Comparing Children's Book to Brochures for Safe Sleep Education in a Home Visiting Program

Safe sleep and health literacy are priorities at national, state, and local levels. While
greatly improved since the launch of the Back to Sleep campaign in the 1990s, the rate of
sleep-related infant deaths, notably Sudden Infant Death Syndrome (SIDS), has been stagnant
for over a decade. While printed materials are widely distributed for SIDS education, to
date none have been proven effective, and overall satisfaction has been low. Reasons include
passive delivery, unappealing content, and excessively high reading level, especially for
low-socioeconomic status populations. Evidence suggests that an ideal strategy involves
printed materials combining simplicity, emotional appeal, cultural sensitivity, and low
reading level, conveyed by health care practitioners and reviewed multiple times. Children's
books are a potentially ideal medium for this, combining pictures and text to invoke emotion
and inspire a shared parent-child experience that is valued and repeated.

This is a randomized controlled trial involving a population of at-risk, low-socioeconomic
status, first-time mothers enrolled in an early intervention home visitation program, Every
Child Succeeds (ECS). ECS home visitors from 9 agencies will be randomly assigned to utilize
either a specially-designed children's book (intervention) or standard brochures (control)
for safe sleep education. Our target enrollment is 230 mothers. Trained ECS home visitors
will obtain consent, distribute the book or brochures, and perform baseline assessment of
health literacy (via the REALM-R screen), safe sleep knowledge, and home literacy
orientation during a third trimester, prenatal home visit. Outcomes data will be collected
by the same visitor during subsequent home visits at 1 week old, when infant sleep routines
are being established, and 2 months old, at onset of peak SIDS risk. At each visit, the book
or brochures will be reviewed.

Outcomes will be compared between intervention and control groups in the following
categories: 1) maternal safe sleep knowledge, 2) maternal adherence to safe sleep guidelines
(observed), 3) maternal and provider satisfaction with materials utilized to convey safe
sleep guidelines, and 4) the degree to which utilizing a children's book for health
education impacts home literacy orientation (i.e. attitudes towards reading).

Inclusion Criteria:

- Prenatal enrollment in the Every Child Succeeds home visitation program,

- English speaking (intervention book was not available in Spanish), and

- at least 15 years old.

Exclusion Criteria:

- Non-English speaking,

- age under 15 years,

- delayed hospital discharge such that an initial postnatal home visit prior to 3 weeks
old is not possible.