Table 2.

Intervention Model Studies

Source	Design	Focus/Dependent variable	Sample description	Results
Anderson (1981)	Experimental/pre-/post-test design; three groups	Effect on maternal reciprocity of an intervention for familiarizing mothers with infant capabilities and characteristics. Reciprocity measured with the AMIS attachment scale (Price, 1983) at 1 and 10–12 days postpartum. Group 1 observed administration of the Brazelton Neonatal Behavior Assessment Scale and were told their infants’ responses; Group 2 was given explanations of Scale items and their infants’ responses but did not observe them; Group 3 (control) received instruction on infant furnishings.	Thirty mother–newborn dyads, 10 in each group Infants: healthy, term, 1–12 days old Mothers: all Caucasian United States	Mothers in Group 1 who were both shown and told about their infants’ capabilities and individual characteristics scored higher on reciprocity from pre- to post-test than the control group. Similar results were obtained for infant responsiveness.
Barnard, Booth, Mitchell, and Telzrow (1988)	Quasi-experimental, longitudinal; three intervention approaches	Effect on infant development, maternal and infant feeding, and teaching interaction (Parent-Child Interaction [PCI] scales), and Home Observation for Measurement of the Environment (HOME; Caldwell & Bradley, 1984) of the three interventions provided during the infant’s first 3 months (Nursing Parent and Child Environments, Nursing Support of Infants’ Biobehavior, and Nursing Standard Approach to Care).	One hundred eighty-five mother–infant dyads (169 in newborn period, 153 at 3 months, 118 at 10 months, 58 at 24 months) United States	No maternal or infant differences were found by intervention group for feeding or teaching interaction at either 3, 10, or 24 months. Mothers’ scores for both teaching and feeding declined between 3 and 10 months. Teaching scores improved by 24 months, HOME score did not differ by intervention group but improved between 10 and 24 months. Across groups, feeding scores were higher for mothers without family problems, suggesting a moderating effect of family conditions on maternal feeding behavior. Effects of sample attrition not discussed.
Benzies, Magill-Evans, Harrison, MacPhail, and Kimak (2008)	Secondary analysis of pre-/post-test data from a randomized clinical trial (RCT, Magill-Evans, Harrison, Benzies, Gierl, and Kimak, 2007) of a parenting education program for fathers	Exploration of demographic predictors of improvement in fathers’ teaching interaction skills from 5 to 10 months, shown by the PCI teaching scale, administered twice.	Eighty-one father–infant dyads Infants: 5 and 8 months Fathers: primarily European Canadian	Controlling for baseline (5-month) PCI teaching scores, demographic variables (father’s age, education, marital status) did not predict interactions at 8 months. The authors concluded that further research is needed to identify fathers who will benefit from the program.
Carson and Virden (1984)	Quasi-experimental, post-test only; control and two experimental groups. Replication of Carter-Jessop (1981)	Effect of the Carter-Jessop (1981) prenatal attachment intervention administered by public health nurses, compared with relaxation techniques and to usual care on attachment behaviors 2–16 days postpartum.	Sixty-nine mother–newborn dyads Mothers: 42% Caucasian; 44% Black; 14% other ethnicity United States	Unlike the earlier Carter-Jessop study, treatment groups did not differ either on attachment indicators or by parity. Investigators suggest differing results reflect the influence of ethnicity/culture on a mother’s style of interaction.
Carter-Jessop (1981)	Quasi-experimental, post-test only; two groups	Effect of a prenatal attachment intervention received 1 to 3 times during the third trimester at 1- to 2-week intervals (feeling for baby’s parts and checking position daily, increasing awareness of fetal activity, and massaging the mother’s abdomen), compared with usual care, on early postpartum attachment behaviors assessed with an investigator-developed instrument.	Ten mother–newborn dyads (5 per group) Mothers: Caucasian United States	Mothers who received the prenatal attachment intervention had a higher frequency of attachment behaviors on the postnatal attachment test than controls.
Dihigo (1998)	Quasi-experimental, pre-/post-test; two treatment groups and one control group	Effect on infant crying (colic) of an individualized counseling and educational intervention designed to increase sensitivity to cues and responsiveness to distress. The intervention was formulated from one pretreatment administration of PCI feeding scales and a diary of crying and daily activities. Group 1 received empathy and supportive follow-up; Group 2 received education and counseling; Group 3—control. Randomization to group not clear. Mean time between pre/post-test was defined by length of time diary was kept: Group 1, 6.0 days; Group 2, 4.3 days, Group 3, 6.4 days.	Twenty-three parent–infant dyads (8 Group 1, 6 Group 2, 9 control) Infants: healthy, full term, less than 3 months Mostly Caucasian United States	Feeding scores were lower on parent responsiveness to the child’s distress and on the child’s responsiveness to the parent for treatment Group 2 (individualized education and counseling). The crying times of the infants in Group 2 decreased, whereas crying time did not for Group 1. Change in PCI feeding scores was not examined. The investigator suggested parent–infant interaction is a locus of both cause and treatment for infant colic.
