Multi-modal Intervention for Lactation Care (MILC) will be a mHealth platform to increase

项目摘要/摘要 2017年疾病控制和预防中心(CDC)的母乳喂养成绩单报告称 尽管在美国的拉美裔人口中，母乳喂养(BF)的启动率约为80% 在美国，不到25%的婴儿通过6个月的纯母乳喂养(EBF)，进一步延续 糖尿病、肥胖症和高血压等慢性疾病的种族差异。西班牙裔女性更多 与非西班牙裔或非裔美国人(AA)母亲相比，更有可能用配方奶粉补充喂养。研究表明， 报告说，高炉教育不足、缺乏高炉技术支持(即锁闭问题、疼痛)等障碍 乳头)，重返工作岗位，轻松获得免费或打折的母婴配方奶粉 (WIC)，缺乏社会支持，感知不便，文化信念，配方奶粉和母乳(LOS- DOS)对婴儿最好，感觉婴儿不饱，以及与以下方面相关的尴尬 母乳喂养导致低收入的西班牙裔母亲过早断奶。因此，增加 低收入西班牙裔妇女的EBF和持续BF的持续时间将需要创新和 解决上述各种障碍的综合办法。建议的快速通道 名为多模式哺乳护理干预(MILC)的提案将成为一个包括以下内容的移动健康平台 以下创新组件：1)聊天机器人系统提供虚拟同伴辅导员支持；2)使用 根据远程监测的母乳喂养不断升级的激励措施；3)不同步和 促进哺乳和社会支持的同步沟通工具；以及4)虚拟同伴母亲 母亲支持网络。我们为第一阶段提出了以下目标： 1)与a)低收入拉美裔母亲，b)认证和国际董事会--进行形成性研究 注册哺乳顾问(CLCS/IBCLCs)和c)深入访谈(IDI)WIC工作人员/初级保健S 提供商(PCP)。 2)与20名分娩的低收入拉美裔BF母亲进行MILC原型的中试测试 在TUH和在TUH工作的5个CLC/IBCL，以证明可行性(可用性和接受度)。 我们为第二阶段提出了以下目标： 1)修改第一阶段MILC原型以实现商业化； 2)对来自TUH和Christian Care Health的178名参与者进行随机对照试验(RCT) 系统(CCHS)和20个CLCS/IBLC对MILC进行评估，以评估MILC在显著提高EBF率方面的有效性 6个月，包括任何高炉在1个月、3个月和6个月的加息。 从长远来看，随着利率的提高，MILC的影响将使EBF利率最多提高6个月 任何长达12个月的高炉。

PROJECT SUMMARY/ABSTRACT The 2017 Centers for Disease Control and Prevention’s (CDC) Breastfeeding Report Card reported that despite a high breastfeeding (BF) initiation of approximately 80% among the Hispanic population in the United States (US), less than 25% of infants were exclusively breastfed (EBF) through 6 months, further perpetuating ethnic disparities in chronic diseases such as diabetes, obesity, and hypertension. Hispanic women are more likely to supplement feeding with formula, than non-Hispanic or African American (AA) mothers. Research has reported that barriers such as insufficient BF education, lack of BF technical support (i.e. latching issues, sore nipples), returning to work, easy access to free or discounted formula milk from Women Infants and Children (WIC), lack of social support, perceived inconvenience, cultural belief that both formula and breastmilk (los- dos) is best for the babies, perception that the infant is not satiated, and embarrassment associated with breastfeeding result in premature weaning off BF among low-income Hispanic mothers. Therefore, increasing the duration of EBF and continuous BF among low-income Hispanic women would require an innovative and comprehensive approach that addresses the diverse range of barriers listed above. The proposed Fast-track proposal titled Multi-modal Intervention for Lactation Care (MILC) will be a mHealth platform that consists of the following innovative components: 1) Chat bot system to provide virtual peer counselor support; 2) Use of escalating magnitude of incentives contingent on remotely observed breastfeeding; 3) Asynchronous and synchronous communication tools to facilitate lactation and social support; and 4) Virtual peer mother to mother support network. We propose the following aims for the Phase I: 1) Conduct formative research with a) low-income Hispanic mothers, b) Certified and international board- certified lactation consultants (CLCs/IBCLCs) and c) in-depth Interviews (IDI)s with WIC staffs/primary care providers (PCPs). 2) Conduct pilot testing of MILC prototype with 20 low-income Hispanic BF mothers who delivered their babies at TUH and 5 CLC/IBCLCs working at TUH to demonstrate feasibility (usability and acceptance). We propose the following aims for the Phase II: 1) Modify Phase I MILC prototype for commercialization and; 2) Conduct a randomized control trial (RCT) with 178 participants from TUH and Christiana Care Health System (CCHS) and 20 CLCs/IBCLCs on MILC to assess MILC’s efficacy to significantly improve EBF rates at 6 months including increasing rates of any BF at month 1, month 3 and month 6. In the long term, the impact of MILC will increase the rates of EBF up to 6 months along with increasing rates of any BF up to 12 months.