Preventable infant deaths: Improving uptake of safe sleep messages in high-risk families

5.1 Research question How will an intervention targeted to families most at risk, improve safety for babies during sleep, and reduce Sudden and Unexpected Deaths in Infancy (SUDI)? 5.2 Background Advice for parents on safe sleep has reduced the incidence of SUDI in the general population over the last 3 decades, but less so for more deprived families.

SUDI deaths have always been more common in these groups but now about two-thirds (approximately 200/300) occur in this group.

An era of global case control studies has identified risk and protective factors for the infant sleep environment, which if adhered to, could reduce deaths further.

Using what I have learned about the factors that influence decision making in high-risk families, I can now start to put this evidence into action in the form of a targeted intervention to reduce risk. 5.3 Aim and objectives The aim is to develop and evaluate a targeted intervention for improving uptake of safer sleep practices in families at higher risk for SUDI.

In order to meet this aim, five work packages with the following objectives are proposed: Examine the prevalence and population demographics of known risk factors of SUDI deaths in England since 2018 using data from the National Child Mortality Database (NCMD).

Investigate the factors influencing decision-making for infant care in high-risk families (including fathers/partners and grandparents). Co-produce the support package with families, health professionals, academics, and health services commissioners. Conduct a Realist Evaluation study of the intervention.

Write a protocol and funding application for a feasibility study to test intervention methods for assessing effectiveness and investigate scope for widening the intervention to include other child health related topics. 5.4 Methods I will conduct comparative analyses of NCMD data to describe the prevalence of known risk factors present in recent unexpected infant deaths and compare those at high risk or normal risk of unexpected infant deaths.

I will use qualitative thematic analysis of interviews with families.

I will use co-production to develop the intervention, bringing together an intervention development team to work together to produce the content.

Realist Evaluation methods will then allow me to explore the context, mechanisms and outcomes associated with the intervention. This will include observations, surveys, interviews and focus groups.

Finally, I will investigate the most appropriate methodology for a future study and write a protocol and funding application. 5.5 Timelines for delivery A paper describing the NCMD data will be published at the end of the first year.

A paper with the findings from the mixed methods study on high-risk families and wider caregivers will be published at the end of the second year.

Two other papers (one on co-production study and one on evaluation study) will be delivered in the fifth year. 5.6 Anticipated impact The intervention will have the potential to improve sleep safety for infants in high-risk families and reduce infant deaths.

Learning from this work will contribute to understanding the mechanisms of complex interventions for high-risk groups across a range of infant care practices.