title: Breastfeeding knowledge, attitudes, and practices among providers in a medical home.
abstract: OBJECTIVE
  Breastfeeding offers numerous health advantages to children, mothers, and society. From obstetrics to pediatrics, breastfeeding dyads come in contact with a wide range of healthcare providers. The American Academy of Pediatrics (AAP) calls for pediatricians to support breastfeeding enthusiastically and for all children to have a medical home. We studied an inner-city healthcare system with a Dyson Community Pediatrics Training Initiative Model Medical Home clinic, to explore how a breastfeeding/baby-friendly medical home might be built upon this framework. We describe breastfeeding knowledge, attitudes, and practices among a full range of providers and healthcare system-level barriers to effective and coordinated breastfeeding services.
  
  
  METHODS
  We conducted eight focus groups using semistructured interviews: (1) pediatricians; (2) obstetricians; (3) pediatric nurses and allied health professionals; (4) obstetric nurses and allied health professionals; (5) 24-hour telephone triage answering service nurses; (6) public health nurses; (7) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) personnel; and (8) lactation consultants and peer counselors.
  
  
  RESULTS
  We identified gaps in providers' breastfeeding knowledge, counseling skills, and professional education and training. Providers' cultures and attitudes affect breastfeeding promotion and support. Providers used their own breastfeeding experiences to replace evidence-based knowledge and AAP policy statement recommendations for breastfeeding dyads. There were communication disconnects between provider groups. Providers underestimated their own, and overestimated others', influence on breastfeeding. The system lacked a coordinated breastfeeding mission.
  
  
  CONCLUSIONS
  This study illuminated key disconnectedness challenges (and, hence, opportunities) for a model medical home in fostering continuous, comprehensive, coordinated, culturally effective, and evidence-based breastfeeding promotion and support.
authors.affiliation: Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA. kszucs@iupui.edu
authors.forename: Kinga A
authors.initials: KA
authors.lastname: Szucs
authors.forename: Donna J
authors.initials: DJ
authors.lastname: Miracle
authors.forename: Marc B
authors.initials: MB
authors.lastname: Rosenman
mesh_terms: D001942:Breast Feeding / Q000523:psychology*; D003376:Counseling; D004506:Education, Nursing; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000193:education* / Q000523:psychology*; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D007407:Interviews as Topic; D008880:Midwifery / Q000193:education; D009726:Nurses / Q000523:psychology; D009774:Obstetrics / Q000193:education; D010372:Pediatrics / Q000193:education; D014481:United States