Safe Infant Sleep Interventions: What Is The Evidence For Successful Behavior Change?

Introduction

A baby dying suddenly is devastating for any family. The ramifications spread to wider friends and family, and to health care professionals who supported them during the start months of the baby'southward life (1). Sudden unexpected death of an infant (SUDI) is the term used at the indicate of presentation and includes deaths for which a cause will exist identified, such as infection, and those that cannot be fully explained and are categorized equally sudden babe expiry syndrome (SIDS) (two) or unascertained, accounting for ~200 infant deaths annually in England and Wales (three). The demographic profile of these deaths now reveals an inequity gradient, with younger parents living in socio-economic deprivation experiencing the highest rate of babe deaths at 1.xviii per 1,000 live births, more than four times the charge per unit in the general population (3). Several characteristics accept been associated with higher rates of SUDI which include vulnerable infants (depression birthweight, pre-term, multiple births, and admission to NICU), young maternal age, smoking exposure during and subsequently pregnancy, canteen feeding, male person preponderance, and lower socio-economic condition (three–five). The peak age of decease is not the first few weeks of life when infants are at their almost vulnerable only at ii–3 months of age. Observational testify over the final thirty years has identified risk factors pertaining to the infant sleep environment that, when modified, take been shown to reduce the gamble of some baby deaths (half-dozen). These risks include placing infants to sleep on their side or front, using too many and/ or loose bedclothes, solitary sleep room in the first half-dozen months, and specific hazardous circumstances for bed-sharing and co-sleeping, such as infants sleeping next to carers who fume, take consumed alcohol or drugs, or share inappropriate surfaces, for example, sofas; or bedsharing or co-sleeping with a babe born with a depression birthweight or pre-term (4, 6, seven).

Some of the background characteristics and recognized risks for SUDI overlap with, but are not predicted by, those of child maltreatment, and families with children who may exist at risk of abuse or neglect often face multiple vulnerabilities, including risks of SUDI (8). A recent thematic analysis of 27 SUDI cases leading to Serious Case Reviews in England (9), institute families had circuitous social backgrounds, with long-term fail, booze or drug misuse and not-appointment with services as a prominent feature. The review besides identified that safer sleep communication was only documented in half of these families. I of the key challenges in working with high-risk families is not limited to just sharing safer sleep advice, only ensuring the evidence underpinning these messages is ameliorate communicated to, and understood past parents, and implemented into both usual and out of routine parenting practices. Out of routine situations which alter the infant sleep environs can unintentionally increment risk for infants where make-shift sleeping arrangements or co-sleeping may exist the simply option and particularly where the priority is to accomplish sleep for both baby and parent rather than consider the safe of the sleep environment (10–fifteen). Understanding how all-time to reach and engage vulnerable families to adopt safer babe care practices has been highlighted in previous research (14–16), however, identifying the virtually effective interventions or methods to achieve this, or identifying the effective components of interventions that are successful are lacking (17). The second National Child Safeguarding Practise Review (NCSPR) (18) focused on the occurrence of SUDI in families where children were considered to be at risk of abuse or neglect, aiming to identify the most constructive methods for professionals to provide effective support to ensure that safer sleep communication tin can exist clearly understood and embedded. As part of their work, the NCSPR Console deputed a systematic review in iii cardinal areas (19): (1) interventions to improve engagement with back up services (20), (2) improving our agreement of parental decision-making processes related to the infant sleep environment (21), and (3) the evidence on interventions for improving the uptake of safer slumber advice, which is the field of study of this newspaper.

This systematic review focuses on the third key area addressing the enquiry question: what safer slumber interventions have been tested for families with infants at chance of SUDI, and what tin these tell us about what works to reduce the chance and embed safer slumber practices for infants at higher take chances?

Methods

The review protocol was registered with the International prospective register of systematic reviews, PROSPERO number: CRD42020165302. We focused our review on families with children considered to exist at high risk for SUDI, which may significantly overlap with the wider group of families with children considered to be at high take a chance of pregnant harm through corruption or neglect. The population of interest included families with infants nether the age of i year and considered to exist at high risk of SUDI, all the same divers by private studies. Inclusion criteria for what constituted "high take chances" populations were broad due to the variability of definitions within individual studies. We included all studies that took a targeted arroyo to intervention and included interventions aimed at improving babe safer sleep practices and included those which sought to influence the infant sleep environment, rather than those aimed at reducing risks such as stopping smoking or increasing breastfeeding. We therefore included interventions with an aim to accept whatsoever affect on infant sleep position, co-sleeping, bed-sharing, dummy/pacifier use, swaddling, room sharing, infant bedding, exposure to tobacco smoke in the home, or room temperature. Where studies tested an intervention, the comparator was expected to be either standard care or a less intensive version of the intervention.

Our search strategy included terms relating to our population, outcome of interest and intervention terms. Our sample search terms are shown in Appendix one. Our inclusion criteria at screening limited studies of interventions to those reported in the last 15 years and those form Western Europe, Due north America or Australasia. Given that infant care practices alter over time, a scope of fifteen years was felt to be reasonable to capture the current practices of parents and carers. One of the main aims of the review was to draw the literature on interventions relevant to the UK population, which meant that consideration for the context in which interventions took place was a relevant factor. While we did non wish to ignore constructive interventions from other parts of the world, we did desire to focus on those which had been developed and evaluated within broadly similar cultural contexts and baby care practices.

Unpublished reports were included where they met the inclusion criteria and included data on the results or outcomes of the study. Other exclusion criteria included papers relating to explained not-sleep causes of expiry, for example infections or metabolic disorders found at post-mortem (non-relevant result); studies describing interventions for the general population with no high-risk targeting (not-relevant population) and studies describing interventions not related to safer slumber or the sleep environment (non-relevant intervention).

