Insights into Inconsistent Infant Safe Sleep Practices among African American Caregivers

Abstract

Background: After the 1994 national “Safe Sleep Campaign,” acceptance of infant sleep practices was followed by a significant reduction in the national SIDS death rate. Interestingly, SIDS deaths of African American (AA) infants has remained comparatively high --creating an incidence rate disparity. The elusive question is “why?” Understanding the basis of infant safe sleep practices by given AA caregivers is therefore important to effectively address inconsistency surrounding the “ABCs” of safe sleep practices. Objective: To understand the knowledge base, attitudes, circumstances, and current behavioral patterns surrounding infant safe sleep practices among given AA caregivers. Methods: A purposive sampling strategy, including 31 participants from three targeted Baltimore communities, was employed. Knowledge and attitudes of caregivers were assessed using a Focus Group questionnaire to draw participant responses about why ABC strategies for safe sleep were not consistently followed. Caregivers’ practices of infant placement for sleep were first assessed by having them demonstrate their routine using a life-size doll in a crib which purposefully contained other items. All group conversations were audio-recorded and transcribed. Collected data were analyzed using Atlasti and by two researchers. Results: A substantial percentage of the AA caregivers of these communities did not fully understand safety-based and anatomical rationale for placing infants alone and on their backs for sleep. Many expressed fears that the baby might choke, the goal of getting maximum sleep for baby and caretaker, while some sought easy monitoring ability. Conclusion: Understanding the misgivings, circumstances, and fears are instrumental for imagining and supplementing existing safe sleep practice recommendations. Continued Town Hall forums that include practical demonstrations, along with meaningful discussions with educational tools, inclusive of Q & A follow-up should be developed to reduce fears and misconceptions to best increase consistent practice of placing infants alone in supine reduce the risk of SRID.