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

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.