Glazebrook et al. (2007)	Cluster RCT, with crossover design and 3-month washout; two groups (intervention and control)	Effects of a NICU parenting intervention (Parent Baby Interaction Programme [PBIP]), designed to enhance parents’ observations of the infant and sensitivity to infant cues through progressive involvement in infant care. PBIP included tactile contact, discussion of infant characteristics, verbal interaction, and observation. Outcomes were parenting stress, maternal responsivity on the Home, PCI teaching scores, and infant neurobehavioral development, assessed at 3 months post discharge.	Two hundred four mother–infant dyads (95 intervention, 109 control) Infants: very low-birth-weight Mothers: predominantly White United Kingdom	No differences were found between groups in parental stress, HOME maternal responsivity, PCI teaching scores, or infant neurobehavioral outcomes at either predischarge or 3 months postdischarge. Although parents were not socially or economically disadvantaged, more mothers than expected had high levels of parenting stress, and PCI and HOME scores were low, suggesting that mothers were ineffectively engaged with their infants. The investigators did not question the validity of using the PCI teaching scales to assess mother–infant interaction with preterm infants. Multivariate analysis was not used to examine the effect of parenting stress on parent–infant interaction.
Harrison, Sherrod, Dunn, and Olivet (1991)	Quasi-experimental, post-test only; three groups	Effect of NICU teaching about infant characteristics and observation of behavior (Group 1) compared with only explanation of an assessment of infant behavior, Mother’s Assessment of the Behavior of her Infant (Field, Hallock, Dempsey, & Shuman, 1978; Group 2) or routine support (Group 3—control) on mother–preterm infant feeding interaction (PCI) and maternal rating of the infant behavior 6–8 weeks postdischarge.	Thirty-two mother–infant dyads (10 Group 1; 10 Group 2; 12 control) Infants: healthy preterm Mothers: 66% Black United States	Total feeding score and the maternal subscale scores were highest for the mothers who received both instruction in rating behavior and demonstration of infant behaviors (Group 1). These results, although not significant, suggested that the intervention had beneficial effects. Group 1 infants were clearer in cues than infants of mothers who received no instruction (control). The investigators conjectured that significant effects might have been identified if the sample had included only high-risk families, who are known to have the greatest need for support.
Horowitz et al. (2001)	Longitudinal RCT; two groups (intervention, control)	Test of a coaching intervention to aid depressed mothers in being responsive to their infants through the first 18 postpartum weeks (4–8, 10–14, and 14–18). Interaction rated in the home from 5 minutes of live or video-taped observation of structured face-to-face play without toys using the Dyadic Mutuality Coding system (Censullo, Bowler, Lester, & Brazelton, 1987).	One hundred seventeen mother–infant dyads Mothers: 69% Euro–American, 7.4% each African American and Latina, 3.3% Asian or Pacific Islander, 1.6% Native American, and 4% designated as “other” United States	Repeated measures analysis showed that the intervention group was higher in responsiveness than the control group. Depression was not affected by the treatment. Responsiveness increased and depression decreased over time for both groups. Group and time did not significantly interact.
Huckabay (1987)	Quasi-experimental; (pre-/post-test), two groups (intervention, control)	Effect of giving mothers a photograph of their premature infants in the NICU compared with no photograph on attachment behavior assessed with the investigator-developed Bonding Observation Check List. Pretest on Infant’s 2nd day of life; post-test end of the 4th week.	Forty mother–preterm infant dyads (20 in each group) Mothers: 47.5% Black; 32.5% Hispanic; 20% White United States	Mothers who had received a photograph of their premature infant showed more attachment behavior at 4 weeks than mothers who had not received a photograph.
