Engaging Field-Based Professionals in a Qualitative Assessment of Barriers and Positive Contributors to Breastfeeding Using the Social Ecological Model

Abstract

Despite broad recognition of benefits associated with breastfeeding, rates in the United States continue to be below targets established by Healthy People 2020, especially for economically disadvantaged women. This study engaged field-based professionals through a focus group process to collect perceptions on factors that determine a woman's decision to breastfeed. Field-based professionals participated in one of six focus groups. Following the social ecological model (SEM), focus group questions addressed barriers and contributors to breastfeeding at the individual, interpersonal, community, organizational, and public policy levels. Thematic content analysis was used in identifying, analyzing, and reporting on themes within the focus group data. Commonly reported themes were identified that negatively influence a mother's decision to breastfeed such as modesty/general discomfort to breastfeed in front of others, negative breastfeeding perceptions of family members, friends, boyfriends and co-workers, breastfeeding not being viewed as the societal "norm", and the availability of free formula samples. Despite identified barriers, commonly reported themes that positively influence a mother's decision to breastfeed included general knowledge on the benefits, positive breastfeeding perceptions of family members, friends, boyfriends, and co-workers, the availability of "mom and baby" groups, and Baby Friendly hospital practices. The findings provide field-based perspectives that identify opportunities to support breastfeeding through the lens of the SEM. Opportunities to better support breastfeeding include educating mothers and their social support systems on the specific benefits of breastfeeding, challenging existing breastfeeding norms, and working with hospitals on establishing policy to not provide free formula samples.

Workplace support and breastfeeding duration: The mediating effect of breastfeeding intention and self‐efficacy

“…Understanding the pathway between workplace environments and breastfeeding duration is necessary to design effective interventions. This study is grounded in the social‐ecological model that is adapted to fit health promotion activities due to widespread consensus that individual behaviors are influenced by social environments . The social‐ecological model also states that community and social environmental factors can interact with individual factors, such as breastfeeding intentions and self‐efficacy, to produce a desired outcome (ie, breastfeeding duration)…”

“…This study is grounded in the social-ecological model that is adapted to fit health promotion activities due to widespread consensus that individual behaviors are influenced by social environments. 13 The social-ecological model 14 also states that community and social environmental factors can interact with individual factors, such as breastfeeding intentions and self-efficacy, to produce a desired outcome (ie, breastfeeding duration). 15 Several studies have demonstrated a relationship between breastfeeding intention, self-efficacy, and breastfeeding duration.…”

Pacifier use in newborns: related to socioeconomic status but not to early feeding performance

“…Due to the significant benefits of breastfeeding (2)(3)(4), education and support are common in and out of the hospital. However, there are many prenatal, medical, hospital, societal and sociocultural barriers that make it more difficult for mothers to actively meet the recommended goals for breastfeeding (5,6). One potential barrier to breastfeeding that has been identified is the use of artificial teats (7)(8)(9)(10)(11)(12)(13).…”

The Maternal Ecology of Breastfeeding: A Life Course Developmental Perspective

“…As ecological models have demonstrated [Dunn, Kalich, Henning, & Fedrizzi, 2015;Vitzthum & Aguayo, 1998], a nested set of environments provides the context in which infant feeding decisions occur. These nested contexts provide the backdrop to the pre-action and action phases that follow, informing and moderating the ongoing decision-making and behaviors going forward in time.…”