Abstract C50: Applying the Stages of Change Model to breastfeeding in African-American women: A qualitative study
Authors: Gross Tyra 
Published: March 2017

Background: Breastfeeding is the optimal form of infant nutrition, and has numerous health benefits for both infant and mother. One such maternal health benefit is decreased likelihood of breast cancer. Breastfeeding trends in the United States have improved in the past decade. However, racial disparities remain, with African-American women having the lowest breastfeeding rates among all racial/ethnic groups. Although breastfeeding trends in African-American women have also improved greatly, current rates do not meet Healthy People 2020 objectives. According to the CDC, African-American women are more likely to develop an aggressive form of breast cancer (triple negative) and also have a higher mortality rate from breast cancer. In addition, breast cancer has a tendency to onset at younger ages in African-American women. Thus, efforts to improve breastfeeding initiation and duration rates in this population can help alleviate breast cancer disparities. The Stages of Change model is one behavioral health theory useful in gauging readiness to adopt a preventive health behavior. There is a gap in the breastfeeding literature regarding the usefulness of this theory for breastfeeding in African-American women. The current research described here helps to fill that gap.

Study Question: How can the Stages of Change model be used to increase motivation and readiness to initiate and sustain breastfeeding in African-American women?

Methods: A secondary data analysis was conducted of qualitative data from a dissertation exploring the long-term breastfeeding experiences of African-American women. In the first study, 3 focus group discussions were conducted with 23 WIC breastfeeding peer counselors (PCs) to better understand breastfeeding norms and behavior of the African-American women they serve. Focus groups were conducted at community health clinics and lasted approximately 90 minutes. In the second study, semi-structured individual interviews were conducted with 11 African-American mothers who were WIC participants (identified as positive deviants), who had breastfed one child for at least 6 months, and the breastfed child was younger than 2 years old. Interviews were conducted in participant homes or public settings (ie. library, café) and lasted approximately 60 minutes. Both focus groups and interviews were audio-recorded and conversations were transcribed. Data was coded by two researchers and analyzed using thematic analysis techniques. The Stages of Change model was used as a guide in the secondary data analysis.

Results: WIC PC's and interview participants described historical and socio-cultural complexities influencing African-American women's breastfeeding behaviors. Four themes developed across both studies about African-American women's motivation and readiness to breastfeed using the Stages of Change model and strategies useful to encourage breastfeeding at each stage of behavioral change. 1) Pre-contemplation Stage: Increasing Breastfeeding Awareness (preconception and pregnancy); 2) Contemplation & Preparation Stages: Breastfeeding Decision-Making (pregnancy and childbirth); 3) Action Stage: Initial Breastfeeding Triumphs and Trials (childbirth and early postpartum period); 4) Maintenance Stage: Committing to Long-term Breastfeeding (extended postpartum period).

Conclusions: Findings indicate opportunities to enhance breastfeeding education and strengthen breastfeeding support for African-American women at each stage of behavioral change. Lessons learned can be used in designing culturally-tailored breastfeeding interventions for African-American women and also a survey tool to assess women's readiness to breastfeed. Healthcare providers and researchers should be aware of the unique historical and socio-cultural complexities influencing African-American women's breastfeeding behaviors when developing interventions. By improving breastfeeding in African-American women, aggressive breast cancer in may be prevented.

Citation Format: Tyra Gross. Applying the Stages of Change Model to breastfeeding in African-American women: A qualitative study. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C50.