Rainbow Babies and Children’s Hospital and Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA.
Breastfeed Med. 2013 Feb;8(1):73-8. doi: 10.1089/bfm.2012.0027. Epub 2012 Aug 14.
Low breastfeeding rates persist as a health disparity among high-risk inner-city mothers. We sought to obtain input of community health workers (CHWs) in preparation for a breastfeeding intervention.
We conducted audiotaped focus groups with CHWs of the Cleveland (OH) Department of Public Health's MomsFirst™, a federally funded Healthy Start program, which addressed interest in breastfeeding, positives and negatives of breastfeeding, perceived barriers, and an intervention concept. We used notes-based and tape-based analysis with a previously developed theme code modified for breastfeeding relevance.
Seventeen (50%) of 34 actively employed CHWs participated in two focus groups. Issues that emerged were as follows: (1) breastfeeding is "hard" for young mothers, with multiple obstacles identified, including lack of support at home, pain with nursing, extra time required, incompatibility with medications and lifestyle, body image concerns, and "no equipment" (breast pumps); (2) expected supports such as postpartum hospital care have not been helpful, and in-home help is needed; (3) many CHWs' personal breastfeeding experiences were difficult; (4) CHWs requested additional breastfeeding education for themselves; and (5) while strongly endorsing "making a difference" in their clients' lives, CHWs worried that additional curricular mandates would create burden that could become a disincentive.
CHWs who make home visits are in a unique position to impact their clients' breastfeeding decisions. A targeted intervention for high-risk inner-city mothers must meet the educational needs of the teachers (CHWs) while minimizing administrative burden, address issues identified by the clients (mothers), and provide hands-on help within the home.
低母乳喂养率仍然是高风险城市内母亲的健康差异。我们试图获得社区卫生工作者（CHW）的投入，为母乳喂养干预做准备。
我们对克利夫兰（俄亥俄州）公共卫生部的 MomsFirst ™的 CHW 进行了录音焦点小组讨论，这是一个由联邦政府资助的健康起点计划，该计划涉及对母乳喂养的兴趣、母乳喂养的积极和消极方面、感知障碍以及干预概念。我们使用基于注释和基于磁带的分析，并使用先前开发的主题代码进行了修改，以适应母乳喂养的相关性。
34 名在职 CHW 中有 17 名（50%）参加了两个焦点小组。出现的问题如下：（1）母乳喂养对年轻母亲来说“很难”，有多个障碍，包括家庭缺乏支持、母乳喂养疼痛、需要额外时间、与药物和生活方式不兼容、身体形象问题和“没有设备”（吸奶器）；（2）预期的支持，如产后医院护理，并没有帮助，需要家庭帮助；（3）许多 CHW 的个人母乳喂养经历都很困难；（4）CHW 要求为自己提供更多的母乳喂养教育；（5）虽然强烈支持“在客户生活中有所作为”，但 CHW 担心额外的课程要求会增加负担，从而成为一种抑制因素。
进行家访的 CHW 处于影响客户母乳喂养决定的独特地位。针对高风险城市内母亲的目标干预措施必须满足教师（CHW）的教育需求，同时最大限度地减少行政负担，解决客户（母亲）确定的问题，并在家庭中提供实际帮助。
