Abstract
This pilot randomized trial study evaluated the effectiveness of the Pebbles of Hope Thrive Guide, an interactive educational course designed for parents of premature infants. The study assessed changes in breastfeeding practices, maternal nutrition, and use of Kangaroo Care among 50 mothers in total randomized to one of three groups: Supervised, Independent, or Control. The purpose of the study was to assess the provision of mother's breast milk, improved material nutrition behaviors, and adoption of Kangaroo Care among mothers that received access to the course compared to those that received standard education without Thrive Guide access. The primary outcome assessed was the provision of breast milk at three months post-intervention, while secondary outcomes included improvements in maternal confidence, changes in maternal nutrition behaviors, the adoption and frequency of providing Kangaroo Care, and the impact of educator supervision. Although the intervention improved mothers' confidence and knowledge, it did not significantly impact breast milk provision or maternal nutrition behaviors at 3 months. Breast milk provision declined across all groups, but the amount of decline was not statistically different between them. Similarly, no significant differences were observed in the number of nutritional improvements made between the two periods. However, Independent users exhibited a notable increase in Kangaroo Care frequency. Qualitative interviews highlighted the importance of ongoing support and addressing practical barriers to following nutritional guidelines. These findings suggest that further research is needed to explore the conditions that enhance long-term behavior change and to identify strategies that optimize the impact of educational interventions on caregiving practices.