摘要：Objectives. There is a critical need for effective, large-scale health communication programs to support parents of children aged 0–5 years. We evaluated the effectiveness of the Kit for New Parents, a multimedia health and parenting resource now distributed annually to 500000 parents in California. Methods. In this quasi-experimental study, 462 mothers in the intervention group and 1011 mothers in the comparison group, recruited from prenatal and postnatal programs, completed a baseline interview about health-relevant parenting knowledge, and mothers in the intervention group received the kit. Both groups were reinterviewed 2 months later. At 14-months postbaseline, 350 mothers in the intervention group and a sample of 414 mothers who had equivalent demographic characteristics (comparison group) were interviewed about parenting knowledge and practices. Results. Of the mothers in the intervention group, 87% reported using the kit within 2 months after receiving it, and 53% had shared it with their partner. At both follow-ups, mothers in the intervention group showed greater gains in knowledge and reported better practices at 14 months than did mothers in the comparison group. Gains were greater for prenatal recipients and for Spanish speakers. Providers considered the kit a valuable resource for their parenting programs. Conclusions. The kit is an effective, low-cost, statewide health intervention for parents. A critical public health challenge is to translate research findings into effective, large-scale, and sustainable interventions. 1 – 3 Interventions during pregnancy and early childhood are especially important because they have shown some of the greatest impacts on children’s long-term health and development. 4 – 8 Parents’ knowledge and practices related to health care, bonding with their baby, nutrition, smoking, safety, and other factors can greatly affect children’s healthy development. 9 – 13 Although parenting education should be a priority public health investment, this has not been achieved at the population level. 6 A national survey found that first-time, adolescent, single, and low-income parents cited parenting information as one of their greatest needs. 14 In a California survey, the majority of parents (including 70% of Spanish-speaking parents) believed they did not have adequate knowledge to care for their young children. 15 Most of the effective interventions reported to date have involved relatively intensive, expensive, person-to-person programs. 7 , 16 , 17 Affordable mass coverage will require greater reliance on less expensive, materials-based approaches. These interventions must address the traditional concern that such approaches have weak effects, especially for underserved and low-literate groups who may show relatively low levels of knowledge both before and after interventions, i.e., “knowledge gaps.” 18 – 20 We found 16 published experimental or quasi-experimental studies that tested materials-based parenting education interventions. Although most of these studies were small and focused on limited topics in fairly homogeneous populations, they generally showed positive outcomes on parents’ knowledge, attitudes, or practices. 21 Research on communication, adult learning, and motivation indicates that educational interventions are more effective when the intended beneficiaries participate in their design and when the approaches are interactive, adaptable to different learning styles, build on people’s self-identified needs, fit within their social contexts, and connect them with local resources. 21 – 25 In 2001, the First 5 California Children and Families Commission (“First 5”) took up the challenge to provide health and parenting education to all new parents in the state by developing the Kit for New Parents; the kit was primarily funded by a tobacco tax. Using guidance from past research, the commission worked with experts and providers to develop and test content in the following priority areas: prenatal care; child safety, nutrition, and health care; early childhood learning and development; childcare; and access to services. Examples of content include ways to stop smoking, childproof homes, feed infants healthy foods, and encourage early learning. Each kit contains 6 videos (featuring celebrities, experts, and diverse parents and children), a 60-page resource guidebook, topical brochures, and a book to read to babies (Figure 1 ▶ ). Printed materials are written at about the 6th grade level. The kits are produced and distributed in English and Spanish at a unit cost of $17.50. They are now distributed free to approximately 500 000 expectant and new parents each year through prenatal care providers, delivery hospitals, home visits, childcare, a toll-free telephone number, and other means. The kit program is the nation’s largest statewide health-promotion intervention to support parents during pregnancy and their child’s early years. Open in a separate window FIGURE 1— The original First 5 Kit for New Parents. To determine whether to launch the kit program statewide, First 5 commissioned an evaluation to answer the following questions: 1) Do parents use the kit and find it helpful? 2) Do mothers who use the kit show greater knowledge gains in the short and long term than mothers who do not receive a kit? 3) Do mothers make positive changes in parenting practices because of the kit? 4) Do Spanish-speaking mothers benefit from the kit as much as English-speaking mothers? And 5) What changes could improve the kit and its distribution?
