Promoting equity in breastfeeding through peer counseling: the US Breastfeeding Heritage and Pride program.
Promoting equity in breastfeeding through peer counseling: the US Breastfeeding Heritage and Pride program.
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DOI：
10.1186/s12939-021-01408-3
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发表时间：
2021-05-27
影响因子：
4.8
通讯作者：
Pérez-Escamilla R
中科院分区：
文献类型：
--
作者：
Rhodes EC;Damio G;LaPlant HW;Trymbulak W;Crummett C;Surprenant R;Pérez-Escamilla R
在美国，黑人和西班牙裔母亲的母乳喂养率低于白人母亲。为了解决母乳喂养不平等的问题，母乳喂养传统和骄傲计划(BHP)为康涅狄格州和马萨诸塞州以低收入为主的少数族裔母亲提供母乳喂养支持。我们描述了必和必拓的设计过程、计划模型及其对母乳喂养结果的影响。本必和必拓案例研究基于对必和必拓设计者和实施者、同行顾问和客户的深入访谈；对必和必拓影响评估研究的文献综述；以及对必和必拓材料的回顾。为了指导分析和组织结果，我们使用了社区能源平衡框架，这是一个以公平为导向的多层次框架，旨在促进健康的生活方式。拉美裔健康理事会设计了必和必拓，以解决通过与拉丁裔社区进行形成性定性研究确定的母乳喂养障碍，即缺乏榜样、有限的社会支持、在公共场合母乳喂养时的尴尬、缺乏母乳喂养知识以及配方奶喂养的规范。根据必和必拓的模式，客户从产前开始，一直到产后一年，通过面对面的家访和医院探访，辅之以电话，获得教育和支持。咨询是由同伴咨询师提供的，她们是成功母乳喂养的女性，与她们服务的客户具有相似的文化根源和生活经历，并完成了关于哺乳管理和沟通技能的强化培训。国际委员会认证的哺乳顾问为同伴顾问提供临床指导和持续培训，如果需要更多的专业知识和临床专业知识，还可以为客户提供直接支持。面临住房和食品不安全或其他社会经济障碍，可能对母乳喂养以及更广泛的健康和福祉产生负面影响的客户，与解决其健康需求的社会决定因素所需的其他健康和社会服务有关，包括医疗保健机会以及食品和租金援助计划。为了不断改进服务提供，必和必拓拥有强大的监测和评估系统。在两个随机对照试验中，BHP被证明可以改善任何母乳喂养和纯母乳喂养的开始时间和持续时间。必和必拓强调了社区参与的形成性研究对母乳喂养计划设计的重要性。它还提供了一个循证的方案模式的例子，该方案模式提供了连续的母乳喂养支持，考虑了文化背景对母乳喂养的影响和健康的社会决定因素，并纳入了持续的质量改进。
In the United States, Black and Hispanic mothers have lower breastfeeding rates compared with White mothers. To address breastfeeding inequities, the Breastfeeding Heritage and Pride program (BHP) provides breastfeeding support for predominately low-income minority mothers in Connecticut and Massachusetts. We described the process of designing BHP, the program model, and its impact on breastfeeding outcomes. This BHP case study is based on in-depth interviews with BHP designers and implementers, peer counselors, and clients; a literature review of BHP impact evaluation studies; and a review of BHP materials. To guide the analysis and organize results, we used the Community Energy Balance Framework, an equity-oriented, multi-level framework for fostering healthy lifestyles. The Hispanic Health Council designed BHP to address barriers to breastfeeding identified through formative qualitative research with the Latino community, namely lack of role models, limited social support, embarrassment when breastfeeding in public, lack of breastfeeding knowledge, and a norm of formula feeding. According to the BHP model, clients receive education and support through in-person home and hospital visits supplemented by phone calls, beginning prenatally and continuing through one year postpartum. Counseling is delivered by peer counselors, women who have successfully breastfed, have similar cultural roots and life experiences as the clients they serve, and have completed intensive training on lactation management and communication skills. International Board Certified Lactation Consultants provide clinical guidance and ongoing training to peer counselors, as well as direct support to clients, if more specialized knowledge and clinical expertise is needed. Clients facing housing and food insecurity or other socio-economic obstacles that may negatively influence breastfeeding and health and well-being more broadly are connected to other health and social services needed to address their social determinants of health needs, including health care access and food and rent assistance programs. To continuously improve service delivery, BHP has a robust monitoring and evaluation system. In two randomized-controlled trials, BHP was shown to improve breastfeeding initiation and duration of any and exclusive breastfeeding. BHP highlights the importance of community-engaged formative research for informing breastfeeding program design. It also provides an evidence-based example of a program model that offers a continuum of breastfeeding support, considers cultural-contextual influences on breastfeeding and social determinants of health, and incorporates continuous quality improvement.
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影响因子：
8
作者：
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通讯作者：
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影响因子：
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