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）：在重新提交的 R03 申请中，我们建议单独确定同伴支持小组并与基于小组的经济激励措施相结合以延长母乳喂养 (BF) 持续时间的可行性、可接受性和初步效果大小低收入波多黎各母亲。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 的当前目标以及使用激励措施支持 BF 的当前实践——这些因素可能会增加可持续发展和传播的潜力。的干预。这项研究很重要，因为： 1) 世界卫生组织（WHO）和联合国儿童基金会（UNICEF）推荐的支持 BF 的 10 项建议步骤中，同伴支持 BF 是唯一维持 BF 的策略，以延长 BF； 2) 拟议的干预措施有可能解决与母乳喂养时间不足有关的健康差异，这种情况在低收入波多黎各妇女中尤为普遍； 3）母乳喂养不足与多种母婴健康问题有关； 4) 增加母乳喂养时间可以节省数百亿美元的健康费用。我们将遵循三阶段战略。形成期间 在这一阶段，我们将咨询 WIC 工作人员、波多黎各产后母亲以及 BF、行为健康激励以及 WIC 人群和环境方面的专家，以制定干预和研究手册。在实施阶段，我们将试点干预措施和研究程序。我们将随机分配 60 名开始 BF 的波多黎各女性： 照常治疗 (TAU)； TAU 加上母乳喂养同伴支持小组 (BFS)；或 TAU 和 BFS，具有基于团体的财务激励（也称为团体应急管理；(GCM)）。将鼓励同伴支持小组的参与者谈论他们的 BF 经验和解决 BF 问题。同时接受 GCM 的参与者将在同伴支持小组内分为两个团队，每周 BF 母亲比例最高的团队（通过直接观察 BF 确定）将获得每位团队成员 5 美元的现金奖励，我们将在以下时间进行评估。基线、产后 1、3、6 和 12 个月，测量 BF 持续时间、BF 排他性、BF 自我效能和婴儿体重增加。在评估阶段，我们将检查每月的招募、同意和登记率以及入组率。干预措施和研究参与的出勤率和保留率（即可行性和可接受性）我们还将估计 BF 持续时间、BF 排他性、BF 的效果大小。自我效能感和婴儿体重，将两种干预措施与 TAU 以及彼此进行比较。随着 WIC 项目遍布每个州、领地和部落组织，开发具有成本效益、广泛实施和可持续的 BF 干预措施的潜力越来越大。