RHP&EO is the electronic journal of the International Union for Health Promotion and Education

•  Retour en français
• Apoye en el español

SIDS awareness - Let's not clown around

Nickels, K.M., Tran, P., McIlwaine, K., Tan, C.O.

Internet publication: 7 February, 1998

Abstract

The purpose of our Sudden Infant Death Syndrome (SIDS) awareness project was to promote awareness of the risk factors for SIDS in two groups of prospective parents attending antenatal classes at Gippsland Base Hospital (GBH) Sale, and Monash Medical Centre (MMC) Clayton. Our aim was to promote awareness of the four main risk factors for SIDS, thereby empowering the parents to reduce the risk of SIDS in their infants.

Our health promotion team surveyed both groups before and after Red Nose Day (first intervention), and once again at both Monash and Sale antenatal classes following a didactic discussion/workshop (second intervention).

This approach enabled us to assess the target group’s baseline knowledge of SIDS, gauge the effectiveness of Red Nose Day in educating the priority population, and to measure the improvement in knowledge and attitudes following our health promotion workshop.

Conducting a workshop gave us the advantage of being able to receive both verbal and non-verbal feedback from the target group and allowed the groups to ask questions on an individual basis at the conclusion of each workshop.

Our research into SIDS indicated that there has not been any significant knowledge of risk factors since the ‘Reducing the Risks’ campaign began in 1990. We did observe however, that back sleeping is now thought to be safer for young infants, was sleeping on the side.

The main findings were an improvement in mean questionnaire scores in both cohorts after the interventions (Red Nose Day and our workshops).

Table 1:

*Control was a randomly generated set of answers to simulate an uneducated population.

The principle conclusions were :

1. Initial questionnaire scores were higher than the control, indicating a greater baseline knowledge than would be expected in an uneducated population.

2. The first intervention (ie. Red Nose Day) had some impact on knowledge but

3. was not as effective as the second intervention (ie. our workshop).

Key Words:

Sudden Infant Death Syndrome (SIDS), Cot death, Reducing risks, Awareness, SIDS foundation, Smoking, Overheating, Sleeping position, Breastfeeding

Background

Sudden Infant Death Syndrome (SIDS), also known as Cot Death, is the most common cause of death in babies aged one month to one year. Although much time and money has been spent on research, the cause of death is these apparently healthy babies is yet to be determined. Research has, however, suggested certain risk factors which are thought to interact together, and may or may not contribute to any one cot death. Since the conception of the "Reducing the Risk of SIDS" program in July 1990, the incidence of SIDS in Victoria has dropped by over 59%. Four significant risk factors have been identified to date, however others may also be involved.

Health Issue

The purpose of our SIDS awareness project was to educate our target group about the four major risk factors for SIDS. This would then empower them to reduce the risk of SIDS in their own infants.

The rationale behind our study was a perceived lack of knowledge in the target group (future parents) regarding the risk factors implicated in SIDS.

Priority Population Group

The priority population consisted of two groups of prospective parents attending antenatal classes - one group at MMC Clayton, and the other at GBH Sale. We chose prospective parents as our target group because they are yet to have their own children, and therefore an intervention at this stage would be more likely to result in SIDS-preventing practices.

Prospective parents are an easily accessible group, as many attend antenatal classes weekly. They also tend to be receptive to useful information concerning their children. For these reasons, they were chosen as our target group. The selection of both metropolitan and rural settings allowed us to analyse and compare the impact of Red Nose Day and our intervention in different centres.

Goals

To empower the target group (prospective parents) to reduce the risk of SIDS in their future babies by promoting awareness of the risk factors for SIDS, and teaching them how they can reduce these risks.

Targets

To measure change in attitude, and awareness of the four main risks factors for SIDS, in two groups of prospective parents attending antenatal classes at Monash Medical Centre Clayton, and Gippsland Base Hospital Sale.

The true period of time for intervention and assessment was from August 20 1996 through to September 20 1996.

