Calloway Eric E, Stern Katie L, Schober Daniel J, Yaroch Amy L
Gretchen Swanson Center for Nutrition, 8401 West Dodge Road, Suite 100, Omaha, NE, 68114, USA.
College of Liberal Arts and Social Sciences, DePaul University, 14 E. Jackson Blvd., MPH Suite 710, Room 710D, Chicago, IL, 60604, USA.
Matern Child Health J. 2017 Apr;21(4):809-817. doi: 10.1007/s10995-016-2174-y.
Objectives To understand the process by which early childhood education (ECE) providers effectively used an existing intervention to facilitate the creation or strengthening of a written breastfeeding policy, understand the factors important to this process, and present a logic model to guide future intervention design and evaluation. Methods A purposive sample of interviewees who recently completed an ECE nutrition and physical activity intervention and reported positive pre-post scores for breastfeeding support were recruited to complete semi-structured interviews. Interviews were recorded, transcribed, and coded, following a Grounded Theory approach. Results The ECE programs (n = 23) had a written breastfeeding policy and were located across six states in the United States. The most common aspects of breastfeeding support covered in the policies were handling and storing of breastmilk, pieces of equipment to be provided (e.g., breast pump), and the creation of a space or room designated for breastfeeding and pumping. Many factors important to the policy creation process were identified such as motivation, education, technical assistance, perceptions of parental indifference, staff buy-in, and time and administrative constraints. Once motivated to create a policy, ECE providers described actions, such as gathering background information and model policies, discussing policy needs with stakeholders, utilizing technical assistance, and overcoming barriers. Conclusions for Practice From these findings, a logic model was created to guide future intervention design and evaluation, and several recommendations were made to help guide subsequent interventions in promoting the development and implementation of written breastfeeding policies at ECE programs.
目标 了解幼儿教育（ECE）提供者有效利用现有干预措施来促进制定或强化书面母乳喂养政策的过程，理解该过程中重要的因素，并提出一个逻辑模型以指导未来的干预设计和评估。方法 采用目的抽样法，招募了近期完成幼儿教育营养与身体活动干预且报告母乳喂养支持前后得分呈阳性的受访者，以完成半结构化访谈。按照扎根理论方法对访谈进行录音、转录和编码。结果 幼儿教育项目（n = 23）有书面母乳喂养政策，分布在美国六个州。政策中涵盖的母乳喂养支持最常见的方面包括母乳的处理和储存、要提供的设备（如吸奶器），以及设立专门用于母乳喂养和吸奶的空间或房间。确定了许多对政策制定过程重要的因素，如动机、教育、技术援助、对家长冷漠态度的认知、工作人员的支持，以及时间和行政限制。一旦有动力制定政策，幼儿教育提供者描述了一些行动，如收集背景信息和示范政策、与利益相关者讨论政策需求、利用技术援助以及克服障碍。实践结论 根据这些发现，创建了一个逻辑模型以指导未来的干预设计和评估，并提出了若干建议，以帮助指导后续干预措施，促进幼儿教育项目书面母乳喂养政策的制定和实施。
