Rhonda Marriott

Aboriginal and Torres Strait Islander people have some of the highest rates of infant death in Australia, including Sudden Unexpected Death in Infancy (SUDI) and Sudden Infant Death Syndrome (SIDS). In 2018, data from the Australian Mothers and Babies report (Australian Institute of health and Welfare, 2020) reported that 1 in 18 or 5.7% of all babies born in Australia were Aboriginal and/or Torres Strait Islander. While the proportion of Aboriginal infant deaths occurring out-of-hospital is not reported, there has been an identified need to address the issues of community competence and awareness in cardiopulmonary resuscitation (CPR) and first aid in Western Australia, for many years (Celenza et al., 2002; Lynch et al., 2005)…

Introduction: Reviews have indicated that community-based interventions targeting infant sleep can be effective. However, the literature is less clear as to the theoretical underpinnings and active components of infant sleep interventions, whether these are related to parental measures, such as acceptability, adherence, satisfaction and mood, and whether certain characteristics of interventions are associated with greater effectiveness on sleep measures.

Aim: This review broadly aimed to characterise behavioural infant sleep interventions delivered in a community setting in terms of theoretical underpinnings and behaviour change techniques. Where applicable, this review also aimed to explore associations between meaningful groupings of theory type (e.g., operant conditioning and extinction; attachment theory) and behaviour change techniques and secondary outcomes including parent and infant sleep, parent satisfaction and intervention adherence.

Method: Online databases were searched from inception to October 2022 to identify Randomised Controlled and cluster Randomised Controlled Trials of behavioural interventions delivered in community settings that targeted the prevention or treatment of sleep problems in infants (0-3 years). Using the PRISMA guidelines, records were independently screened by two reviewers and eligible interventions were coded for the presence and type of theoretical underpinnings used. Active components were also coded using a taxonomy for behaviour change techniques. The role of secondary outcomes, such as intervention feasibility and parent satisfaction, were also explored.

Conclusions: This systematic review elucidates the specific components used by behavioural infant sleep interventions and the theories that are drawn upon to inform intervention development. This study concludes with a discussion of how obtained results may aid in the development of community based infant sleep support, such as the consideration around which behaviour change components to utilise when addressing particular outcomes. Implications for selection of theoretical underpinnings in intervention development on parent outcomes are also explored.

Aboriginal and Torres Strait Islander infants currently have one of the highest rates of Sudden Unexpected Death in Infancy (SUDI) and infant death of any population in a developed nation. Prompt initiation of cardiopulmonary resuscitation (CPR) is crucial for survival in an emergency situation. This is particularly relevant in remote communities where delayed response times from trained personnel could affect survival and parents are likely to be the first responders in these instances. In the neonatal intensive care unit (NICU) and special care nursery (SCN) health-related education is offered to parents prior to discharge, which includes Sudden Infant Death Syndrome (SIDS) and safe sleeping guidelines; however, it rarely includes infant cardiopulmonary resuscitation. Although some health-related education is also offered in maternity units, infant CPR is generally not included. By talking with Aboriginal parents in Western Australia who were discharged from the NICU/SCN or the maternity units within the first 12 months of the infant’s life, this study aims to determine what they understand about infant resuscitation and their perspectives on learning the skills to perform it. This will also include the views of grandparents, aunties and extended family of the participants. Using community participatory action research (CPAR), this study will utilise a well-established Indigenous research practice of yarning to gain a detailed understanding of Aboriginal parents’ perspectives and understanding of infant cardiopulmonary resuscitation. Whether these perspectives differ depending on if the mother and baby spent time in the NICU/SCN or the maternity unit in the postnatal period will also be identified. It is anticipated that a culturally responsive infant CPR education program and framework could result from the findings of the research.

Background: Aboriginal women experience poor maternity outcomes compared with other women in Australia. Few mechanisms and resources exist to support health services and professionals to provide culturally responsive care to Aboriginal women. The right of Aboriginal women to express their diverse cultural needs during pregnancy and birthing requires maternity services to be culturally secure as well as clinically safe. Existing policies state that Cultural Competence (CC) of hospital services and staff is ‘critical to achieve positive outcomes for both mother and baby' and a priority reform area in closing the gap in Aboriginal maternal and child health outcomes. Yet an audit of antenatal care in Western Australia (WA)in 2010 found that 75% of services fail to provide culturally competent care to Aboriginal women. Methods: The audit findings were provided to key health services personnel and Aboriginal women during an extensive consultation. Based on their feedback and a review of the literature, an individual and organisational Cultural Competence Assessment Toolkit (CCAT) was developed, trialled and evaluated with 75 staff in two hospitals. Results: All participants found the CCAT highly relevant and useful to effectively enhance organisational and workforce CC in health services and policy sectors with great potential to be effective if embedded as part of the CQI mechanism in maternity services. Conclusion: A review of the maternity services framework and indicators recommended the CCAT be implemented as part of the National Maternity Services Plan. Building on these recommendations our current study is investigating how to support Aboriginal women's diverse needs to ensure their cultural security in an urban maternity setting: and evaluating the cultural competency, workforce and education needs of midwives. This involves conducting culturally sensitive, semi-structured interviews with Aboriginal women using a personal and conversational manner yarning and deep listening practices to explore the meaning of birthing on country with Aboriginal women. The findings will be used to refine and validate the CCAT and inform CC policies and practice, midwifery education and services reform to enhance the quality of and access to maternal health services and improve health and wellbeing outcomes for Aboriginal and other marginalised populations.

OBJECTIVES AND AIMS OF THE STUDY: • Enhance the perinatal mental health of Aboriginal families in the urban Swan and regional Kalgoorlie - Boulder areas; • Build the capacity of Aboriginal and new expectant fathers and their families; • Develop and validate culturally inclusive Aboriginal concepts of perinatal mental health; • Develop and implement a culturally secure family - based support program for Aboriginal new and expectant parents with a specific focus on fathers; and, • Build the capacity of Aborignal researchers through the active recruitment processes of the research team. .

Introduction: Reviews have indicated that community-based interventions targeting infant sleep can be effective. However, the literature is less clear as to the theoretical underpinnings and active components of infant sleep interventions, whether these are related to parental measures, such as acceptability, adherence, satisfaction and mood, and whether certain characteristics of interventions are associated with greater effectiveness on sleep measures.

Aim: This review broadly aimed to characterise behavioural infant sleep interventions delivered in a community setting in terms of theoretical underpinnings and behaviour change techniques. Where applicable, this review also aimed to explore associations between meaningful groupings of theory type (e.g., operant conditioning and extinction; attachment theory) and behaviour change techniques and secondary outcomes including parent and infant sleep, parent satisfaction and intervention adherence.

Method: Online databases were searched from inception to October 2022 to identify Randomised Controlled and cluster Randomised Controlled Trials of behavioural interventions delivered in community settings that targeted the prevention or treatment of sleep problems in infants (0-3 years). Using the PRISMA guidelines, records were independently screened by two reviewers and eligible interventions were coded for the presence and type of theoretical underpinnings used. Active components were also coded using a taxonomy for behaviour change techniques. The role of secondary outcomes, such as intervention feasibility and parent satisfaction, were also explored.

Conclusions: This systematic review elucidates the specific components used by behavioural infant sleep interventions and the theories that are drawn upon to inform intervention development. This study concludes with a discussion of how obtained results may aid in the development of communitybased infant sleep support, such as the consideration around which behaviour change components to utilise when addressing particular outcomes. Implications for selection of theoretical underpinnings in intervention development on parent outcomes are also explored.