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Published on: January 26, 2019
Safe Sleep Education Across Healthcare Settings: A Systematic Review of Delivery, Content, and Outcomes
Mary Beth Howard1, Olivia A Wilson-Lall2, Sarah Sprauer3
1Division of Pediatric Emergency Medicine, Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland; Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, Baltimore.
Background:
Sleep-related infant deaths remain a leading cause of postneonatal mortality. Healthcare systems represent critical touchpoints for delivering safe sleep education, yet delivery varies across clinical settings.
Objectives:
To synthesize how safe sleep education is delivered across healthcare settings, evaluate its impact on caregiver knowledge and adherence, and identify gaps to inform scalable, equitable interventions.
Data Sources:
PubMed/MEDLINE, Embase, CINAHL, PsycINFO, Scopus, and Cochrane CENTRAL were searched from inception through July 15, 2025.
Study Eligibility Criteria, Participants, And Interventions:
Eligible studies evaluated healthcare-delivered safe sleep education for caregivers of infants ≤12 months and reported caregiver-level outcomes.
Study Appraisal And Synthesis Methods:
Four reviewers independently screened studies, extracted data, and assessed risk of bias using Cochrane RoB1. Due to heterogeneity in design and outcomes, findings were synthesized narratively.
Results:
Twenty-three studies across eight countries were included. Interventions included bedside counseling, written materials, videos, quality improvement initiatives, mobile health messaging, and sleep space provision. Most studies reported improved caregiver knowledge and adherence, particularly supine positioning. Multicomponent interventions incorporating clinician modeling and post-discharge reinforcement demonstrated the most consistent improvements across behaviors.
Limitations:
Evidence was limited by heterogeneity, reliance on self-reported outcomes, short follow-up periods, and moderate-to-high risk of bias.
Conclusions And Implications Of Key Findings:
Healthcare-delivered safe sleep education is associated with improved caregiver knowledge and behaviors, but effectiveness varies across settings. Multicomponent, system-level strategies extending beyond hospitalization may offer the most scalable approach. Future research should prioritize rigorous evaluation of equitable, implementable interventions across healthcare systems.
Systematic Review Registration Number:
PROSPERO CRD420251050656.
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