The expected outcome in the target group was an increase in knowledge of SIDS risk factors after Red Nose Day on August 30th and a further increase after a seminar conducted by the health promotion group at antenatal classes on the 12th and 18th of September.

Specifically, the intervention should result in the priority group understanding the four main methods of reducing the risk of SIDS:

1. SLEEP BABY ON THE BACK

2. KEEP BABY IN A SMOKE-FREE ENVIRONMENT

3. DO NOT LET BABY OVERHEAT

4. BREASTFEED IF POSSIBLE

Strategies and Methods

In the initial stages of our SIDS awareness project, the health promotion group met frequently to discuss the current research and knowledge of SIDS. We devised a list of possible target groups for the project: family day care workers, child health care centres, new parents and prospective parents.

We initially followed up on the first two options, but to no avail. Negotiating with local councils to locate these former two target populations proved time consuming and in the end futile. We visited the SIDS Foundation and discussed possible projects with them over the phone. They were however, very busy preparing for Red Nose Day, and had to defer consideration of our project plan until after August 30th. Due to time constraints, availability and, following advice from our supervisor, we chose two antenatal classes as our target group: one from a rural area, and the other urban.

Information was gathered by questionnaire from the target group before Red Nose Day. The questionnaire was designed to obtain demographic details of the priority population, and to assess their awareness of SIDS risk factors using a five-point numerical scale for each response. The questionnaire was completed again in both groups after Red Nose Day on the 20/8/96. Sale group 20/8/96 and by the Clayton group on 22/8/96.

The health promotion team presented a workshop to the Clayton group on Thursday 12/9/96, and to the Sale group on Wednesday 18/9/96. The workshop format was chosen as the most appropriate method for information transfer as it involves more group interaction than a lecture. This enabled the team to monitor feedback from the antenatal couples.

The didactic approach used by the team to address the target group requires content knowledge, and lecturing skills. The group ensured that they were fully informed and ? with the latest information regarding SIDS. We researched the subject using journal articles, information produced by the SIDS Foundation, results from the Tasmanian Infant Health Survey, and information presented by the media.

The workshop involved an initial brainstorm about the risk factors for SIDS, which served both to put the audience at ease and enabled a subjective assessment of the target group’s knowledge. A presentation followed, employing visual aids such as diagrams, graphs and three-dimensional interactive displays. Adult groups need to have learned practices reinforced. This was achieved by distributing a magnetised pamphlet highlighting the four main risks, which could be stuck on the fridge.

The workshops were held at MMC and GBH where the target groups regularly attend antenatal classes. The chosen location and presentation approach were both convenient and economical for all involved.

Although it is very useful technique, the workshop approach limits the number of people that can be targeted once.

Statistical methods used included sample formulae, ie. SD (standard deviation), Mean, Median, Rule of combinations, Normal distribution, frequency distribution and cumulative frequency distribution.

Evaluation Plan

By comparing mean & median questionnaire scores and frequency distributions between the groups (Sale vs. Monash, and before vs. after each intervention), conclusions were drawn on the impact of the interventions and possible effects of different settings (ie. rural and urban).

To compare questionnaire results to a standard, a random set of answers designed to simulate a sample population with no knowledge of SIDS was used (ie. subject would have 1/5 chance of choosing the correct answer. This is defined as ‘set 0’ .

To analyse and compare the results we have utilised frequency distribution as it considers all data points rather than just measures of centre (mean, median, mode). However with such small sample sizes trends can be hard to observe.

Further analysis utilising cumulative frequency distribution can assist in identifying any significant trends. Any curve skewed to the right of the ‘Set 0’ curve (‘right hand skewness’ - RHS) indicates higher scores in more subjects. To compare sets, the RHS is graded from lowest to highest as can be seen in Table.8.

A quantitative measure of skewness is the median. The median, as the value which divides an ascending data set (scores of subjects from lowest to highest) into two equal halves, will be the x-value on the graph that corresponds with 0.5 (half the total number of subjects) on the y-axis3. A higher median value indicates more RHS.

Results were compared according to-

Table 2.

