Abstract: This study describes perceptions of African American mothers related to infant health care. The study's significance arises from the increased incidence of SIDS and disparity in infant mortality among African Americans. SIDS disproportionately affects African American infants and failure of parents to adhere to supine sleep is offered as a contributing factor. An understanding of parents' perceptions of healthcare provider interactions can uncover barriers to adherence with recommendations for safe infant sleep. Interviews revealed that African American mothers valued care from friendly, caring, attentive, respectful nurses. As a result of receiving respectful care, mothers indicated increased likelihood of adhering to health teachings.
Key Words: African American Parents, Infant Mortality, Culture Care Meanings, Health Care
Sudden infant death syndrome (SIDS) is among the leading causes of infant mortality in the United States (National Center for Health Statistics, 2000). Research findings indicate that infants 2000; Gessner, Ivés, & Perham-Hester, 2001; Hauck et al. 2003). A "Back to Sleep" campaign developed to publicly advocate the supine sleep position resulted in a significant decrease in the United States rate of SIDS (American Academy of Pediatrics Task Force). African American infants are still twice as likely to be placed prone for sleep as White infants (Gibson, Dembofsky, Rubin, & Greenspan, 2000; Hauck et al., 2002; Johnson et al., 1999; Pollack & Frohna, 2002; WiIlinger, 2000). Additionally, African American infants continue to have the highest SIDS rate in the United States (Anderson & Smith, 2005) and infant mortality statistics among African Americans remain more than twice that of other racial/ethnic populations (Hessol & Fuentes-Afflick, 2005; Lukacs & Schoendorf, 2004). Johnson et al. (1999) reported that 40% of African American parents put their 2-month old infants to bed prone and at age 4 months the incidence had risen to 47%. A study of inner-city African American parents Ray, Metcalf, Franco, & Mitchell, 1997) revealed that only 54% of families reported they followed the supine sleep position advice given by clinic personnel.
Persistent nonadherence with health care recommendations suggests that the currently available public health messages are incongruent with the health habits of this ethnic group. It is essential to consider that the provision of health education that is not consistent with an individual's beliefs, values, and cultural practices is a significant barrier to adherence. The degree to which care recipients act in support of health care provider teachings is dependent on optimal communication, and is directly related to communication and culture. Health teachings and explanations are more likely to yield positive responses when instructions are delivered with a cultural orientation. Further, health care professionals' lack of awareness of health practices of certain ethnic and cultural groups can lead to individual care recipients feeling embarrassment and pain (Leininger & McFarland, 2002). In this situation, words or actions perceived by the recipients of care to be insulting, discriminating, or contrary to cultural beliefs result in withdrawal from the offender. Subsequent encounters with perceived offenders are avoided and recommendations for care may be met with suspicion. The ultimate result is an increased risk for distrust and potential nonadherence with health education teaching (Leininger & McFarland). Thus, African American parent resistance to safe sleep position recommendations of the AAP, in view of its risky association with incidence of SIDS, is a public health concern.
REVIEW OF RELATED LITERATURE
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