The review was conducted in December 2019 and eight online databases were searched (run into Appendix 1). Additional searches for gray literature and relevant interventions were conducted in Jan 2020, by emailing all English language Child Decease Overview Panels, Designated Doctors for Child Expiry and Safeguarding, UK safeguarding children'south partnerships, and the membership of The International Guild for the Report and Prevention of Perinatal and Babe Death, a global not-turn a profit system of researchers, wellness professionals and parents. Further snowball searches of included and relevant papers' reference lists were also conducted.

Four authors (AP, JG, CE, DW) scoped the initial search terms and refined a terminal listing of terms for inclusion in each search by assessing the offset 30 titles and abstracts in Medline for relevance and other terms. Titles and abstracts were deduplicated in Endnote and imported into Rayyan, online screening software (https://rayyan.qcri.org/). All returned titles and abstracts were screened past four authors (AP, JG, CE, DW), applying the inclusion and exclusion criteria, and conflicts were resolved by examination of the total text and word. All included texts were sourced, and the quality of papers assessed using the Quality Assessment Tool for Studies with Various Designs (QATSDD) (22). This arroyo was adult specifically for review questions where the show addressing a enquiry question uses a variety of different study designs. The tool is used beyond both quantitative and qualitative research designs, to facilitate assessment of the quality of studies comparatively across all included studies. Iv team members (AP, JG, CE, DW) scored each paper from 0 to 3 on either xiv or 16 items (depending on study design) and converted each score into a percentage. Included papers of review author's own work were independently rated by another squad fellow member. Given the expected paucity of data in this field studies were not excluded based on quality assessment but limitations to the findings are discussed where necessary.

Data extraction templates were piloted and refined for use with nine of the included papers of dissimilar study designs. The last information extraction grade included fields for author'south names, year of publication, written report design, country, sample size, target population, blazon of outcome, comparator, outcomes measured and effectiveness. Specific fields for qualitative studies included method of analysis and broad topic categories. For the intervention papers, the mode of delivery was extracted using variables influenced past Michie et al.'south Mode of Delivery Taxonomy (23) and collected data on whether interventions were confront to face, on printed material, digital, used equipment, delivered individually, in groups, involved one-way or two-way interaction, and whether they were tailored, meaning that the intervention was responsive to, or inverse depending on circumstances of participants. Popay et al.'s (24) framework for conducting narrative reviews is used to standardize narrative approaches to systematic reviews, where the principal synthesis comes from understanding how and why an intervention worked or did not work, rather than meta-analysis which was not possible in this review given the heterogeneity of the reported results. Narrative synthesis offers a systematic approach to evaluating both outcomes and processes in intervention studies and is therefore particularly relevant in the review of these papers.

Results

Following de-duplication in Endnote, a total of three,367 records were screened. X percent of records (324 records) were screened by two authors with a 97% agreement charge per unit. 20-four conflicts were resolved through give-and-take and exam of the full text. Duplicates identified at the full text screening stage were conference abstracts from studies that were included equally full text papers. Lx-vii papers were included in the systematic review, 23 of which identified interventions to reduce the chance of SUDI in loftier-hazard families (Figure one).

Figure 1. PRISMA flow diagram of literature search and selection process.

Xx-three papers of interventions with populations identified as vulnerable were included for synthesis and are grouped by intervention type in Table 1.

Table 1. Characteristics of included interventions to reduce the risk of SUDI in families with children considered to be at high risk.

From these 23 publications, over half of the studies (14/23) were conducted in the USA (26, 28, 30, 33, 35, 37, 40–47), iv in New Zealand (25, 29, 32, 38), three in the United kingdom of great britain and northern ireland (31, 34, 39), and 2 in Australia (27, 36). The studies span 14 years from 2005 to 2019 and the overall quality scores ranged from 23 to 83%, with xx/23 papers scoring l% and above. The newspaper scoring 23.8% was a short descriptive digest, a "instance report" of good practice describing the intervention and key outcomes, rather than a inquiry newspaper (34). The majority of these studies were quantitative; eight were randomized controlled trials (25, 32, 35–37, 45–47) and half dozen were evaluations (26, 29, 38–41); the remainder were mixed methods or used a variety of quantitative approaches. Three papers utilized the same research data set, just presented dissimilar outcomes (45–47). The number of participants ranged from seven (38) to half-dozen,515 (30) and participants were significant women, mothers or families identified to have some vulnerability, or characteristics that increased risk of SIDS to their infants. Seven studies recruited based on ethnicity alone (27, 32, 40, 43, 45–47), with ethnicity being used as a marker for impecuniousness or increased take chances due to socioeconomic status.

From these 23 results, five types of intervention were identified which are discussed beneath:

ane. Infant sleep infinite and safer sleep education programs – 9 papers (25–33)

ii. Intensive or targeted home visiting services – four papers (34–37)

three. Peer educators/ambassadors – ii papers (38, 39)

4. Health Education/Raising Awareness Interventions – 5 papers (40–44)

five. Targeted health education messages using digital media – 3 papers (45–47)

Infant Sleep Space and Safer Sleep Education Programs

Ix papers (25–33) reported on the provision of a prophylactic babe sleep space (crib, Pepi-Pod^®, Wahakura or plastic box baby bed) with a safer slumber educational component, aiming to improve parental safe sleep knowledge and influence behavior to reduce the risks of hazardous babe slumber environments. Studies investigated safety sleep devices for both use external to the parental bed (cribs) (26, 28, xxx, 33), and devices intended equally a separate safe sleep space for the babe, but for use within the parental bed (Pepi-Pod^®, Wahakura or plastic box infant bed) (25, 27, 29, 31, 32).

There were a number of study designs inside this theme comprising of mixed methods evaluations of cohort studies based on parental self-report behavior and/or intention data (26, 28, 30, 33) two RCT'southward (25, 32), two feasibility studies (27, 31) and one report of intervention implementation (29).

