Applying the RE-AIM framework to evaluate the implementation of the Supporting and Enhancing NICU Sensory Experiences (SENSE) program

Abstract

Background To maximize the benefit of parent-directed, positive sensory exposures in the NICU, a structured sensory-based program titled the Supporting and Enhancing NICU Sensory Experiences (SENSE) program was developed that includes specific doses and targeted timing of evidence-based sensory exposures. Methods The Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework was used to systematically evaluate the SENSE program as an implementation strategy. One-hundred preterm infants ≤32 weeks gestation were studied (61 receiving the SENSE program and 39 standard-of-care). Parent education time and infant sensory exposures were tracked, and parents completed a questionnaire that probed their perceptions about the SENSE program. Results One-hundered thirty-one families were recruited, and 100 (76%) enrolled. The SENSE program was initiated at an average postmenstrual age of 29.8 (±2.4) weeks; 4.9 (±5.6) days after birth. The average number of education sessions with families was 4.8 (±3.7) amounting to 72.3 (±37.4) total minutes over hospitalization. The total time of logged tactile and auditory exposures among SENSE recipients over the length of hospitalization was a median (IQ range) of 9325 (5295-15,694) minutes over an average of 10.1 (±7.6) weeks of hospitalization. There were differences in the proportion of tactile and auditory exposure targets received by the infant among those receiving the SENSE program compared to standard-of-care (91% compared to 48%; p < 0.0001). Ninety-five percent of infants tolerated the SENSE program as defined, with 5% of infants requiring intermittent adaptations or the interventions being stopped for a period that typically lasted 1–2 weeks. Earlier parent education was related to more parent participation in SENSE program interventions (p = 0.04). Eighty-five percent of participants receiving the SENSE program had most of the sensory interventions completed by parents, as opposed to the medical or sensory support team. Seventy-two percent of infants had at least 100% of the auditory and tactile doses conducted over the length of stay. Parents reported acceptability. Conclusion The SENSE program had good reach, was effective and acceptable with minimal cost, was adopted, and had good fidelity. Insights from implementation of the SENSE program (within a research study) informed future strategies to aid maintenance during dissemination.

Randomized clinical trial investigating the effect of consistent, developmentally-appropriate, and evidence-based multisensory exposures in the NICU

“…Continuous review of sensory exposures during the course of the study also enabled activation of the sensory support team as needed. Differences in sensory exposure in the SENSE and standard-of-care groups are reported in a previous publication ( 24 ).…”

“…The use of statistical interactions to assess the effect of the SENSE program in the midst of different levels of parent engagement could aid in evaluating this, however, a much larger sample size would be needed to establish power. There were times within the complex, level IV NICU when sensory interventions had to be put on hold ( 24 ). While 100% of infants in the SENSE group received >75% of the SENSE program doses, only 65% received 100% or more of the dosage across all of hospitalization.…”

A feasibility randomized controlled trial of a NICU rehabilitation program for very low birth weight infants

“…The NeoRehab dosing goal is on par with that of other multisensory program where the recommended dosing recommendations vary from daily interventions to 6 h per week. The parental time commitment for education on how and when to provide interventions was comparatively small in our study, with other program requiring upwards of 70 h for education 15 , 16 , 25 , 26 . In contrast to other programs, we strictly focused our analysis on parent-administered interventions excluding interventions provided by health care professionals and/or sensory support team members.…”

Acceptability, Feasibility, and Fidelity of a NICU Rehabilitation Program: A Single Center Randomized Controlled Trial in Very Low Birth Weight Infants

“…The parental time commitment for education on how and when to provide interventions was comparatively small in our study, with other program requiring upwards of 70 hours for education. [15,16,25,26] In contrast to other programs, we strictly focused our analysis on parent-administered interventions excluding interventions provided by health care professionals and/or sensory support team members.…”