title: Exploration of factors influencing initiation and continuation of breastfeeding among Hispanic women living in rural settings: a multi-methods study.
abstract: BACKGROUND
  Healthy People 2020 has the important goal of increasing the number of breastfed babies in the USA. The purpose of this pilot study was to explore factors that influence breastfeeding initiation and continuation among Hispanic women living in rural settings. Further, the objective of this study was to develop a framework for an educational breastfeeding program to meet the needs of Hispanic women living in rural settings.
  
  
  METHODS
  A convenience sample of 12 Hispanic women, age 19 years or older, was enrolled from the Regional West Medical Center, Scottsbluff, a rural setting in Nebraska, during October 2012. A multimethod approach was used to gather both quantitative and qualitative data. Two focus groups were conducted to collect qualitative data, and various quantitative variables included study population characteristics, Breastfeeding Self-efficacy Scale Short Form (BSES-SF) and Breastfeeding Attrition Prediction Tool (BAPT).
  
  
  RESULTS
  The majority of the mothers did not take prenatal breastfeeding classes and did not intend to (83%, n=10). Half of the participants decided at the time they were pregnant to breastfeed their children. The most common factors for deciding to breastfeed were the perceived benefits for the health of the baby, and family influence. The average BSES-SF score was 55 (s=12), with the scores ranging from 36 to 67. BAPT results indicated an above-average intention to breastfeed with an average of 31 (standard deviation 4). Results of the focus group, BSES-SF and BAPT helped to develop submodules such as breastfeeding initiation, feeding cues, nutrition for breastfeeding mother and cost-effectiveness of breastfeeding.
  
  
  CONCLUSIONS
  The study describes the factors that impact on breastfeeding practices among Hispanic rural women. Further, assessment of BSES and BAPT scales facilitate the development of the breastfeeding educational content. The study highlights the importance of behavioral and cultural factors that might be essential to increase adoption of breastfeeding among Hispanic rural women.
authors.affiliation: Center for Global Health and Development, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA. ashish.joshi@unmc.edu.
authors.forename: Ashish
authors.initials: A
authors.lastname: Joshi
authors.affiliation: Center for Global Health and Development, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA. kate.trout@unmc.edu.
authors.forename: Kate E
authors.initials: KE
authors.lastname: Trout
authors.affiliation: College of Nursing, West Nebraska Division, University of Nebraska Medical Center, Scottsbluff, Nebraska, USA. taguirre@unmc.edu.
authors.forename: Trina
authors.initials: T
authors.lastname: Aguirre
authors.affiliation: College of Nursing, West Nebraska Division, University of Nebraska Medical Center, Scottsbluff, Nebraska, USA. slwilhel@unmc.edu.
authors.forename: Susan
authors.initials: S
authors.lastname: Wilhelm
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000208:ethnology*; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D009329:Nebraska; D010865:Pilot Projects; D011594:Psychometrics; D012424:Rural Population; D020377:Self Efficacy; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Assessment; Health Promotion; Maternal and Child Health; Nutrition