Delivering safe sleep and breastfeeding education to pregnant and new mothers through private Facebook groups: study protocol for a 4-armed randomized controlled trial

BACKGROUND: Annually, more than 3500 US infants die suddenly and unexpectedly. Many sudden unexpected infant deaths (SUID) are preventable with greater adherence to safe infant sleep guidelines. There are racial and economic disparities in guideline adherence and SUID rates. Education alone has proven ineffective at altering behavior for many parents, and social networks and social norms regarding infant care have been found to influence rates of unsafe sleep. Using the power of social networks to shape social norms by delivering education through moderated online social media groups provides a unique opportunity to influence these practices in large groups of parents. METHODS: Our five-year study is a 4-armed RCT to determine if delivering safe sleep and breastfeeding educational curricula in moderated private Facebook (FB) groups, starting in the third trimester of pregnancy and continuing until infant age 6 months, changes perceived social norms regarding these behaviors and shapes infant care practices among mothers with low income. To achieve a target analytic sample of 1536, we plan to randomize approximately 2400 pregnant women enrolled in Women Infant and Children (WIC) or seen at Federally Qualified Health Centers (FQHC) at 32-34 weeks' gestation to receive one of 4 interventions via FB groups: 1) Safe Sleep (SS), 2) Breastfeeding (BF), 3) SS + BF, and 4) attention-matched control. We will utilize mixed-method analyses. Quantitative data (surveys, text message queries, FB posts) will allow us to examine the influence of social media groups and norms therein on parental practices regarding infant sleep and breastfeeding. Social network analysis will ascertain the structure of mothers' social networks, the influence of network members, and changes in these networks and influences over the study period. Qualitative analysis of FB posts and in-depth interviews will allow us to probe systematically for differential influences (i.e., social media group vs other influences) on decision-making. DISCUSSION: Findings from this clinical trial will inform future strategies to broadly utilize social media groups to change social norms around safe sleep practices among groups with historically high rates of SUID. TRIAL REGISTRATION: This trial is registered on ClinicalTrials.gov (NCT05767658; date of initial release March 2, 2023). Protocol version 1. Date December 15, 2025.