Effect of Baby Massage Training on Knowledge Levels of Midwifery Students

Detailed Description

Background and Rationale Touch is one of the earliest senses to develop and supports bonding, regulation, and growth in infants. Infant massage is a touch-based caregiving practice commonly taught by midwives and nurses. Although its benefits for infants and parents are well described, there is limited evidence on structured infant-massage education for midwifery undergraduates. This study was designed to test whether a brief, structured baby massage training improves midwifery students' knowledge about preparation, safe application, and post-application steps of infant massage.

Objectives Primary objective: To determine the effect of a structured baby massage training program on midwifery students' infant-massage knowledge measured immediately after training.

Hypothesis: Students receiving the training will have higher post-test knowledge scores than students who do not receive the training.

Study Design Randomized, parallel-group, educational intervention trial with a 1:1 allocation ratio. Stratified randomization by class year (3rd vs 4th year) using a random-number table. Open-label; outcome assessors scored written forms and checklist responses.

Setting and Dates Department of Midwifery, Faculty of Health Sciences, Atatürk University (Erzurum, Türkiye). Recruitment and delivery occurred April-May 2024 in a classroom equipped with suitable light, seating, and privacy.

Participants Target population: undergraduate midwifery students who had completed Child Health and Neonatal courses.

Inclusion criteria

3rd or 4th year midwifery student; completed relevant courses; literate in Turkish; provided informed consent.

Exclusion criteria

withdrawal during training; missing pre- or post-test data.

Sample Size and Power A priori power analysis (medium effect size d=0.50, 95% confidence, 80% power) indicated ≥27 participants per arm. Allowing for attrition, 32 per arm were enrolled (total N=64).

Recruitment and Allocation

An invitation and study information were delivered via WhatsApp to ~240 eligible students. Sixty-four volunteers consented and were randomized by an independent researcher into two strata (3rd and 4th year), then assigned to:

Experimental group (n=32)

Control group (n=32) Participant confidentiality was maintained using four-digit codes to pair pre-/post-tests.

Intervention (Experimental Group)

A three-session structured education program on infant massage delivered by an experienced instructor holding certifications in breastfeeding counseling (200 h) and PIOMI. Sessions lasted 30-45 minutes each with 15-20-minute breaks and included:

Orientation and Pre-test: study overview, consent, completion of baseline forms.

Education Session: content prepared from current literature and adult-learning principles; video demonstration covering massage stages (preparation, technique, safety, communication).

Supervised Practice and Post-test: guided practice on a mannequin with feedback; completion of post-test.

Practical skills were observed with a simple checklist to ensure correct sequence and safety (no scoring is reported as an outcome).

Comparator (Control Group) No infant-massage training during the study period. Control participants completed the same baseline and post-test knowledge assessments over the same timeframe.

Outcomes and Measures

Primary Outcome: Infant Massage Knowledge score, measured at baseline and immediately post-intervention using the 15-item Baby Massage Knowledge Form (yes/no format) with three subdomains:

Preparation before massage (5 items)

During-massage practices (6 items)

Post-massage practices (4 items) Higher total scores indicate greater knowledge.

Data Collection and Management Forms were administered in paper or secure digital format and linked using participant codes. Data were checked for completeness before entry. Only the research team had access to the de-identified dataset.

Statistical Analysis Analyses were performed in SPSS v26. Descriptive statistics summarized demographics (means, SDs, frequencies). Group equivalence at baseline was examined with chi-square tests for categorical variables and appropriate parametric/non-parametric tests for continuous variables. The primary analysis compared post-test knowledge between groups (independent samples t-test or non-parametric equivalent as required). Within-group pre/post change was assessed with paired t-tests (or non-parametric equivalent). Two-sided α = 0.05 defined statistical significance.

Results (as completed study) Groups were comparable at baseline in age, income level, residence type, family type, prior awareness of infant massage, and information sources. Pre-test scores did not differ significantly between groups. Post-test scores were significantly higher in the experimental group than the control group, and the experimental group showed a significant pre/post increase; the control group showed only a small, non-significant change. These findings support the effectiveness of the brief structured training in improving infant-massage knowledge among midwifery students.

Ethical Considerations Ethics approval was obtained from the Atatürk University Non-Interventional Clinical Research Ethics Committee (Approval No. B.30.2.ATA.0.01.00/45, Date: 07 June 2024). Participation was voluntary, and written or verbal informed consent was obtained. The study involved minimal risk and confidentiality was maintained through coded data. No Data Monitoring Committee was required due to the short duration and low-risk nature of the study.

Data Monitoring and Harms No investigational drugs or devices were used. No adverse events were expected or observed. Any concerns raised by participants would have been documented and reported to the ethics committee per institutional policy.

Protocol Deviations None affecting primary outcome collection or analysis were recorded.

Dissemination Aggregate results will be shared through academic publications and presentations. No individual participant data are planned for public sharing.

Significance and Implications A short, structured classroom program combining video demonstration and supervised mannequin practice produced a meaningful gain in knowledge. Incorporating such modules into midwifery curricula may strengthen neonatal care competencies and support consistent, safe parent education on infant massage.

Limitations Single-institution sample may limit generalizability; outcomes focused on knowledge rather than long-term skill retention or clinical behaviors; immediate post-test timing prevents conclusions about durability of learning. Future studies should include multi-site cohorts, longer follow-up, and observational assessments of skills in clinical settings.

Current Study Status Enrollment and data collection are complete; analyses are finalized. Overall recruitment status: Completed. Study start: April 2024 (Actual). Primary completion: May 2024 (Actual). Study completion: June 2024 (Actual).

Inclusion criteria

• Midwifery students enrolled in the 3rd or 4th year of study.
• Completed coursework in Child Health and Diseases Nursing and Neonatal Health.
• Literate in Turkish.
• Voluntarily agreed to participate and provided written and/or verbal informed consent.

Exclusion criteria

• Withdrew participation before completing data collection.
• Missing pre-test or post-test data.