Preventing Perceived Insufficient Milk: Development of a Text Message-Based Inter

描述(申请人提供)：这个K99-R00独立之路奖的目的是加速候选人发展成为一名独立的调查员，在进行与母乳喂养教育和支持相关的大规模行为干预和健康沟通方面具有专业知识。在这个5年的奖励中，头两年(K99阶段)将致力于获得实现这些目标所需的培训，并开发R00阶段使用的干预内容。在R00阶段(获奖的最后3年)，候选人将进行一项研究，利用所获得的培训技能来解决产妇感觉到的母乳不足(PIM)，这是 过早停止母乳喂养。这项研究将涉及K99开发的母乳干预的试点随机试验-一种移动的、基于短信的半自动干预，以防止在没有母乳喂养经验的母亲群体中感觉到的母乳供应不足或不足。在现有母乳喂养支持干预措施的基础上，牛奶通过转移到其他环境的可能性、可持续性和对IM预防的特别关注，而不是对个别母乳喂养问题的特殊治疗，改进了现有的母乳喂养支持干预措施。自动文本构成了牛奶的基础，将包括产前和产后教育以及预防PIM的支持。信息将具有时间敏感性(例如，特定于胎儿/婴儿的胎龄、分娩后的时间)，并以母乳喂养自我效能(社会认知)理论和在K99阶段开展的试点工作为基础。母乳干预将与对照干预组进行试验，干预组将通过全国Text4Baby系统接受更一般的围产期教育。从怀孕25周到产后8周，这两组人每周都会收到3-5次短信。感兴趣的测量结果将包括感知的母乳供应、母乳喂养信心、母亲焦虑、母乳喂养排他性和母乳喂养持续时间。数据将在基线(13-25周)、34-36周以及产后1、2、4和8周收集。为了评估干预措施的潜在长期影响，将在产后6个月通过电话重新评估母乳喂养的延续和排他性。将通过图形和线性混合模型检查两组和x组之间结果测量的时间差异。为了评估修改牛奶的潜在需求，将对每组参与者进行电话访谈，以评估和比较干预措施的使用、负担和挑战，以及建议的修改。这项R00研究的结果有望为更大规模的多点干预试验提供参考。拟议的牛奶干预既及时又意义重大，因为它解决了母乳喂养持续时间和排他性的障碍，这些障碍已被健康人2020年和美国卫生局局长指定为国家健康优先事项。这项研究还阐述了NINR的使命，即为个人和社区创建创新的沟通干预措施，在促进健康的同时降低相关的医疗成本。

DESCRIPTION (provided by applicant): This purpose of this K99-R00 Pathway to Independence Award is to expedite the candidate's development into an independent investigator with expertise in the conduct of large-scale behavioral interventions and health communication related to breastfeeding education and support. Within this 5 year award, the first two years (K99 phase) will be dedicated to obtaining the training necessary to accomplish these goals and developing the intervention content to be used in the R00 phase. In the R00 phase (final 3 years of award), the candidate will conduct a study that utilizes the acquired training skills to address maternal perceived insufficient milk (PIM), the most frequent reason for premature breastfeeding cessation. The study will involve a pilot randomized trial of the K99-developed MILK intervention-a mobile, semi-automated text message-based intervention to prevent perceived low or insufficient milk supply, in a population of mothers without prior breastfeeding experience. MILK improves upon existing breastfeeding support interventions through its potential for transferability to other settings, sustainability, and specific focus on IM prevention, rather than post-hoc treatment of individual breastfeeding problems. Automated texts, which comprise the basis of MILK, will include both prenatal and postpartum education and support geared toward prevention of PIM. Messages will be time-sensitive (e.g., specific to gestational age of fetus/infant, time since delivery) and based on the Breastfeeding Self-Efficacy (Social Cognitive) Theory and pilot work undertaken in the K99 phase. The MILK intervention will be trialed against a control intervention group, who will receive more general perinatal education through the national Text4Baby system. Both groups will receive text messages 3-5 times per week from week 25 of pregnancy through week 8 postpartum. Measured outcomes of interest will include perceived breast milk supply, breastfeeding confidence, maternal anxiety, breastfeeding exclusivity, and breastfeeding duration. Data will be collected at baseline (13-25 gestational weeks), 34-36 gestational weeks, and at 1, 2, 4, and 8 weeks postpartum. To assess the potential longer-term impact of the intervention, breastfeeding continuation and exclusivity will be reassessed via telephone at 6 months postpartum. Between group and group x time differences in outcome measures will be examined graphically and via linear mixed modeling. To assess the potential need for modifications to MILK, telephone interviews will be conducted with a subset of participants in each group to assess and compare intervention use, burdens and challenges, and suggested alterations. The results from this R00 study are expected to inform a larger, multisite intervention trial. The proposed MILK intervention is both timely and significant, as it addresses barriers to breastfeeding duration and exclusivity which have been designated national health priorities by Healthy People 2020 and the U.S. Surgeon General. This study also addresses NINR's mission to create innovative communication interventions for individuals and communities that promote health while reducing associated healthcare costs.