title: Using group model building to develop a culturally grounded model of breastfeeding for low-income African American women in the USA.
abstract: OBJECTIVE
  To identify barriers and supporting factors for breastfeeding, and the dynamic interactions between them, as identified by low-income African American women and lactation peer helpers.
  
  
  BACKGROUND
  Stark breastfeeding disparities exist between African American mothers and their White counterparts in the USA. This pattern is often replicated across the globe, with marginalised populations demonstrating decreased breastfeeding rates. While breastfeeding research focused on sociocultural factors for different populations has been conducted, a more dynamic model of the factors impacting breastfeeding may help identify effective leverage points for change.
  
  
  METHODS
  Group model building was used as a grounded theoretical approach, to build and validate a model representing factors impacting breastfeeding and the relationships between them.
  
  
  METHODS
  Low-income African American women (n = 21) and lactation peer helpers (n = 3) were engaged in model building sessions to identify factors impacting breastfeeding. A two-cycle process was used for analysis, in vivo and axial coding. The final factors and model were validated with a subgroup of participants.
  
  
  RESULTS
  The participants generated 82 factors that make breastfeeding easier, and 86 factors that make breastfeeding more challenging. These were grouped into 10 and 14 themes, respectively. A final model was constructed identifying three domains impacting breastfeeding: a mother's return to work or school, her knowledge, support and persistence, and the social acceptance of breastfeeding.
  
  
  CONCLUSIONS
  This study documented the sociocultural context within which low-income African American women are situated by identifying factors impacting breastfeeding, and the dynamic interactions between them. The model also provided various leverage points from which breastfeeding women can be supported.
  
  
  CONCLUSIONS
  Postpartum nurses are critical in supporting breastfeeding practices. To be most effective, they must be aware of the factors impacting breastfeeding, some of which may be unique to women based on their culture.
authors.affiliation: College of Public Health, The Ohio State University, Columbus, OH, USA.
authors.forename: Rebecca
authors.identifier: http://orcid.org/0000-0001-9174-2891
authors.initials: R
authors.lastname: Reno
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology; D001291:Attitude of Health Personnel; D001942:Breast Feeding / Q000208:ethnology* / Q000523:psychology; D005260:Female; D066296:Grounded Theory; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D054625:Healthcare Disparities; D006801:Humans; D009035:Mothers / Q000523:psychology; D010379:Peer Group; D011181:Postnatal Care; D011203:Poverty / Q000523:psychology; D012944:Social Support; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: breastfeeding; breastfeeding disparities; grounded theory; postpartum nurses; systems dynamics