The Period of PURPLE Crying program - modified educational video

About the program

The Period of PURPLE Crying program – modified educational video (POPC – modified) builds on the original POPC program.

The program aims to prevent shaken baby syndrome and enact significant parent behavioural change associated with shaken baby syndrome by distributing educational materials to parents.

Parents receive a booklet and DVD and/or app as part of a one-off intervention to parents with newborns younger than two weeks old. The extra modified educational video is an 11-minute video that is shown at either an antenatal class, during home visits by midwives/public health nurses, or during home visits by trained volunteers for all newborns in addition to the original program. The modified video focuses on infant crying, dangers of shaking, a simulation of shaken baby syndrome, dangers of smothering, and how to respond to crying.

The intervention also recommends that parents share the information from the video with other caregivers and neighbours.

Who does it work for?

The program is targeted at parents of newborn infants.

The program has only been tested in Japan (Fujiwara et al. 2020).

One Quasi-Experimental Design study was conducted with 5,961 people (1,634 in the intervention group and 4,327 in the control group). On average, children were 4.6 months old, and mothers were 25-34 years old. No referral requirements were reported for the participants.

The program has not been evaluated in Australia or with Aboriginal Australians.

What outcomes does it contribute to?

Positive outcomes:

• Negative parenting behaviours (shaken baby syndrome): there are less cases of infant shaking, smothering, and overall abuse related to crying/shaking in parents who watch the modified educational video.
• Parenting knowledge (shaken baby syndrome): parents who watch the modified educational video report greater knowledge on crying and shaking of infants than parents who do not.

No effect:

• No non-significant effects were found.

Negative outcomes:

• No negative effects were found.

How effective is it?

Overall, the POPC – modified educational video has a positive effect on client outcomes.

How strong is the evidence?

Promising research evidence:

• At least one high-quality randomised controlled trial (RCT)/quasi-experimental design (QED) study reports statistically significant positive effects for at least one outcome, AND
• Fewer RCT/QED studies of similar size and quality show no observed effects than show statistically significant positive effects, AND
• No RCT/QED studies show statistically significant adverse effects.

How is it implemented?

The POPC program is implemented using an 11-page booklet, DVD and/or app. These are explained to new parents by a healthcare professional at a one-off discussion before their infants are two weeks of age. The materials describe what shaken baby syndrome is, the frustration of crying infants and the dangers of shaking.

The extra modified educational video is an 11-minute video that is shown at either an antenatal class, during home visits by midwives/public health nurses, or during home visits by trained volunteers for all newborns in addition to the original program. The video has the following components:

1. features of infant crying – peak of crying, reasons for crying, parents’ feeling during crying
2. danger of shaking
3. a simulation of the anatomical mechanism of shaken baby syndrome using computer graphics and anatomical doll
4. danger of smothering
5. how to respond to crying – holding, feeding, swaddling, use of rhythmic stimulations, or taking a break (stepping away from the crying infant)

Information on the original program can be found at the Period of PURPLE Crying program summary page, or at the program’s website: http://purplecrying.info  

How much does it cost?

Not reported

What else should I consider?

The POPC – modified educational video was designed specifically for Japanese parents, therefore cultural differences should be taken into consideration when used for Australian populations.

Where does the evidence come from?

One Quasi-Experimental Design study on 5,961 parents in Japan (Fujiwara et al. 2020).

Further resources

The Period of PURPLE Crying Modified video: https://www.youtube.com/watch?v=T09gzgGUOnY&feature=c4-overview&list=UUVgZUHlkoN51FOwoNMBGjfw

Note: the video is in Japanese.

The original POPC Program website: http://purplecrying.info

Fujiwara, T, Isumi, A, Sampei, M, Yamada, F, Miyazaki, Y, (2020), ‘Effectiveness of using an educational video simulating the anatomical mechanism of shaking and smothering in a home-visit program to prevent self-reported infant abuse: A population-based quasi-experimental study in Japan’, Child Abuse & Neglect, vol. 101, pp. 1-9.