Background: Infant deaths experienced in regional and remote areas of Australia are almost double when compared to metropolitan areas while infant mortality rates to sudden unexpected death in infancy (SUDI) are four times higher for Indigenous compared to non-Indigenous babies. Co-sleeping is a culturally valued practice by many Indigenous families however is associated with SUDI in hazardous circumstances. Portable sleep spaces have been used successfully in high risk populations in New Zealand, with infant mortality reductions observed. Indigenous communities have identified this area as a priority for investigation. Aim: This study aims to determine the acceptability, feasibility and safety of the Pēpi-pod Program, a portable infant sleep space embedded within safe sleep health promotion, within Queensland Aboriginal and Torres Strait Islander families. Methods: The Pēpi-pod Program, comprising a safe sleep enabler, safe sleeping parent education and safety briefing; and family commitment to share safe sleeping messages in social networks, was delivered to Aboriginal and Torres Strait Islander families with identified SUDI risks, recruited through Queensland maternal and child health services (n=10 services, 25 communities) across metropolitan, regional and rural/remote areas. Parent questionnaires administered face-to-face or by telephone within 2 weeks of receiving the Pēpi-pod; then monthly thereafter until pod use ceased. Health service feedback was conducted via survey and focus group at participating sites. Results: A total of 111 recruited families meeting eligibility criteria have completed data collection by August 2015. All families recruited had identified SUDI risk factors; 80% had ≥2 known risk factors. Pēpi-pod acceptability as a safe sleep space for babies was supported by parent responses that related to three key themes: safety, convenience and portability. Awareness of safe sleeping messages has been raised within families and through community social networks. Midwifery and health worker feedback relating to implementation of the program indicated that the program was feasible, accessible, flexible, sustainable, and built local workforce capacity with integration into current service models. Relevance: This is the first evaluation of a safe sleep enabler in Australia. Indigenous babies are over-represented in SUDI deaths associated with hazardous sleep environments. The Pēpi-pod program was accepted and used appropriately by parents living in Queensland Indigenous communities. Program principles are applicable to mainstream services which care for vulnerable families. Conclusion: Innovative strategies which allow for co-sleeping benefits, respect cultural norms and infant care practices, whilst enabling safe sleep environments are necessary to further reduce SUDI.
2016 Caring for Country Kids, Alice Springs, Australia 17-19 April 2016