Supporting parents, safeguarding infants: A qualitative evaluation of parental experiences with the ICON program to reduce abusive head injury in England.

BACKGROUND

Abusive head trauma (AHT) is a leading cause of head injuries in children under 12 months of age. ICON is an AHT prevention program delivered in the National Health Service (United Kingdom) that educates and provides strategies for new parents on infant crying: infant crying is normal, comforting strategies can help, it's ok to walk away, never shake a baby. Little is known about parental perspectives on ICON and similar programs.

OBJECTIVE

This study evaluated ICON from the perspective of new parents, identifying factors that influence its reach and effectiveness in providing tools to cope with a baby who is crying.

PARTICIPANTS/

SETTING

Twenty-eight new parents of infants aged between two and six months were recruited from six geographic areas across England, selected to reflect ethnic, socioeconomic and regional diversity.

METHODS

This qualitative evaluation study interviewed new parents to understand their experiences of ICON. Data collection and analysis were concurrent and iterative. Framework analysis and an ecological framework guided analysis to explore factors affecting ICON's reach and effectiveness. A diverse parent advisory panel informed study design and analysis.

RESULTS

ICON messages normalized infant crying for parents, provided comforting strategies and gave them permission to put their baby down when overwhelmed, and reinforced the message to never shake a baby. Mothers were the primary recipient of education. Factors impacting ICON's effectiveness included tailoring education to family needs, presence of family/friend support, and the parent's emotional state. Contextual factors impacted parental receptivity of ICON.

CONCLUSIONS

New parents reported the ICON program messages supported them in coping with their babies when they cried. They identified factors to enhance that support; by engaging fathers, by enhancing healthcare professionals' fidelity to the program while personalising the message, and by addressing wider social and contextual conditions that shape everyday caregiving.