Telephone Peer Counseling of Breastfeeding Among WIC Participants: A Randomized Controlled Trial
Telephone Peer Counseling of Breastfeeding Among WIC Participants: A Randomized Controlled Trial
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DOI：
10.1542/peds.2013-4146
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发表时间：
2014-09-01
期刊：
影响因子：
8
通讯作者：
Altindag, Onur
中科院分区：
文献类型：
--
作者：
Reeder, Julie A.;Joyce, Ted;Altindag, Onur
目的：美国卫生局局长建议，支持母乳喂养的同伴咨询成为妇女、婴儿和儿童补充营养计划（WIC）的核心服务。截至2008年，50%的妇女、儿童和社区服务对象接受了当地妇女、儿童和社区机构提供的同伴咨询服务。很少有人知道这些同伴咨询计划的有效性。在美国低收入妇女中进行的同伴咨询干预的随机对照试验显示，母乳喂养的开始和持续时间有所增加，但值得怀疑的是，所提供的支持水平是否可以扩大到全国范围内为WIC参与者提供服务。我们测试了WIC参与者中的电话同伴咨询计划是否可以增加母乳喂养的开始，持续时间和排他性。方法：我们随机分配了1948名在怀孕期间招募的WIC客户，他们打算母乳喂养或正在考虑母乳喂养到3个研究组：没有同伴咨询，4个电话联系，或8个电话联系。我们合并了2个治疗组，因为同伴接触的分布没有差异。在产后3个月时，治疗组中所有女性的非纯母乳喂养持续时间均较长（校正的相对风险：1.22; 95%置信区间[CI]：1.10-1.34），但仅在6个月时，西班牙语客户的非纯母乳喂养持续时间较长（校正的相对风险：1.29; 95% CI：1.10-1.51）。纯母乳喂养停止的可能性是西班牙语的客户（调整后的比值比：0.78; 95%CI：0.68-0.89）。结论：电话同侪咨询计划取得了收益，非纯母乳喂养，但纯母乳喂养的适度改善仅限于西班牙语的妇女。
OBJECTIVE: The US Surgeon General has recommended that peer counseling to support breastfeeding become a core service of the Supplemental Nutrition Program for Women, Infants, and Children (WIC). As of 2008, 50% of WIC clients received services from local WIC agencies that offered peer counseling. Little is known about the effectiveness of these peer counseling programs. Randomized controlled trials of peer counseling interventions among low-income women in the United States showed increases in breastfeeding initiation and duration, but it is doubtful that the level of support provided could be scaled up to service WIC participants nationally. We tested whether a telephone peer counseling program among WIC participants could increase breastfeeding initiation, duration, and exclusivity.METHODS: We randomly assigned 1948 WIC clients recruited during pregnancy who intended to breastfeed or were considering breastfeeding to 3 study arms: no peer counseling, 4 telephone contacts, or 8 telephone contacts.RESULTS: We combined 2 treatment arms because there was no difference in the distribution of peer contacts. Nonexclusive breastfeeding duration was greater at 3 months postpartum for all women in the treatment group (adjusted relative risk: 1.22; 95% confidence interval [CI]: 1.10-1.34) but greater at 6 months for Spanish-speaking clients only (adjusted relative risk: 1.29; 95% CI: 1.10-1.51). The likelihood of exclusive breastfeeding cessation was less among Spanish-speaking clients (adjusted odds ratio: 0.78; 95% CI: 0.68-0.89).CONCLUSIONS: A telephone peer counseling program achieved gains in nonexclusive breastfeeding but modest improvements in exclusive breastfeeding were limited to Spanish-speaking women.