Characterising non-pharmacological infant sleep interventions for theoretical underpinnings and behaviour change...

In Western settings where solitary, continuous infant sleep throughout the night is emphasised, parents might perceive their infant's nightwaking as a problem and seek solutions. Interventions typically aim to reduce nighttime parent-infant interactions to facilitate independent infant sleep. There are concerns regarding the acceptability of these interventions to parents, and their applicability for families with diverse parenting practices, such as co-sleeping. The specific theories and strategies applied by evidence-based infant sleep interventions have not been systematically explored. This scoping review aimed to characterise infant sleep interventions for their theoretical underpinnings and behaviour change techniques (BCTs). Where applicable, this review also aimed to explore associations between meaningful groupings of theory type and BCTs and outcomes including parent satisfaction and intervention adherence. Online databases were searched for Randomised Controlled and cluster Randomised Controlled Trials of non-pharmacological interventions delivered in non-acute primary care or community settings that targeted the prevention or treatment of sleep problems in infants (0-3 years). Twenty-eight of 34,898 retrieved articles were included, describing 34 unique interventions. Operant conditioning theory underpinned 50 % (13/26) of the theory-informed interventions. Interventions were found to be multicomponent and the application of BCTs was heterogeneous across interventions. Findings suggest a need for more diversity of theoretical underpinnings and a clear indication of BCTs included in interventions. Future research should identify theories that can be adapted to align with family cultural contexts and parenting practices, and BCTs that can be operationalised to facilitate acceptable and culturally sensitive approaches to infant sleep intervention.