Effect of QR Code-Supported Infant Care Education on Maternal Self-Confidence, Maternal Attachment, and Infant Health in the NICU

This randomized controlled trial was conducted to evaluate the effects of a Quick Response (QR) code-supported infant care education program based on Meleis' Transitions Theory on maternal self-confidence, maternal attachment, and infant health among primiparous mothers of infants hospitalized in a neonatal intensive care unit (NICU). Data were collected using the Descriptive Information Form, the Pharis Self-Confidence Scale, the Maternal Attachment Scale, and the Infant Health Assessment Form. Participants were randomly assigned to the intervention (n=42) and control (n=42) groups using block randomization. Mothers in the intervention group received face-to-face infant care education based on Meleis' Transitions Theory before discharge, a printed infant care guide containing QR codes linked to educational videos, and instructions on how to use the mobile application developed for the study. Mothers in the control group received routine care and follow-up services provided by the neonatal intensive care unit. Maternal self-confidence, maternal attachment, and infant health outcomes were assessed before discharge and at one and three months after discharge. The intervention group demonstrated higher maternal self-confidence and maternal attachment scores throughout the follow-up period compared with the control group. Infants in the intervention group also showed more favorable health outcomes, including improved growth indicators, higher breastfeeding frequency, and lower rates of common health problems and hospital visits. The findings suggest that Meleis' Transitions Theory-based QR code-supported infant care education is an effective strategy for improving maternal self-confidence, maternal attachment, and infant health outcomes following NICU discharge.

• QR Code-Supported Infant Care Education (Behavioral): Face-to-face infant care education based on Meleis' Transitions Theory, supported by a printed infant care guide containing QR codes linked to educational videos and a mobile application developed for the study.

Primary outcomes

• Maternal Self-Confidence [Baseline (approximately 1 week before discharge and prior to the intervention), 1 month after discharge, and 3 months after discharge]: Maternal self-confidence was assessed using the Pharis Self-Confidence Scale. The scale consists of 13 items, with total scores ranging from 13 to 65. Higher scores indicate higher levels of maternal self-confidence.
• Maternal Attachment [Baseline (approximately 1 week before discharge and prior to the intervention), 1 month after discharge, and 3 months after discharge]: Maternal attachment was assessed using the Maternal Attachment Scale. The scale consists of 26 items, with total scores ranging from 26 to 104. Higher scores indicate higher levels of maternal attachment.
• Infant Health [Baseline (approximately 1 week before discharge and prior to the intervention), 1 month after discharge, and 3 months after discharge]: Infant health assessed using the Infant Health Assessment Form, including physical growth (weight, length, and head circumference), breastfeeding, urination and stool frequency, non-breastmilk feeding, common infant health problems (gas, fever, vomiting, oral thrush, diaper rash, nasal congestion), and hospital visits

Sex: Female, ages: 18 Years to any

Inclusion Criteria:

* Primiparous mothers with a singleton birth,
* Aged 18 years or older,
* Able to read and communicate in Turkish,
* Owning a smartphone with internet access and having sufficient digital literacy to use QR code applications,
* No diagnosed psychiatric disorder,
* Mothers whose infants had been hospitalized in the neonatal intensive care unit for at least one month,
* Willing to participate and providing written informed consent,
* Infants with a gestational age of ≥34 weeks,
* Infants without life-threatening congenital, neurological, gastrointestinal, or genetic disorders requiring surgical intervention or expected to affect long-term prognosis.

Exclusion Criteria:

* Mothers who did not continue in the post-discharge follow-up period,
* Participants whose mother or infant died (exitus) during the study period.

• Aslınur T GÜZELYAZICI, Principal investigator, Ankara Medipol University