Four studies evaluated crib distribution and safer sleep education programs in the U.s. (26, 28, 30, 33). Carlins and Collins (26) plant that all participants used the crib provided, commenting that 38% of participants at enrolment did not take a crib and would have bedshared. All participants reported attending all well babe checks however, only 65% of parents stated they placed their baby supine to sleep, and although all participants claimed to have read the educational information, 50% could not explain SIDS. Engel et al. (28) reported that 99% of participants used the crib, and knowledge of supine sleep position increased from 59 to 89% following education. Hauck et al. (xxx) found that knowledge of sleep position improved from 76 to 94%, bed-sharing decreased from 38 to 16%, and 90% of parents used a crib for infant sleep. Salm Ward et al. (33) found that cocky-reported parental knowledge on risk factors for sleep position, slumber surface, slumber environs, pacifier use, smoking and breastfeeding all increased significantly following intervention, and participants demonstrated that knowledge was retained at ten-week follow up.

Five studies investigated devices intended as a split up rubber sleep space for the infant, simply for apply within the parental bed (25, 27, 29, 31, 32). These devices included the Wahakura, a traditionally woven flax basket babe bed (25) and the Pepi-Pod^®, a plastic box supplied with appropriate bedding (27, 29, 31, 32). Baddock et al. (25) investigated the apply and acceptability of the Wahakura compared with usual bassinette apply in the command group, final that the Wahakura increased the safety to the infant of bed-sharing, with the advantage of increasing breastfeeding rates. Three studies (27, 29, 32) reported on the Pepi-Pod program, originating in New Zealand, which involves the provision of a safe infant sleep space (plastic box) and a SIDS risk reduction didactics session delivered face to face past the provider. Parents are encouraged to pass on the Pepi-Pod and share the SIDS risk reduction letters with the new owners. Pepi-Pods in some studies also had condom sleep guidance labels stuck to them to facilitate sharing of accurate safer slumber letters. Cowan (29) reported that the program was applied consistently, Pepi-Pods were accepted, used, and liked by parents and were portable. Follow up demonstrated loftier uptake of safer sleep (supine position and infant placed in their own slumber space) and prophylactic baby (immunization, breastfeeding, gentle treatment, being smoke-free or receiving support to quit, and registration with health services) outcomes, and eighty% of recipients reported sharing safer sleep messages across their networks. McIntosh et al. (32) investigated the impact of the educational element of the program on SUDI protective knowledge and infant care practices, and the acceptability of the Pepi-Pod as an babe sleep infinite. I quarter of participants did not take a suitable sleep space for their infant at enrolment to the study. McIntosh reported that knowledge of smoking and bed-sharing every bit risks for SUDI improved mail service intervention in both groups, notwithstanding, 25% of participants reported regular bed-sharing at follow-upward in both groups. All families, both intervention and command group parents, were supplied a Pepi-Pod and safety sleep education; the command group in consequence received better than usual care, therefore it was hard to assess efficacy of this element of the plan by comparison to the control group in this study. Young et al. (27) evaluated the Pepi-Pod program in Australia, reporting improvements in quality of maternal sleep; breastfeeding; convenience and ease of use, and improved infant settling. 50-vii percentage of smoking families reported using the Pepi-Pod. A feasibility written report of introducing a similar intervention based on the Pepi-Pod program in the Great britain was conducted by Yuill et al. (31). They reported mixed reviews but generally, parents liked the concept, and would recommend its use. Yuill identified less exposure to some chancy sleep environments such every bit sofa sharing at one month (6 vs. 23% command) and co-sleeping with overly tired parents at 13 vs. 27% in controls.

Intensive or Targeted Home Visiting Services

Iv studies investigated intensive or targeted multi-modal home visiting interventions (34–37); two were RCTs (35, 37); i process evaluation (36) and a short descriptive "digest" of a citywide intervention (34). These interventions shared characteristics such every bit incorporating evidence-based elements and frameworks for service delivery shown to reduce the affect of biological, social, and environmental factors predisposing infants and children to ill health and reducing their life potential. Due to their intensive and longitudinal nature, these interventions are based on building a relationship betwixt professional and service recipient, and as such facilitate effective conversations and education/ advice giving based on the needs of the family. Hutton et al. (35) tested the efficacy of a specially designed children's volume compared to usual brochures (communication leaflets) for safer sleep knowledge and adherence to safer sleep practices. Habitation visitors provided safer sleep teaching and assessments during iii visits. Results showed that safer slumber knowledge improved across all time points in both groups, however, exclusive crib apply and reduced bed-sharing was greater in the intervention grouping which was attributed to the enhanced dialogue and emotional engagement with the book content, suggesting that the human relationship between professional and parent was a central cistron. Benefits of the book were identified as the interactive delivery, and 81% of the intervention grouping were reading the book with their infant at ii months. The researchers posit that emotional appointment with the volume content might back up the translation of cognition into behavior and identified the benefits of access to the home provided an ecological view of how safer sleep knowledge may be assimilated and translated into adherence. Iii interventions were delivered by midwives and specialist nurses, kickoff in the antenatal menstruum, and continuing well into the postnatal period or up to two years (34, 36, 37). Olds et al. (37) reported on twenty-year follow up data on the Nurse Family Partnership (U.s.). The Nurse Family partnership was launched in 1990 aiming to improve life chances and outcomes for families in the poorest communities in the Us and improve the associated mortality rates influenced by racial and economic disparity. The intervention aimed to tackle through instruction, issues of maternal smoking and substance use, encouraged healthy spacing of pregnancies, supported parenting capability, and facilitated young mothers into further instruction. Mortality rates were used every bit an outcome measure to assess the efficacy of the program due to college rates of mortality being related to SIDS, unintentional injuries and homicide in children of the target population. Using maternal all-cause mortality and child preventable-cause mortality outcome measures, women in the intervention group were less probable to accept died and their children were much less likely to die of preventable causes such as SIDS, unintentional injuries, and homicide withal, this was a small sample from which to brand inferences about bloodshed. The Vulnerable Babe Service (34) delivered in Manchester, a big English city, aimed to appoint vulnerable families in the blueprint of their support package with the objective to reduce risks of SUDI. Since the start of this multi-agency service in 2003, the infant decease rate in Manchester, Uk has declined past 60% and no SUDI have been reported in the intervention group, however, no causal association is identified in the paper. Parental attendance at appointments improved, disclosure of domestic abuse increased, and 86% of fathers proceed to be involved in families. Organizational benefits of increased staff engagement to reduce SUDI, attendance at SUDI preparation and a consistent workforce approach to delivering safer sleep communication were also observed. Kemp et al. (36) conducted a process evaluation on a program theory for pre-natal home visiting by nurses in the context of a sustained nurse dwelling house visiting program. Kemp explored pre and postnatal outcomes and characteristics of the intervention that may have contributed to the outcomes. She found that mothers in the intervention group reported significantly amend general health and well-being at iv–half-dozen weeks post-partum, and a significantly higher proportion could identify ii or more measures to reduce the take chances of SIDS compared to controls. In identifying intervention characteristics, Kemp noted that comprehensive support in the context of an enabling client-nurse relationship and continuity of carer, achieved both clinical and improved service engagement benefits for women and their infants.

