Occupational therapy interventions to facilitate co-occupation among infants and parents or caregivers: A scoping review protocol

Introduction

The implicit involvement of two or more individuals in an occupation in which the occupational participants influence each other is termed co-occupation (Boop et al., 2020). Infant care is considered as co-occupation since caring for an infant requires participation from the infant and the mother, father, partner, or any other family member (WHO Recommendations for Care of the Preterm or Low-Birth-Weight Infant, 2022). However, Nugent concluded that co-occupation was chosen to address the caregiving tasks that a mother performs with her infant in the Neonatal Intensive Care Unit (NICU), considering the explicit demand and caregiving process they share (Nugent, 2015). This demands interaction between mother and child through which they learn about each other and provide a sense of satisfaction and maternal competence (Nugent, 2015).

Prematurity is one of the significant reasons for an infant and parent to be admitted under a Neonatal Intensive Care Unit (NICU), along with other co-morbidities such as respiratory distress, sepsis, low birth weight, and asphyxia. A parent’s average time in NICU with their child varies across countries, with the lowest reported being 3.3 hours per day and the highest being 22.3 hours per day (Pineda et al., 2018). The World Health Organization (WHO) estimated the prevalence of 13.4 million preterm livebirths, with the highest preterm birth in Southern Asia (13.2%), with India having the highest number of preterm births in 2020 (over 20% of all preterm births worldwide) ( WHO Recommendations for Care of the Preterm or Low-Birth-Weight Infant, 2022).

As per the new recommendations of WHO, family involvement in routine care of the preterm infant is suggested through bedside care, including feeding, kangaroo mother care (KMC), and medication administration, with an emphasis on neonate’s better short-term outcomes (Pineda et al., 2018; WHO Recommendations for Care of the Preterm or Low-Birth-Weight Infant, 2022). A study published in 2015 states parental care as a co-occupation process since there is a dyad between the parent’s and the child’s occupations (Dalvand et al., 2015), which is bathing, feeding, diaper changing, comforting and soothing, parent-infant bonding and engaging with the infant through play (Cardin, 2020). This clearly states that co-occupation only exists with the foundation of parent role acquisition, which is severely impaired in the NICU environment (Cardin, 2020).

Co-occupation exists from birth, and the intensity of co-occupation varies as the child ages, with the most involvement occurring in infancy, which can positively or negatively impact the parent (Aubuchon-Endsley et al., 2021). In a study conducted in 2014, the authors established a clear association between preterm births and NICU admission to increased anxiety and depression, which affects family functioning more than parents of term infants, which extends beyond NICU and duration of hospital admission (Treyvaud et al., 2014) where infancy is defined as a period from birth to 2 years (Infant Care and Infant Health|NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development, 2021).

Some of the benefits of co-occupations highlighted through various studies include enhanced confidence and competence in the new role as a parent along with less parental role alteration, which extends beyond NICU to homes and community, especially if the child becomes dependent on the parent due to disability (Harris et al., 2018; Price & Stephenson, 2009). Considering these benefits for the parents and children, occupational therapists are recommended to promote, support, and facilitate the process of involvement in co-occupation within the dyad, helping in developing autonomy and independence in infant care activities (Fraga et al., 2019; Vergara et al., 2006). This occupation-centered practice encourages family-centered care through which the family is placed at the center of the decision-making process throughout assessments and interventions that support co-occupation (Discenza, 2009; Richter et al., 2023).

Knowing the existing interventions that facilitate co-occupation that improve the quality of life and role participation will add to the literature base for the delivery of the early intervention. The study aims to find occupational therapy interventions that facilitate co-occupation among infants, parents, and/or caregivers participation and environmental strategies that support meaningful participation in co-occupation.

Method

The study will be carried out using the framework proposed by Arksey and O’Malley (Arksey & O’Malley, 2005) to report the data and the Person- Environment- Occupation (PEO) Model (Law et al., 1996) to organize the findings. The study will follow the PRISM for Scoping review to report the findings.

The scoping review would consist of the following stages:

Stage 1: Identifying the research question

The question leading the review is: What occupational therapy interventions facilitate co-occupation among infants and parents? By exploring this question, we will identify the possible interventions and strategies that facilitate co-occupations that infants and/or parents initiate as individuals and as dyads, various co-occupations, and strategies that focus on the environment in which co-occupation occurs.

Stage 2: Study identification

The search will be conducted using Scopus, CINAHL Complete, PubMed, Web Of Science, and Embase. The study uses the PICO (population-intervention - context - outcome) format, as listed in Table 1, to identify the concepts.

This is followed by identifying the keywords ( Table 2). Each keyword will be combined using Boolean operators (AND and OR) to create a search string. Truncations appropriate for the selected database will be used while searching.

Additionally, we will search through the reference list of the identified articles to attain the saturation point for the research question we aim to explore through this study. This will also ensure that we include relevant articles which discuss topics of similar interest.

Stage 3: Study selection

A preliminary search will be conducted using broad searches in each database. The studies will be included for title screening after applying the limiters to language and publication type. The results of this initial search will be title-screened, followed by abstract and full-text screening. The inclusion and exclusion criteria ( Table 3) will be considered throughout the screening process.

The screening process will be carried out independently by two reviewers. Inputs from an arbitrary reviewer or a subject expert will be sought if there is any difference in opinion or ambiguities in selecting any article for the study. The articles selected for full-text screening will be downloaded from respective journals through the university library portal. Those articles that are not accessible will be retrieved through a librarian or personal contacts or existing networks.

The articles included in full-text screening will be added to a reference manager (Mendeley), followed by data extraction.

Stage 4: Charting the data

Data from the studies included after full-text screening following the inclusion and exclusion criteria will be organized under the following headings: title, authors, journal, year, country, sample population and setting, the aim of the study, methodology, interventions, and comparison (if any); duration, and important results ( Table 4).

This will be pretested to ensure the relevant information is captured, and necessary changes will be made after piloting the data extraction sheet. Any ambiguity will be discussed with the arbitrary reviewer or a subject expert, and appropriate action will be taken to ensure the quality of the review.

Stage 5: Collating, summarizing, and reporting the results

PRISMA for scoping review will be used to report the screening process, the reasons for exclusion and the number of duplicates removed. Summary tables will be used to portray the vital elements of the selected studies, which are listed in the data extraction sheet. The data will be discussed using thematic descriptive analysis. The gaps and limitations of the studies retrieved will also be recorded.

Discussion

From this study, we will identify the interventions targeting co-occupation among infants and parents or caregivers. The study will also give comprehensive data on the various strategies used in NICU and at home, along with environmental effects or modifications used to facilitate meaningful participation in each of the co-occupations among the dyads.