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Building Relationships with Trusted Community Members

A female doctor and pregnant woman are seated in an examination room. The doctor holds a computer tablet while talking to the pregnant woman, who is resting her hands on her abdomen. 

The goal of the Safe to Sleep® campaign is to educate all parents and caregivers about reducing the risk for SIDS and other sleep-related causes of infant death. However, it's not possible for the campaign alone to reach every parent and caregiver in every community.

The Safe to Sleep® campaign relies on trusted community members to act as intermediaries, sharing safe sleep information with parents and caregivers who come to them for care, services, or information. These intermediaries—health care providers, community health workers, tribal leaders and elders, and leaders of community organizations—help to further the reach of the campaign by spreading safe sleep messages to their patients, clients, and others in the community.

Some campaign activities related to building relationships with trusted community members are described below.

Relationships with Community Health Workers

Community health workers (CHWs) serve as links between health care and social services and the community. They assist individuals and families with accessing community services and improving the quality and cultural competence of service delivery. These trusted community members often have different titles, such as public health advisors, community health advocates, lay health educators, community health representatives, peer health promoters, and promotores de salud.

CHWs often live in or have close relationships with the communities they serve, meaning they also have special insights into the needs and features of those communities. Even though they provide care and services in many locations, CHWs are an integral part of several cultures and may be the main point of health care for members of these communities.

As part of Safe to Sleep® activities with and within American Indian/Alaska Native (AI/AN) communities, the campaign focused some of its efforts on CHWs who work in tribal areas. Recommendations from the Healthy Native Babies Project Workgroup and feedback from members of AI/AN communities enabled the Safe to Sleep® campaign to design materials and tools to help CHWs spread safe sleep messages and create materials tailored for Native Americans. The workgroup also created training materials to help CHWs educate tribal elders and other community leaders about ways to reduce the risk of SIDS and other sleep-related causes of infant death.

Safe to Sleep® activities within Spanish-speaking communities also focus on equipping promotores de salud with the information and training they need to share safe sleep messages with Spanish speakers.

Relationships with Health Care Providers

The Safe to Sleep® campaign traditionally has relied on health care providers—doctors, nurses, pharmacists, midwives, and others—to help spread safe sleep messages to parents and caregivers. These trusted community members often have easy access and multiple opportunities to interact directly with parents and caregivers. More importantly, they can both share safe sleep information and model safe sleep practices to have a real impact on infant care.

In addition to materials and activities related to health care providers in general, the Safe to Sleep® campaign maintains initiatives that aim to capitalize on the unique relationships between patients and providers, specifically nurses and pharmacists.


Nurses are an important information resource for new parents and often spend the most time with families following the birth of a child. Nurses are also in a unique position in that their behavior has a strong influence on parental behavior.

Research has shown that parents are more likely to follow safe sleep practices—particularly placing infants in the back sleep position—when they see nursery staff consistently model this behavior in the hospital.1 A 2002 study in New Haven, CT, found that nurses who placed infants in the back sleep position during the postpartum hospital stay changed parents' behaviors significantly.2 Safe sleep practices also can be modeled during postpartum care in out-of-hospital birth settings, such as birthing centers.

To make the most of this influence, the NICHD and the Safe to Sleep® campaign partnered with the National Institute of Nursing Research (NINR) at the NIH along with First Candle and several nursing and other organizations to create a continuing education course that gives nurses the information and tools needed to communicate and model SIDS risk reduction messages effectively and quickly.

The Continuing Education Program on Sudden Infant Death Syndrome (SIDS) Risk Reduction: Curriculum for Nurses includes:

  • Background information on SIDS, sudden unexplained infant death (SUID), and SIDS research
  • Specific recommendations and risk reduction strategies
  • Practical ways to demonstrate and communicate this information to parents and families

In addition to the NICHD, the NINR, and First Candle, partners in the nurses' CE effort include the Academy of Neonatal Nursing; the American College of Nurse Midwives; the Association of SIDS and Infant Mortality Programs; the Association of Women's Health, Obstetric, and Neonatal Nurses; the March of Dimes; the National Alaska Native/American Indian Nurses Association; the National Association of Neonatal Nurses; the National Association of Pediatric Nurse Practitioners; the Society of Pediatric Nursing; and the Washington State Department of Health.

  1. Pastore, G., Guala, A., Zaffaroni, M., & Bona, G. (2003). Back to Sleep: Risk factors for SIDS as targets for public health campaigns. Pediatrics, 109(4), 453-454.
  2. Colson, E. R., & Cohen, J. S. (2002). Changing nursery practice gets inner-city infants in the supine position to sleep. Archives of Pediatric & Adolescent Medicine, 156, 717-720.
  3. Hodgson, C., & Wong, I. (2004). What do mothers of young children think of community pharmacists? A descriptive survey. Journal of Family Health Care, 14(3), 73-74, 76-79.
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