The 2nd International Closeness Survey

Rationale and Aim

There is a large potential to improve the long-term prognosis of preterm infants by optimizing their early growth environment. An essential element of an environment supporting the development of preterm infants is the presence of parents. Therefore, one tool to improve outcomes of preterm infants is to involve parents more closely in their hospital care.  Even if the benefits are known, the implementation of family centered care varies widely.
Our first International Closeness Survey was carried out in 11 hospitals in 6 European countries in 2013. We showed large variation in parents’ presence and skin-to-skin contact provided in those units. We identified factors explaining some of the variation. Most hospitals have aimed to change their care culture and/or architecture after the survey. We also produced a profile of mothers’ and fathers’ perception of the aspects of the family centered care in each unit. The questions covered parents’ participation in the care and decision-making, and how parents were listened, supported, and trusted. Mothers and fathers were asked to rate one aspect of family centered care every evening as long as the infants was in a hospital.
We wanted to return to these study hospitals to see whether they have succeeded in improving parents’ involvement after five years of development work. We also aimed to expand the scope to cover more European regions, and also to include hospitals in Australia and the United States.
This 2nd survey will provide quantitative data of physical parent-infant closeness and parents’ participation prospectively in 25 different NICUs across 16 countries (Finland, Sweden, Norway, Denmark, Iceland, Belgium, the Netherlands, the UK, Poland, Estonia, Latvia, Lithuania, Spain, Australia, and the United States).
The 2nd International Closeness Survey uses a diary to record parents’ presence, skin-to-skin contact and holding. Parents fill in the diary daily. Parents also respond to one text message question every evening. Nine questions about family centered care are sent in a random order to both mothers and fathers separately as long as the infant is in hospital.
A researcher fills in a ‘Unit characteristics’ questionnaire and together with the parents ‘Infant and Family Background’ questionnaire. The parents are asked to fill in one questionnaire about family centered care and their mood when leaving the study hospital. Parents are asked to fill in a questionnaire about infant feeding and parents’ mood again when the baby is at 4 months of corrected age.  
All parents of preterm infants born below 35 gestational weeks and cared for in the neonatal unit of the study hospital will be approached and asked about their willingness to participate in the study. Every participating hospital will recruit 30 families in the study.
This study includes one outcome measure showing whether breastfeeding rates and parents’ psychological wellbeing are better if the hospital has successfully implemented practices supporting parents’ presence, physical parent-infant closeness and parents’ active participation.
The results will help each neonatal unit to see their performance and profile in family centered care and to compare their caring practices to other units. This is a solid starting point for quality improvement processes.