Reducing the Disparities in Breastfeeding Initiation among Urban Adolescent Mothers through a Prenatal Intervention

Monday, 9 November 2015

Jamie Lynn El Harit, BSN, RN, ASQ, CSSBB
Quality Improvement Department, Rush University Medical Center, Chicago, IL, USA

Breastfeeding has been correlated with many health benefits to both infants and mothers. According to Healthy People 2020, infants who are breastfed have improved nutritional, immunological, developmental, and social outcomes. Despite the benefits of breastfeeding and the focused international efforts to increase levels of breastfeeding, adolescents remain largely unaware (Spear, 2006). According to the Centers for Disease Control (CDC, 2013) adolescents have among the lowest levels of breastfeeding. This is further impacted by socioeconomic status and race (Apostolakis-Kyrus, Valentine, & DeFranco, 2013; CDC, 2013). Disparities thus exist in breastfeeding initiation and potential health outcomes to those populations most at risk for disease. Adolescent mothers are uneducated about the health benefits and protections of breast milk and this population is often overlooked in the promotion and protection of breastfeeding (Hunter, 2012; Moran, Dykes, Burt, & Shuck, 2006). This evidence-based practice (EBP) project aims to reduce the disparities of breast feeding initiation among a group of adolescent pregnant women in an inner city high school by increasing breast feeding self-efficacy and breast feeding intention.

After an exhaustive search in the major databases including CINAHL, ProQuest, MEDLINE, and PsychInfo eleven articles were chosen for inclusion in the development of the EBP solution. Social Cognitive Theory is the framework that is utilized in the development of the EBP solution.  The EBP intervention includes psychological and environmental determinants of behavior, observational learning, self-regulation, and moral disengagement. The EBP implementation will include a series of three group learning activities utilizing an International Board Certified Lactation Consultant (IBCLC) and two peer breast feeding counselors and will focus on increasing self-efficacy and intention through various educational techniques focusing on the benefits of breast feeding, common difficulties, and mechanisms to overcome barriers.

The combined use of various techniques to engage adolescent learners in improving their self-efficacy will be utilized with a team approach, during the second trimester of pregnancy, over the course of three lunch-time educational sessions. Techniques include didactic, discussion, hands-on, demonstration, and literature. Support by a lactation expert will continue through to delivery within their school environment on a weekly basis.

The Prenatal Breastfeeding Self-Efficacy Scale will be utilized to measure pre and post-intervention. The Breast feeding Self Efficacy-Short Form (BFSE-SF)will be administered postpartum to determine postpartum self-efficacy as a mechanism to determine the impact of the intervention. Additionally, stated feeding intention will be collected pre and post intervention, as well as self-report data on initiation and continuation of any breast feeding during a telephone interview conducted between two to four weeks postpartum.