Martinez-Brockman Josefa L, Granner Josephine R, Buchanan Brice, Acosta Lisbette, Lonczak Marilyn, Goeschel Lori, Xu Xiao, Curry Leslie, Nunez-Smith Marcella, Pérez-Escamilla Rafael
Department of General Internal Medicine, Yale University School of Medicine, New Haven, CT, United States of America.
Equity Research and Innovation Center, Department of General Internal Medicine, Yale University School of Medicine, New Haven, CT, United States of America.
PLoS One. 2025 Jan 9;20(1):e0313779. doi: 10.1371/journal.pone.0313779. eCollection 2025.
Breastfeeding (BF) is vital for maternal and infant health, yet post-hospital discharge support remains a challenge. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides BF peer counseling prenatally and up to 1-year postpartum among low-income women in the United States. The Lactation Advice Through Texting Can Help (LATCH) intervention is an evidence-based two-way text messaging intervention that provides BF education and support in the WIC peer counseling program. The intervention is implemented by peer counselors (PCs) in the WIC program, with the supervision and support of a lactation consultant. The aim of this qualitative study was to assess the barriers and facilitators to the implementation of LATCH during the feasibility trial and to investigate strategies for adapting and scaling up the intervention. In-depth interviews with LATCH and PC program key informants aimed to evaluate the intervention and explore its adaptation and scale-up. Interviews were analyzed using line by line inductive thematic analysis. Findings were mapped to the Model for Adaptation Design and Impact (MADI) framework to describe the proposed adaptations, and to the Program Impact Pathways (PIP) framework to identify causal pathways and critical quality control points. Results demonstrate that LATCH facilitates continued engagement between PCs and WIC mothers; however, implementation feasibility issues remain. Suggested adaptations to LATCH include the use of an integrated comprehensive platform, ensuring continuity of care through an expanded spectrum of communication options, the need to develop a PC support model for "off hours" (non-business hours), and the need to obtain local WIC office management's buy-in for the communications platform and the off-hours PC model. Critical quality control points were identified when results were mapped to the MADI and PIP frameworks. Implementing these changes has the potential to expand access to BF peer counseling support and improve BF equity among low-income women.
母乳喂养对母婴健康至关重要，但出院后的支持仍是一项挑战。妇女、婴儿和儿童特别补充营养计划（WIC）在美国为低收入妇女提供产前至产后1年的母乳喂养同伴咨询。通过短信提供泌乳建议有助于（LATCH）干预是一种基于证据的双向短信干预，在WIC同伴咨询计划中提供母乳喂养教育和支持。该干预由WIC计划中的同伴咨询师（PC）在泌乳顾问的监督和支持下实施。这项定性研究的目的是评估可行性试验期间实施LATCH的障碍和促进因素，并调查调整和扩大该干预措施的策略。对LATCH和PC计划关键信息提供者进行深入访谈，旨在评估该干预措施并探索其调整和扩大规模的方法。访谈采用逐行归纳主题分析进行分析。研究结果被映射到适应设计与影响模型（MADI）框架以描述提议的调整，并映射到计划影响路径（PIP）框架以识别因果路径和关键质量控制点。结果表明，LATCH促进了PC与WIC母亲之间的持续互动；然而，实施可行性问题仍然存在。对LATCH的建议调整包括使用集成的综合平台，通过扩大沟通选项范围确保护理的连续性，需要为“非工作时间”（非营业时间）开发PC支持模式，以及需要获得当地WIC办公室管理层对通信平台和非工作时间PC模式的认可。当研究结果映射到MADI和PIP框架时，确定了关键质量控制点。实施这些改变有可能扩大获得母乳喂养同伴咨询支持的机会，并改善低收入妇女中的母乳喂养公平性。
