Individual Breastfeeding Support with Contingent Incentives for Low-Income Mothers

为低收入母亲提供个人母乳喂养支持和或有激励措施

基本信息

批准号：
9759971
负责人：
Yukiko Washio
金额：
$ 55.68万
依托单位：
RESEARCH TRIANGLE INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-09 至 2023-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9759971
关键词：
Academy Address Adherence African American American Breast Feeding Breastfed infant Caring Child Child Support Childhood Childhood Overweight Communicable Diseases Communities Cost Effectiveness Analysis Cost Savings Counseling Data Collection Direct Costs Education Emergency department visit Exclusive Breastfeeding Goals Health Health Care Costs Healthy People 2020 Hispanics Home environment Home visitation Incentives Individual Infant Infant Care Infant Health Infant formula Insurance Intervention Interview Investigation Life Low Income Population Low income Maternal Health Maternal and Child Health Mediating Medical Medical Care Costs Methods Mission Monitor Mothers Motivation National Institute of Child Health and Human Development Obesity Outcome Participant Pediatrics Perinatology Philadelphia Pilot Projects Policies Population Postpartum Period Pregnancy Problem Solving Public Health Puerto Rican Randomized Randomized Controlled Trials Recommendation Research Risk Savings Self Efficacy Services Site Special Supplemental Nutrition Program for Women, Infants, and Children Structure System Testing Translating Translational Research Weaning Weight Gain Woman base efficacy testing ethnic minority population evidence based guidelines financial incentive follow-up health disparity high risk population improved incentive-based intervention infant outcome intervention cost mortality obesity in children peer support primary outcome programs public health priorities racial and ethnic randomized trial secondary outcome societal costs socioeconomic disadvantage standard care treatment as usual

项目摘要

PROJECT SUMMARY/ABSTRACT In this R01 application we propose to examine the efficacy of monthly financial incentives contingent on observed breastfeeding (BF), supplemental to existing support from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program and home-based individual BF support, among low- income mothers. Low-income racial/ethnic-minority women breastfeed for an average duration of four months despite evidence-based recommendations by the American Academy of Pediatrics to exclusively breastfeed for six months of life in addition to continued breastfeeding through the first year. Insufficient duration of any BF is related to multiple maternal and child health problems, and increases in BF duration could be cost saving medically and societally. Though peer support has been effective in prolonging BF duration, the effect has not been as strong for WIC-eligible, low-income mothers. An incentive-based intervention was tested among low- income Puerto Rican mothers in a pilot study (R03HD077057) resulting in promising outcomes of monthly financial incentives contingent on observed BF for 6 months combined with WIC BF usual care, compared to WIC BF usual care only (BF rates: 89% vs. 44% at 1-month; p = 0.01; 89% vs. 17% at 3-month; p<0.01; 72% vs. 0% at 6-month; p<0.01; N = 36). We propose a 2-group parallel randomized controlled trial in which half of the 168 WIC-eligible mothers will be allocated into each of the two study groups: (1) Standard Care BF Support (WIC support + home-based individual support; Standard Care (SC)) and (2) Incentives contingent on demonstrating successful BF (SC + Breastfeeding Incentives; SC+BFI). Participants randomized into SC will receive standard breastfeeding services from WIC and home visitations for individual support and problem- solving. Participants randomized into SC+BFI will receive the same services as Control except that monthly financial incentives are contingent on observed BF and delivered at the end of each month. The study will be conducted in two regional sites with high concentrations of low-income racial/ethnic minority mothers, Philadelphia, PA and Wilmington, DE. The primary outcome will be the BF rate for 6-month postpartum, the exploratory outcome will be the BF rate at 12-month postpartum, and the secondary outcomes will be infant outcomes (i.e., weight gain and emergency room visits). We hypothesize that SC+BFI will increase the BF rate by 25% at 6-month postpartum and have significantly lower infant weight gain and incidents of ER visits for infants at 3-month postpartum, compared to SC. We will track the costs of intervention, formula purchased by mothers, and infant medical care in both groups. We will also conduct interviews with corporate representatives and insurance companies to explore community- and policy-level support to sustain the incentive-based intervention for WIC mothers. The aims of the proposal are guided by the mission of NICHD's Pregnancy and Perinatology Branch to improve the long-term maternal and infant health of low-income populations via encouraging breastfeeding in the translational research context.

项目概要/摘要在此 R01 申请中，我们建议检查每月财务激励的有效性，具体取决于观察母乳喂养 (BF)，作为特殊补充营养现有支持的补充妇女、婴儿和儿童计划 (WIC) 计划和家庭个人 BF 支持，针对低收入群体收入妈妈。低收入种族/少数民族妇女平均母乳喂养时间为四个月尽管美国儿科学会基于证据的建议建议纯母乳喂养除了在第一年继续母乳喂养外，还持续六个月。 BF 持续时间不足与多种母婴健康问题相关，延长BF时间可节省成本医学上和社会上。虽然同伴支持对于延长 BF 持续时间是有效的，但效果并不明显。对于符合 WIC 资格的低收入母亲来说，这种影响同样强烈。在低收入人群中测试了基于激励的干预措施一项试点研究 (R03HD077057) 中波多黎各母亲的收入取得了令人鼓舞的结果经济激励取决于观察 BF 6 个月并结合 WIC BF 常规护理，与仅 WIC BF 常规护理（BF 率：1 个月时 89% 对比 44%；p = 0.01；3 个月时 89% 对比 17%；p<0.01；72% vs. 6 个月时为 0%； p<0.01； N = 36）。我们提出了一项两组平行随机对照试验，其中一半 168 名符合 WIC 资格的母亲将被分配到两个研究组： (1) 标准护理 BF 支持（WIC 支持 + 家庭个人支持；标准护理 (SC)）和 (2) 激励措施取决于展示成功的 BF（SC + 母乳喂养激励；SC+BFI）。随机分配到 SC 的参与者将接受 WIC 提供的标准母乳喂养服务以及家访以获取个人支持和问题 - 解决。随机分配到 SC+BFI 的参与者将接受与对照组相同的服务，但每月服务除外经济激励取决于观察到的 BF 并在每个月底发放。该研究将是在低收入种族/少数民族母亲高度集中的两个区域地点进行，宾夕法尼亚州费城和特拉华州威尔明顿。主要结果是产后 6 个月的 BF 率，即探索性结果是产后 12 个月的 BF 率，次要结果是婴儿结果（即体重增加和急诊室就诊）。我们假设SC+BFI会提高BF率产后 6 个月减少 25%，婴儿体重增加和急诊就诊次数显着降低与 SC 相比，产后 3 个月的婴儿。我们将跟踪干预的成本、购买配方奶的费用两组的母亲和婴儿医疗保健。我们也会对企业进行采访代表和保险公司探讨社区和政策层面的支持，以维持针对 WIC 母亲的基于激励的干预。该提案的目标以 NICHD 的使命为指导妊娠及围产科分会改善低收入母婴长期健康通过在转化研究背景下鼓励母乳喂养来影响人群。