Group Intervention to Increase Breastfeeding Duration among Puerto Rican Mothers

描述（由申请人提供）：在重新提交的R 03申请中，我们建议确定单独的同侪支持小组以及与基于小组的财务激励措施相结合的可行性、可接受性和初步效果大小，以增加母乳喂养（BF）低收入波多黎各母亲的持续时间。这些干预措施将在妇女、婴儿和儿童方案中进行测试，该方案利用妇女、婴儿和儿童方案目前的目标和目前利用奖励措施支持家庭福利的做法-这些因素可能增加干预措施的可持续性和传播潜力。这项研究很重要，因为： 1)在世界卫生组织（世卫组织）和联合国儿童基金会（儿童基金会）建议的支持母乳喂养以延长母乳喂养的10个步骤中，母乳喂养同伴支持是唯一的母乳喂养维持战略; 2）拟议的干预措施有可能解决与母乳喂养时间不足有关的健康差距，这在低收入波多黎各妇女中特别普遍; 3）母乳喂养不足与多种母婴健康问题有关; 4）增加母乳喂养时间可节省数百亿美元的医疗费用。我们将采取三阶段战略。在形成过程中 在第三阶段，我们将咨询WIC工作人员、波多黎各产后母亲和BF、行为健康激励措施以及WIC人群和环境方面的专家，以制定干预和研究手册。在实施阶段，我们将试行干预措施和研究程序。我们将随机分配60名开始BF的波多黎各妇女：治疗作为母亲（TAU）; TAU加上母乳喂养同伴支持小组（BFS）;或TAU和BFS与基于小组的财务激励（也称为小组应急管理;（GCM）。鼓励同伴支持小组的参与者谈论他们的BF经验和解决BF问题的方法。同样接受GCM的参与者将在他们的同伴支持小组中被分成两个小组，每周，BF母亲比例最高的小组（由BF的直接观察确定）将获得每位成员5美元的现金奖励。我们将在基线、产后1、3、6和12个月进行评估，测量BF持续时间、BF排他性、BF自我效能和婴儿体重增加。在评估阶段，我们将检查每月招募、同意和入组率，以及干预和研究参与的出勤率和保留率（即，可行性和可接受性）。我们还将评估BF持续时间、BF排他性、BF自我效能和婴儿体重的效应量，并将两种干预措施与TAU进行比较。随着WIC计划在每个州、地区和部落组织的实施，开发具有成本效益、广泛实施和可持续的BF干预措施的潜力越来越大。

DESCRIPTION (provided by applicant): In this re-submission of the R03 application we propose to determine feasibility, acceptability, and preliminary effect sizes of a peer-support group alone and combined with group-based financial incentives to increase breastfeeding (BF) duration among low-income Puerto Rican mothers. These interventions will be tested in a Women, Infants, and Children (WIC) program, which capitalize on the current goals of WIC and on the current practice of using incentives to support BF - factors that are likely to increase potential for sustainability and dissemination of the intervention. The study is important because: 1) peer support for BF is the only BF maintenance strategy out of 10 recommended steps to support BF by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) for prolonging BF; 2) the proposed interventions have potential to address health disparities related to insufficient durations of breastfeeding, which are particularly prevalent among low-income Puerto Rican women; 3) insufficient breastfeeding is related to multiple maternal and child health problems; and 4) increases in breastfeeding duration could save tens of billions of dollars in health costs. We will follow a three phase strategy. During the Formative Phase we will consult WIC staff, Puerto Rican postpartum mothers, and experts in BF, behavioral health incentives, and WIC populations and settings to develop intervention and research manuals. During the Implementation Phase, we will pilot the interventions and research procedures. We will randomly assign 60 Puerto Rican women who initiate BF to: Treatment-as-Usual (TAU); TAU plus a breastfeeding peer-support group (BFS); or TAU and BFS with group- based financial incentives (also known as Group Contingency Management; (GCM). Participants in the peer- support groups will be encouraged to talk about their BF experiences and problem-solve BF issues. Participants also receiving GCM will be divided into two teams within their peer-support group and each week the team with the greatest proportion of BF mothers (as determined by direct observation of BF) will earn cash incentives in the amount of $5 per team member. We will conduct assessments at baseline, 1, 3, 6, and 12 months postpartum, measuring BF duration, BF exclusivity, BF self-efficacy, and infant weight gain. In the Evaluative Phase, we will examine monthly recruitment, consent, and enrollment rates, as well as attendance and retention rates for the interventions and for research participation (i.e., feasibility and acceptability). We also will estimate effect sizes for BF duraion, BF exclusivity, BF self-efficacy, and infant weight comparing the two interventions to TAU and each other. With WIC programs located in every state, territory, and tribal organization there is increased potential for developing a cost-effective, widely implemented, and sustainable BF intervention.