IMPROVING PHYSICIAN BREASTFEEDING COUNSELING AND SUPPORT

代表儿科医生，产科医生， 和家庭医生都提倡母乳喂养作为首选 一种婴儿喂养方法，因为它对降低婴儿体重有明显效果 发病率。 虽然《2000年健康人群报告》针对75%的母亲， 将母乳喂养作为美国的目标，母乳喂养率 从1984年开始，在所有社会经济阶层中， 超过55%的妇女开始母乳喂养。 虽然有几个因素 有助于婴儿喂养方法的选择， 以前的研究表明，医生可以增加 母乳喂养的发生率和持续时间， 支持和咨询潜在的和目前的母乳喂养母亲。 然而，其他研究表明，大多数医生完成 住院医师培训缺乏必要的知识和经验， 有效的母乳喂养促进者和顾问。 这项拟议研究的具体目标是：（1）进行一次全国性的， 对3,000名儿科、产科和家庭的随机抽样邮件调查 内科住院医师（各专科1,000名）和1800名 委员会认证的从业人员（每个专业600人）进行评估， 具体专业的调查表，目前的知识状况， 关于母乳喂养的经验、态度和临床实践， （2）分析回收的问卷，以确定 具体的教育和经验不足， （3）在住院医师和开业医生中进行母乳喂养; 作为“需求评估”，以指导 用于住院医师连续性的特定专业教育干预措施 （4）进行试点测试和单点试验， 住院医师连续性诊所的干预措施，以评估住院医师感知的 有效性和有用性。 居民教育干预措施将是 根据成人学习的原则，并将利用书面 材料、录像带和辅导技能方面的指导， 积极的医生咨询，支持和解决问题的方法， 潜在的和目前的母乳喂养母亲。 反馈将用于 修改干预措施，为未来的随机试验做准备， 确定其最终的临床效果。 如果证明有效 并在全国范围内实施，该计划将使医生 成为更有效的母乳喂养促进者和顾问， 增加母乳喂养的发生率和持续时间。

The major specialty societies representing pediatricians, obstetricians, and family physicians have all advocated breastfeeding as the preferred method of infant feeding due to its demonstrated effect on lowering infant morbidity. Although the Healthy People 2000 report targets 75% of mothers breastfeeding their infants as a goal for the U.S., rates of breastfeeding began falling in 1984 across all socio-economic strata, and currently less than 55% of women initiate breastfeeding. Although several factors have been identified that contribute to choice of infant feeding method, previous research has demonstrated that physicians can increase the incidence and duration of breastfeeding by giving appropriate guidance, support, and counselling to potential and current breastfeeding mothers. However, other studies have suggested that most physicians complete residency training lacking the knowledge and experience necessary to be effective breastfeeding promoters and counsellors. The specific aims of this proposed study are to: (1) conduct a national, random sample mail survey of 3,000 pediatric, obstetric, and family medicine resident physicians (1,000 from each specialty) and 1,800 board-certified practitioners (600 from each specialty) to assess, through specialty-specific questionnaires, the current state of knowledge, experience, attitude, and clinical practice regarding breastfeeding among these specialties; (2) analyze the returned questionnaires to identify specific educational and experience-related deficiencies regarding breastfeeding among resident physicians and practitioners; (3) utilize the identified deficiencies as a "needs assessment" to guide the formulation of specialty-specific educational interventions for use in resident continuity clinics; and (4) perform a pilot test and single-site trial of the interventions in residency continuity clinics to assess resident-perceived efficacy and usefulness. The resident education interventions will be based on the principles of adult learning and will utilize written materials, videotapes, and instruction in counselling skills to focus on active methods of physician counselling, support, and problem-solving for potential and current breastfeeding mothers. Feedback will be used to modify the interventions in preparation for a future randomized trial to determine their ultimate clinical effectiveness. If proven to be effective and implemented on a national level, this program will prepare physicians to become more effective breastfeeding promoters and counsellors, helping to increase the incidence and duration of breastfeeding.