Considerations in Safe to Sleep® messaging: Learning from African-American mothers

J Spec Pediatr Nurs. 2020 Jan;25(1):e12277. doi: 10.1111/jspn.12277. Epub 2019 Nov 19.


Purpose: The purpose of this study was to identify why African-American mothers do not tend to follow the Safe to Sleep® recommendations and to begin to identify a way to frame the Safe to Sleep® message so that African-American mothers might be more likely to follow these recommendations.

Design: We recruited African-American mothers with infants over the age of 6 months to participate in two focus groups facilitated by a community engagement manager experienced in focus group facilitation. We used ethnography to find shared patterns of behavior and beliefs in African-American women related to safe sleep.

Results: We identified 14 concepts and formulated them into three categories: it's just easier; can't fight culture and grandma; and Effectively teaching mother. From these we were able to identify the shared value of multifaceted learning.

Practice implications: African-American mothers say that they are generally aware of the Safe to Sleep® recommendations, even though the majority of mothers do not follow them. The reasons they give for not following them are that they are not comfortable doing so, they feel they are unable to do so, or find it unnecessary. Many of the mothers attempted to follow the Safe to Sleep® recommendations but abandoned the effort due to the stress of their crying infant. Trying to follow the Safe to Sleep® recommendations were stressful for the mothers, even though there was concern expressed by some that their infant could indeed suffocate or die from sudden infant death syndrome. The mothers gave suggestions on how they would change the message or the delivery of the message.

Keywords: African American; Safe to Sleep®; bed-sharing; black; cosleeping; infant death; infant mortality; safe sleep; sudden unexpected infant death/sudden infant death syndrome (SUID/SIDS).

Publication types

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

MeSH terms

  • Adult
  • Black or African American / psychology*
  • Black or African American / statistics & numerical data
  • Child
  • Child, Preschool
  • Female
  • Focus Groups
  • Health Knowledge, Attitudes, Practice / ethnology
  • Hispanic or Latino / psychology
  • Hispanic or Latino / statistics & numerical data
  • Humans
  • Indiana
  • Infant
  • Infant Care / standards*
  • Infant Mortality*
  • Male
  • Mothers / psychology*
  • Practice Guidelines as Topic
  • Prone Position*
  • Qualitative Research
  • Risk Factors
  • Sudden Infant Death / prevention & control*
  • Supine Position*
  • White People / psychology
  • White People / statistics & numerical data