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Strengthening the evidence base for maternal and child health programs

New: MCH Best strategies database for sample ESMs

Evidence Tools
MCH Best. NPM 5: Safe Sleep

MCH Best Logo infant in a crib looking up at the camera

Strategy. Building on Campaigns with Conversations

Approach. Provide training to professionals who interact with expecting and new mothers and families that emphasize a nuanced approach to take family needs, beliefs, and context into account when talking about safe sleep, breastfeeding, and smoking.

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Overview. This is a new approach to supporting caregivers to help overcome barriers to safe sleep and breastfeeding. It is part of a greater trend in public health promotion—utilizing an individualized approach that takes into account each family’s needs, beliefs, and the context of their lives.

This training on the Conversations Approach is based on Ajzen’s Theory of Planned Behavior and follows current recommendations from the American Academy for Pediatrics (AAP) for safe sleep and optimal breastfeeding for healthy infants.1

Evidence. Expert Review and Consensus. The NAPPSS coalition developed the conversations approach with input and review from over 70 national organizations who represent service systems, providers, programs, and community support networks. Initial articles have included the conversations approach in the group of “provider training modules that integrate effective behavior change methods, such as motivational interviewing” that “show promise to improve safe sleep practices.”2

The modules have also been identified as resources that “acknowledge nuance and encourage conversation.”3 The approach has been shared by the AAP, the United States Breastfeeding Committee, University of Washington, Healthy Start EPIC Center, the Safe to Sleep Campaign, NICHQ NAPPSS project and the Oregon Health Authority.

(Read more about understanding evidence ratings).

Target Audience. Multiple (caregiver + child care provider + health care provider + hospital systems).

Outcome. Infants placed to sleep on their backs. For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the "Intervention Results" for each study.

Examples from the Field. Wisconsin has developed a guide to implement a conversations approach with families. West Virginia developed an on-line continuing education module for home visitors on how to implement the conversations approach (through their Abused Children’s efforts, which is where safe sleep sits organizationally).

In addition, NICHQ through its MCHB funded National Action Partnership to Promote Safe Sleep (NAPPSS) activities is working at sites in five states to utilize quality improvement methods to integrate safe sleep and breastfeeding promotion within hospitals, with prenatal health care providers and with community partners.

The Role of Title V. Title V Agencies can support a conversations approach/motivational interviewing by:

For additional suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies.

Sample ESMs. Using the approach “Provide training to professionals who interact with expecting and new mothers and families that emphasize a nuanced approach to take family needs, beliefs, and context into account when talking about safe sleep, breastfeeding, and smoking,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework:

Quadrant 1:
Measuring Quantity of Effort
("What/how much did we do?")

  • Number of professionals/hospitals trained in the conversations approach.

Quadrant 2:
Measuring Quality of Effort
("How well did we do it?")

  • Percent of professionals/hospitals trained in the conversations approach.

Quadrant 3:
Measuring Quantity of Effect
("Is anyone better off?")

  • Number of professionals/hospitals trained in the conversations approach who reported an increase in knowledge/skills.
  • Number of professionals/hospitals trained in the conversations approach who indicate that they are now using the approach in communications with families.

Quadrant 4:
Measuring Quality of Effect
("How are they better off?")

  • Percent of professionals/hospitals trained in the conversations approach who reported an increase in knowledge/skills.
  • Percent of professionals/hospitals trained in the conversations approach who indicate that they are now using the approach in communications with families.

Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4).

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.


Reference:

1 Building on Campaigns with Conversations: An Individualized Approach to Helping Families Embrace Safe Sleep and Breastfeeding. Learning modules.

2 Hirai AH, Kortsmit K, Kaplan L, et al. Prevalence and Factors Associated With Safe Infant Sleep Practices. Pediatrics. 2019;144(5):e20191286

3 Main M. The Perplexing State of Sleep-Related Infant Death – Emerging Data, New Trends, and Current Approaches. Northwest Bulletin. 2018.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.