P2.G122: Prenatal consults with spaced repetition: Incorporating parental feedback into the development of a perinatal educational tool

Background: Prenatal consultations are a tool neonatologists use to convey information to parents anticipating the delivery of newborns requiring intensive care. In addition to high anxiety during these consults, factors including maternal age, comorbidities, and limited English proficiency can limit comprehension. Studies have shown the use of visual aids during consultations can decrease anxiety and improve recall. This approach limits dynamic learning that continues after the consultation is completed. Thus, an alternative approach could provide means to efficiently review information at systematic intervals, a method referred to as spaced repetition. The objective of this study is to collaborate with parents of former premature infants requiring NICU hospitalization to curate flash cards to be utilized as an educational tool for parents at risk for preterm delivery.

Methods: The Newborn Center Family Advisory Committee served as stakeholders in a series of focus groups. Each focus group emphasized topics which directed the development of flash cards. Focus group #1 provided each stakeholder an opportunity to describe their NICU experience and to discuss their ideal prenatal consult. They were then introduced to the concept of spaced repetition while being given a chance to look at the first iteration of flash cards. Focus group #2 emphasized important topics to include, ideal utilization, and card aesthetics. Two authors used thematic coding to independently analyze each focus group transcript, then compared and edited codes until agreement reached. Final codes were then categorized into common themes and subthemes shared among participants.

Results: Thematic coding yielded four themes: Cognitive Load, Emotional Toll, Card Content, and Card Format. Under cognitive load, parents highlighted subthemes: information overload, lack of understanding and retention, medical jargon, burden placed on parents, cultural differences, decision-making, and incorporating support staff/family. Under emotional toll, parents highlighted subthemes: journaling, validation of concerns, and specific emotions experienced while admitted. Under card content, parents highlighted the need for cards acclimating to the NICU environment, emphasizing the use of pictures and the need for a breadth of topics. Under card format, parents suggested offering a digital option and focused on card aesthetics. Specific quotes related to each theme/subtheme are displayed in Figure 1.

Conclusion: During the focus groups, stakeholders emphasized: (1) the need for an educational tool to supplement the prenatal consult secondary to the cognitive load and emotional toll experienced and (2) how this educational tool should be implemented with suggestions related to content and formatting. These themes were directly utilized in the development of flash cards. A pilot randomized controlled trial is ongoing implementing these flash cards after traditional prenatal consults. Cards are left with parents to review at systematic intervals and the research team follows up at specific time points to assess effect on anxiety and knowledge retention.