Testing the Effectiveness of a Breastfeeding Assessment Process for Low-Income, African American Women

Background:

The benefits of breastfeeding for mothers and infants have been well established in the literature, as have pervasive racial disparities in breastfeeding. Breastfeeding is a health behavior that can work toward the achievement of health equity, which is identified as a social work grand challenge by the American Academy of Social Work & Social Welfare.

The dynamic breastfeeding assessment process (D-BAP) is an activity developed using CBPAR, with input from low-income African American women, breastfeeding scholars, and lactation practitioners. It engages pregnant women to identify their unique barriers and supporting factors for breastfeeding, and results in an individualized postnatal breastfeeding plan. Breastfeeding self-efficacy and intent are both associated with increased rates of breastfeeding initiation, thus this represents two critical areas that can be targeted through intervention. Thus this study sought to determine: 1. When the D-BAP is delivered, is there a difference in breastfeeding self-efficacy and intent among pregnant, low-income African American women? 2. Do the results differ based on the woman’s previous breastfeeding experience?

Methods:

To determine the impact of the D-BAP on prenatal breastfeeding intent and self-efficacy, a pre-post, paired-samples design was utilized. Theoretical sampling was used to identify 25 women who were African American, WIC recipients, 20 or more weeks pregnant, over 18 years of age, and planning on breastfeeding. Participants ranged from age 18-43 years (M = 27.64, SD = 6.30) and were between 22-38 weeks pregnant (M = 30.44, SD = 4.87).

The Breastfeeding Self-Efficacy Scale – Short Form and the Infant Feeding Intentions Scale were selected as they have undergone psychometric testing with samples similar to the present study. Wilcoxon Signed Ranks tests were used as the data were non-parametric (negatively skewed). Cohen’s calculation was used to determine effect sizes.

Results:

Regarding the research question focused on breastfeeding self-efficacy and intent among all participants, the Wilcoxon Signed Rank Test indicated that participation in the D-BAP did not have a statistically significant impact on breastfeeding intent (z = -.71, p = .48). The effect size was small (r = .14). The increase in breastfeeding self-efficacy was statistically significant (z = -2.01, p = .04). The effect size was medium (r = .40).

The second research question focused on participants with no previous breastfeeding experience (n=12). Again there was no statistically significant increase in their intent to breastfeed (z = -1.58, p = .12). The effect size was medium, however (r = .46). For breastfeeding self-efficacy, the subsample demonstrated a statistically significant increase (z = -2.36, p = .02). This effect size was large (r = .68).

Conclusions and Implications:

Given the low-rates of breastfeeding among low-income African American women and the multiple benefits of breastfeeding, culturally-responsive, effective breastfeeding interventions are needed. This research has implications for the potential of the D-BAP to increase prenatal breastfeeding self-efficacy among pregnant, low-income African American women. Additional research is needed to determine the impact of the D-BAP on breastfeeding behavior postpartum, however this research demonstrates the effectiveness of the D-BAP in increasing breastfeeding self-efficacy in the prenatal period.