Module 5: Respectful Dialogue & Structure of a Conversation

5.3 Persuading Conversations

EvidenceHow Do Your Perspectives Align with the Families You Hope to Reach?

Current recommendations for safe sleep and breastfeeding are based on scientific evidence. Research and science confer the authority on those recommendations. While not everyone may agree about the implications for the research findings, within the health and public health arenas there is general agreement that such evidence makes the recommendations the “right” and best ways to prevent SUID and enhance child well-being. 

Evidence and Culture

Looking to the authority of scientific evidence, however, is actually a cultural perspective. For many families and communities we hope to reach, authority and expertise to guide behavior may come from very different sources. Personal experiences (I know many babies who have slept on their stomachs and they are fine); advice from friends, family and elders; religion; and information from the internet are common sources of authority and expertise. 

Their evidence is very different from our evidence. In fact, there is actually a fair amount of distrust of scientific findings in the general population (Last year wine was bad, this year wine is healthy!). Among some racial and ethnic groups, there is also distrust based on a history of egregious research practices and a lack of awareness in the scientific community about historical connotations of behaviors and concerns that findings about disparities in health behaviors and outcomes are presented in ways that further stigmatize their communities. 

In addition, there are beliefs and values about the issues you will be discussing that come from deep religious or cultural ties that are viewed as authoritative. Thus, approaches to sharing information about safe sleep and breastfeeding that talk about myths (what non-science people may believe) vs truths (what scientific evidence shows) can actually stop the conversation before it starts. To implement the Conversations Approach, one needs to understand and acknowledge one’s own framework as well as the frameworks of the families. Being able to explain the “whys” of recommendations (see Module 3) and provide more detailed information to address doubts about the recommendations (see Module 4) are critical.

Relying on the message that these recommendations are scientifically based and should be implemented may not be particularly persuasive.

How People Decide to Try New Things

There are a number of models that help us understand how people decide whether or not to adopt a new or different behavior. One model that is very useful comes from Rogers’ Diffusion of Innovation Theory (You may want to consider this model as you make your own decision about adopting the Conversations Approach. You may be an early adopter who is willing to try out the Conversations Approach based on your own experiences and values or you may be someone who needs to see the advantages from others’ experiences or evaluations before you adopt it).

Rogers indicates that the following factors come into play as a person decides on whether to try out a new behavior. Consider the implications of this model for breastfeeding and safe sleep and how approaches that have largely told families what behaviors to adopt and not accounted for the ambivalence and need to explore why they might not want to choose those approaches might not have been as effective as hoped.


1. Ask yourself, is the new behavior better, easier, more convenient, more effective, less expensive? Think of one or more concerns or issues families might have for not adopting safe sleep or breastfeeding that relate to this factor.

Here are some issues you might have considered:

  • Worries about babies choking on their backs = not a better way to keep them safe.
  • Concerns about being tied down by breastfeeding and concerns that it is difficult to succeed with breastfeeding may lead families to conclude that formula feeding is more convenient and easier.
  • Concerns that the recommended behavior does not result in parents getting much-needed sleep (they may not view it as better and easier without exploring the full range of benefits and trade-offs).

2. Is the new behavior consistent with existing values, past experiences, and needs?

Here are some issues you might have considered:

  • In our traditions, we have the baby sleep in bed with us.
  • I need to go back to work and cannot breastfeed.
  • All of my aunts have told me that breastfeeding is not what we do in our family.
  • My friends all say their babies slept on their stomachs and they were fine.

3. Is the new behavior perceived as easy to understand? Can people try it out? Any long-term commitments?

Here are some issues you might have considered:

  • While the basic recommendations are straightforward, the way terms are used in them may not be clear to families without some discussion (e.g. firm sleep surface, exclusive breastfeeding). In addition, actually implementing these behaviors takes some detailed planning, and families may have many questions and concerns about how and if they can follow through. Without opportunities to explore those questions and concerns, families may decide not to adopt safe sleep and/or breastfeeding recommendations.
  • On the positive side, families do not have to feel that they are “stuck” with their decision. On the other hand, families often find that implementing safe sleep and breastfeeding is difficult or they cannot figure out how to make it work within the context of their lives. In fact, studies that compare intent with actual follow through on these behaviors make it abundantly clear that families do not see any long-term commitments to these decisions.  While this is a positive for supporting decisions to implement the behaviors, the fact that they are totally voluntary emphasizes the need for helping families make a plan for implementation that includes dealing with roadblocks and difficulties. Creating this plan is a key part of the Conversations Approach (See Module 6). Note: Not everyone who starts a conversation will be working within a context that allows the time to develop such a plan with families. As already mentioned, the Conversations Approach is really a team sport. If your role doesn’t realistically allow time for developing the plan, you will need to create collaborations with others who can provide that support.

4. Is the new behavior and its benefits visible?

Here are some issues you might have considered:

  • It is difficult for families to see the benefits of safe sleep. Rogers notes that “selling” preventive behaviors is difficult, because you don’t see the effects directly. While SUID is too frequent, it is not extremely common, and many families do not know about any SUIDs within their own experience. In addition, such deaths are often not talked about openly.  Breastfeeding benefits are also not immediately observable—most babies seem healthy and the long-term health benefits will not be observable during the time families make decisions.  Thus, it is important during a conversations approach to share those benefits and to find ways to connect families to others who have used the approach or who didn’t implement it and had a negative outcome. 

5. Do adopters know someone who has used and liked the innovation? Can the behavior be changed to suit the adopters needs?

  • This criterion for adopting safe sleep and breastfeeding is a key component of the Conversations Approach.  If families are told to “take it or leave it” in terms of following every recommendation offered, they may turn off to the overall concept. This is where using the Conversations Approach and a personalized plan provide the opportunity to have guidance from those with intimate knowledge of safe sleep and/or breastfeeding to help families either try to minimize risk or maximize the benefit if they are not willing to implement all aspects of the recommendations (e.g. intend to bed-share and need to address specific risks of the adult bed or only want to breastfeed if someone else can feed the baby in their absence).  In a conversations approach, keeping the dialogue open and helping families problem-solve to meet their own goals is critical.  It is not a failure if families do not embrace all of the recommendations offered.  It is an opportunity to try to mitigate risk and enhance benefits in a dialogue that gives families access to the deep knowledge and information that you can offer them.