Barriers to following the back-to-sleep recommendations: insights from focus groups with inner-city caregivers

Ambul Pediatr. Nov-Dec 2005;5(6):349-54. doi: 10.1367/A04-220R1.1.


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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • African Americans / psychology*
  • Caregivers / psychology*
  • Female
  • Focus Groups
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Sleep*
  • Supine Position*
  • Treatment Refusal / ethnology
  • Treatment Refusal / psychology*
  • Urban Health*