Extended Psychosocial Analysis of PHONE Study Data

Wake Forest University Health Sciences, Winston-Salem NC

Investigators

Abstract

DESCRIPTION (provided by applicant): This application is a resubmission of an RO3 to analyze existing Post-Hospital Nursing Effectiveness (PHONE) study data. The PHONE study was a randomized comparison of two methods of providing post-discharge care for 150 infants with neonatal chronic lung disease (CLD), the most prevalent chronic illness in infants who survive extreme prematurity. One group of infants and their families (CEN) received follow-up care that involved frequent visits to a multidisciplinary specialty clinic. The other group (COM) received follow-up care from their primary physicians along with frequent telephone contact with the same nurse who saw patients in the multidisciplinary specialty clinic. The two groups were compared on infant health and developmental outcomes through one year of age, costs associated with medical care, and general psychological functioning in the families. Psychosocial data were collected until the children reached two years of age. The current study proposes to extend the analysis of data from the PHONE study to examine more closely family psychosocial functioning in the overall sample of study participants. A better understanding of family functioning is essential because families caring for a medically fragile infant at home may encounter multiple stressors regardless of the type of post-discharge care provided. This stress can result in psychosocial difficulties for family members, which in turn can impede the optimal development of the infant. However, if we better understand how families function psychologically, and what enhances functioning, appropriate psychosocial support can be incorporated into post-discharge care to improve outcomes for both the infant and family members. This proposal has the following specific aims, which were developed to include aspects of caring for chronically ill children that have often been neglected in the literature: (1) to determine differences in mothers' and fathers' psychosocial states (including depressive symptoms, general life satisfaction, perceived health, and perceived family impact) during the first year of caring for a prematurely born infant with CLD; (2) to examine an index of illness mastery and its correlates in families caring for an infant with CLD; (3) to examine change in parental perceptions of child vulnerability (PPCV) over time and correlates of PPCV at two years; and (4) to determine illness factors, maternal intrapersonal factors, and socio-ecological factors associated with parenting stress when the child is 24 months adjusted age. Repeated measures analysis of covariance will be used to determine changes in psychosocial status over time, and regression analyses will be used to determine predictors of psychosocial outcomes based upon the specific aims.