IMPROVING PHYSICIAN BREASTFEEDING COUNSELING AND SUPPORT

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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.