title: Effectiveness of educational materials designed to change knowledge and behavior about crying and shaken baby syndrome: a replication of a randomized controlled trial in Japan.
abstract: OBJECTIVE
  Infant crying is particularly frustrating to caregivers in the first few months of life and the most common trigger for shaking and abuse. The effectiveness of the Period of PURPLE Crying prevention materials (DVD and booklet) designed to increase knowledge and change behaviors related to crying and the dangers of shaking was reported in North America. The aim of this study was to replicate the effectiveness of the PURPLE materials with mothers of newborns in Japan.
  
  
  METHODS
  In a randomized controlled trial, 201 parents received either PURPLE materials or analogous control materials on infant safety via mail within 2 weeks of birth. At 6 weeks, mothers completed a 4-day behavioral diary. At 2 months, participants completed a predefined 20-min structured telephone survey by an independent firm to assess knowledge and behavior.
  
  
  RESULTS
  Scores on crying knowledge scales (out of 100) were significantly higher in the intervention than control groups (56.1 vs. 53.1; difference=3.0, 95% confidence interval [CI]: 1.0-4.9, p<0.005). Percentage of sharing of advice to walk away if frustrated by crying was significantly higher in the intervention than control groups (22.4% vs. 4.1%; difference=18%, 95% CI: 7.4-29.1). Walking away during unsoothable crying was significantly higher in the intervention group than controls (0.085 vs. 0.017 events per day, rate ratio=4.8, 95% CI: 1.1-21.2) by diary. Self-talk behavior scale (out of 100) tended to significance in the intervention group (16.6 vs. 8.9, difference=7.7, 95% CI: -1.0 to 16.4, p<0.1).
  
  
  CONCLUSIONS
  Crying knowledge, sharing of walk away information with others and walk away behavior when crying was unsoothable were higher for those who received intervention than control materials. The Period of PURPLE Crying materials may be useful in Japan as well as in North America for informing caregivers about the properties of infant crying and changing some behaviors related to infant crying and shaking. (UMIN Clinical Trials Registry register no. UMIN000001711.).
authors.affiliation: Department of Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Fujiwara
authors.forename: Fujiko
authors.initials: F
authors.lastname: Yamada
authors.forename: Makiko
authors.initials: M
authors.lastname: Okuyama
authors.forename: Isamu
authors.initials: I
authors.lastname: Kamimaki
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Shikoro
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Barr
mesh_terms: D000328:Adult; D016251:CD-ROM; D003448:Crying; D005260:Female; D005639:Frustration; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D009035:Mothers / Q000523:psychology; D010174:Pamphlets; D010353:Patient Education as Topic / Q000379:methods*; D038642:Shaken Baby Syndrome / Q000517:prevention & control*