Crenças e práticas parentais de estimulação do desenvolvimento infantil: fatores associados e efeitos de uma intervenção psicossocial

Abstract

The study analyses the effects of a model of intergenerational intervention with the objective of contributing to strengthen the emotional bond, reduce parental stress and stimulate caretaking practices that promote the overall development of children. Objective: To analyze the effect of a longitudinal psychosocial intervention on the parental beliefs and practice of care and the association of these beliefs and practices with the overall development of children at 9 months of age. Methods: A total of 446 infants born at the Sofia Feldman Hospital in Belo Horizonte, Minas Gerais, recruited between January and October 2015 were assessed at 2, 4, 6, 9, and 12 months of age. Developmental was evaluated by the Bayley Scales of Infant and Toddler Development III (Bayley III). The evaluation of parental beliefs and practices of care was performed through the Escala de Crenças Parentais e Práticas de Cuidado (E-CPPC) before discharge from hospital and at 9 months of life. The homogeneity between the control and intervention groups was verified by the Chi-square test and Fisher's test. A Logistic Regression was adjusted to analyze the association of socioeconomic, demographic and perinatal factors and the parental beliefs and practices with the performance of the children in each Bayley III domain. We also implemented the Stepwise method for selection of variables. Adjusted Linear Regression was also used to analyze the factors that exerted influence on the dimensions of E- CPPC. The Wilcoxon paired test was used to compare the differences between how often the parents performed the items associated with primary care and child development stimulation practices and the importance attributed to these practices by mothers over time. The Mann- Whitney test was used to evaluate the impact of the intervention on the means in each dimension of the E-CPPC. Cohen's d test was used to size the effect of the intervention. Values p <0.05 were considered significant in all analyzes. Results: The present study was divided into two research axes. The first research axis consists of a cross-sectional analytical study that evaluated 148 infants in the control group at 9 months of age. Parental beliefs and practices of stimulation have not been shown to be associated with children's motor, cognitive, and communication performance on the Bayley III scale. With the exception of the Bolsa Familia variable (p = 0.029), no other socioeconomic, demographic or perinatal factors were associated with the results in the developmental evaluation. A baby whose mother received the benefit “Bolsa Família" had a decrease of .28 [.09; 0.88] times in the chance of being considered normal in the communication domain when compared to a baby whose mother received no family grant. The second investigative axis consists of a quasi-experimental trial, in which 234 families were included, being 153 of the control group and 81 of the intervention. In a univariate form, there was a significant influence of the baby's weight on the frequency of the stimulation practices (p-value = 0.015). A born baby weighing less than 1,500 grams had an average increase of 1.94 [-3.50; -0.38] units in the "frequency of practice of stimulation" score when compared to a baby born weighing between 1,500 and 2,500 grams. Over time, there was an increase in the mean of "Frequency of stimulation practices" in the control and intervention groups with a large effect size (Cohen's d = 1.33 and 1.54, respectively). The size of the effect of the intervention was considered very small in all dimensions of the E-CPPC and the differences were not significant in any of the dimensions. However, it is observed that the dimension "Frequency of stimulation practices" was the one that showed the greatest differences between zero and 9 months in both groups, having increased almost one unit in the intervention group, whereas this difference was practically negligible in the other dimensions of E-CPPC. Conclusion: Child development was not directly affected by parental beliefs and practices, nor by most of the socioeconomic, demographic and perinatal factors analyzed, except for the benefit named "Bolsa Família". Children whose families received this benefit had a greater chance of delayed communication development than the others. The intervention did not significantly affect the beliefs and care practices of the mothers of this group when compared to the control group, although both groups presented a significant increase in the frequency scores and importance attributed to the stimulation practices between birth and 9 months of corrected age. At both times and in both groups, the scores of primary care practices were higher than those of stimulation. Parental developmental stimulation practices appear less important when compared to primary care and are more less valued in the early days of the baby's life. This result can be justified by the fact that when the child is younger, depends more on their parents for survival and there is a greater need for primary care. Consequently, there is less possibility of investment in developmental stimulation activities.