Researchers tested a new online course called the Pebbles of Hope Thrive Guide designed to help parents of premature babies learn better feeding and care practices. The study involved 50 mothers divided into three groups: some got the course with a teacher’s help, some used it on their own, and some got regular education without the course. While the course helped mothers feel more confident and knowledgeable, it didn’t significantly change how much breast milk they provided or improve their eating habits after three months. However, mothers who used the course independently did practice more skin-to-skin contact (called Kangaroo Care) with their babies. The researchers concluded that educational programs need more ongoing support and help solving real-life challenges to truly change how parents care for their premature infants.

The Quick Take

  • What they studied: Whether an interactive online educational course could help parents of premature babies improve their breastfeeding practices, their own nutrition, and use of skin-to-skin contact with their babies.
  • Who participated: 50 mothers of premature infants were randomly assigned to three groups: one group received the online course with a teacher’s guidance, another group used the course on their own, and a third group received standard education without the course.
  • Key finding: The course increased mothers’ confidence and knowledge, but after three months, it did not significantly increase breast milk provision or improve mothers’ eating habits compared to standard education. However, mothers who used the course independently did increase their skin-to-skin contact with their babies.
  • What it means for you: If you’re a parent of a premature baby, educational courses can boost your confidence, but they work best when combined with ongoing support and practical help solving real-world challenges. The skin-to-skin contact benefit suggests these programs may help with bonding even if other outcomes take longer to show.

The Research Details

This was a pilot randomized controlled trial, which is a gold-standard research design where participants are randomly assigned to different groups to test whether an intervention works. Researchers divided 50 mothers into three equal groups: one received the Pebbles of Hope Thrive Guide with supervision from an educator, one received the guide to use independently, and one received standard education without the guide. The study measured outcomes at three months after the intervention began, looking at how much breast milk mothers provided, their eating habits, their confidence levels, and how often they practiced skin-to-skin contact (Kangaroo Care) with their babies. The researchers also conducted interviews with mothers to understand their experiences and challenges.

This design is important because randomly assigning people to groups helps researchers determine whether changes are actually caused by the intervention rather than other factors. By including a control group that didn’t receive the new course, researchers could compare whether the course made a real difference compared to standard care.

The study also tested whether having an educator supervise the course made a difference compared to using it independently, which helps identify the best way to deliver educational programs.

Understanding how to help parents of premature babies is crucial because premature infants have special nutritional and care needs that are different from full-term babies. Breast milk is particularly important for premature babies’ development, and skin-to-skin contact helps with bonding and temperature regulation. This research helps identify which educational approaches actually change parent behavior in the long term, rather than just increasing knowledge. The findings suggest that simply providing information isn’t enough—parents need ongoing support and practical help solving real obstacles.

This is a pilot study, which means it’s a smaller test run before larger research. The sample size of 50 mothers is relatively small, so results may not apply to all populations. The study was randomized, which is a strength because it reduces bias. However, the study only followed mothers for three months, which may not be long enough to see lasting behavior changes. The researchers also conducted qualitative interviews, which provides valuable real-world context about why mothers did or didn’t follow recommendations. The fact that this is published in a peer-reviewed journal means other experts reviewed the work before publication.

What the Results Show

The main finding was that the Pebbles of Hope Thrive Guide did not significantly increase the amount of breast milk mothers provided at three months compared to standard education. All three groups showed a decline in breast milk provision over the three-month period, but the amount of decline was similar across all groups—meaning the course didn’t prevent or slow this decline more than regular education did.

However, the course did successfully increase mothers’ confidence and knowledge about caring for their premature babies. Mothers who received the course felt more capable and understood better practices, even though these feelings didn’t translate into measurable changes in breast milk provision or their own eating habits.

An interesting finding was that mothers who used the course independently (without an educator’s supervision) significantly increased how often they practiced Kangaroo Care—skin-to-skin contact with their babies. This suggests the course may be particularly helpful for promoting this bonding and comfort practice.

The qualitative interviews revealed that mothers faced real-world barriers to following nutritional guidelines, such as time constraints, fatigue, and difficulty accessing resources. These practical obstacles appeared to be more influential than knowledge or confidence in determining whether mothers actually changed their behaviors.

