Multimedia Tablet or Paper Handout to Supplement Counseling During Preterm Birth Hospitalization

Published:January 25, 2023DOI:



      Parents of premature infants engage in shared decision making regarding the care of their infant. The process of prenatal counseling typically involves a verbal conversation with a neonatal provider during hospitalization. Support people may not be available and the pregnant person's memory is impaired by medications, pain, and stress. The American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and the National Institute of Child Health and Human Development have called for improvements to this process, including the development of educational aids.


      We hypothesized that a multimedia tablet would be more effective than a paper handout to supplement verbal clinician counseling during preterm birth hospitalization.

      Study Design;

      Design: Randomized controlled trial. Inclusions: ≥ 18 years old English-speaking pregnant people hospitalized 22 through 33 weeks gestational age for preterm birth. Exclusions: known fetal or chromosomal anomaly, delivery before study completion. Intervention: Pregnant people received either multimedia tablet or paper handout before verbal clinician counseling. Pre-intervention assessment: demographics and State-Trait Anxiety Inventory. Post-intervention assessment: The Parent Knowledge of Premature Birth Questionnaire and State-Trait Anxiety Inventory. Statistical analysis: Continuous variables were analyzed by t-test and categorical variables by Fisher's exact test.


      122 pregnant people referred for counseling were screened, 76 were randomized, and 59 completed the study. Demographics were similar between groups, except that pregnant people in the handout group were older, mean 32 years v 29 years, p=0.03. The multimedia tablet group (n=32) was less likely to report reviewing all the educational material than the paper handout group (n=27); 41% vs.72%, p=0.037. Both groups correctly answered a similar number of knowledge items, p=0.088. Post-intervention state-anxiety decreased in both groups, p<0.0001, with no difference between groups. Computerized tracking showed the multimedia group spent a median of 37 minutes reviewing the tablet.


      Contrary to our hypothesis, a paper handout and multimedia tablet were equally effective in the labor unit to supplement verbal preterm birth counseling and decrease parental anxiety.


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