Peer Educators/Ambassadors

Two papers evaluated interventions with peer educators (38, 39). An infant health promotion activity in New Zealand (38) aimed to support link workers (parents) from the community to have focused discussions, supported past a babe book resource, with family and friends on central health topics to enhance awareness in communities that make depression use of traditional health services. The "pay-it-forward" principle of this project aimed to create a "ripple event" of knowledge transfer to penetrate deeper into communities by using members of that community to share health pedagogy messages; this principle was observed to create leverage in sharing wellness education within the customs. Link worker experiences were positive, the baby book was designed equally an easy read, compact and colorful prompt for conversations based on the "Facts for Life" publication by UNICEF/WHO and UNESCO (48), and covered topics including a smoke-complimentary pregnancy and environment, back sleeping in a safe sleep space, breastfeeding and the benefits of reading to your infant. The book supported and structured conversations and was valued, and information was received well by friends and family. This intervention provides an easily scalable reach for safer sleep messages into traditionally "difficult to attain" communities, however, one of the concerns with this method of intervention was the loss of control and allegiance of data being shared by link workers, and difficulties in recruiting men as link workers (38). Gilchrist (39) evaluated an intervention provided by Niggling Lullaby, a subsidiary of The Lullaby Trust, a Britain SIDS prevention charity. Little Lullaby trains young parents equally Ambassadors to evangelize safer sleep advice and work with immature people and professionals to raise awareness and reduce risks of SIDS. The service is delivered via a website and face to face talks and workshops. Evaluation of the intervention indicates that safer slumber messages are existence understood and applied by young parents, with 97.5% reporting they had learnt something new about safer sleep and SIDS, and 36.7% of immature parents would change their parenting do considering of the session. Benefits of the intervention include providing an effective model for engaging and empowering young parents, however, at the time of the evaluation, the Ambassador programme was based in London and a survey of relevant health professionals establish that sensation of this scheme and the piece of work of Little Lullaby was reported to be relatively depression.

Health Pedagogy/Raising Awareness Interventions

All v studies in this section were conducted in the United states (twoscore–44); two were evaluations (40, 41), two were pre and mail-test designs (42, 43) and i tele-survey (44). The focus of these studies was on health education or raising sensation, and although Ahlers-Schmidt et al. (twoscore) provided a cot to participants, this was not the focus of their study. While specific educational elements are presented here, it is acknowledged that there is some potential for overlap between these studies and those reported in theme 1. Ahlers-Schmidt et al. (twoscore) evaluated safer sleep community "babe showers" designed to increase cognition and practice of safer sleep advice and promote social cohesion; participants were likewise given portable cots. While cognition of safe sleep and intentions for safe baby care were high, no baseline measure out or use of controls ways that changes in knowledge or intentions due to the intervention could not be assessed. In a later study of knowledge, confidence, and intentions to follow safer slumber recommendations, Ahlers-Schmidt et al. (41) found significant increases in participants' reported plans to follow the American Academy of Pediatrics Safer sleep guidelines however, these were once more parental self-reported intentions, not a reflection of actual infant-care practice. However, 86.iv% of mothers reported their infant would take slept in an alternative potentially hazardous sleep infinite, had they not received the cribs. Burd et al. (43) evaluated an educational intervention delivered past hospital nurses or habitation visiting staff, where nine SIDS risk factors were discussed. Many participants had young children, therefore there was expectation that parents already had some noesis regarding recommended safer sleep practices, however at base-line testing, substantial noesis deficits were identified in both groups. Following intervention, participants from both groups demonstrated equivalent rates of learning across each of the take a chance concepts. An evaluation by Ostfeld et al. (42), of an interactive loftier school program to accost health risks associated with smoke exposure and non-supine infant slumber, found that students were able to recognize specific risks for SUDI, retained that knowledge over time, and demonstrated better noesis of SUDI take a chance factors than a convenience sample of first-fourth dimension parents. Reinks and Oliva (44) evaluated three multi-media campaigns to raise awareness of infant mortality disparity in black infants. Reinks concluded that social marketing is an effective tool to increase disparity awareness, especially among groups disproportionately affected by the disparity, however, no overall pregnant increase in knowledge near sleep position was identified.