Jung, Short, Letourneau, and Andrews (2007)	Quasi-experimental: (pre-/post-test); one group (intervention)	Enhancement of depressed mothers’ understanding of and response to infant behaviors using the PCI-based Keys to Caregiving intervention (Spietz, Johnson-Crowley, Sumner, & Barnard, 1990). Outcome assessed as change in infant’s expression of positive affect during play interaction. Mother–infant dyads videotaped prior to and after 5 weekly intervention sessions using the Still-Face paradigm (Tronick, Als, Adamson, Wise, & Brazelton, 1978). Maternal depression assessed with the Edinburgh Postnatal Depression Scale and Beck Depression Inventory.	Seventeen mother–infant dyads Infants: average age at enrollment 3.5 months. Mothers: Race–ethnicity not given Canada	Although mothers’ scores on the depression screening instruments did not change, infants showed a marked increase in interest and joy in face-to-face interaction with their mothers. The investigators concluded that intervention focused on maternal behavior during interaction with the infant instead of on how the mother feels may be an effective component of treatment for mothers who are depressed.
Kang et al. (1995)	Quasi-experimental, longitudinal. Mothers were assigned to groups based on their education: high education (HE, education 13 years or greater) or low education (LE, education 12 years or less).	Effect on PCI feeding and teaching interaction scores at 40 weeks postmenstrual age and at 1.5 and 5 months of age adjusted for prematurity. In hospital, mothers were randomly assigned by education (HE or LE) to either the State Modulation (SM) program concerning reading infant behavioral cues and modulating states of consciousness during feedings or to a car seat (CS) program. After hospital discharge, LE mothers in each of the two groups, SM and CS, were randomly assigned to either a home visit intervention, Nursing Systems for Effective Parenting (NSTEP-P), to improve interactive competence, caregiving skills, and use of coping resources or to standard public health nurse (PHN) visits.	Three hundred twenty-seven mother–preterm infant dyads Mothers: 56% White non-Hispanic; 21% Hispanic; 16% African American; 3% Asian/Pacific Islander; 2% other United States	Although HE SM and CS groups did not differ on feeding interaction at 40 weeks postmenstrual age, the SM and CS groups differed on feeding interaction at 1.5 months. SM infants had higher scores on clarity of cues and total infant score. At 5 months, SM mothers had higher scores on social–emotional-growth fostering, cognitive-growth fostering, responsiveness to parent, mother total, infant total, and total score. LE groups did not differ on feeding interaction scores at 40 weeks. At 1.5 months, infants in the SM/NSTEP-P and in the SM/PHN groups had higher clarity of cues scores on feeding interaction than infants in the CS/PHN group. Total infant feeding interaction scores for SM/PHN and SM/NSTEP-P groups were higher than infants in the CS/PHN group. SM/PHN infants had higher responsiveness to parent scores during feeding than CS/PHN infants. Total infant feeding interaction scores for SM/PHN and SM/NSTEP-P infants were higher than scores of CS/PHN infants. At 5 months, SM/NSTEP-P mothers had higher sensitivity to cues and cognitive-growth fostering teaching interaction scores than mothers in the SM/PHN group. These scores as well as social–emotional-growth fostering were higher for SM/NSTEP-P mothers than for CS/PHN mothers. Mothers’ average total teaching score was higher for the SM/NSTEP-P group than the SM/PHN group. In sum, effect of state modulation instruction by intervention group (NSTEP-P or PHN) depended on the interaction context (feeding, teaching) and infant age (1.5, 5 months). Infants of LE mothers who received the NICU state modulation instruction and in-home NSTEP-P instruction showed more responsive behavior during feeding at 1.5 months and more sensitivity to infant cues and developmental stimulation during teaching at 5 months.
Lee (2006)	Quasi-experimental without randomization; nonequivalent control group pre-/post-test design; two groups; two observations; mothers in the intervention group had completed the program prior to selection of the control group	Effects of multisensory stimulation (infant massage, auditory via mother’s voice, tactile/kinesthetic via massage, and visual via eye-to-eye contact) on infant growth (weight and height) and on mother-interaction during play, assessed with the Mother–Infant Play Interaction (MIPI) Scale (Walker & Thompson, 1982). The intervention was delivered weekly for 4 weeks. Mothers agreed to provide infant massage more than 4 days/week for 4 weeks at home. Outcomes assessed after completion of program.	Fifty-two mother–infant dyads; 26 in each group Infants: Healthy, full-term 2–6 months Mothers: Korean	Differences not found in either infant gain in weight or increase in height, but maternal interaction scores on the MIPI scale were higher for the intervention group than for controls. Gain from pre- to post-test for dyadic and infant response was also greater for the intervention group.
