Online Program

Improving the Work of Breastfeeding Support Professionals through Home Visitation: What Works?

Tuesday, November 3, 2015

Stephen Edward McMillin, PhD, School of Social Work, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO
Tyler S. Glassford, MSW, College for Public Health and Social Justice, School of Social Work, Saint Louis University, Saint Louis, MO
Background: A recent Cochrane review suggests that early childhood home visitation may encourage more women to breastfeed their infants.  However, little is known about how professionals using evidence-based program models of home visitation conceptualize breastfeeding promotion.  This study uses interviews with home visiting program administrators to explore their perspectives on what factors are important to improve breastfeeding outcomes.

Methods: Interviews approximately 90-120 minutes in length were conducted with 34 home visiting program administrators in a large Midwestern state.  Interviews were audio-recorded, transcribed, coded thematically, and subjected to content analysis. 

Results: Fifty-one breastfeeding references across interviews were collapsed into 27 reference groups and then three breastfeeding domains: 1) the process of how visited mothers decided to breastfeed; 2) the training home visitors received to promote breastfeeding; and 3) the breastfeeding outcomes home visiting programs were able to achieve.  Across domains, two primary themes emerged: 1) Home visitors share scientific evidence for breastfeeding from home visitor training with mothers; and 2) Evidence sharing happens in the context of a strong helping relationship.

Conclusions: Respondents saw breastfeeding outcomes and training as connected to both the interpersonal connection a home visitor made with a mother as well as the quality of evidence a home visitor presented to emphasize that breastfeeding was meaningful.  These findings are important because maintaining implementation fidelity for evidence-based interventions containing open-ended interpersonal processes is challenging.  Training for home visitors, and other professionals to support breastfeeding promotion may benefit from integrating interpersonal skill enhancements with a focus on consuming research well.

Learning Areas:

Administer health education strategies, interventions and programs
Diversity and culture
Ethics, professional and legal requirements
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Identify specific outcome measures related to breastfeeding on which home visitation programs are formally evaluated. Describe characteristics of a strong helping relationship between a home visitor and a mother participating in a home visiting program Identify interpersonal skills needed to build a helping relationship with home visiting participants in order to present scientific evidence for breastfeeding to participants in credible ways

Keyword(s): Breastfeeding, Training

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: home visitation program administration is my principal area of research and I have completed extensive qualitative interviews with home visiting program trainers and administrators. I hold a master's degree in health policy and administration from Northwestern University and a master's degree and PhD in social service administration from the University of Chicago.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.