Individual breastfeeding support with contingent incentives for low-income mothers in the USA: the ‘BOOST (Breastfeeding Onset & Onward with Support Tools)’ randomised controlled trial protocol

Abstract

IntroductionNational breastfeeding rates have improved in recent years, however, disparities exist by socioeconomic and psychosocial factors. Suboptimal breastfeeding overburdens the society by increasing healthcare costs. Existing breastfeeding supports including education and peer support have not been sufficient in sustaining breastfeeding rates especially among low-income women. The preliminary outcomes of contingent incentives for breastfeeding in addition to existing support show promising effects in sustaining breastfeeding among mothers in the Special Supplemental Nutrition Programme for women, infants and children (WIC).Methods and analysisThis trial uses a parallel randomised controlled trial. This trial is conducted at two sites in separate states in the USA. Mothers who were enrolled in WIC and initiated breastfeeding are eligible. Participants (n=168) are randomised into one of the two study groups: (1) standard care control (SC) group consisting of WIC breastfeeding services plus home-based individual support or (2) SC plus breastfeeding incentives (SC +BFI) contingent on demonstrating successful breastfeeding. All participants receive standard breastfeeding services from WIC, home-based individual support and assessments. Participants in SC receive financial compensation based on the number of completed monthly home visits, paid in a lump sum at the end of the 6-month intervention period. Participants in SC +BFI receive an escalating magnitude of financial incentives contingent on observed breastfeeding, paid monthly during the intervention period, as well as bonus incentives for selecting full breastfeeding food packages at WIC. The primary hypothesis is that monthly incentives contingent on breastfeeding in SC +BFI will significantly increase rates of any breastfeeding compared with SC. The primary outcome is the rate of any breastfeeding over 12 months. Randomisation is completed in an automated electronic system. Staff conducting home visits for support and assessments are blinded to study groups.Ethics and disseminationThe Advarra Institutional Review Board has approved the study protocol (Pro00033168). Findings will be disseminated to our participants, scientific communities, public health officials and any other interested community members.Trial registration numberNCT03964454

How does Governance Impact Malnutrition ? A Close Look at Factors Associated with Underweight in Children Under 5 Years in Ghana

“…This paper makes the nding of negative externalities faced by urban dwellers due to di culty by the health workers to send information to all residents in a locality especially poor urban communities as a result of a lack of consultation with residents and The paper makes the nding of rent-seeking behavior by members of mother support groups in urban areas who demand for incentives and payments in return for their services which conforms with similar nding by (Mercier, 2019) in her study of United States food aid programs found that, when these programs initially commenced they provided rents to implementing partners through their purchasing and shipping preferences which moved more of the program resources to producers of requested commodities, non-governmental organizations and shipping companies often raising program cost and resulting in the achievement of suboptimal program goals .Findings by (Washio et al, 2020) attest to nancial incentives provided to experimental subjects in a randomized control trial in the special supplemental nutrition program for women infants and children to signi cantly increase breastfeeding rates. However rate increases obtained were contingent on any level of breastfeeding rather than exclusive breastfeeding which would have been the ultimate.…”

“…commodities, non-governmental organizations and shipping companies often raising program cost and resulting in the achievement of suboptimal program goals .Findings by(Washio et al, 2020) attest to nancial incentives provided to experimental subjects in a randomized control trial in the special supplemental nutrition program for women infants and children to signi cantly increase breastfeeding rates. However rate increases obtained were contingent on any level of breastfeeding rather than exclusive breastfeeding which would have been the ultimate.…”

Racial and socioeconomic disparities in breast milk feedings in US neonatal intensive care units

“…CCTs should (1) focus on sustaining not initiating MOM provision; 142,144,145 (2) use cash rather than non-cash payments; 145,146 (3) make payments frequently to strengthen the impact of the intervention; 150 (4) compensate mothers fairly for MOM provision; 140 and (5) focus on short-term behavior change, for which CCTs have been shown most effective vs long-term or lifelong behavior change. 151 Ongoing RCTs of CCT in US term 152 and VLBW infants 153 will provide evidence regarding the efficacy of this strategy in reducing disparities in MOM feedings.…”

Study protocol for reducing disparity in receipt of mother’s own milk in very low birth weight infants (ReDiMOM): a randomized trial to improve adherence to sustained maternal breast pump use

“…This innovative economic intervention bundle is based on principles of conditional cash transfers (CCTs). While CCTs have and are currently being investigated in term populations to increase lactation rates [52,53], they have not been tested as an intervention to increase MOM provision by mothers of hospitalized very preterm (VP, < 32 weeks gestational age (GA), inclusive of extremely preterm (EP), < 28 weeks GA) infants. Data from an RCT in term infants demonstrate that the use of a CCT resulted in higher rates of any but not of exclusive breastfeeding at 6-8 weeks post-birth but had no effect on mothers' decisions to initiate lactation [52].…”