Targeted Health Teaching Letters Using Digital Media

Iii papers (45–47) reported on different aspects of the results from a RCT which evaluated the impact of targeted safe sleep messages in the USA (45). Controls were sent standard text messages emphasizing recommended sleep practices while the intervention group received enhanced letters to include suffocation prevention. Results identified a decrease in utilise of supine sleep position (45) and a gradual increment in bed-sharing (47) over time and in both groups, despite families existence in trial weather advising the contrary, and despite reported skilful parental noesis of the recommended sleep position. Commonly cited reasons for using sleep positions other than the recommended supine position were fear of suffocation, choking and baby preference. Some influence was noted on maternal selection of supine slumber position if nurses had discussed sleep position with the mothers, however, where mothers discussed this with the father of their infant, these mothers were more than likely to select prone position and over time, the opinion of maternal friends became more significant on influencing choice of sleep position. Matthews et al. (46) found a decrease in the utilise of soft bedding where mothers "believed" that soft bedding increased the risk of suffocation or SIDS, while mothers who were more likely to use soft bedding, including mothers who bed-shared, cited "vigilance" as protective.

The master findings presented here suggest that the almost convincing testify for interventions that piece of work accept a number of identifiable characteristics which are: personalized, culturally sensitive, enabling, empowering, relationship edifice, interactive, accepting of parental perspective, non-judgmental and are delivered over fourth dimension (Table 2).

Table two. Intervention characteristics matrix.

Give-and-take

In that location is good evidence that multi-modal interventions that provide a safe infant sleep infinite for use both in and out of the parental bed, along with comprehensive face to confront safer slumber education programs are effective, delivering improvement beyond several key outcome measures for safer sleep and safe baby practices in vulnerable families. Safe sleep space (equipment) provision was assessed in combination with other elements, however, about studies reported high percentage of parental use of the safe slumber space provided, even where noesis scores varied. Therefore, consideration of equipment provision alongside current health and social care provision in the U.k. may be a useful approach to consider every bit basic provision when resources are stretched. This has been seen in the proliferation of cardboard baby box schemes in the England since 2016 (49). Nonetheless, the adoption of these programs is non without criticism and a number of concerns, including infant safety, have been identified. While there is no evidence to support that using a cardboard box for infant sleep reduces the risk for SIDS, some of these schemes are being marketed on this basis. Of more concern is that some of these schemes are existence provided through commercial partnerships with health and social care services, which parents are probable to view every bit an endorsement to the safety of these products. The cardboard baby box schemes were not included in the systematic review equally they were widely distributed and outcome data specific to high-chance groups was not bachelor. Notwithstanding, 86% of parents reported that they intended to utilize the cardboard box for infant sleep, which supports the notion that parents are receptive to accepting an infant slumber infinite provided to them, information supported past Yuill'southward (31) feasibility report to introduce the Pepi-Pod program into the UK, which offers an testify-based and safer alternative to the cardboard box. Several interventions engage peer educators or a mechanism of "paying-it-forward," using intervention participants to spread baby safety messages farther into communities and those traditionally viewed "hard to reach" and vulnerable populations. Such interventions offering a scalable and achievable method to share safer sleep messages which need non exist resources heavy. However, some concerns identified with these approaches are the potential for loss of control of fidelity of the messages beingness communicated by link or peer educators, and the potential that relevant and culturally appropriate peer supporters can be challenging to engage and/or retain. Targeted and long-term show-based interventions with continuity of service provider, delivered in the context of enabling parent-provider relationships has benefits for infants and families. The initial contact can exist built upon to provide support for parents and opportunities for professionals to identify changes in both the sleep environment and infant intendance practices, which might subtract the risk of SUDI and SIDS as the infant grows and develops, and family circumstances change. Interventions that have been subsumed into "usual service provision" have delivered sustainable improvements in reducing risks for SUDI and SIDS for infants, and resultant decreases in babe mortality rates. 1 digital intervention was available for review (45) and was non identified equally constructive in reporting knowledge comeback and behavior modify, except for reducing the use of soft bedding. Withal, digital interventions are potentially scalable and depression cost, and are becoming more popular, particularly with the current SARS-COV-ii pandemic driving the demand to find alternative delivery options. It might too be argued that this generation, and time to come generations of parents are more than tech savvy than previous generations, providing an opportunity to capitalize on digital intervention options, and future research should consider approaches to meliorate the effectiveness and relevance of digital wellness interventions for families with children considered to exist at increased risk of SUDI. One media entrada was reviewed (44), and while no improvements in knowledge were observed, it was identified that targeted campaigns may be successful in raising awareness in the population of involvement. This was demonstrated in the national "Back to Sleep" campaign of the early 1990's, which had pregnant impact on the infant mortality charge per unit at the time. Since and then, there have been small localized safe sleep campaigns, simply perhaps consideration of another national safer slumber campaign might be useful in raising awareness to a new generation of parents and coupled with targeted interventions that are considered relevant by the population of interest, could offer a cohesive approach to SUDI risk reduction.

While much of the information reported on in these intervention papers were parental cocky-study, and reported parental behavioral intention, several studies identify decreases in infant mortality and SIDS rates, which, while not shown to be a clear consequence of the interventions, raise the possibility that increased knowledge and adherence to safer sleep recommendations is a valid result of these interventions. In considering the evidence to support the development of new interventions, research would be required to understand the relevance and appropriateness for delivery to the Uk target population. 7 of the 23 intervention papers used ethnicity as a marking of risk for SUDI, these studies are relevant where characteristics or behavior that increases risk for SUDI in the United kingdom of great britain and northern ireland population are described. While parental motivations for certain behaviors may exist culturally different, the principal of exhibiting that behavior increasing risk for SUDI should be explored when considering potential application to the United kingdom of great britain and northern ireland setting. Interventions likewise need to accept a sound theoretical foundation, for case the Wellness Conventionalities model (50, 51) or the beliefs change cycle (COM-B model) (52). Behavioral models back up the assumptions well-nigh the links between the intervention and beliefs alter outcomes and should be clearly stated. To support this, interventions should accept clear explanations, considering the needs for parents/carers to exist provided with credible advice that incorporates mechanisms of protection which are understandable, and account for the irresolute needs of a sleeping baby. Intervention design should exist collaborative between parents and professionals and consider incorporating robust evaluation and methods of measuring actual practice rather than parental knowledge and intention.

