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Funded Projects

Purposeful Parenting Enhanced Anticipatory Guidance for the First Year of Life

Grantee: Boston Medical Center
Principal Investigator: Megan Bair-Merritt
Project Number: R40MC28315
Project Date: 04/01/2015

Age group(s)

  • Perinatal/Infancy (0-12 months)


Pediatricians' provision of parenting-focused anticipatory guidance often does not meet parents' needs; the few studies that have investigated primary-care based strategies to promote positive parenting rely on time-intensive, high-cost interventions, thereby limiting their generalizability. Therefore, our team developed Purposeful Parenting, a universal program of enhanced anticipatory guidance. All aspects of Purposeful Parenting have been designed with scalability in mind. At each well-child visit in the first year of a child's life, Purposeful Parenting provides parents with: 1) scripted anticipatory guidance and handouts focused on the child's emerging social-emotional and linguistic (SEL) skills, brain development and the importance of responsive parenting; and 2) a 'reminder item' (e.g., a 'Smile at Me' onesie) that allows for in-office role modeling and promotes practicing of an age-specific, nurturing parent-child interaction. We propose a two-phase study. Phase I (months 1-4) will entail a brief pilot of Purposeful Parenting in three Boston-based federally qualified community health centers to optimize quality and logistical details. Phase II (months 5-36) will determine, with a parallel group randomized controlled trial (RCT), whether delivering Purposeful Parenting leads to increased responsive parenting, assessed using a validated observational measure. As secondary outcomes, we will explore the degree to which Purposeful Parenting increases parental knowledge about responsive parenting and child development, reduces parenting stress and improves perceptions of parenting self-efficacy (via validated parental self-report measures). Finally, we will explore potential changes in child SEL development. The RCT will include the collection of process level data including cost. We will enroll 260 low-income families with a full term newborn infant who present for well-child care; mindful of national priorities to reduce health disparities, we intentionally will recruit in practices serving low-income, underrepresented patients. Families randomized to the control group will receive usual anticipatory guidance at each well-child visit in the first 12 months of life. Families randomized to the intervention group will receive usual anticipatory guidance plus Purposeful Parenting. To ensure fidelity within this pragmatic efficacy trial, Purposeful Parenting will be delivered to intervention families by a trained member of the site-based medical team, with fidelity checks throughout the trial. This proposal is well aligned with MCHB's strategic priorities, as it seeks to improve the quality of pediatric primary care, and to promote maternal-child health. The project will result in a parenting-focused anticipatory guidance program that can be disseminated nationally.


Listed is descending order by year published.

Fong HF, Rothman EF, Garner A, Ghazarian SR, Morley DS, Singerman A, Bair-Merritt MH. Association between parental self-efficacy and health literacy among parents of newborn children. J Pediatr. 2018 Nov; 202:265-271.e3

Singerman A, Cadena L, Bair-Merritt M. Using health care extenders to deliver parenting guidance. Clin Pediatr 2019;58(3):361-363.

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