Elsevier

Ambulatory Pediatrics

Volume 5, Issue 6, November–December 2005, Pages 349-354
Ambulatory Pediatrics

Barriers to Following the Back-to-Sleep Recommendations: Insights From Focus Groups With Inner-City Caregivers

https://doi.org/10.1367/A04-220R1.1Get rights and content

Background.—African American infants have a higher incidence of SIDS and increased risk of being placed in the prone position for sleep.

Objective.—To determine new barriers and more information about previously identified barriers that interfere with adherence to the Back-to-Sleep recommendations among inner-city, primarily African Americans.

Design/Methods.—We conducted 9 focus groups with caregivers of infants and young children from women, infants, and children centers and clinics in New Haven and Boston. Themes were identified using standard qualitative techniques.

Results.—Forty-nine caregivers participated, of whom 86% were African American, 6% were Hispanic, 4% were white, and 4% were other. Four themes were identified: 1) Safety: Participants chose the position for their infants based on which position they believed to be the safest. Some participants did not choose to put their infants in the supine position for sleep because they feared their infants would choke; 2) Advice: Participants relied on the advice of more experienced female family members. Health care providers were not uniformly a trusted source of advice; 3) Comfort: Participants made choices about their infants sleeping positions based on their perceptions of whether the infants appeared comfortable. Participants thought that their infants appeared more comfortable in the prone position; 4) Knowledge: Some participants had either limited or erroneous knowledge about the Back-to-Sleep recommendations.

Conclusions.—We identified multiple barriers to adherence to recommendations regarding infant sleep position. Data obtained from these focus groups could be used to design educational interventions aimed at improving communication about and adherence to the Back-to-Sleep recommendations.

Section snippets

Participant Selection

Participants were recruited on site from women, infant, and children centers (WICs) at Yale-New Haven Hospital and at Boston South End Health Center as well as from the maternity unit at Yale-New Haven Hospital. The WIC Supplemental Nutrition Program is a federally funded program for low-income women who are pregnant, breastfeeding, and/or postpartum and for children under age 5 from low-income families. Those recruited from the maternity unit at the hospital planned to bring their children to

RESULTS

A total of 49 caregivers participated. Most identified themselves as Black (86%) and most were female (92%). Sixteen percent were grandmothers. The ages of the participants' biological children ranged from newborn to 26 years (Table 1).

In this section, we present brief transcript excerpts representative of each core theme to illustrate the issues at stake from the respondents' perspectives in their own voices. Excerpts were also selected for inclusion here in light of the investigators'

DISCUSSION

In 1994, the Back-to-Sleep campaign was initiated to get caregivers to place their infants in the supine position for sleep. Ten years later, some caregivers, particularly African Americans, are still not following the recommendations.4, 5, 7, 8, 9 With this qualitative research study, we identified 4 themes that are important to inner-city, primarily African American caregivers when deciding about infant care practices related to SIDS.

The first major barrier was fear that the supine position

ACKNOWLEDGMENTS

Supported by funds from the National Institute of Child Health and Human Development grant U10 HD029067-09A1.

We thank Amy Margolis for her research assistance and Drs Eugene Shapiro and Marian Willinger for review of this manuscript. Thanks also to the Deborah Diehl and her staff at the WIC center at Yale-New Haven Hospital and Rhonda Dickson and her staff at the South End WIC center in Boston.

REFERENCES (33)

  • OttoliniMC et al.

    Prone infant sleeping despite the “Back to Sleep” campaign

    Arch Pediatr Adolesc Med

    (1999)
  • WillingerM et al.

    Factors associated with the transition to nonprone sleep positions of infants in the United States: The National Infant Sleep Position Study

    JAMA

    (1998)
  • FoxK

    Cultural issues in pediatric care

  • KleinmanA

    The Illness Narratives: Suffering, Healing, and the Human Condition

    (1988)
  • KleinmanA

    Local worlds of suffering: an interpersonal focus of illness experience

    Qualitative Health Res

    (1992)
  • YangL et al.

    Ethnography in health research and practice

    Ambul Child Health

    (1999)
  • Cited by (58)

    • Social network influences on new mothers’ infant sleep adjustments

      2021, Social Science and Medicine
      Citation Excerpt :

      Because network members are generally more capable of exercising influence when they are interconnected (e.g., see Coleman 1988), we also control for the density of the respondent's network (calculated as the proportion of alter-alter dyads in the network who interact with each other). Finally, we add respondents' demographic attributes that were previously shown to be associated with women's child health outcomes: respondent's age (in decades) (Molina-García et al., 2019), educational attainment (college or less than college) (Desai et al., 1998; Keats 2018), race (White or African-American) (Colson et al. 2005, 2009bib_Colson_et_al_2005bib_Colson_et_al_2009), and whether they are first-time mothers (Aston 2002). The aim of our study is to explore the respective roles of personal social networks and health professionals in affecting new mothers' probability of changing their infant sleep practices over time.

    • Comparison of Text Messages Versus E-mail When Communicating and Querying With Mothers About Safe Infant Sleep

      2017, Academic Pediatrics
      Citation Excerpt :

      They received these videos on a daily basis for the first 11 days after enrollment, and then every 3 to 4 days for 60 days (see Table 1 for schedule of videos and queries). Videos were timed to anticipate known barriers to safe sleep practices, on the basis of previous research.27–31 Unique links were used to track when and how many times each participant opened one of the videos, and a video was counted as “viewed” if the link was clicked at least once.

    View all citing articles on Scopus

    Presented in part at the Pediatric Academic Societies Meeting, May 2004.

    View full text