Leitch (1999)	Experimental with random assignment; two groups; one observation	Effect on mother–infant interaction of prenatal videotaped education on infant state and communication cues and maternal alleviation of distress and growth-fostering behavior in the first 24 hours after birth, assessed with the PCI.	Twenty-nine mother–newborn dyads (14 intervention; 15 control) Infants: full term/within 24 hours of birth Mothers: race–ethnicity not described Alberta, Canada	Mothers who had viewed the video tape scored higher than control group mothers on the PCI maternal total teaching score, particularly on sensitivity to cues and social–emotional growth-fostering behaviors and on contingency of response. Infants in the experimental group scored higher on the child total teaching score.
Macke (2001)	Quasi-experimental; pre-/post-test; two groups (analgesia and placebo)	Effect of a pain-reducing intervention during and after circumcision on mother–infant feeding interaction assessed with the PCI. Infant pain assessed by investigator observation (percent of time crying and heart rate) during and following the circumcision.	Sixty mother–infant dyads (29 analgesia, 31 placebo) Infants: Male, full term Mothers: 90% White United States	Pain distress increased for all infants during circumcision. Feeding scores for infants in both groups were lower after circumcision. However, infants in the analgesia group decreased less in clarity of cues and responsiveness, and overall their scores were higher. Analgesia group mothers increased in social–emotional-growth fostering behaviors.
Magill-Evans et al. (2007)	RCT with two groups (intervention and control)	Effect of video-taped self-modeling and feedback, using the Keys to Caregiving program on father–infant interaction (PCI) and father self-efficacy. Intervention administered at 5 and 6 months by a home visitor. PCI assessed at 8 months; self-efficacy at 5 and 8 months. Self-efficacy was assessed with the Parenting Sense of Competence Scale (Johnson & Mash, 1989).	One hundred sixty-two father–infant dyads, 81 in each group Infants: Healthy, full term Fathers: most European Canadian Canada	Fathers in both groups reported increased competence in parenting over time. Fathers in the intervention group increased their skill in fostering the infants’ cognitive growth and maintained their sensitivity to infant cues from 5–8 months. Control group fathers’ scores on the same scales, on average, declined. The groups did not differ on fostering infant social–emotional-growth or on self-efficacy.
Melnyk et al. (2006)	RCT two groups (intervention and comparison)	Evaluation of the efficacy of an educational–behavioral intervention (Creating Opportunities for Parent Empowerment [COPE]) designed to enhance parent–infant interactions and parent mental health. Audio-taped and printed infant-behavior and parent-role information delivered to parents in four phases. Phase I, 2–4 days after NICU admission, characteristics of the infant. Phase II, 4–8 days after admission, infant cues of readiness for interaction. Phase III, 1–4 days before discharge, best times for interaction, developing positive parent–infant relationship. Phase IV, at home 1 week after discharge, positive parent–infant relationship. Beliefs about the infant were rated on the Parental Belief Scale: NICU, developed by the investigators. The Melnyck Index of Parental Behavior in the NICU (IPBN) used to assess quality of interaction.	Two hundred sixty families; mothers: 147 COPE, 113 comparison/fathers: 81 COPE, 73 comparison Infants: Preterm no handicapping conditions Mothers and fathers: race–ethnicity: 67.4% White, not Hispanic; 22.5% Black, not Hispanic; 10.1% other (Hispanic, American Indian, other) United States	IPBN factors measured: (a) positive interaction with the infant in a quiet alert state; and (b) altering the environment and interaction with a stressed infant. Before discharge, relative to the comparison group, COPE parents were rated by blinded observers as having more positive interactions with their infants and scored higher on observer-rated 1-item scales concerning overall appropriateness of parent interaction, involvement in physical care, and sensitivity to the needs of the infant, and reported more positive beliefs about their infants and their parental roles. In addition, COPE fathers were more involved in infant care and more sensitive to infant needs than comparison group fathers. COPE mothers were lower in state anxiety and depressive symptoms than comparison mothers at 2 months infant age corrected for prematurity.
Melnyk, Crean, Feinstein, and Fairbanks (2008)	Secondary data analysis of an RCT with a treatment and placebo control	Test of a theoretical model of the influence of an educational-behavioral intervention program, COPE on the anxiety and depression of mothers 2 months after discharge of their premature infants from the NICU. The IPBN was used to rate interaction in the NICU (see Melnyk et al., 2006).	Two hundred forty-six mothers of low-birth-weight preterm infants Infants: observed in interaction in NICU Mothers: race–ethnicity: Percent for COPE and Control mothers, respectively—White not Hispanic 90.1, 64.2; Black not Hispanic 22.6, 22.9; Hispanic 3.6, 3.7; other 3.6, 9.2	Mothers who had participated in the COPE program had higher mother–infant interaction scores and fewer symptoms of postpartum depression and anxiety scores. COPE had a direct effect on interaction; socioeconomic status was a covariate. Interaction did not have a relationship with mothers’ posthospital symptoms of depression and anxiety. The COPE effect on these symptoms operated through the mediation of mothers’ beliefs about what to expect in their infants and their ability to care for their infants.
