Group Intervention to Increase Breastfeeding Duration among Puerto Rican Mothers

描述(由申请人提供)：在R03申请的重新提交中，我们建议确定同伴支持小组的可行性、可接受性和初步效果大小，并与基于小组的财政激励相结合，以增加低收入波多黎各母亲的母乳喂养(BF)持续时间。这些干预措施将在妇女、婴儿和儿童(WIC)计划中进行测试，该计划利用妇女、婴儿和儿童(WIC)当前的目标和当前使用激励措施支持BF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。这项研究之所以重要，是因为： 1)在世界卫生组织(WHO)和联合国儿童基金会(儿基会)为延长BF而建议的支持BF的10个步骤中，同行对BF的支持是唯一的BF维护战略；2)拟议的干预措施有可能解决与母乳喂养持续时间不足有关的健康差距，这在低收入波多黎各妇女中尤为普遍；3)母乳喂养不足与多种妇幼健康问题有关；4)增加母乳喂养持续时间可节省数百亿美元的保健费用。我们将遵循三个阶段的战略。在形成过程中 阶段我们将咨询WIC工作人员、波多黎各产后母亲以及BF、行为健康激励、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。我们将随机将60名发起BF的波多黎各妇女分配到：照常治疗(TAU)；TAU加母乳喂养同行支持小组(BFS)；或TAU和BFS以小组为基础的经济奖励(也称为团体应急管理；(GCM)。同伴支持小组的参与者将被鼓励谈论他们的BF经历和解决BF问题。同样接受GCM的参与者将被分成两个小组，在他们的同伴支持小组中，每周BF母亲比例最大的小组(由BF的直接观察确定)将获得每位小组成员5美元的现金奖励。我们将在基线、产后1个月、3个月、6个月和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，我们将检查每月的招募、同意和入学率，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自我效能感和婴儿体重的效应大小，将两种干预措施与TAU和彼此进行比较。随着WIC项目分布在每个州、地区和部落组织，开发具有成本效益、广泛实施和可持续的BF干预的潜力越来越大。

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.