Effect of preterm infant behavioral assessment education on maternal stress and attachment: comparison of booklet-based and face-to-face education

Abstract Background Mothers of preterm infants hospitalized in neonatal intensive care units (NICUs) often experience high stress levels and challenges in developing early mother–infant attachment. Educational interventions based on the Assessment of Preterm Infants’ Behavior (APIB) may improve mothers’ understanding of infant behavioral cues and support maternal psychological adaptation in NICU settings. This study aimed to evaluate the effect of booklet-based and face-to-face APIB-based education on stress and attachment among mothers of preterm infants. Methods The present quasi-experimental study was conducted between February 2023 and January 2024 in the NICU of a referral hospital. This study included 90 mothers of preterm infants assigned sequentially to booklet-based education ( n = 30), face-to-face education ( n = 30), or routine care ( n = 30). Maternal stress and attachment were assessed before and after intervention using the Parental Stressor Scale and Maternal Attachment Inventory. Data were analyzed using ANCOVA and adjusted pairwise comparisons. Findings Maternal stress decreased significantly in all groups ( p < 0.001). Adjusted comparisons showed significantly lower stress in the booklet-based education group (mean difference = − 6.09, p = 0.004) and face-to-face education group (mean difference = − 4.16, p = 0.040) versus control, with no difference between intervention groups ( p = 0.338). Maternal attachment increased significantly within both intervention groups, but no significant between-group differences were observed after adjustment ( F = 0.94, p = 0.394). Conclusion APIB-based education may provide benefits beyond routine NICU support by improving maternal interpretation of infant behavioral cues. Longer follow-up may be required to detect changes in attachment. APIB-based parental education may be a feasible strategy for reducing maternal stress in NICUs and could be incorporated into family-centered neonatal care to support mothers of preterm infants.