Abstract
Background: Aboriginal and Torres Strait Islander babies currently die suddenly and unexpectedly at a rate three times higher than non-Aboriginal and Torres Strait Islander infants. Sharing sleep with babies is the cultural norm in many Indigenous communities; however infant deaths are associated with hazardous co-sleeping environments. Valued practices, including co-sleeping, need recognition in order to make public health messages effective. Positive findings have been reported from a New Zealand-based safe sleep enabler program. Use of portable sleep spaces for co-sleeping Indigenous families have not been previously reported in Australia; Indigenous families have identified this area as being important for investigation. Objectives: The key objective was to pilot a culturally appropriate adaptation of the Pēpi-pod Program in Queensland Aboriginal and Torres Strait Islander communities to determine acceptability and feasibility. Methods: An exploratory descriptive design was used to report parent experiences of using the Pēpi-pod Program to support safe infant sleep practices. Five families were purposively selected through health services providing maternity care to Aboriginal and Torres Strait Islander families in metropolitan, rural and remote areas of Queensland. Eligible participants were parent/s of babies (target recruitment <1 month of age) with one or more known SUDI risk factors. Health care workers identified eligible families through usual health assessments and referred to the Program, with family permission. The Pēpi-pod Program is delivered as three interlinked components:1) Safe Space: a polypropylene box transformed into an infant bed through addition of appropriate bedding; 2) Safe Care: Parent education; 3) Family commitment to spread what they had learned about protecting babies as they sleep. Data collection included acceptability and use of the Pēpi-pod Sleep Space. Parent questionnaires were administered within 2 weeks of receiving the Pēpi-pod; then monthly thereafter until Pēpi-pod use ceased; (approximately 4-6 months dependent on baby's growth and development). Results: Five eligible families (infant age 8 days to 9 weeks) were recruited and followed-up each month. Demographic characteristics included: 2 of 5 families were single parents; all babies identified as Aboriginal; all families intended to bed share with two or more risk factors for SUDI present. Four of five families identified they had utilised the Pēpi-pod. The fifth family elected to co-sleep without the Pēpi-pod. The acceptability of the Pēpi-pod as a safe sleep space for babies was supported by parent responses that related to three key themes: safety, convenience and portability. Conclusions: Parent responses highlighted that the Pēpi-pod Program was acceptable to families. Study design and methodology proved feasible through engagement with existing maternal and child health services demonstrating the potential for long term support and sustainability. Pilot results have informed a larger trial (n=300) within six communities across Queensland during 2013-2015. Innovative strategies which allow for benefits of bed-sharing, respect cultural norms and infant care practices, whilst enabling the infant to sleep in a safe environment are necessary if a reduction in Sudden Unexpected Deaths in Infancy (SUDI) is to be achieved amongst Aboriginal and Torres Strait Islander communities.