Evaluation of a Safe Infant Sleep Education and Crib Distribution Program in Georgia to Reduce Risk of Sleep-Related Infant Death

Background: The American Academy of Pediatrics (AAP) recommends infant sleep practices to reduce risk of sleep-related infant deaths. The Georgia Department of Public Health implemented a group safe sleep education program paired with distribution of portable cribs across multiple sites in Georgia. The program is based on AAP recommendations and developed with community partners. The program lasts 20-30 minutes and uses a PowerPoint presentation that includes pictures and information for participants and a discussion guide for the educator. Program is delivered by local educators who received specialized training by the state safe infant sleep program manager. Program content was informed by the health belief model and included susceptibility to sleep-related death, benefits of adherence to recommendations, and addressed barriers to adherence. Program is provided in an informal, conversational style that includes “ask the parent” questions to engage parents and to help parents demonstrate self-efficacy. Program concludes with portable crib assembly instructions. Evaluation results from a pilot program in Fulton County with 132 participants were used to improve program delivery.

Purpose: The purpose of this study is to compare participant knowledge and practices related to infant sleep before and after receipt of the program.

Methods: This is a prospective, matched pre- and post-test survey design cohort study with a follow-up survey ten weeks after the birth of the infant. Participants are recruited through local community organizations and must meet the following criteria: (1) women who are between 32-40 weeks pregnant or within 3 months postpartum, and (2) demonstrated financial need (e.g., eligibility for the Women, Infants and Children nutrition program; Medicaid; or Temporary Assistance for Needy Families). Participants complete a pre-test survey before the program and a post-test survey upon completion. For those who agree, a follow-up survey via email or phone is conducted when the infant is approximately ten weeks old. McNemar’s Chi square tests were conducted to detect differences between specific items on pre-test, post-test, and follow-up surveys, and paired sample t tests were conducted to compare differences in knowledge and practice scores.

Results: One hundred sixty-five participants completed the education program. Preliminary results indicate that knowledge of recommendations regarding position, surface, environment, smoking, breastfeeding, and pacifier use increased between pre- and post-test, with most participants maintaining knowledge at follow-up. The proportion of participants reporting engaging in recommended practices also increased significantly. When asked where their babies would sleep if they had not received the portable crib, less than half (40%) planned to use a recommended sleep location with the remainder planning to use an adult bed or other location, or not sure where their infant would sleep.

Conclusions and Implications: A group-based safe infant sleep educational program with portable crib distribution can be effective in reducing risky infant sleep practices by increasing knowledge and long-term self-reported behavior changes. Evaluation offers opportunities to modify program components to increase effectiveness.