Exclusive breastfeeding for the first six months of life has been shown to decrease morbidity and mortality of women and infants. Organizations such as the United Nations Children’s Fund (UNICEF, 2018), American Academy of Pediatrics (AAP, 2012), and the World Health Organization (WHO, 2017a) have universally endorsed exclusive breastfeeding for the first six months of life, and then continuation of breastfeeding for a minimum of one to two years, with only supplementation of other liquid or solid food sources. Breastfeeding rates in the United States have not met the minimum goals set forth by Healthy People 2020 (n.d.). Although 81% of U.S. mothers initiated breastfeeding after the birth of their infant, only 22% of mothers were found to be exclusively breastfeeding at six months postpartum (Centers for Disease Control and Prevention [CDC], 2016a). This prospective, longitudinal, structural equation modeling study examined millennial-aged, exclusively breastfeeding women within one month postpartum who were followers of at least one of 17 social media breastfeeding support groups. Relationships of the conceptual constructs within Pender’s (1996) revised health promotion model (RHPM); House’s (1981) dimensions of social support; and the added constructs of breastfeeding knowledge, breastfeeding confidence, and breastfeeding attitude were analyzed in an effort to better understand the variables that lead to sustained exclusive breastfeeding to six months. Data supported the use of the integrated model for breastfeeding women. The normed referenced chi-square (2) of 1.9 (CFI =.94, IFI =.94, NFI =.89, RMSEA =.06, CFI [PCFI] >.5) indicated a good model fit. Additionally, there were statistically significant gains in the confidence, knowledge, and attitude scores from pretest to follow-up at six months. Exclusive breastfeeding to six months was reported to be three times (66%) higher than the U.S. national average (22%) (CDC, 2016a). Future use of the integrated model has great potential to impact public health by the exploration of variables that promote exclusive breastfeeding to six months. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2018. / FAU Electronic Theses and Dissertations Collection

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Case Report: The Tennessee Initiative for Perinatal Quality Care (TIPQC) is a statewide quality improvement collaborative founded in 2009. Members elected to develop a project to address Tennessee’s low breastfeeding rates. The project aim is to improve the health of infants and mothers in Tennessee by increasing initiation and duration of breastfeeding through systematically promoting breastfeeding at prenatal care visits. The short-term project goal is to increase the fraction of infants who are fed breastfmilk at the maternal post-partum visit by 50% by March 2012. A toolkit of evidence-based practices was developed by an interdisciplinary project development team through a combination of face-to-face meetings and webinars. Published tools from the AAP, ACOG, ABM, and elsewhere were reviewed to complete this toolkit. Inclusion of a practice in the toolkit was based on evidence of effectiveness and consensus/approval by the project development team and pilot centers. Toolkit format and project protocols were designed to be consistent with other TIPQC projects. The target population for this project includes expectant mothers presenting for routine prenatal care in the outpatient clinic. Project outcomes will be measured at the first postpartum visit at 4-8 weeks post-delivery. The project pilot was launched in three TN practices in spring 2011. Participating practices will first establish a primary improvement team that includes relevant stakeholders and a project champion and team leader. Ongoing project support will be provided through regional learning session and webinars. In recognition of the range of needs and varied resources across the state, the toolkit includes a menu of “potentially better practices” (PBPs) that may be implemented individually, or as a bundle. Success of this project relies on high reliability (>90%) implementation of processes that promote breastfeeding in the prenatal clinic and the use of rapid Plan-Do-Study-Act (PDSA) cycles. Use of a web-based data-entry system through REDCap will allow practices to access on-demand run-charts and control charts for their project data as well as automated comparisons to project-wide aggregate data. The fractions of mothers’ exclusively feeding breastmilk, feeding both breastmilk and formula, and feeding exclusively formula at the first post-partum visit at 4-8 weeks post-delivery will be determined. The fraction of mothers with infants readmitted to the hospital after birth will be tracked as a balancing measure. Local audits will be used to evaluate reliability of implementation of potentially better practices. Discussion: This project may serve as a model for how quality improvement methodologies may be combined with use of distance-learning and web-based data entry and reporting to facilitate dissemination and measured implementation of potentially better practices across a broad geographic region with highly diverse populations. The approach has the potential to increase breastfeeding rates and improve health and could be modified for application in delivery and postnatal settings.

Case Report: Through the Tennessee Initiative for Perinatal Quality Care (www.tipqc.org), four pilot prenatal (Family Medicine and OB-GYN) practices representing academic and private groups from across the state established primary improvement teams including relevant stakeholders. An online toolkit of evidence-based practices and published tools from the AAP, ACOG, ABM, and elsewhere was developed by an interdisciplinary team and provided to pilot practices. The toolkit included a menu of “potentially better practices” (PBPs) that could be implemented individually, or as a bundle. Success of this project relied on use of rapid Plan-Do-Study-Act (PDSA) cycles. Pilot practices were educated on basic QI procedures, data collection, toolkit content, etc. and shared experiences through monthly webinars called “Huddles”. Regional trainings were also provided at various intervals by the TIPQC staff. Before implementation of a PBP, each practice collected their baseline breastfeeding rate at the 4-8 week postpartum visit. Practices used a web-based, HIPAA-compliant data-entry system through REDCap. The project was reviewed and approved by the Institutional Review Boards (IRBs) of participating pilots, and funded under an agreement with the state of Tennessee. PBPs implemented by the pilot practices included: - Providing resident and provider education - Distributing written literature on breastfeeding benefits and advice - Providing written breastfeeding prescriptions - Having patients view educational breastfeeding videos - Creating a breastfeeding-friendly office environment Baseline pilot data revealed that at presentation for the first postpartum visit, 28.1%, 23%, and 49% of mothers were exclusively feeding breastmilk, feeding a mix of breastmilk and formula, and exclusively feeding formula, respectively (n=196). Baseline data was successfully collected, and early data following the first PDSA has been collected across the four pilot participants. For participating practices, this is the first time they have systematically looked at their 6-week breastfeeding rates. Open communication and brainstorming across the various practices has been very helpful. A numbers of challenges have been cited, including time constraints related to large volumes of patients and inability to extract data electronically, coordination of efforts among large numbers of providers and staff who may be unfamiliar with breastfeeding, and a need for more family, hospital, and community provider support for breastfeeding. Discussion: This quality improvement prenatal breastfeeding promotion pilot project provides insight into the process of team building and use of thin data sets to drive practice level improvement, and lays the groundwork for statewide spread, where challenges encountered in the pilot centers can be addressed. Participants are now looking at the reliability of their implementation, and determining whether their initial selections from the menu/toolkit were effective.

Factors that influence exclusive breastfeeding in Namibia are important, especially in light of the implementation of the Baby and Mother Friendly Initiative. Infant feeding practices, especially breastfeeding, are important public health issues, particularly in the prevention of HIV transmission from mother to child. This thesis determined the prevalence of exclusive breastfeeding and measures the association of demographic and service-related factors on exclusive and non-exclusive breastfeeding practices.

Thesis (M.A.)--University of North Texas, May, 2008. / Title from title page display. Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1994. / Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1994. / Includes bibliographical references.

Master of Public Health - MPH / Factors that influence exclusive breastfeeding in Namibia are important, especially in light of the implementation of the Baby and Mother Friendly Initiative. Infant feeding practices, especially breastfeeding, are important public health issues, particularly in the prevention of HIV transmission from mother to child. This thesis determined the prevalence of exclusive breastfeeding and measures the association of demographic and service-related factors on exclusive and non-exclusive breastfeeding practices. / South Africa

No description available.