Optimising parental self-efficacy in the neonatal intensive care unit (NICU) and its implications on child care and parenting quality: a study protocol.

introductionParenting an infant in the neonatal intensive care unit (NICU) can be highly stressful, undermine parental confidence and minimise involvement in infant care. Enhancing parental self-efficacy is therefore crucial to promoting active engagement and supporting positive child outcomes. This study aims to identify the psychosocial needs (emotion regulation and stress management) of NICU parents and examine the factors that influence their engagement in infant care. It also seeks to determine whether higher levels of parental self-efficacy are associated with greater engagement and collaboration with healthcare providers (HCPs) and a shorter NICU stay. METHODS AND ANALYSIS: A mixed-methods study will be conducted at the Montreal Children's Hospital's Level III NICU located in Quebec, Canada. Parents (ie, mothers and, when available, their partners) will be recruited during their infant's hospitalisation. Participants will complete a set of self-report questionnaires measuring parental engagement, self-efficacy, parent-infant attachment, mental health, perceived stress and social support. Additionally, one parent per family will be invited to participate in a qualitative interview to discuss their experience in the NICU. Qualitative data will be analysed thematically using NVivo 12 to identify key themes, and statistical analyses will be conducted using RStudio to determine which factors are most strongly associated with parental engagement and their interactions with the clinical team. Finally, HCPs will be invited to assist and participate in a qualitative interview regarding their perspectives on the NICU environment and the study's impact on the unit (ie, reduction in HCP burden due to increased parental engagement). Findings from this study will offer valuable insights to inform future clinical strategies aimed at enhancing parental engagement and self-efficacy in the NICU. These outcomes may contribute to improved neonatal outcomes, parental mental health and the advancement of evidence-based, family-centred care policies. ETHICS AND DISSEMINATION: The protocol was approved by the Montreal University Health Centre's (MUHC) Research Ethics Board (2025-9392). Findings derived from this study have the potential to optimise parental engagement in the NICU to promote family resilience and child well-being. IMPLICATIONS OF

findingsOur study protocol aims to underscore the critical role of self-efficacy and other key psychosocial factors, such as lower parental stress and higher emotion regulation, in promoting parental engagement and collaboration within the NICU. We anticipate that higher levels of self-efficacy will correlate with parental well-being, increased caregiving engagement (ie, basic baby care, improved communication with NICU staff) and enhanced parent-infant bonding. These findings may support the development of structured interventions that empower parents and streamline provider-parent collaboration. In clinical practice, these insights can guide the integration of tailored parental support programmes to optimise discharge preparation and reduce provider burden by promoting shared caregiving responsibilities. Future initiatives could build further on this model to guide institutional policies that aim to prioritise parental empowerment (ie, greater self-efficacy and engagement) as a fundamental pillar of neonatal care.