Group Intervention to Increase Breastfeeding Duration among Puerto Rican Mothers

增加波多黎各母亲母乳喂养时间的团体干预

• 批准号: 8700929
• 负责人: Yukiko Washio
• 金额: $ 6.69万
• 依托单位: TREATMENT RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-10 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8700929
• 关键词: Academy; Address; American; Awareness; Behavior; Belief; Breast Feeding; Caring; Centers for Disease Control and Prevention (U.S.); Child; Child Care; Childhood; Communicable Diseases; Communities; Consent; Consult; Counseling; Education; Enrollment; Food Packaging; Funding; Future; Goals; Health; Health Care Costs; Health Professional; Health behavior change; Healthy People 2020; Hispanics; Incentives; Infant; Infant formula; Intervention; Lactation; Lead; Life; Low income; Maintenance; Malignant Childhood Neoplasm; Malignant neoplasm of ovary; Manuals; Maternal and Child Health; Measures; Medical; Mid-Atlantic Region; Minority Groups; Mothers; Newborn Infant; Nipples; Overweight; Participant; Pediatrics; Peer Group; Phase; Population; Postpartum Period; Prevention; Problem Solving; Procedures; Public Health; Puerto Rican; Randomized; Randomized Clinical Trials; Recommendation; Reporting; Research; Risk; Self Efficacy; Social Development; Subgroup; Supplementation; Support Groups; Surgeon; Testing; Time; United Nations; United States; Weaning; Weight; Weight Gain; Woman; World Health Organization; base; behavior change; behavioral health; contingency management; cost; cost effective; design; effective intervention; experience; financial incentive; group intervention; health disparity; improved; malignant breast neoplasm; meetings; member; metropolitan; nutrition; peer; prenatal; programs; public health relevance; racial and ethnic; secondary outcome; social; stem; treatment as usual; tribal organization

DESCRIPTION (provided by applicant): In this re-submission of the R03 application we propose to determine feasibility, acceptability, and preliminary effect sizes of a peer-support group alone and combined with group-based financial incentives to increase breastfeeding (BF) duration among low-income Puerto Rican mothers. These interventions will be tested in a Women, Infants, and Children (WIC) program, which capitalize on the current goals of WIC and on the current practice of using incentives to support BF - factors that are likely to increase potential for sustainability and dissemination of the intervention. The study is important because: 1) peer support for BF is the only BF maintenance strategy out of 10 recommended steps to support BF by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) for prolonging BF; 2) the proposed interventions have potential to address health disparities related to insufficient durations of breastfeeding, which are particularly prevalent among low-income Puerto Rican women; 3) insufficient breastfeeding is related to multiple maternal and child health problems; and 4) increases in breastfeeding duration could save tens of billions of dollars in health costs. We will follow a three phase strategy. During the Formative Phase we will consult WIC staff, Puerto Rican postpartum mothers, and experts in BF, behavioral health incentives, and WIC populations and settings to develop intervention and research manuals. During the Implementation Phase, we will pilot the interventions and research procedures. We will randomly assign 60 Puerto Rican women who initiate BF to: Treatment-as-Usual (TAU); TAU plus a breastfeeding peer-support group (BFS); or TAU and BFS with group- based financial incentives (also known as Group Contingency Management; (GCM). Participants in the peer- support groups will be encouraged to talk about their BF experiences and problem-solve BF issues. Participants also receiving GCM will be divided into two teams within their peer-support group and each week the team with the greatest proportion of BF mothers (as determined by direct observation of BF) will earn cash incentives in the amount of $5 per team member. We will conduct assessments at baseline, 1, 3, 6, and 12 months postpartum, measuring BF duration, BF exclusivity, BF self-efficacy, and infant weight gain. In the Evaluative Phase, we will examine monthly recruitment, consent, and enrollment rates, as well as attendance and retention rates for the interventions and for research participation (i.e., feasibility and acceptability). We also will estimate effect sizes for BF duraion, BF exclusivity, BF self-efficacy, and infant weight comparing the two interventions to TAU and each other. With WIC programs located in every state, territory, and tribal organization there is increased potential for developing a cost-effective, widely implemented, and sustainable BF intervention.

描述（由申请人提供）：在对R03申请的重新提出时，我们建议单独确定同伴支持组的可行性，可接受性和初步效应大小，并与基于组的经济激励措施相结合，以增加母乳喂养（BF）持续时间（BF）持续时间。这些干预措施将在妇女，婴儿和儿童（WIC）计划中进行测试，该计划利用了WIC的当前目标以及当前使用激励措施来支持BF的实践 - 这些因素可能会增加可持续性和干预措施传播的潜力。该研究很重要，因为： 1）对BF的同伴支持是世界卫生组织（WHO）和联合国儿童基金（UNICEF）支持BF的10个建议步骤中唯一的BF维护策略，以延长BF； 2）拟议的干预措施有潜力解决与不足持续时间的健康差异有关，这在低收入波多黎各妇女中尤为普遍； 3）母乳喂养不足与多个母亲和儿童健康问题有关； 4）母乳喂养持续时间增加可以节省数百亿美元的健康成本。我们将遵循三个阶段策略。在形成期间 阶段我们将咨询WIC员工，波多黎各产后母亲以及BF的专家，行为健康激励措施以及WIC人群和环境，以制定干预和研究手册。在实施阶段，我们将试用干预措施和研究程序。我们将随机分配启动BF的60名波多黎各妇女为：治疗习惯（tau）； tau加母乳喂养的同伴支持组（BFS）；或带有基于团体的经济激励措施（也称为团体应变管理；（GCM）的TAU和BFS）。将鼓励同伴支持小组的参与者谈论他们的BF经验和问题解决BF问题。参与者还将接受GCM的参与者在同伴组中的每周一周的企业（BF）（BF）的企业中的每周分配给BF MFM的杰出人数，将其分为两个团队，该团队的经历（每支团队的$ 5将估计BF持久性，BF排他性，BF自我效能感和婴儿体重的效果大小，将两种干预措施与Tau和彼此相比。随着WIC计划位于每个州，领土和部落组织，开发具有成本效益，广泛实施和可持续的BF干预的潜力。