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The Status of Iowa Sleep-Related Infant Mortality: an Evaluation Of

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The Status of Iowa Sleep-Related Infant Mortality: an Evaluation Of THE STATUS OF IOWA SLEEP-RELATED INFANT MORTALITY: AN EVALUATION OF SAFE SLEEP EDUCATION DELIVERY, POLICY, AND PRACTICE IN BIRTHING HOSPITALS By Meghan L. Harris, MPH, MPA A dissertation submitted in partial fulfillment of the requirements for the degree of DOCTOR OF EDUCATION Dissertation Committee: Sally Beisser, Ph.D., Chair Catherine Gillespie, Ph.D. M. Patricia Quinlisk, MD, MPH Dean of the School of Education: Janet M. McMahill, Ph.D. Drake University Des Moines, IA 2014 Copyright © Meghan L. Harris, 2014. All rights reserved. 2 Dedication I fell in love with babies my first day in the nursery. As an undergraduate I worked in the newborn nursery at the largest hospital in Iowa. I held babies born addicted to crack, to prison inmates; babies with only a functioning brain stem allowing them to suck, cry and sleep, but only live two weeks. I gave hundreds their first baths, swaddled them for comfort and happily witnessed many weary and euphoric new mothers learning how to care for their child. The first time I witnessed an infant autopsy, my youngest son was the same age as the victim of SIDS. I was intent on determining why an excessive number of babies were dying, possibly from some uniform infectious cause, anything but the unknown. I have read many times in literature quotes from mothers who question why their actions can prevent something that is unexplained. The truth is we know some of the reasons why babies die of SIDS and related causes. There are a multitude of factors that contribute to the “why” we just cannot fully explain why it happened “when” it did. I believe it is possible to prevent many of these deaths with vigilance, education, and empowerment. Knowing this has propelled me through years of study, writing, meeting, motivating, speaking, and educating. I look at my two boys who lived through their infancy and are now captivating young people. I want them to know that this work had meaning and that even if it is only one infant saved, that is one less infant absent from the world. I could not have succeeded in this endeavor without my partner, a physician, who has helped me comprehend the world of clinical practice. He edited my pages, pushed me through countless hours of writing, and sometimes made me take a much-needed break. I cannot imagine doing this without his incessant love and support. I dedicate this writing to the parents who are just now falling in love with their new little one. I hope my work ensures that you always secure a safe sleep space for your baby. 3 TABLE OF CONTENTS LIST OF FIGURES ...................................................................................................................... 6 LIST OF TABLES ........................................................................................................................ 7 ACKNOWLEDGEMENTS ......................................................................................................... 9 ABSTRACT ................................................................................................................................. 10 CHAPTER I ................................................................................................................................ 11 INTRODUCTION ....................................................................................................................... 11 Statement of the research problem ........................................................................................... 16 Purpose statement ....................................................................................................................... 18 Research questions ...................................................................................................................... 19 Significance of the study ............................................................................................................. 19 Conceptual framework ............................................................................................................... 20 Bronfenbrenner’s ecological model ............................................................................... 20 The Health Belief Model ................................................................................................. 25 Definitions of Key Terms and Acronyms ................................................................................. 28 Summary ...................................................................................................................................... 29 CHAPTER II ............................................................................................................................... 30 LITERATURE REVIEW .......................................................................................................... 30 Trends in infant mortality .......................................................................................................... 31 SIDS and related mortality classifications .................................................................... 34 Infant sleep environment ................................................................................................ 36 Contributory and protective factors ............................................................................. 39 Role of health care ...................................................................................................................... 42 Maternal practices of infant care .............................................................................................. 45 Child death review teams ........................................................................................................... 46 4 Structure and classification of the Iowa hospital system ........................................................ 48 Summary ...................................................................................................................................... 50 CHAPTER III ............................................................................................................................. 52 METHODOLOGY ..................................................................................................................... 52 Philosophical assumptions and research design ....................................................................... 52 Methodological approach ........................................................................................................... 53 Methods ........................................................................................................................................ 54 Sample size requirements ............................................................................................... 56 Data collection procedures ............................................................................................. 58 Data analysis procedures ............................................................................................................ 60 CDR system data adjustments ....................................................................................... 60 Hospital safe sleep characterization and survey analyses ........................................... 64 Retracted analyses .......................................................................................................... 65 Design issues ................................................................................................................................ 65 Limitations and delimitations .................................................................................................... 66 Infant mortality analysis ................................................................................................ 66 Hospital survey ................................................................................................................ 67 Summary ...................................................................................................................................... 68 CHAPTER IV .............................................................................................................................. 69 RESULTS .................................................................................................................................... 69 Sleep-Related Cause Infant Cohort ........................................................................................... 69 All cause infant cohort ................................................................................................................ 77 Safe sleep education survey ....................................................................................................... 82 Summary answers to research questions .................................................................................. 90 Research question one .................................................................................................... 90 Research question two .................................................................................................... 91 Research question three ................................................................................................. 92 Summary ...................................................................................................................................... 92 CHAPTER V ............................................................................................................................... 93 5 DISCUSSION,
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