The Effect of a Supportive-Educative Nursing Program on the Knowledge and Behaviors of First-Time Mothers in Caring for Premature Infants at Home

Abstract

Introduction Caring for premature infants at home is a complex responsibility due to their physiological immaturity and vulnerability across multiple systems. Although these infants are discharged after clinical stabilization, they remain at high risk, particularly during the transition from hospital to home. First-time mothers often have basic knowledge but lack practical experience, confidence, and continuous support, which can compromise the effectiveness of caregiving. This situation highlights a gap in structured supportive-educative interventions during the post-discharge period. Therefore, the researchers developed the Supportive Educative Nursing Program (SENP), guided by Orem’s theory, with the aim of enhancing maternal competence to ensure appropriate and sustainable infant care.

Objectives This study aimed to 1) compare the mean scores of knowledge and caregiving behaviors related to premature infants among first-time mothers in the experimental group before and after participating in the program, and 2) compare the mean scores of knowledge and caregiving behaviors between first-time mothers in the experimental group and the control group. 

Design This study employed a quasi-experimental design with two-group pretest and posttest. 

Methodology The study participants comprised first-time mothers caring for premature infants at home at least four days per week. Eligible infants had no congenital anomalies and had previously been admitted to neonatal units of public hospitals in Health Region 5 before discharge. A total of 76 participants were recruited through simple random sampling. Participants were then matched according to key infant criteria. The experimental group received the Supportive Educative Nursing Program (SENP), developed based on Orem’s theory, and implemented in four phases: 1) assessment of individual caregiving needs; 2) knowledge enhancement and skill development through practice, self-learning materials, and counseling via the Line Application “Growing Well, Caring for Your Baby”; 3) review and repeated practice to build confidence in caregiving; and 4) follow-up through home visits and outcome evaluation to provide psychological support and refine caregiving approaches. The control group received routine care. Research instruments included 1) a general information questionnaire, 2) a knowledge assessment on premature infant care, and 3) a caregiving behavior assessment covering four domains: general care, developmental promotion, health problem management, and disease prevention. Content validity indices (CVI) for the program, knowledge questionnaire, and behavior questionnaire were 1.00, .86, and .82, respectively. Reliability testing yielded a Kuder-Richardson (KR-20) coefficient of .82 for the knowledge questionnaire and a Cronbach’s alpha of .78 for the behavior questionnaire. The SENP was conducted over 12 weeks. In week 1, participants underwent needs assessment, received introductory knowledge, and were trained in the use of the manual. Weeks 2–3 focused on skill development and learning support through online media and counseling via the Line Application, twice weekly. Weeks 4–5 emphasized review and repeated practice to strengthen caregiving confidence. In week 6, follow-up was conducted through home visits with ongoing psychological support, continuing until week 12, when post-intervention evaluations of maternal knowledge and caregiving behaviors were performed. The control group received standard instruction on breastfeeding, developmental stimulation, and the Developmental Assessment for Intervention Manual (DAIM). Data were analyzed using Descriptive statistics for general information, Paired t-test to compare pre- and post-program scores within the experimental group, and Independent t-test to compare post-program scores between the experimental and control groups. 

Results The mean knowledge score regarding premature infant care among mothers in the experimental group after receiving the program (M = 23.50, SD = 3.02) was significantly higher than before the program (M = 8.79, SD = 2.68) and also higher than that of the control group (M = 15.50, SD = 2.82) (t = 12.698, p < .001; t = 10.850, p < .001, respectively). Similarly, the mean caregiving behavior score of the experimental group after the intervention (M = 98.00, SD = 10.84) was significantly greater than before the program (M = 32.08, SD = 14.32) and higher than that of the control group (M = 32.50, SD = 4.28) (t = 7.128, p < .001; t = 13.581, p < .001, respectively). 

Recommendation Nurses can apply the program to support home-based care for premature infants as a complement to existing standard practices. Future research should employ more rigorous control designs to further validate the program’s effectiveness and incorporate long-term follow-up to assess sustained outcomes.