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Introduction
The following analysis is related to the article, “The effect of nursing quality improvement and mobile health interventions on infant sleep practices” by Moon et al. (2017). The study under review is a randomized clinical trial, which is indicated in its title. The purpose of the trial was to determine whether two interventions, nursing quality improvement (NQI) and mobile health intervention, increased mothers’ adherence to infant safe sleep practices when used separately and combined. This paper will analyze the article’s strengths and weaknesses, reliability and validity, ethics, and topic summary. Overall, the reviewed trial may be considered well-designed, providing reliable and valid results, and performed in accordance with ethics, although some limitations are also present.
Overall Strengths and Weaknesses
The article by Moon et al. (2017) explored the effectiveness of two interventions on improving infant safe sleep practices, which could be used to reduce the risk of sudden infant death syndrome (SIDS). The study used cluster randomization and provided a clear explanation of the rationale for the chosen trial design. A detailed description of interventions for experimental and control groups is also present. The findings indicated that mobile health intervention improved mothers’ self-reported adherence to infant safe sleep practices, whereas the effect of the NQI intervention appeared to be not statistically significant. These results have implications for practitioners and guide further research into this field. For example, Moon et al. (2017) stated that it was necessary to examine whether the widespread use of mobile health intervention was feasible and whether it decreased the rate of SIDS. Thus, this study has significant strengths that make it a well-designed randomized clinical trial.
Yet, the article also has certain limitations regarding the generalizability of the results. First of all, researchers excluded non-English speaking mothers from the study sample, which implies that the generalizability of the results cannot be applied to the non-English speaking population. Apart from that, the rate of participants lost to follow-up was 21%, and this group was comprised mostly of “younger, black, single, and less well educated” women (Moon et al., 2017, p. 358). As a result, the findings regarding the effectiveness of mobile health intervention in promoting infant safe sleep practices may not apply to this population. In addition, the trial did not assess adverse events and clinical outcomes, such as SIDS rates. The researchers used participants’ self-reported adherence to safe sleep practices. Although self-reported data has many advantages, its weakness is that some participants’ responses may be exaggerated or biased. Finally, the authors did not describe the procedure of blinding, which may imply that it was not used in this study.
Reliability and Validity
The study under consideration is a well-designed randomized clinical trial, which puts it at Level II in the hierarchy of evidence. The randomization procedure is clearly described and well-explained in the article. Moon et al. (2017) divided sixteen hospitals into four groups and then randomly assigned one of the four interventions to each of the groups using computer-generated random numbers and a blocked randomization scheme. The interventions assigned to the four groups included safe sleep NQI and safe sleep mHealth, and the control interventions were breastfeeding NQI and breastfeeding mHealth. The interventions were allocated in such a way as to assess the effects of each of the experimental interventions individually and in combination with each other. Cluster randomization was justified for this trial because providing nurses within the same hospital with different training was not feasible. Moreover, providing different interventions to patients in the same hospital could lead to result contamination. Therefore, cluster randomization ensured the reliability of the results in this case. The sample size was large enough to provide generalizable results for the English-speaking population. Eligibility criteria were thoroughly described, and non-eligible participants were excluded from the trial.
The results of the study can be considered valid because the researchers’ methods assessed what they intended to assess. The provided experimental interventions were aimed at increasing mothers’ awareness of infant safe sleep practices. Data were collected by means of a survey that assessed the effect of these interventions on mothers’ adherence to safe sleep practices. The statistics used for data analysis included 95% CIs, Bonferroni-adjusted P values, and post hoc imputation analyses. The findings were consistent in different groups, across all endpoints, and with the prestudy data, which proves the validity of the obtained results.
Ethics
The researchers followed the ethical standards and procedures required for conducting experimental research. The Institutional Review Board approval was received from all hospitals involved in the trial and Boston University, the University of Virginia, and Yale University. Written informed consent was obtained from all participants, and their anonymity and confidentiality were protected. The used interventions did not pose a risk of harm to the participants, and the researchers gave them the right to withdraw from the trial.
Topic Summary
The study addressed a significant research topic in the field of infant care. Moon et al. (2017) explained their interest in studying the effects of interventions directed toward promoting infant safe sleep practices by the need for reducing the rates of SIDS. The risk of SIDS may decrease when mothers adhere to infant safe sleep practices. These practices include infants’ supine sleep position, sharing rooms but not beds with parents, use of pacifiers, and non-use of soft bedding (Moon et al., 2017). Thus, examining the ways of increasing mothers’ adherence to safe sleep practices is an important research question.
Reference
Moon, R. Y., Hauck, F. R., Colson, E. R., Kellams, A. L., Geller, N. L., Heeren, T., Keer, S. M., Drake, E. E., Tanabe, K., McClain, M., & Corwin, M. J. (2017). The effect of nursing quality improvement and mobile health interventions on infant sleep practices: A randomized clinical trial. JAMA, 318(4), 351-359. Web.
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