and grouped interventions into 5 themes. Most studies were non-randomised involving preterm infants. Parent satisfaction was measured by 334 different questions in 29 questionnaires (only 6/29 fully validated). 18/32 studies reported higher parent satisfaction in the intervention group. The intervention theme with most studies reporting higher satisfaction was parent involvement (10/14). Five (5/32) studies reported involving parents in intervention design. All studies had high risk of bias.ConclusionsMany interventions, commonly relating to parent involvement, are reported to improve parent satisfaction. Inconsistency in satisfaction measurements and high risk of bias makes this low-quality evidence. Standardised, validated parent satisfaction measures are needed, as well as higher quality trials of parent experience involving parents in intervention design.PROSPERO registration numberCRD42017072388.

Parents’ Experiences of Communication in Neonatal Care (PEC): a neonatal survey refined for real-time parent feedback

“…This refined parent experience survey, which focuses on communication and parent involvement, was evaluated to have favourable performance in the neonatal parent population, and can be used to assess parent experience in UK neonatal care. Inconsistency in and lack of validation of survey instruments measuring parent satisfaction in neonatal care (and specifically with family centred care) have been highlighted worldwide 8 14. The lead author’s systematic review of interventions aiming to improve parent experience of neonatal care identified that less than 20% of studies used fully validated surveys 8.…”

“…Inconsistency in and lack of validation of survey instruments measuring parent satisfaction in neonatal care (and specifically with family centred care) have been highlighted worldwide 8 14. The lead author’s systematic review of interventions aiming to improve parent experience of neonatal care identified that less than 20% of studies used fully validated surveys 8. Most surveys are administered around the time of discharge from neonatal care and retrospectively assess parent experience, like the recently developed CO-PARTNER tool, which measures parent participation and collaboration with staff 19.…”

“…6 Parent satisfaction, defined as 'the perception of parents' needs and expectations being met' is inversely related to parental stress. 7 Consequently, interventions aimed at improving parent satisfaction are being developed worldwide 8 to reduce parent stress, improve parent-infant bonding 9 and outcomes. 10 11 In 2009, the UK Department of Health published the Toolkit for High-Quality Neonatal Services, which emphasised the importance of family-centred care.…”

“…Inconsistent and unvalidated instruments are commonly used. Most existing validated instruments in the English language worldwide have been primarily designed for retrospective parent feedback, near to or after discharge from neonatal care 8 14. In UK neonatal care, only one validated survey for parents in neonatal care exists: the Parents’ Experiences of Neonatal Care.…”

Better Use of Data to improve parent Satisfaction (BUDS): protocol for a prospective before-and-after pilot study employing mixed methods to improve parent experience of neonatal care

“…There is evidence that parent satisfaction can be improved through simple interventions, such as providing written information to parents,11 12 however, previous interventions required additional work from staff to collect, record, collate and provide information to parents, limiting their sustainability and generalisability. Further limitations of previous studies include the failure to involve parents in study development and the use of invalidated questionnaires to measure the impact of interventions 13…”