An evaluation of a safe sleep health promotion strategy amongst Aboriginal and Torres Strait Islander families and Health Care Providers

Background: Australia’s Aboriginal and Torres Strait Islander population suffer poorer outcomes in relation to many of the measures for health and wellbeing. Maternal and infant health indicators in particular are recognised as a sensitive measure of a country’s socio-economic climate, and in Australia the Aboriginal and Torres Strait Islander infant mortality rate remains consistently higher than that of their non-Indigenous counterparts. Sudden Unexpected Death in Infancy [SUDI] is an infant mortality classification that groups the death of infants who were otherwise thought to be ‘well’ and expected to thrive, but for some reason (sometimes not identifiable) have died suddenly and unexpectedly, usually during sleep or in an environment in which the baby was placed to sleep. At the time that this research began, the SUDI rate for Aboriginal and Torres Strait Islander infants was over three times higher than the non-Indigenous infant SUDI rate. Methods: This study sought to evaluate the introduction of an innovative safe sleep health promotion initiative within a complex social system, that included a sample population of Aboriginal and Torres Strait Islander families who frequently face greater challenges which influence infant care. This study was informed by a socio-ecological framework which took into consideration the social, cultural and systematic influences on infant care practices. A mixed methods approach was used to conduct two strands of investigation to evaluate the Pēpi-Pod® Program. An exploratory descriptive longitudinal research design employing repeated survey measures was used for Strand One, with the aim being to determine the acceptability, feasibility and carer perceptions of safety of the Pēpi-pod® Program within Aboriginal and Torres Strait Islander families living in Queensland. Strand Two used a participatory research methodology, a modified photo-voice and focus group interviews, to evaluate the perspectives of the safe sleep health promotion initiative amongst a sample of health care providers delivering the Pēpi-Pod® Program within their community. Results: Data from this population of Aboriginal and Torres Strait Islander families demonstrated considerable vulnerability in terms of the presence of known risk factors for SUDI at the time of recruitment. Families found the program to be acceptable, and the portable sleep space was perceived by carers to be safe, convenient and useful for settling their baby. The Pēpi-pod® was used predominantly in the bedroom and placed within the parental bed with one or both parents; but was also placed beside the bed, in other rooms of the house, and outside as a safe space for baby to sleep. Indigenous Health workers who participated in Strand Two found the program to be flexible, with aims consistent with their health promotion work. The Program facilitated difficult discussions that needed to occur around infant sleep and was valued by the Health Workers. Health workers reported safe sleep messages being taken up in the community and improved infant care practices particularly amongst their younger mothers. These Health Workers indicated that they would recommend the program to other service sites. Conclusion: Findings have supported that parents and carers perceive the Pēpi-Pod® Program to be safe, culturally acceptable to Indigenous communities, and feasible to undertake in partnership with local service providers. The program has offered Health Workers support for their health promotion role; was capacity building in terms of building skills in safe sleep health promotion and has been an effective tool for introducing safe sleep education to community. The model of implementation, where a known and familiar health care provider implemented the program within the community, has proven to be sustainable, particularly when embedded into existing programs of maternal and child health.Submitted in the fulfilment of the requirements of the degree of Doctor of Philosophy, University of the Sunshine Coast, 2018