Norr, Roberts, and Freese (1989)	Quasi-experimental, post-test, three-group comparison; one observation	Comparison of maternal attachment behaviors during infant feeding 2–3 days after delivery for: (a) mothers receiving rooming-in, (b) mothers requesting rooming-in but not receiving it, and (c) mothers not having an opportunity for rooming in.	One hundred ninety mother–infant dyads (80 Group 1; 72 Group 2; 35 Group 3) Infants: Healthy, full term Mothers: 83–86% African American USA	Rooming-in group mothers had higher attachment scores than the other two groups, accounting for maternal age, perinatal conditions (episiotomy or lacerations, epidural anesthesia), infant contact at delivery, and time of feeding observation. Younger mothers gained more in attachment behaviors from rooming-in than older mothers.
Pridham et al. (2005)	Quasi-experimental, longitudinal; pre- and post-test; two groups	Effect of guided participation (GP) compared with standard care (SC) on premature infant and maternal social–emotional and task-related feeding competencies assessed with the Parent-Child Early Relational Assessment at 1, 4, 8, and 12 months post-term age. GP focused on expectations and intentions for the relationship with the infant. The infant’s health status, estimated by bronchopulmonary dysplasia diagnosis, family poverty status, and mother’s depressive symptoms were treated as covariates in the fixed effects model.	Forty-two mother–infant dyads (24 GP, 18 SC) Infants: premature, extremely-low-birth-weight (<1,000 g), Mothers: 55% African American; 38% Euro–American; 7% Asian or Latina United States	Benefit of GP for mothers and infants was shown by greater competency in regulating negative affect and behavior during feeding at one or more times in the first year, age adjusted for prematurity. Specifically, infants in the GP group were higher on regulation of negative affect and behavior than SC infants at 1 and 8 months. Mothers in the GP group were higher on regulation of negative affect and behavior at 4 months. A moderating relationship of depressive symptoms with maternal competencies in regulating negative affect and behavior during feedings was demonstrated at 8 months.
Schroeder and Pridham (2006)	Quasi-experimental, longitudinal; two groups (intervention, comparison).	Effect of guided participation (referred to as guided learning, GL) compared with standard care teaching (SCT) on mothers’ competencies in relating to their premature infants in the NICU. GL delivered weekly for 6 weeks beginning at 30 weeks gestational age. Relationship competencies were assessed with a 27-item observational checklist, the Relationship Competencies Assessment, to describe being with the baby and knowing and relating to the infant as a person. Mothers were interviewed at 29 weeks postmenstrual age (study baseline) and at each of the 6 study weeks with a video-assisted interview for attunement and adaptiveness of their internal working model of parenting.	Sixteen mother–infant dyads (8 GP; 8 SC) Infants: Premature, very low birth weight (<1,500 g) Mothers: 75% White; 1 each African American, Asian, Latina, and Native American United States	Relationship competencies increased to a higher level and at a greater rate for GP mothers than for mothers receiving SC. The internal working models of parenting observed in GL mothers were more attuned and adaptive to their infants’ needs. Although GL mothers did not make greater gains in attunement and adaptiveness than SCT mothers, GL mothers made a consistent gain with time and demonstrated almost all of the 27 relationship competencies, compared with about two-thirds of the relationship competencies for the SCT mothers. Furthermore, GL mothers’ relationship competency scores increased to a higher level and at a greater rate than scores for SCT mothers.
White-Traut & Nelson (1988)	Quasi-experimental; two treatment groups, one control group; one observation	Effect on feeding interaction of (a) massage (maternal tactile–vestibular stimulation) compared with (b) maternal talking or singing, and (c) routine care. Groups 2 and 3 received instruction on infant clothing. Mother-infant interaction assessed with the PCI prior to NICU discharge.	Thirty-three mother–infant dyads (11 per group) Infants: Premature Mothers: 94% African American United States	Mothers in the massage group showed more sensitivity to infant cues and cognitive-growth fostering behavior than mothers in the other two groups. Infant clarity of cues and responsiveness did not differ by group.

NICU, neonatal intensive care unit.