title: Health care and social service providers' descriptions of pacific islander mothers' breastfeeding patterns.
abstract: BACKGROUND
  Despite recommendations and numerous health benefits attributed to breastfeeding, rates in the United States are below desired levels, particularly within vulnerable populations. In Hawaií, breastfeeding rates are higher than national averages except in Native Hawaiian and other Pacific Islander populations. Health care and social service providers are integral to successful breastfeeding promotion efforts. They are in an ideal position to reflect on the context in which their clients live and on its relationship to breastfeeding activities. The aim of this study was to describe health care and social service providers' perceptions of the influences on the breastfeeding patterns of Pacific Islander women.
  
  
  METHODS
  Focus ethnographic methods were used to collect interview data from health care and social service providers (N=20) serving Native Hawaiian and Pacific Islander women in one rural community. An iterative analysis process of coding and categorizing, followed by conceptual abstraction into patterns, was completed.
  
  
  RESULTS
  Four patterns emerged: shaped by connections, lived unfamiliarity, stressed by circumstance, and missed opportunities. Participants' insights concerning the needs of this population yielded population-specific issues and health care system issues affecting breastfeeding promotion. A number of gaps in breastfeeding services were identified.
  
  
  CONCLUSIONS
  Sociocultural, maternal knowledge, and workload barriers to successful breastfeeding predominated providers' perspectives. Broader system and community level issues were implied, but not directly addressed. The nature of successful breastfeeding support and promotion requires inclusion of this broader level perspective.
authors.affiliation: University of Hawaií at Hilo, 200 W. Kawili Street UCB 237, Hilo, HI 96720, USA. jflood@hawaii.edu
authors.forename: Jeanie L
authors.initials: JL
authors.lastname: Flood
authors.forename: Joan E
authors.initials: JE
authors.lastname: Dodgson
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000453:epidemiology / Q000208:ethnology / Q000523:psychology; D005260:Female; D017144:Focus Groups; D006254:Hawaii / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods / Q000458:organization & administration; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D044468:Native Hawaiian or Pacific Islander / Q000523:psychology* / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data; D012919:Social Behavior; D012944:Social Support; D012947:Social Work / Q000706:statistics & numerical data; D016526:Workload