The study found no significant differences in how many nutritional improvements mothers made between the beginning and end of the study period. This suggests that educational content about nutrition alone may not be sufficient to change eating habits without addressing the practical barriers mothers face. The comparison between supervised and independent use of the course showed that independent users actually had better outcomes for Kangaroo Care, suggesting that some parents may benefit from self-directed learning rather than requiring educator supervision. The qualitative data highlighted that ongoing support and problem-solving assistance were important factors mothers felt were missing from the intervention.

This research adds to a growing body of evidence suggesting that educational interventions alone—without ongoing support and practical problem-solving—have limited impact on changing parent behaviors in the long term. Previous research has shown that knowledge and confidence are necessary but not sufficient for behavior change. This study supports the idea that educational programs need to be combined with strategies that help parents overcome real-world obstacles like time, energy, and access to resources. The finding that Kangaroo Care increased in the independent group is somewhat surprising and suggests that different delivery methods may work better for different outcomes.

This is a pilot study with only 50 mothers, so results may not apply to all populations or different cultural groups. The study only followed mothers for three months, which may not be long enough to see lasting changes in complex behaviors like breastfeeding and nutrition. The study didn’t measure whether mothers continued using the course or how much time they spent with it, so we don’t know if engagement affected results. The researchers didn’t track other factors that might influence breastfeeding and nutrition, such as return to work, family support, or health complications. The study was conducted in one location, so results may differ in other communities with different resources and support systems.

The Bottom Line

If you’re a parent of a premature baby, educational courses like this can help you feel more confident and knowledgeable about caring for your infant. However, to actually change your feeding and nutrition practices, you’ll likely need more than just an online course—you should seek ongoing support from healthcare providers, lactation consultants, or support groups who can help you solve practical problems. Practicing skin-to-skin contact (Kangaroo Care) appears to be a benefit of these educational programs and is recommended for all parents of premature babies. Confidence level: Moderate—this is a small pilot study, so larger research is needed to confirm these findings.

This research is most relevant to parents of premature infants, healthcare providers who work with these families, and organizations developing educational programs for neonatal care. Parents of full-term babies may find some information helpful, but the specific recommendations are tailored to premature infant care. Healthcare providers should consider that educational courses work best when combined with practical support and problem-solving assistance. This research is less relevant to parents whose babies are already past the newborn stage.

Based on this study, you might notice increased confidence and knowledge within weeks of starting an educational program. However, changes in actual feeding practices and nutrition habits may take longer than three months to develop and stick. Skin-to-skin contact (Kangaroo Care) may increase more quickly if you’re motivated by the educational content. Real, lasting behavior change typically requires ongoing support beyond the initial course, so expect to need continued help from healthcare providers or support groups over several months.

Want to Apply This Research?

  • Track the number of Kangaroo Care sessions per week (skin-to-skin contact duration and frequency) since this showed the most promise in the study. Set a goal of 2-3 sessions daily and log each session with duration. This is measurable, specific, and aligns with the study’s positive findings.
  • Use the app to set daily reminders for Kangaroo Care practice and log each session. Create a checklist of practical barriers you face (time, fatigue, support) and use the app to track which barriers are most challenging. Connect with support resources through the app when you encounter obstacles, rather than trying to solve problems alone.
  • Monitor Kangaroo Care frequency weekly and celebrate increases. Track your confidence level monthly using a simple 1-10 scale. If you’re breastfeeding, track milk supply or feeding frequency, but recognize that this may decline naturally and isn’t necessarily a failure. Use the app to identify which practical barriers are preventing behavior changes and flag these for discussion with your healthcare provider at appointments.

This research is a pilot study with a small sample size and should not replace personalized medical advice from your pediatrician or healthcare provider. If you’re a parent of a premature baby, consult with your neonatal care team about the best feeding and care practices for your specific infant. Educational programs can support your confidence and knowledge, but they work best as part of comprehensive care that includes ongoing professional support. Always discuss any changes to feeding practices or nutrition with your healthcare provider before implementing them.