Awareness, Use and Acceptability of Infant Behavioural Sleep Interventions: An Initial Exploration Among Caregivers Residing in Five Countries

This study aimed to assess caregivers' awareness, use and acceptability of common infant behavioural sleep strategies/interventions and explore differences in awareness and acceptability based on country of residence. A cross-sectional online survey was conducted with caregivers (n = 914) of infants aged between 6 and 18 months residing in Australia, Canada, Turkey, the United Kingdom and the United States. Caregivers were provided descriptions of common infant behavioural sleep interventions and reported their awareness of, use, and level of acceptability (using a validated measure: the acceptability of intervention measure [AIM]) for each intervention. Awareness of interventions ranged from 50% to 70% of caregivers, with significant variability by country. Overall, 70% of caregivers had used at least one intervention, with usage rates varying from 25% to 80% depending on the intervention and 30% to 55% of caregivers ceasing use prematurely. Unmodified extinction (AIM = 2.12; 5 = high acceptability), parental presence (AIM = 2.75) and modified extinction (AIM = 2.85) had lower levels of acceptability compared to responsive settling with gradual reduction (AIM = 3.48) and response-based with settling in arms (AIM = 3.51) and bed (AIM = 3.23). Significant differences in acceptability (AIM) scores by country were evident for most of the interventions. As none of the interventions were universally acceptable, a model of care that provides caregivers with information about a range of interventions and the opportunity to choose based on their preferences, parenting styles and cultural beliefs may increase the likelihood of successful intervention adoption.