The Roles of Relationship and Evidence in Training to Improve Breastfeeding Outcomes through Home Visitation
Social interventions to promote breastfeeding are important because strong evidence suggests that breastfeeding has multiple benefits for mothers and infants as well as for society in general. A recent Cochrane review suggests that early childhood home visitation may encourage more women to breastfeed their infants exclusively (Yonemoto, Dowswell, Nagai, & Mori, 2014). However, little is known about how professionals using evidence-based program models of home visitation conceptualize and develop training to promote breastfeeding. This paper uses interviews with administrators in a statewide network of home visiting programs in a large Midwestern state to explore their perspectives on what factors are important to improve breastfeeding outcomes.
Methods
In-depth, semi-structured, qualitative interviews approximately 90-120 minutes in length were conducted with 34 trainers and program administrators in a Midwestern, statewide network of home visiting programs. Interviews were transcribed, coded thematically, and subjected to content analysis.
Results
Fifty-one breastfeeding references across interviews were collapsed into 27 reference groups, and three primary, interconnected breastfeeding themes emerged: 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. Themes were interrelated; 75% of training references also referenced the breastfeeding decision process, as did 91% of references to breastfeeding outcomes. Further content analysis allowed process subthemes to emerge. The relationship a home visitor developed with a participant was referenced in 56% of training references to breastfeeding and in 55% of references to outcomes and was seen as something that influenced mothers to breastfeed. As one home visitation trainer noted, “Regarding breastfeeding…the goal is to get people to think about something aside from the line they were on already. So how do you do that? You do that just by being who you are and being the way you are with them. You do it by providing things you think will benefit, but without being demanding about it. You do it by being willing to hear what they have to say.” The scientific evidence behind promoting breastfeeding were referenced in 19% of training references and 36% of outcome references as influential, as one administrator noted: “Research in areas such as spanking, discipline, breastfeeding, it is really helpful to have that material that backs you up” with participants.
Conclusions and Implications
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 social workers, home visitors, and other professionals to support breastfeeding promotion may benefit from integrating interpersonal skill enhancements with a focus on consuming research well.
Reference
Naohiro, Y., Dowswell, T., Shuko, N., & Rintaro, M. (2014). Cochrane in context: Schedules for home visits in the early postpartum period. Evidence‐Based Child Health: A Cochrane Review Journal, 9(1), 100-102. doi: 10.1002/ebch.1957