The strengths of this systematic review were that searches of the gray literature and a snowballing arroyo of relevant citations within the references of the selected records produced a further 42 papers in addition to the 3,506 records identified by the initial database searches; this suggests that our search terms were comprehensive. The agreement rate between authors on choice of included papers was high, and enough papers were identified for meaningful discussion. At that place are several limitations to this work. The quality of the intervention papers reviewed is variable and synthesis is difficult given the disparate ways in which studies take been reported. While eight were RCT'southward using big samples and reporting robust results, the remainder of papers reported evaluations or mixed methods approaches potentially impacting on the quality and robustness of reported show. The lack of controlled observations in some studies or comparing intentions of babe care practise to bodily do is often very unlike and leads to a weak design and questionable conclusions. To include papers on interventions specific to loftier-take chances populations, we relied on individual studies' definitions of "high-adventure," pregnant that included studies chronicle to a diversity of populations which was necessary equally "high-take chances" populations vary across cultures and countries. While this means that our conclusions are drawn from a wider pool of literature, it does hateful that intendance must be taken to consider the specific circumstances of, and relevance to, UK loftier-risk families. We restricted included studies to those which were targeted to higher risk groups, and while the justification for this is articulate, it does likewise hateful that we did not include interventions for the general population (e.g., Cardboard babe box schemes) equally we would not be able to review their touch in high-gamble families separately.

Conclusion

This paper reports the findings from ane arm of a wider systematic review to identify current evidence near how best to increase uptake of safer sleep communication in families with infants considered to be at risk of harm through corruption or neglect. Overall, we found evidence suggestive of how future interventions might be designed to achieve a large scale, targeted arroyo to risk reduction in families where the infants are considered to be nearly at hazard of SUDI. Interventions should, ideally, be delivered face to face, and from the prove, innovations that consider how to capitalize on leverage from peer-to-peer models may be of utilize in this context. Parents and carers require evidence-based advice so they tin make decisions on how to go along their infants condom and wellness professionals should exist provided with consequent advice that can be delivered using plain linguistic communication to families, with plausible explanations as to why this advice will keep their infant safe. Advice should consider parents' own experience and tailor the content of safer slumber conversations to private families' needs, while as well taking account of how to include partners, peers, and wider family members, to extend knowledge and agreement of safer sleep and safety infant care practices to all those who may be caring for a immature babe. Further research into how to translate successful interventions for appropriate and relevant application to the Great britain target population is required. Intervention design should be collaborative between parents and professionals and must include robust evaluation and methods of measuring infant care exercise rather than parental knowledge and behavior intention.

Data Availability Statement

The datasets presented in this report can exist found in online repositories. The names of the repository/repositories and accession number(s) can exist found beneath: NCBI with the accretion number PRJNA778186 (https://www.ncbi.nlm.nih.gov/sra?linkname=bioproject_sra_all&from_uid=778186).

Author Contributions

AP, Pb, PF, CE, JG, and DW led the review, designed the scope of the work, and wrote the protocol. AP conducted the searches with support on terms from PF, PB, CE, JG, and DW. CE, JG, AP, and DW screened the titles, abstracts and total texts, and discussed final papers for inclusion. Themes were discussed between all authors via input into drafts of the final written report. All authors contributed to the writing of the manuscript drafts providing comments and changes until a final manuscript for submission was agreed.

Funding

This piece of work was deputed by the Child Safeguarding Panel Funding Ref No. RDx135, as function of its review into sudden unexpected death in infancy.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential disharmonize of involvement.

Publisher's Annotation

All claims expressed in this article are solely those of the authors and practice not necessarily correspond those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Whatsoever product that may be evaluated in this article, or claim that may exist fabricated by its manufacturer, is not guaranteed or endorsed past the publisher.

Supplementary Cloth

The Supplementary Material for this article tin be found online at: https://www.frontiersin.org/articles/10.3389/fped.2021.778186/full#supplementary-fabric

References

1. Forster E, Hafiz A. Paediatric death and dying: exploring coping strategies of health professionals and perceptions of support provision. Int J Palliat Nurs. (2015) 21:294–301. doi: ten.12968/ijpn.2015.21.6.294

PubMed Abstract | CrossRef Full Text | Google Scholar

2. Krous HF, Beckwith JB, Byard RW, Rognum TO, Bajanowski T, Corey T, et al. Sudden infant death syndrome and unclassified sudden infant deaths: a definitional and diagnostic approach. Pediatrics. (2004) 114:234–8. doi: x.1542/peds.114.1.234

PubMed Abstract | CrossRef Full Text | Google Scholar

three. Function for National Statistics. Unexplained Deaths in Infancy, England and Wales: 2017 (2019).

Google Scholar

iv. Fleming P, Blair P, Bacon C, Berry J. Sudden Unexpected Deaths in Infancy: The CESDI-SUDI Studies, 1993–1996. London: Stationery Office Books (2000). 172 p.

