Behavioral predictors of breastfeeding include a mother’s breastfeeding beliefs and knowledge (leading to breastfeeding self-efficacy, or BSE), support of family and friends (perceived and actual), and the support of healthcare workers and the community (perceived and actual). These determinants are derived from a combination of Theory of Planned Behavior (TPB), the Health Belief Model (HBM) and Social Cognitive Theory (SCT) (see figure 1). BSE translates into the mother’s initiation and maintenance of breastfeeding, and should be reflected with an increase in breastfeeding rates. The strength of a mother’s BSE influences her thoughts and efforts regarding breastfeeding.
In a meta-analysis performed by Brockway, Benzies, and Hayden (2017), compared with those receiving standard care, mothers in intervention groups that focused on improving BSE reported BSE scores that were significantly higher at discharge and at one month and two months postpartum. Dieterich et al. (2013) also made the connection that low BSE is associated with perceptions of insufficient milk supply, which can then lead to the early termination of breastfeeding. In a study that looked at the perceptions, experiences and attitudes towards breastfeeding among Hispanic women living in rural Washington state, women reported avoiding breastfeeding in public because they perceived people in the United States to be offended by breastfeeding mothers (Hohl et at., 2016). One woman mentioned, “It’s just that here [in the U.S], there are many people that don’t see [breastfeeding as] normal…I think that it’s normal. And many people see it as dirty and they’re always with that mentality, that, ‘Oh look, how is she not embarrassed?’” (Hohl et at., 2016).
The primary goal of this project is to decrease the incidence of necrotizing enterocolitis (NEC) in LA County by increasing the number of Hispanic women who are breastfeeding their infant upon hospital discharge at California Hospital Medical Center. The health objective is to reduce NEC by 20% among Hispanic infants in LA County by the end of the project (2 years). The behavioral objective of the project is to increase hospital-discharge breastfeeding rates of LA County Hispanic mothers by 20% by the end of the project, which will be measured administering self-reported questionnaires. The environmental objective of the program will be to eliminate infant feeding formula marketing materials such as signs, posters, coupons, and free products, as well as add additional breastfeeding promotion materials featuring Hispanic mothers and babies in 100% of California Hospital Medical Center after 1 year of the program’s initiation.
