Exploring factors associated with parental adherence to prevention strategies for positional plagiocephaly or brachycephaly: multi-method study results

This multi-method study explored factors influencing parental adherence to prevention strategies for positional cranial asymmetry (CA), specifically plagiocephaly and brachycephaly. Parents of newborns (N = 218) completed a 39-question online survey using 7-point Likert-type items and responded to one open-ended question. Survey development was guided by the Theoretical Domains Framework (TDF) and Capacity, Opportunity, and Motivation Model of Behavior (COM-B). The open-ended question (n = 112) aimed to capture the main barriers hindering parental adherence. Descriptive analysis of item ratings and deductive-inductive theming of open-ended responses were synthesized. Survey findings underscored factors related to six COM-B subdomains-psychological and physical capability, social and environmental opportunity, and automatic and reflective motivation-influenced parental adherence. Open-ended responses revealed six overarching themes: (1) comprehensive detailed information, (2) infant's limited tolerance for prone position, (3) parental-related adjustment factors, (4) time and household management, (5) access to reliable resources, and (6) social support. This study highlights key factors influencing parental adherence to CA prevention, including a need for clear information, social support, and practical strategies for busy households. Addressing these barriers may enhance adherence and improve prevention efforts and newborn outcomes.