Abstract
Objectives: To identify which indigenous-designed sleep components improve perception of infant sleep and family well-being when delivered online over 6 months.
Methods: A 32 optimization factorial trial was undertaken across New Zealand in caregivers with pēpi (infants) aged 2 to 12 months. Participants were randomized to one of 8 combinations of 3 intervention components (off/on conditions) in a 6-month online intervention: Rongo time (creating calm in the household prior to sleep), Uru time (promoting a smooth transition from wake to sleep), and Whānau support (enabling support from a variety of sources). Outcomes of interest included caregiver perception of infant sleep (3-item Perception of Infant and Toddler Sleep Scale, PoiTSS), caregiver well-being (WHO-5), and connectedness (11-item indigenous questionnaire). Linear regression models assessed main effects of components and interactions using effect coding.
Results: Of 503 randomized infants (6.2 [SD 2.9] months, 50.5% female, 45.7% indigenous Māori, and 38.8% high deprivation), follow-up data were available for 377 (75%) at 6 months. While qualitative data indicated good support for the program, no statistically significant improvements in well-being or connection were observed. Whānau support significantly improved caregiver perception of sleep (mean difference; 95% CI: 0.4; 0.0, 0.7), but not Uru (0.2; -0.2, 0.5) or Rongo (0.3; -0.1, 0.6) time. Both synergistic and antagonistic interactions were observed between components, but these were small.
Conclusions: An indigenous-led intervention produced few improvements in perception of infant sleep or well-being despite considerable support from participants. Further work is required to develop interventions that resonate with indigenous groups and reduce sleep inequities.
Clinical trial registration: Australian New Zealand Clinical Trials Registry (anzctr.org.au, AACTRN12622000921785, 28 June 2022).