My Baby's Sleep: Feasibility and Acceptability of a Safe Sleep Coaching Intervention for African American Infant Caregivers

Background: Every year in the United States, about 3,500 infants die from sleep-related causes such as Sudden Infant Death Syndrome (SIDS) and accidental suffocation. Some families report having difficulties adhering to the American Academy of Pediatrics (AAP) recommendations for a safe infant sleeping environment, especially African American families who are living in under-resourced neighborhoods. Infant safe sleep intervention research suggests several strategies that may address these difficulties: Approaches focused on increasing mothers’ self-efficacy; partnering to develop harm reduction strategies; engaging the mothers’ wider social networks; and providing coaching over time as sleep challenges change. My Baby’s Sleep (MBS) is a 4-session in-home coaching education intervention designed to support African-American families and address barriers to following safe sleep recommendations. Participation in MBS begins during pregnancy and continues until baby is 3 months of age.

Purpose: The purpose of this study is to test the feasibility and acceptability of MBS among African American families.

Methods: Participants include 5 women who meet the following criteria: (a) identify as African-American, (b) 6-8 months pregnant, and (c) available over the next 7 months. Participants were excluded if they received other formal safe infant sleep programming. Women identified one to two co-caregivers to participate with them. Feasibility was evaluated based upon whether the MBS could successfully be carried out and demonstrate improvements on the target variables of perceived maternal support and cooperation, infant sleep knowledge and attitudes, perceived maternal self-efficacy, and infant sleep intentions and practices. Acceptability was evaluated through open-ended evaluation questions. Surveys were completed at baseline, each visit, and after the intervention. Visits were audio or video-recorded to develop a fidelity checklist.

Results: Five families have been enrolled in the intervention. Family demographics include 5 mothers (average age: 25 years; 4 meet income criteria for the Women, Infants, and Children Nutrition Program). Seven co-caregivers are enrolled and include 4 fathers (average age: 27 years), 2 grandmothers (average age: 63 years); and 1 aunt (age: 19 years). All family members identify as African American with the majority having a high school education. Surveys indicate improvements in knowledge and attitudes about AAP recommendations such as back to sleep, separate sleep surface, and no soft items. The majority of intervention components and visits were delivered within the specified timeframe. Surveys indicate improvements in perceived maternal support and maternal self-efficacy. Comments from families indicate the sessions are informative and the coaches are perceived as helpful and supportive.

Conclusion and Implications: MBS appears generally feasible and acceptable to families. Study results will be used to further refine MBS and to inform a larger-scale study of intervention effectiveness.