Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA.
Food and Health Lab at Montana State University, Department of Health and Human Development, 960 Technology Blvd., Room 215, Bozeman, MT 59717, USA.
Soc Sci Med. 2018 Jul;208:80-88. doi: 10.1016/j.socscimed.2018.05.017. Epub 2018 May 8.
While breastfeeding is well recognized as beneficial, rates of breastfeeding among American Indian women are below average and contribute to health inequities. Culturally specific approaches to breastfeeding research are called for to inform appropriate interventions in American Indian communities. Specifically, a grandmother's role in breastfeeding promotion is of great import particularly in American Indian (AI) groups, although is an understudied topic to date.
This research seeks to fill a prominent literature gap by utilizing a grounded theory and community-based research approach to inform breastfeeding practices from the voices of grandmothers and health care professionals in a rural AI community in the United States.
A community-based approach guided the research process. Convenience and snowball sampling was used to recruit for semi-structured and follow up member checking interviews with AI grandmothers (n = 27) and health care professionals (n = 7). Qualitative data were transcribed, characterized into meaning units, and coded by a review panel. Data were reconciled for discrepancies among reviewers, organized thematically, and used to generate community-specific breastfeeding constructs.
Three major themes emerged, each with relevant subthemes: (1) importance of breastfeeding; (2) attachment, bonding, and passing on knowledge; and (3) overburdened health care system. Multiple subthemes represent stressors and impact breastfeeding knowledge, translation, and practice within this community including formula beliefs, historical traumas, societal pressures, mistrust, and substance abuse.
Interventions designed to raise breastfeeding rates in the study site community would ideally be grounded in tribal resources and involve a collaborative approach that engages the greater community, grandmothers, health care professionals, and scientific partners with varying skills. More research is needed to determine stressors and any potential impact on infant feeding practices among other AI groups. Application of the research approach presented here to other AI communities may be beneficial for understanding opportunities and challenges to breastfeeding practices.
尽管母乳喂养的益处已得到广泛认可，但美国印第安女性的母乳喂养率低于平均水平，这导致了健康方面的不平等。需要采用针对特定文化的方法来研究母乳喂养，以为美国印第安社区提供适当的干预措施。具体来说，祖母在促进母乳喂养方面的作用非常重要，特别是在美国印第安（AI）群体中，尽管迄今为止这一主题的研究还很少。
本研究旨在利用扎根理论和基于社区的研究方法，从美国一个农村 AI 社区的祖母和医疗保健专业人员的角度来了解母乳喂养的实践，从而填补该领域的重要文献空白。
社区为基础的方法指导了研究过程。采用方便抽样和滚雪球抽样的方法，对 AI 祖母（n=27）和医疗保健专业人员（n=7）进行半结构式和后续成员检查访谈。对定性数据进行转录、特征化为有意义的单位，并由评审小组进行编码。评审小组成员对数据进行了审查，以解决其中的差异，对数据进行了主题组织，并用于生成特定社区的母乳喂养结构。
出现了三个主要主题，每个主题都有相关的子主题：（1）母乳喂养的重要性；（2）依恋、结合和传递知识；（3）负担过重的医疗保健系统。多个子主题代表了该社区中对母乳喂养知识、翻译和实践产生影响的压力源，包括配方奶信仰、历史创伤、社会压力、不信任和药物滥用。
旨在提高研究地点社区母乳喂养率的干预措施，理想情况下应立足于部落资源，并采用一种协作方法，让更广泛的社区、祖母、医疗保健专业人员和具有不同技能的科学合作伙伴共同参与。需要进一步研究以确定压力源以及其对其他 AI 群体婴儿喂养实践的潜在影响。将本文提出的研究方法应用于其他 AI 社区，可能有助于了解母乳喂养实践的机会和挑战。