Results

OVERALL QUESTIONNAIRE

Figure 1 shows that:

• Baseline knowledge of both cohorts is greater than expected for uneducated population

• Monash cohort began with the lower baseline knowledge but both cohorts reached an equivalent level of knowledge after both interventions

• After the workshop both cohorts obtained a near perfect score of 59/60.

RISK FACTORS

The same analysis format was used for the separate risk factors. In the questionnaire, some factors had more questions than others. The number of questions per risk factor had an effect on the cumulative frequency curve resulting in fewer data points in some graphs.

All risk factors except Breastfeeding indicate significant baseline knowledge (ie. significant right-hand skew from the set 0 curve).

Sleeping position

Improvements follow trends described in Overall Questionnaire, except that there is a decrease in knowledge in the Sale cohort after Red Nose Day. Possible explanations for this include:

• less exposure to SIDS promotion in rural areas

• ambiguity in SIDS promotion of sleeping position

• rejection of the logic regarding the supine sleeping position

Smoking

Initial baseline knowledge was quite high in both cohorts, however after Red Nose Day both groups scored lower points in the questionnaire. This may be due to:

• lack of exposure to SIDS promotion

• ambiguity in SIDS promotion.

Both cohorts achieved perfect scores for questions regarding this risk factor after both interventions indicating a high level of understanding.

Cot setup/ Overheating

Initial baseline knowledge in this risk factor was only slightly greater than one would expect for an uneducated population (Set ‘0’). Reasons for this include:

• the substantial detail that is required to make a ‘SIDS Safe’ cot

• to make such a cot may go against parents’ ‘instincts’

However, after the interventions, both cohorts achieved almost perfect scores for questions regarding this risk factor.

Breastfeeding

Baseline knowledge for the Monash cohort was less than set 0, which implies that Monash had a less than expected baseline knowledge. Thereafter, knowledge gained trends followed Overall Questionnaire analysis. After Red Nose Day, improvement in the understanding of this risk factor in the Monash cohort was larger than for any other risk factor (31%), although this may be due to their initial low Baseline Knowledge.

Discussion

New Important Aspects of Study

• SIDS education is offered to the general public by the mass-media approach. Small group workshops are offered to a limited number of antenatal classes, and preliminary research shows that family day care workers, baby furniture retailers and child care centres have not been reached.

• Most people have a significant baseline knowledge of SIDS, yet they lack knowledge of the more detailed risk factors.

• SIDS exposure was less in rural areas, and the presentation of certain risk factors was ambiguous

• This indicates a need for the workshop style of promotion, as the response from parents and midwives to the small group teaching was extremely positive.

Findings and Limitations

The didactic approach was more successful than the mass-media approach, minimising ambiguity of information. This approach can only reach small numbers of people, though, while mass-media reaches most of the population.

Conclusions

Use of didactic approach achieved our goal of empowering prospective parents with knowledge how to reduce the risk of SIDS in their new baby.

Recommendations

• SIDS education should be included in all antenatal classes

• The "Reducing the Risks" campaign by the SIDS Research Foundation should include more education concerning the risk factors associated with SIDS as well as their successful fund raising efforts

• Information presented in pamphlets should not be ambiguous

Support

• Professor M. Adamson, Department of Paediatrics, Monash Medical Centre Clayton (guidance and printing equipment)

• SIDS Research Foundation (pamphlets and advice)

• Elizabeth McIlwaine, Department of Obstetrics and Gynaecology, Gippsland Base Hospital Sale (research material, access to her antenatal class as a target population)

• Tania Samson, Department of Obstetrics, Monash Medical Centre Clayton (use of department equipment, access to her antenatal class as a target population)

• Postnatal ward, Monash Medical Centre Clayton (use of equipment for demonstration of correct cot layout)

[ Home ] [ Up ] [ IUHPE ] [ Our Mission ] [ Editorial Board ] [ Reviews ] [ IJHP Articles ]

Copyright © 1999-2001 Reviews of Health Promotion and Education Online,
Last modified: June 21, 2001

Internet Explorer 5.0 or later version gives the optimal visual effect of this website.