Rhodes Elizabeth C, Wilde LaPlant Helen, Zahid Mahrukh, Abuwala Nafeesa, Damio Grace, Crummett Carrianne, Surprenant Rebecca, Pérez-Escamilla Rafael
Yale School of Public Health, Yale University, New Haven, CT, United States.
Hispanic Health Council, Hartford, CT, United States.
Front Health Serv. 2022 Nov 16;2:1020326. doi: 10.3389/frhs.2022.1020326. eCollection 2022.
The Breastfeeding Heritage and Pride program (BHP) provides evidence-based breastfeeding peer counseling to low-income women. Due to the COVID-19 pandemic, BHP shifted from delivering in-person and virtual services to providing only virtual services. Program adaptations can impact implementation success, which could influence program effectiveness. We documented program adaptations and explored their impacts on implementation outcomes, guided by the Model for Adaptation Design and Impact.
Through a community-clinical-academic partnership, we conducted in-depth interviews with 12 program implementers and peer counselors and conducted a rapid qualitative analysis. To efficiently capture information on adaptations over time, we collected and analyzed information from program meetings and extracted data from a program report. We then triangulated data from these multiple sources.
Peer counselors received training on virtual service delivery and increased supportive supervision. They recruited women via phone instead of in hospitals, which was viewed as feasible. In-person counseling visits at hospitals and clients' homes were replaced with phone and video calls. Examples of changes to the content delivered included breastfeeding education in the context of the pandemic such as the latest COVID-related infant feeding guidance, provision of face masks, and more assistance with social and economic challenges. Although peer counselors increasingly adopted video calls as a substitute for in-person visits, they emphasized that in-person visits were better for relationship building, helping with breastfeeding problems like latching, and identifying barriers to breastfeeding in the home environment like limited familial support. While adaptations were reactive in that they were made in response to the unanticipated COVID-19 pandemic, most were made with clear goals and reasons such as to ensure the safety of peer counselors and clients while maintaining service delivery. Most adaptations were made through a systematic process based on program implementers' expertise and best practices for peer counseling and were largely but not fully consistent with BHP's core functions.
BHP was able to shift to virtual service delivery for continued provision of breastfeeding counseling during the pandemic. Overall, virtual services worked well but were less optimal for several aspects of counseling. Evaluations of program effectiveness of virtual services are still needed.
母乳喂养传承与自豪项目（BHP）为低收入女性提供循证母乳喂养同伴咨询服务。由于新冠疫情，BHP从提供面对面和虚拟服务转变为仅提供虚拟服务。项目调整可能会影响实施的成功与否，进而可能影响项目效果。我们记录了项目调整情况，并在适应设计与影响模型的指导下，探讨了这些调整对实施结果的影响。
通过社区 - 临床 - 学术伙伴关系，我们对12名项目实施者和同伴咨询师进行了深入访谈，并进行了快速定性分析。为了有效获取随时间推移的调整信息，我们收集并分析了项目会议信息，并从一份项目报告中提取了数据。然后，我们对来自这些多个来源的数据进行了三角验证。
同伴咨询师接受了虚拟服务提供方面的培训，并增加了支持性监督。他们通过电话而非在医院招募女性，这被认为是可行的。医院和客户家中的面对面咨询访问被电话和视频通话所取代。所提供内容的变化示例包括在疫情背景下的母乳喂养教育，如最新的新冠相关婴儿喂养指南、提供口罩，以及在社会和经济挑战方面提供更多帮助。尽管同伴咨询师越来越多地采用视频通话来替代面对面访问，但他们强调面对面访问更有利于建立关系、帮助解决诸如 latch（文中未明确该词含义，可能是指衔乳等母乳喂养问题）等母乳喂养问题，以及识别家庭环境中母乳喂养的障碍，如家庭支持有限。虽然调整是被动做出的，即它们是为应对意外的新冠疫情而进行的，但大多数调整都有明确的目标和理由，例如在维持服务提供的同时确保同伴咨询师和客户的安全。大多数调整是通过基于项目实施者专业知识和同伴咨询最佳实践的系统过程进行的，并且在很大程度上但并非完全与BHP的核心功能一致。
BHP能够在疫情期间转向虚拟服务提供，以继续提供母乳喂养咨询。总体而言，虚拟服务运行良好，但在咨询的几个方面并非最佳。仍需要对虚拟服务的项目效果进行评估。