Google Scholar

v. Blair PS, Sidebotham P, Berry PJ, Evans M, Fleming PJ, Blair PS, et al. Major epidemiological changes in sudden infant decease syndrome: a 20-twelvemonth population-based study in the UK. Lancet. (2006) 367:314–nine. doi: 10.1016/S0140-6736(06)67968-3

PubMed Abstract | CrossRef Full Text | Google Scholar

six. Blair PS, Sidebotham P, Evason-Coombe C, Edmonds G, Heckstall-Smith EM, Fleming P. Chancy co-sleeping environments and adventure factors amenable to alter: instance-control written report of SIDS in southwest England. BMJ. (2009) 339:b3666. doi: 10.1136/bmj.b3666

PubMed Abstract | CrossRef Full Text | Google Scholar

ix. Garstang JJ, Sidebotham P. Qualitative analysis of serious case reviews into unexpected baby deaths. Curvation Dis Childhood. (2019) 104:thirty–36. doi: x.1136/archdischild-2018-315156

PubMed Abstract | CrossRef Full Text | Google Scholar

x. Joyner BL, Oden RP, Ajao TI, Moon RY. Where should my baby slumber: a qualitative study of African American infant sleep location decisions. J Natl Med Assoc. (2010) 102:881–ix. doi: ten.1016/S0027-9684(15)30706-nine

PubMed Abstract | CrossRef Full Text | Google Scholar

11. Gaydos LM, Blake SC, Gazmararian JA, Woodruff West, Thompson WW, Dalmida SG. Revisiting safe sleep recommendations for African-American infants: why current counseling is insufficient. Matern Kid Health J. (2015) xix:496–503. doi: x.1007/s10995-014-1530-z

PubMed Abstract | CrossRef Full Text | Google Scholar

xiii. Clarke J. Velcro Babies: A Qualitative Written report Exploring Maternal Motivations in the Night-Time Care of Infants (Master of Science), University of Otago (2016).

Google Scholar

14. Pease A, Ingram J, Blair PS, Fleming PJ. Factors influencing maternal controlling for the infant sleep environment in families at college chance of SIDS: a qualitative study. BMJ Paediatr Open up. (2017) 1:e000133. doi: 10.1136/bmjpo-2017-000133

PubMed Abstract | CrossRef Full Text | Google Scholar

15. Ellis C. Safely Sleeping? An Exploration of Mothers' Understanding of Safe Sleep Practices and Factors that Influence Reducing Risks in Their Baby's Sleep Surround. (Doctoral Thesis), University of Warwick. (2019)

Google Scholar

16. Caraballo Chiliad, Shimasaki Southward, Johnston K, Tung G, Albright K, Halbower AC. Knowledge, attitudes, and take chances for sudden unexpected babe death in children of boyish mothers: a qualitative study. J Pediatr. (2016) 174:78–83. e2. doi: 10.1016/j.jpeds.2016.03.031

PubMed Abstract | CrossRef Full Text | Google Scholar

xix. Pease A, Garstang J, Ellis C, Watson D, Blair PS, Fleming PJ. Systematic Literature Review Report for the National Kid Safeguarding Practice Review Into the Sudden Unexpected Death of Infants (SUDI) in Families Where the Children Are Considered to Be at Chance of Significant Harm (2020).

Google Scholar

20. Garstang J, Watson DL, Pease AS, Ellis C, Blair PS, Fleming PJ. Improving engagement with services to prevent sudden unexpected death in infancy (SUDI) in families with children at risk of pregnant impairment: a systematic review of evidence. Child Care Health Dev. (2021) 47:713–31. doi: 10.1111/cch.12875

PubMed Abstract | CrossRef Full Text | Google Scholar

21. Pease A, Garstang JJ, Ellis C, Watson DL, Blair PS, Fleming PJ. Decision-making for the infant slumber environment amongst families with children considered to be at adventure of sudden unexpected expiry in infancy: a systematic review and qualitative meta-synthesis. BMJ Paediatr Open. (2021) 0:e000983. doi: x.1136/bmjpo-2020-000983

PubMed Abstract | CrossRef Full Text | Google Scholar

22. Sirriyeh R, Lawton R, Gardner P, Armitage Grand. Reviewing studies with diverse designs: the development and evaluation of a new tool. J Eval Clin Pract. (2012) 18:746–52. doi: 10.1111/j.1365-2753.2011.01662.x

PubMed Abstract | CrossRef Full Text | Google Scholar

23. Michie S, Atkins L, West R. The Behaviour Change Wheel: A Guide to Designing Interventions. London: Silverback Publishing (2014).

PubMed Abstract | Google Scholar

24. Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers Chiliad, et al. Guidance on the behave of narrative synthesis in systematic reviews. Prod ESRC Methods Prog Vers. (2006) i:b92. doi: 10.13140/two.1.1018.4643

CrossRef Full Text | Google Scholar

25. Baddock SA, Tipene-Leach D, Williams SM, Tangiora A, Jones R, Iosua E, et al. Wahakura versus bassinet for prophylactic infant sleep: a randomized trial. Pediatrics. (2017) 139:e20160162. doi: 10.1542/peds.2016-0162

PubMed Abstract | CrossRef Full Text | Google Scholar

26. Carlins EM, Collins KS. Cribs for kids: chance and reduction of sudden infant death syndrome and accidental suffocation. Health Soc Piece of work. (2007) 32:225–nine. doi: x.1093/hsw/32.three.225

PubMed Abstract | CrossRef Full Text | Google Scholar

27. Young J, Cowan S, Watson G, Kearney 50, Craigie L. The Queensland Pepi-Pod^® Plan: A Strategy to Promote Safe Sleeping Environments and Reduce the Gamble of Sudden Unexpected Deaths in Infancy in Ancient and Torres Strait Islander Communities. Section of Kid Safety, Youth & Women (2018).

Google Scholar

29. Cowan S. Their First 500 Sleeps. Pepi-Pod Report: 2012-2014. Christchurch: Modify for our Children Limited (2015)

Google Scholar

xxx. Hauck FR, Tanabe KO, McMurry T, Moon RY. Evaluation of bedtime basics for babies: a national crib distribution program to reduce the take a chance of slumber-related sudden infant deaths. J Community Health. (2015) forty:457–63. doi: ten.1007/s10900-014-9957-0

PubMed Abstruse | CrossRef Full Text | Google Scholar

31. Yuill C, Taylor C, Blair PS, Russell C, Ball HL. Let's Talk Nearly Sleep! A Feasibility Written report of a New Approach for Improving Infant Sleep-Sharing Rubber: Combined Study Executive Summary (2017).

