Safe Sleep Video Intervention via Text Messaging to Low-Income Families: The SMARTER Randomized Clinical Trial

Area of Science:

• Public Health
• Pediatrics
• Maternal and Child Health

Background:

• Safe sleep practices are crucial for reducing sudden unexpected infant death (SUID).
• Adherence to safe sleep guidelines remains low in the U.S., especially among low-income populations.
• Targeted interventions are needed to improve safe sleep behaviors in vulnerable families.

Purpose of the Study:

• To assess the efficacy of prenatal and postnatal text-delivered video interventions promoting safe sleep.
• To evaluate these interventions among participants of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Main Methods:

• A randomized clinical trial involving pregnant mothers recruited from WIC and Federally Qualified Health Centers.
• Participants were randomized to receive safe sleep or control interventions via text messages during the prenatal and/or postnatal periods.
• Outcomes measured included maternal reports of infant sleep practices at 60 days postpartum.

Main Results:

• No significant differences were observed in primary safe sleep outcomes (supine position, room sharing, soft bedding, pacifier use) between intervention and control groups.
• A secondary outcome, exclusive supine positioning at 60 days, was significantly higher in the group receiving the prenatal intervention compared to controls.
• Adherence to safe sleep practices remained high across all groups, with no statistically significant improvements attributed to the intervention.

Conclusions:

• Text-delivered video interventions promoting safe sleep did not significantly impact primary infant sleep practices among WIC participants.
• Prenatal exposure to the safe sleep intervention showed a potential benefit for exclusive supine sleep positioning.
• Further research may be needed to optimize digital interventions for improving safe sleep adherence in low-income populations.