Factors influencing infant care practices in the sleep environment among families at high risk of sudden infant death syndrome

Abstract

Introduction. Advice for reducing the risk of Sudden Infant Death Syndrome (SIDS) by modifying the infant sleep environment has led to significant reductions in the number of babies who die. The highest burden of SIDS now lies with the most deprived families in society, where rates remain higher than in the general population. This thesis employed a mixed methods approach to examine knowledge and attitudes to SIDS risk reduction advice and explore the factors that influence decision making for the infant sleep environment among families most at risk. Methods. The four parts to this programme of work included: 1) A systematic review of the literature to reveal how mothers' knowledge of SIDS risk reduction has been measured and provide a suitable tool for use in a quantitative survey. 2) An analysis of longitudinal postal questionnaires from birth to late infancy to assess whether a high risk scoring system for SIDS based on routine demographics identifies risky infant care practices. 3) A quantitative survey of mothers recruited from health visitor-led clinics in deprived areas of Bristol, UK to measure mothers' knowledge and attitudes to SIDS advice. 4) A qualitative survey using home interviews with mothers of infants at higher risk of SIDS to determine decision making processes for the infant sleep environment. Results. The systematic review screened over 3000 papers and uncovered a useful tool for measuring knowledge of SIDS risks. The analysis of 591 postal questionnaires found that a scoring system of demographic characteristics can pick up on differences in infant care for a higher risk group, especially sleeping position and breastfeeding. The face-to-face survey with 400 mothers found poorer knowledge of SIDS risks in a higher risk group using the same scoring system and home interviews with 20 mothers most at risk gave insights into the complex challenges of night time infant care for this group. The interviews suggested that mothers are influenced by family and friends, their own self-efficacy, beliefs they hold about infant safety and care and their perceived barriers to following the recommended advice. Conclusions. This work confirms that families at higher risk for SIDS have poorer knowledge of the risk factors and are more likely to engage in sleep practices that may put their infants at further risk of SIDS. It also confirms that decision-making for infant care is interconnected with social contexts and psychological constructs that can help or hinder when it comes to safe sleep. Where good reasons for following advice were lacking, mothers would fill in the blanks with their own interpretations that risk supporting unsafe sleep decisions. Interventions that target groups of parents where the risks of SIDS are higher, need to consider social influences, beliefs and understanding behind the safer sleep messages if they are to be effective and engage this group in change.

Date of Award	10 May 2016
Original language	English
Awarding Institution	University of Bristol
Supervisor	Peter S Blair (Supervisor), Peter J Fleming (Supervisor) & Jenny Ingram (Supervisor)