32. McIntosh C, Trenholme A, Stewart J, Vogel A. Evaluation all of a sudden unexpected death in infancy intervention program aimed at improving parental sensation of risk factors and protective infant care practices. J Paediatr Kid Health. (2018) 54:377–82. doi: x.1111/jpc.13772

PubMed Abstract | CrossRef Full Text | Google Scholar

33. Salm Ward TC, McClellan MM, Miller TJ, Brownish Southward. Evaluation of a crib distribution and safe sleep educational program to reduce risk of sleep-related babe death. J Community Health. (2018) 43:848–55. doi: 10.1007/s10900-018-0493-1

PubMed Abstract | CrossRef Total Text | Google Scholar

34. Dillon E. Central Manchester Foundation Trust (CMFT) Vulnerable Baby Service (2012).

35. Hutton JS, Gupta R, Gruber R, Berndsen J, DeWitt T, Ollberding NJ, et al. Randomized trial of a children'southward book versus brochures for safety sleep knowledge and adherence in a loftier-take chances population. Acad Pediatr. (2017) 17:879–86. doi: 10.1016/j.acap.2017.04.018

PubMed Abstract | CrossRef Full Text | Google Scholar

36. Kemp L, Harris East, McMahon C, Matthey S, Vimpani G, Anderson T, et al. Benefits of psychosocial intervention and continuity of care by child and family wellness nurses in the pre- and postnatal period: process evaluation. J Adv Nurs. (2013) 69:1850–61. doi: x.1111/jan.12052

PubMed Abstract | CrossRef Full Text | Google Scholar

37. Olds DL, Kitzman H, Knudtson Doctor, Anson E, Smith JA, Cole R. Outcome of home visiting by nurses on maternal and child mortality: results of a 2-decade follow-up of a randomized clinical trial. JAMA Pediatr. (2014) 168:800–6. doi: 10.1001/jamapediatrics.2014.472

PubMed Abstruse | CrossRef Full Text | Google Scholar

38. Cowan SF. Pease As. half dozen +one: A Kid Survival Intervention for Accessing the Social Networks of Priority Groups. Report on a Pilot Project. Education for Alter (2008).

39. Gilchrist A. Little Lullaby evaluation 2014-2016. London: The Lullaby Trust (2016)

Google Scholar

40. Ahlers-Schmidt CR, Schunn C, Dempsey M, Blackmon Due south. Evaluation of customs baby showers to promote condom slumber. Kans J Med. (2014) 7:1–5. doi: x.17161/kjm.v7i1.11476

CrossRef Full Text | Google Scholar

41. Ahlers-Schmidt CR, Schunn C, Engel M, Dowling J, Neufeld K, Kuhlmann S. Implementation of a statewide program to promote safe sleep, breastfeeding and tobacco cessation to loftier-adventure meaning women. J Customs Health. (2019) 44:185–91. doi: ten.1007/s10900-018-0571-4

PubMed Abstract | CrossRef Full Text | Google Scholar

42. Ostfeld BM, Esposito Fifty, Harbinger D, Burgos J, Hegyi T. An inner-urban center school-based program to promote early awareness of risk factors for sudden infant death syndrome. J Adolesc Wellness. (2005) 37:339–41. doi: x.1016/j.jadohealth.2004.12.002

PubMed Abstract | CrossRef Full Text | Google Scholar

43. Burd 50, Peterson Grand, Face GC, Confront FC, Shervold D, Klug M. Efficacy of a SIDS risk factor instruction methodology at a Native American and Caucasian site. Matern Child Health J. (2007) 11:365. doi: x.1007/s10995-007-0182-7

PubMed Abstract | CrossRef Full Text | Google Scholar

44. Rienks J, Oliva 1000. Using social marketing to increase sensation of the African American baby mortality disparity. Health Promot Pract. (2013) 14:408–14. doi: 10.1177/1524839912458107

PubMed Abstract | CrossRef Total Text | Google Scholar

45. Carlin RF, Abrams A, Mathews A, Joyner BL, Oden R, McCarter R, et al. The bear on of health letters on maternal decisions about infant sleep position: a randomized controlled trial. J Customs Health. (2018) 43:977–85. doi: x.1007/s10900-018-0514-0

PubMed Abstract | CrossRef Full Text | Google Scholar

46. Mathews A, Joyner BL, Oden RP, He J, McCarter R, Jr., et al. Messaging affects the beliefs of African American parents with regards to soft bedding in the babe slumber environment: a randomized controlled trial. J Pediatr. (2016) 175:79–85. e2. doi: x.1016/j.jpeds.2016.05.004

PubMed Abstract | CrossRef Total Text | Google Scholar

47. Moon RY, Mathews A, Joyner BL, Oden RP, He J, McCarter R. Health messaging and african-american infant sleep location: a randomized controlled trial. J Community Wellness. (2016) 42:1–9. doi: 10.1007/s10900-016-0227-ane

PubMed Abstract | CrossRef Full Text | Google Scholar

48. UNICEF, WHO and UNESCO. Adamson P, Williams Grand. Facts for Life: A Communication Challenge. Oxfordshire: P&LA (1989).

Google Scholar

52. Michie Due south, Van Stralen MM, Westward R. The behaviour change bike: a new method for characterising and designing behaviour change interventions. Implement Sci. (2011) six:42. doi: x.1186/1748-5908-6-42

PubMed Abstract | CrossRef Total Text | Google Scholar

Source: https://www.frontiersin.org/articles/10.3389/fped.2021.778186/full

Posted by: knappspass1986.blogspot.com

Share this post