title: Engaging field-based professionals in a qualitative assessment of barriers and positive contributors to breastfeeding using the social ecological model.
abstract: Despite broad recognition of benefits associated with breastfeeding, rates in the United States continue to be below targets established by Healthy People 2020, especially for economically disadvantaged women. This study engaged field-based professionals through a focus group process to collect perceptions on factors that determine a woman's decision to breastfeed. Field-based professionals participated in one of six focus groups. Following the social ecological model (SEM), focus group questions addressed barriers and contributors to breastfeeding at the individual, interpersonal, community, organizational, and public policy levels. Thematic content analysis was used in identifying, analyzing, and reporting on themes within the focus group data. Commonly reported themes were identified that negatively influence a mother's decision to breastfeed such as modesty/general discomfort to breastfeed in front of others, negative breastfeeding perceptions of family members, friends, boyfriends and co-workers, breastfeeding not being viewed as the societal "norm", and the availability of free formula samples. Despite identified barriers, commonly reported themes that positively influence a mother's decision to breastfeed included general knowledge on the benefits, positive breastfeeding perceptions of family members, friends, boyfriends, and co-workers, the availability of "mom and baby" groups, and Baby Friendly hospital practices. The findings provide field-based perspectives that identify opportunities to support breastfeeding through the lens of the SEM. Opportunities to better support breastfeeding include educating mothers and their social support systems on the specific benefits of breastfeeding, challenging existing breastfeeding norms, and working with hospitals on establishing policy to not provide free formula samples.
authors.affiliation: Department of Health Science, Keene State College, 229 Main Street, Keene, NH, 03435-2903, USA, rdunn@keene.edu.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Dunn
authors.forename: Karrie A
authors.initials: KA
authors.lastname: Kalich
authors.forename: Margaret J
authors.initials: MJ
authors.lastname: Henning
authors.forename: Rudolph
authors.initials: R
authors.lastname: Fedrizzi
mesh_terms: D001942:Breast Feeding / Q000523:psychology*; D002755:Choice Behavior; D055812:Community-Based Participatory Research; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D009513:New Hampshire; D011640:Public Policy; D036301:Qualitative Research; D012931:Social Environment; D012944:Social Support; D012959:Socioeconomic Factors
references.citation: J Perinat Educ. 2003 Summer;12(3):7-15
references.pmid: 17273349
references.citation: J Adv Nurs. 2004 Nov;48(4):361-70
references.pmid: 15500530
references.citation: Breastfeed Med. 2011 Jun;6(3):145-9
references.pmid: 21034164
references.citation: Matern Child Health J. 2012 Dec;16(9):1887-95
references.pmid: 22205423
references.citation: BMC Med Res Methodol. 2011 Mar 11;11:26
references.pmid: 21396104
references.citation: J Obstet Gynecol Neonatal Nurs. 2007 Jan-Feb;36(1):9-20
references.pmid: 17238942
references.citation: MCN Am J Matern Child Nurs. 2002 May-Jun;27(3):154-61; quiz 162
references.pmid: 12015443
references.citation: Nurs Outlook. 2013 Nov-Dec;61(6):466-70
references.pmid: 23993250
references.citation: J Clin Nurs. 2010 Jul;19(13-14):2014-22
references.pmid: 20920027
references.citation: Matern Child Health J. 2012 Dec;16(9):1926-32
references.pmid: 22246714
references.citation: Breastfeed Med. 2010 Feb;5(1):9-15
references.pmid: 19772374
references.citation: Matern Child Health J. 2004 Jun;8(2):65-70
references.pmid: 15198173
references.citation: Breastfeed Med. 2009 Oct;4 Suppl 1:S41-3
references.pmid: 19827922
references.citation: Health Educ Q. 1988 Winter;15(4):351-77
references.pmid: 3068205
references.citation: J Am Diet Assoc. 2010 May;110(5):702-9
references.pmid: 20430131
references.citation: Matern Child Health J. 2012 Nov;16(8):1583-93
references.pmid: 21822964
references.citation: J Hum Lact. 2006 Feb;22(1):27-38
references.pmid: 16467285
references.citation: J Hum Lact. 2010 Aug;26(3):266-73
references.pmid: 20689103
references.citation: Am J Health Promot. 1996 Mar-Apr;10(4):282-98
references.pmid: 10159709
references.citation: Breastfeed Med. 2009 Mar;4(1):25-30
references.pmid: 19196037
references.citation: J Nurs Scholarsh. 2002;34(3):235-41
references.pmid: 12237985
references.citation: MCN Am J Matern Child Nurs. 2013 Jul-Aug;38(4):244-9
references.pmid: 23812063
references.citation: Matern Child Health J. 2008 May;12(3):402-14
references.pmid: 17636458
references.citation: J Perinat Educ. 2004 Summer;13(3):39-50
references.pmid: 17273399
references.citation: J Hum Lact. 2007 Nov;23(4):314-24
references.pmid: 17991796
references.citation: Pediatrics. 2005 May;115(5):1367-77
references.pmid: 15867049