An Examination Of Medical Resident Practices Regarding Patient Communication About Infant Safe Sleep Practices

Date of Award


Degree Name

Doctor of Philosophy



First Advisor

Amy Damashek, Ph.D.

Second Advisor

Scott Gaynor, Ph.D.

Third Advisor

Wayne Fuqua, Ph.D.

Fourth Advisor

Roger Apple, Ph.D.


Health disparities, infant mortality, medical residents, observations, racial disparities, safe sleep


Infant mortality is a significant public health concern in the United States, particularly because of the large racial disparities in death rates. In particular, Black infants die at a rate twice that of white infants (Center for Disease Control, 2016). Sleep-related deaths are one of the most preventable causes of infant mortality. In Kalamazoo, Black and multi-racial infants account for the majority (3 out of 4) of sleep-related deaths (Sleep-Related Infant Deaths in Kalamazoo County Fact Sheet, 2017). To reduce sleep-related deaths, the American Academy of Pediatrics published recommendations for safe sleep practices (American Academy of Pediatrics, 2016).

Unfortunately, caregivers of infants report barriers to following the safe sleep guidelines. Healthcare providers are in a position to promote safe sleep practices with their patients; however, physicians may face challenges in communicating safe sleep recommendations effectively, particularly when working with clients from different racial or ethnic backgrounds. Given racial disparities in sleep-related deaths, research is needed to examine the communication style of physicians when discussing safe sleep practices with their patients, and whether communication style and skills (i.e., use of Motivational Interviewing) differs based on client race.

The present study collected data from medical residents (N = 17) at a local pediatric clinic via questionnaires and observations of well-baby visits (N = 102) to examine (1) medical residents’ knowledge of and attitudes toward safe sleep recommendations; (2) the amount of time with which medical residents discuss safe sleep guidelines with their patients; (3) the rate of Motivational Interviewing skill use when discussing safe sleep with their patient’s caregivers; (4) whether the amount of time medical residents discuss safe sleep guidelines with their patients and the rate of MI skill use over time differs by client race; and (5) the role of empathy in physician communication style and information presentation when discussing infant safe sleep.

Our results indicate that medical residents are knowledgeable about the safe sleep recommendations and overall have positive attitudes toward the safe sleep recommendations. Further, residents provided accurate information about infant safe sleep in nearly 60% of appointments, no information in 35% of appointments, and inaccurate information in 4% of appointments.

In multilevel models, we found that caregiver race and receptiveness to safe sleep information predicted the amount of time providers spent discussing safe sleep with caregivers. Specifically, providers spent less time discussing safe sleep with patients of color and with those patients who appeared less receptive to the safe sleep information. The disparity was greatest when comparing white and black patients such that medical residents discussed safe sleep practices three times longer with white caregivers than they did with Black caregivers. We also found a significant relationship between caregiver receptiveness and MI skill rate such that greater patient receptiveness predicted greater provider MI skill use. Further, our results indicated that provider empathy did not interact with client race to predict time spent discussing safe sleep or MI skill use.

Overall, these results indicate that medical schools and residency programs may want to consider including additional didactics that are pointed toward improving cultural sensitivity and challenging implicit biases.

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