Evaluation of a Community Health Nurse/Peer Counselor Program to Help Low-Income Women Breastfeed Longer
Condition: Breastfeeding Rates
Study type: Interventional
Phase: Phase 3

Summary: 
      This research was done to better understand how new mothers who are breastfeeding feel and
      the questions they have. We wanted to use ways to help new mothers to breastfeed
      successfully. We compared a new approach (home visits and telephone calls) to the usual care
      given at Johns Hopkins Hospital with strong support to new mothers from nurses, and a peer
      counselor (another mother with breastfeeding experience).
    

Detailed description: 
      Healthy People 2010 included the goal of increasing breastfeeding duration to 6 months for
      50% of all mothers. Other professional and national health organizations and the Health and
      Human Services Blueprint for Action on Breastfeeding recommend that women breastfeed
      exclusively for six months. Increasing breastfeeding among low-income women is a priority, as
      disparities exist. Only 20.1% of low-income women (on WIC) breastfeed for six months compared
      to 40.7 % of more affluent women. Consistent, comprehensive, culturally sensitive
      breastfeeding support increases duration of breastfeeding, thus offering well-documented
      health benefits often specifically appropriate for low-income women. Breastfeeding relates to
      lower formula cost, lower health care costs, and breastfeeding may be less time consuming.
      These cost savings can potentially offset costs of breastfeeding promotion. Facilitating
      breastfeeding among low-income women includes comprehensive and culturally relevant support
      in the hospital, during the first week postpartum, and periodic support in the mother's home.
      Nearly 35% of low-income women stop breastfeeding within eight days of delivery. Repeated
      contact with supportive persons such as peer counselors and nurses, affects the duration and
      exclusivity of breastfeeding practice after the immediate postpartum period. However, support
      for low-income women has been neglected and not made available because of generally
      unsubstantiated claims that it is not cost effective. The breastfeeding intervention used an
      enhanced traditional community health nurse/peer counselor home visit, which is no longer
      usual care for contemporary community health nursing practice, along with in-hospital and
      telephone support. The overall hypothesis was the intervention group will have improved
      breastfeeding outcomes and will demonstrate a net cost savings over usual care.

      The consent form explained the purpose of the study; the actual number of visits and
      telephone calls (if randomized into the intervention group) and the data collecttion
      procedures. There were no identified risks for those enrolled in the study. Incentives
      included $105 if the participant completed each data point.
    

Intervention name(s): Usual Care; Community Health Nurse/Peer Councelor Team
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The usual care group will received standard care from the Johns Hopkins Hospital lactation consultant and nurses, which may have included a visit in the hospital by the lactation consultant if mothers delivered Monday through Friday. The lactation consultant was also available by request. A "warm-line" was also standard. This was a telephone line that was connected to an answering machine; the lactation consultant checked this line once daily (Monday through Friday) and returned calls.; Visits by a community health nurse/peer counselor team during the first six postpartum months. Based on prior research and experience, the team was developed to provide culturally relevant support and health-care education to low-income mothers, who were a high percentage of African American women. The goals of this team were to 1) increase the duration of breastfeeding while emphasizing ways to decrease fatigue, and decrease breast discomfort; 2) strengthen maternal competence with breastfeeding and commitment to breastfeeding; 3) provide parent education about the infant regarding breastfeeding; 4) provide/find social support needed for continued breastfeeding; and 5) foster linkages to community services that will facilitate the maintenance of breastfeeding.
The specific activities of the CHN/peer counselor team included hospital visitation after enrollment, home visiting during the first postpartum month, and telephone support throughout the first six postpartum months.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Health Services Research
Keywords: Breast feeding; breastfeeding; randomized clinical trial; poverty