Pease Anna, Ingram Jenny, Blair Peter S, Fleming Peter J
Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, UK.
BMJ Paediatr Open. 2017 Sep 4;1(1):e000133. doi: 10.1136/bmjpo-2017-000133. eCollection 2017.
Qualitative interviews with mothers of babies at higher risk of sudden infant death syndrome (SIDS) were carried out to understand their views and decision-making process on the infant sleep environment and safe sleep messages.
Twenty semi-structured interviews were conducted between February and November 2014 in deprived areas of Bristol, UK. Mothers were asked about their decision-making for the infant sleep environment and safe sleep messages including infant sleep position, co-sleeping, smoking, dummy use, feeding and disrupted routines. The interviews were transcribed, coded and thematic analysis carried out.
Participants were invited based on an algorithm developed in a previous SIDS case control study that identified an increased risk of SIDS from four demographic characteristics: young maternal age, smoking during pregnancy, three or more children, and a measure of deprivation. The presence of three, or more characteristics led to being invited to take part in the qualitative study.
Factors influencing mothers' adherence to the safe sleep messages included previous experience and the credibility of the advice given. They described disrupted routines that led to risky scenarios with a belief that occasional risks were acceptable. Where circumstances made following the advice more difficult they found alternative strategies to reduce the risk, including the use of movement monitors, regular checking and a belief that lighter maternal sleep in the presence of a baby was protective.
Safer sleep messages should be tailored to fit with the lived realities of mothers, especially those at higher risk. The traditional list of 'do's' and 'don'ts' was not well accepted by this group. Interventions that seek to influence this higher-risk group should acknowledge mothers' own protective instincts and consider their beliefs and understanding behind the safer sleep messages if they are to be effective and encourage this group to change.
对婴儿猝死综合征（SIDS）高危婴儿的母亲进行定性访谈，以了解她们对婴儿睡眠环境和安全睡眠信息的看法及决策过程。
2014年2月至11月间，在英国布里斯托尔的贫困地区进行了20次半结构式访谈。询问母亲们关于婴儿睡眠环境的决策以及安全睡眠信息，包括婴儿睡眠姿势、同床共眠、吸烟、使用安抚奶嘴、喂养和日常作息紊乱等。对访谈内容进行了转录、编码并开展了主题分析。
根据之前一项SIDS病例对照研究中开发的算法邀请参与者，该算法从四个人口统计学特征中识别出SIDS风险增加：母亲年龄小、孕期吸烟、育有三个或更多子女以及贫困程度指标。具备三个或更多特征的母亲被邀请参加定性研究。
影响母亲遵守安全睡眠信息的因素包括既往经历和所给建议的可信度。她们描述了导致危险情况的日常作息紊乱，认为偶尔的风险是可以接受的。在遵循建议更加困难的情况下，她们找到了降低风险的替代策略，包括使用运动监测器、定期检查，以及认为在婴儿身边母亲浅睡眠具有保护作用。
更安全的睡眠信息应根据母亲的实际生活情况进行调整，尤其是那些高危母亲。这一群体对传统的“该做”和“不该做”清单接受度不高。旨在影响这一高危群体的干预措施应承认母亲自身的保护本能，并考虑她们在更安全睡眠信息背后的信念和理解，这样才会有效并鼓励这一群体做出改变。
