Research Institute for Equitable Development EQUIDE, Universidad Iberoamericana, Mexico City, Mexico.
Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA.
Int Breastfeed J. 2020 Jun 29;15(1):59. doi: 10.1186/s13006-020-00297-6.
Mexico has shown a worrisome decrease in breastfeeding indicators, especially in the lowest socioeconomic level. Improving breastfeeding protection, promotion, and support services through workforce development is a key area of intervention. The objective of this study is to assess the influence on breastfeeding knowledge and abilities of a semi-virtual training for primary healthcare providers assisting beneficiaries of PROSPERA in Mexico, which is one of the largest conditional cash-transfer programs in the world.
Two independent cross-sectional samples of healthcare providers were drawn at baseline and post-intervention in three states of Mexico. Baseline data were collected among primary physicians, registered nurses and nurse technicians (i.e. unit of analysis) on July 2016 (n = 529) and post-training between March and April 2017 (n = 211). A 19-item telephone questionnaire assessed providers' general knowledge about breastfeeding, breastfeeding benefits and clinical aspects of breastfeeding, clinical ability to solve problems and abilities to overcome breastfeeding challenges. The effects of the training were assessed through a propensity score matching (PSM) stratified by types of providers (i.e. physicians, registered nurses, nurse technicians).
The PSM analysis showed significant improvements among all providers in the general knowledge about breastfeeding (around 20 percentage points [pp]) and knowledge about breastfeeding benefits (approximately 50 pp). In addition, physicians improved their knowledge about clinical aspects of breastfeeding (7 pp), while registered nurses improved in their ability to solve breastfeeding problems (14 pp) and in helping mothers overcome breastfeeding challenges (12 pp).
Promoting a breastfeeding enabling environment in Mexico to improve breastfeeding rates will require improving the knowledge and skills of healthcare providers. While a semi-virtual training showed large improvements in knowledge, developing skills among providers may require a more intensive approach.
墨西哥的母乳喂养指标呈令人担忧的下降趋势，尤其是在社会经济水平最低的人群中。通过发展劳动力来改善母乳喂养的保护、促进和支持服务是干预的关键领域。本研究的目的是评估对墨西哥 PROSPERA 受益人的初级保健提供者进行半虚拟培训对母乳喂养知识和能力的影响，PROSPERA 是世界上最大的有条件现金转移支付计划之一。
在墨西哥的三个州，分别在基线和干预后抽取了两组独立的初级保健提供者的横断面样本。基线数据于 2016 年 7 月（n=529）在初级医生、注册护士和护士技术员（即分析单位）中收集，培训后于 2017 年 3 月至 4 月之间收集（n=211）。一个 19 项的电话问卷评估了提供者对母乳喂养的一般知识、母乳喂养的益处以及母乳喂养的临床方面、解决问题的临床能力和克服母乳喂养挑战的能力。通过倾向评分匹配（PSM）按提供者类型（即医生、注册护士、护士技术员）分层来评估培训的效果。
PSM 分析显示，所有提供者在母乳喂养的一般知识（约 20 个百分点[pp]）和母乳喂养益处的知识（约 50pp）方面都有显著提高。此外，医生提高了他们对母乳喂养临床方面的知识（7pp），而注册护士提高了他们解决母乳喂养问题的能力（14pp）和帮助母亲克服母乳喂养挑战的能力（12pp）。
为了提高母乳喂养率，在墨西哥营造一个有利于母乳喂养的环境，需要提高医疗保健提供者的知识和技能。虽然半虚拟培训在知识方面显示出了较大的提高，但要提高提供者的技能，可能需要更密集的方法。
