Date of Award


Degree Type


Degree Name

Doctor of Philosophy


School of Nursing and Midwifery


Faculty of Health, Engineering and Science

First Advisor

Professor Anne Wilkinson

Second Advisor

Associate Professor Kate Andre


Background: Sudden Infant Death Syndrome (SIDS) is a problem worldwide. In North Jordan, SIDS rate was high as 1.32 per 1,000 live births and contributed 6% to the infant mortality rate (Bataineh, Shawagfeh, & Twalbeh, 2008). However, SIDS risk factors are preventable and can be reduced by improving knowledge and changing relevant behaviours of parents and healthcare providers (American Academy of Pediatrics, 2013; American SIDS Institute, 2011; Bataineh, Hussein Shawagfeh, & Twalbeh, 2008; Bredemeyer, 2004; Grazel, Phalen, & Polomano, 2010b; Moon, Oden, & Grady, 2004; NICHD, 2010). Still educating Jordanians about SIDS has not been a national health policy priority. Currently, Jordanians demonstrate infant care practices that increase the risk of SIDS, such as side sleep position and excessive bedding and clothing being the most common practices. Commonly, home environments also are not SIDS safe because of smoking and poor ventilation. Healthcare providers can assume the role of information provider and change agent by working with mothers, families and the community to change practices.

Aims: This study aimed to determine whether a hospital-based SIDS education intervention program, relevant to Jordanian settings, would encourage Jordanian neonatal healthcare providers to revise parent education and training practices regarding SIDS prevention. The long-term goal was to reduce the incidence of SIDS by influencing Jordanian lifestyles and infant care practices.

Methods: This mixed method intervention study included both quantitative and qualitative data collection methods and was conducted at a major education hospital in Jordan, King Abdullah University Hospital (KAUH), over three phases. Phase-1 used two main surveys, an observation-survey explored baseline data on SIDS-safe sleeping positioning practices using an audit of sleeping positions of healthy and medically stable infants in open cots in the neonatal units. The questionnaire-survey explored baseline data on available SIDS teaching resources and staff knowledge and their parental/family instruction regarding SIDS and relevant prevention practices. Phase-2 investigated the development, implementation, and impact of a Jordanian SIDS Infant Education Package (JSEP) among a sample of neonatal healthcare providers at the hospital using the same tools as in the pre intervention phase. This phase examined the impact the JSEP on neonatal healthcare provider SIDS-knowledge, access to appropriate SIDS resources, SIDS-safe sleeping positioning practices in the neonatal units at KAUH. Phase-3 used focus groups of the JSEP participants to explore participants’ experience in undertaking the JSEP.

Results: Phase-1 revealed that high proportion (47%) of a total of 403 infant positioning observations; infants were placed in a high SIDS risk sleeping position. In addition, 33% of a total 231 neonatal healthcare providers who completed the questionnaire-survey had never accessed information or resources for SIDS at baseline. Moreover, 40% of the 231 neonatal healthcare providers who completed the questionnaire-survey did not have any knowledge about national SIDS prevention guidelines released by the American Academy of Paediatrics. In addition, the neonatal healthcare providers had not played an active role in the education of parents and families in Jordan regarding SIDS prevention practices. Only 21% of neonatal healthcare providers sometimes provided SIDS information to parents and families and another 33% rarely advised them. The questionnaire-survey discovered that most advice provided for parents and families regarding infant sleep care practices were inappropriate and, in fact, could heighten the risk of SIDS.

The JSEP in phase-2 resulted in significant improvement in infant positioning practices at KAUH. The proportion of infants who were placed in a high SIDS risk sleeping position decreased to only 21% of the total post-intervention infant positioning observations (N=400), and this change was statistically significant (Chi-square= 40.777; df= 1; p

Conclusions: The SIDS education program targeted at neonatal healthcare providers within the Jordanian context was effective in improving staff knowledge, practices and preparedness to instigate parental/family education. Healthcare providers were identified as an effective education and training group for community health promotion. However, challenges were identified in achieving this goal, including overwork, time limitations, staff shortages, and hospitalisation policies, as well as resistance from Jordanian families to adopting SIDS-safe infant sleep care or having a SIDS-safe home environment.

Recommendations: SIDS education programs for health care providers need to be extended, with continued research and evaluation on the effectiveness of specific initiatives in Middle Eastern countries. Further research is needed to explore the incidence of SIDS, SIDS risk factors and associated cultural issues. Furthermore, research need to targeted potentially high risk groups such as refugees, rural and remote residents, and Bedouin families living in isolated regions of Jordan.


Paper Location