Rachel Y Moon1, Michael J Corwin2, Stephen Kerr2, Timothy Heeren2,3, Eve Colson4, Ann Kellams5, Nicole L Geller2, Emily Drake6, Kawai Tanabe7, Fern R Hauck7. 1. Departments of Pediatrics and rym4z@virginia.edu. 2. Slone Epidemiology Center and. 3. Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts; and. 4. Department of Pediatrics, Yale University, New Haven, Connecticut. 5. Departments of Pediatrics and. 6. Department of Family, Community, and Mental Health Systems, School of Nursing, University of Virginia, Charlottesville, Virginia. 7. Family Medicine, School of Medicine and.
Abstract
OBJECTIVES: To determine mediators of improvements in infant safe-sleep (SS) practices in a mobile health intervention. METHODS: In a cluster-randomized controlled trial, mothers received SS intervention or breastfeeding control videos for 60 days. Maternal responses about infant sleep position and location (outcomes) and mediators (attitudes, perceived social norms, and perceived control) from the theory of planned behavior were assessed. Intervention effects on mediators and association between mediators and outcomes were examined. RESULTS:Of 1600 recruited, 1263 mothers participated. Mothers receivingSS videos were more likely to have positive attitudes and norms for supine sleep (attitudes: adjusted odds ratio [aOR] = 2.35 [95% confidence interval (CI) 1.72 to 3.20]; norms: aOR = 1.75 [95% CI 1.27 to 2.42]) and recommended sleep location (attitudes: aOR = 1.91 [95% CI 1.54 to 2.36]; norms: aOR = 1.37 [95% CI 1.13 to 1.66]). Positive attitudes and norms toward supine sleep and room-sharing without bed-sharing were associated with higher odds of both practices (supine: aOR = 8.25 [95% CI 4.72 to 14.43] for positive attitudes and aOR = 6.67 [95% CI 4.25 to 10.46] for norms; room-sharing: aOR = 7.14 [95% CI 5.35 to 9.53] for positive attitudes and aOR = 4.44 [95% CI 3.03 to 6.51] for norms). Both positive attitudes and positive norms mediated the effect of the intervention. CONCLUSIONS: The intervention achieved success in improving adherence to SS recommendations by changing maternal attitudes and norms about supine sleeping and room-sharing without bed-sharing. Recognition that these attitudes and norms appear to be the main drivers of mothers' choices regarding infant-sleep practices should inform health messaging strategies to promote SS.
RCT Entities:
OBJECTIVES: To determine mediators of improvements in infant safe-sleep (SS) practices in a mobile health intervention. METHODS: In a cluster-randomized controlled trial, mothers received SS intervention or breastfeeding control videos for 60 days. Maternal responses about infant sleep position and location (outcomes) and mediators (attitudes, perceived social norms, and perceived control) from the theory of planned behavior were assessed. Intervention effects on mediators and association between mediators and outcomes were examined. RESULTS: Of 1600 recruited, 1263 mothers participated. Mothers receiving SS videos were more likely to have positive attitudes and norms for supine sleep (attitudes: adjusted odds ratio [aOR] = 2.35 [95% confidence interval (CI) 1.72 to 3.20]; norms: aOR = 1.75 [95% CI 1.27 to 2.42]) and recommended sleep location (attitudes: aOR = 1.91 [95% CI 1.54 to 2.36]; norms: aOR = 1.37 [95% CI 1.13 to 1.66]). Positive attitudes and norms toward supine sleep and room-sharing without bed-sharing were associated with higher odds of both practices (supine: aOR = 8.25 [95% CI 4.72 to 14.43] for positive attitudes and aOR = 6.67 [95% CI 4.25 to 10.46] for norms; room-sharing: aOR = 7.14 [95% CI 5.35 to 9.53] for positive attitudes and aOR = 4.44 [95% CI 3.03 to 6.51] for norms). Both positive attitudes and positive norms mediated the effect of the intervention. CONCLUSIONS: The intervention achieved success in improving adherence to SS recommendations by changing maternal attitudes and norms about supine sleeping and room-sharing without bed-sharing. Recognition that these attitudes and norms appear to be the main drivers of mothers' choices regarding infant-sleep practices should inform health messaging strategies to promote SS.
Authors: Carrie K Shapiro-Mendoza; Eve R Colson; Marian Willinger; Denis V Rybin; Lena Camperlengo; Michael J Corwin Journal: Pediatrics Date: 2014-12-01 Impact factor: 7.124
Authors: Rachel Y Moon; Fern R Hauck; Eve R Colson; Ann L Kellams; Nicole L Geller; Timothy Heeren; Stephen M Kerr; Emily E Drake; Kawai Tanabe; Mary McClain; Michael J Corwin Journal: JAMA Date: 2017-07-25 Impact factor: 56.272
Authors: Cicely W Fadel; Eve R Colson; Michael J Corwin; Denis Rybin; Timothy C Heeren; Colin Wang; Rachel Y Moon Journal: J Pediatr Date: 2017-03-03 Impact factor: 6.314
Authors: Rachel Y Moon; Jennifer LoCasale-Crouch; Khara L P Turnbull; Eve Colson; Ann Kellams; Timothy Heeren; Stephen Kerr; Fern R Hauck; Michael J Corwin Journal: Acad Pediatr Date: 2020-03-19 Impact factor: 3.107
Authors: Floortje Kanits; Monique P L'Hoir; Magda M Boere-Boonekamp; Adèle C Engelberts; Edith J M Feskens Journal: Front Pediatr Date: 2021-12-06 Impact factor: 3.418