Breastfeeding Attitudes and Social Support Among Christian African Americans.

Purpose: To describe the breastfeeding attitudes and subjective norms of breastfeeding among African American Christians from the New England region. Study Design and Methods: A study was conducted using an online survey. Participants were recruited from four Christian churches in the New England region during the summer of 2021. Responses from direct questions about exclusive breastfeeding histories were tabulated. Open-ended question responses were analyzed using thematic analysis. Two results were merged to make the conclusions. Results: Participants (n = 101) aged 18-44 years (62.3%), college graduates (72.3%), and Catholics (71.4%) responded. Participants were willing to recommend six months of exclusive breastfeeding practice to relatives (89.9%) and friends/peers (87.9%) and support relatives (94.0%) and friends/peers (94.8%) to practice exclusive breastfeeding for 6 months. Breastfeeding attitude themes included beneficial and natural and receiving breastfeeding support. Subjective norms of breastfeeding themes included receiving support for breastfeeding; Christian leadership, teachings, and communal engagements; and gaps in Christian influence. Conclusion: The African American Christian community may be an emergent agent of breastfeeding social support for African American Christian women who chose to breastfeed. Health professionals should collaborate with African American Christian leadership to initiate programs to promote breastfeeding among African American Christian women in the United States.

Clinically Integrated Breastfeeding Peer Counseling to Promote Breastfeeding Equity.

OBJECTIVE: This study aimed to determine whether clinically integrated Breastfeeding Peer Counseling (ci-BPC) added to usual lactation care reduces disparities in breastfeeding intensity and duration for Black and Hispanic/Latine participants. STUDY DESIGN: This study is a pragmatic, randomized control trial (RCT) of ci-BPC care at two ci-BPC-naïve obstetrical hospital facilities in the greater Chicago area. Participants will include 720 patients delivering at Hospital Site 1 and Hospital Site 2 who will be recruited from eight prenatal care sites during midpregnancy. Participants must be English or Spanish speaking, planning to parent their child, and have no exposure to ci-BPC care prior to enrollment. Randomization will be stratified by race and ethnicity to create three analytic groups: Black, Hispanic/Latine, and other races. RESULTS: The primary outcome will be breastfeeding duration. Additional outcomes will include the proportion of breastmilk feeds during the delivery admission, at 6-week postdelivery, and at 6-month postdelivery. A process evaluation will be conducted to understand implementation outcomes, facilitators, and barriers to inform replication and scaling of the innovative ci-BPC model. CONCLUSION: This research will produce findings of relevance to perinatal patients and their families, the vast majority of whom desire to provide breastmilk to their infants and require support to succeed with their feeding goals. As the largest RCT of ci-BPC in the United States to date, this research will improve the quality of evidence available regarding the effectiveness of ci-BPC at reducing disparities. These findings will help patients and stakeholders determine the benefits of accepting and adopting the program and inform policies focused on improving perinatal care and reducing maternal/child health disparities. This study is registered with Clinical Trial (identifier: NCT05441709). KEY POINTS: · Ci-BPC can promote racial breastfeeding equity.. · Ci-BPC has not been tested as a generalized lactation strategy in prior trials and is underused.. · This RCT will identify if ci-BPC can reduce breastfeeding disparities for Black and Hispanic patients..

Disparities in 6 Month Exclusive Breastfeeding in Ghana, Africa: A Scoping Review.

BACKGROUND: Exclusive breastfeeding practice for 6 months is a critical global public health goal. In 2020, only 44% of infants globally, 31% in Central and West Africa, and 43% in Ghana, were exclusively breastfed for the first 6 months of life. RESEARCH AIM: To critically evaluate disparities in exclusive breastfeeding practice for 6 months in Ghana. METHODS: The scoping review was guided by Arksey and O'Malley's (2005) six-stage scoping review process. The online databases of American Psychological Association PsychInfo (APA PsychInfo), Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and Scopus were searched with keywords inclusive of Ghana, exclusive breastfeeding, breastfeeding, infant feeding, lactation, lactating, and exclusive. Eligibility criteria included full-text, peer-reviewed research articles written in the English language without limitation to specific years. Data were analyzed thematically. RESULTS: Initially, 317 records were identified, and 15 full-text articles were eligible for the scoping review. Four main themes emerged as disparities in exclusive breastfeeding practice in Ghana. The themes were healthcare (prenatal clinic visits, delivery place, exclusive breastfeeding knowledge), personal (maternal age, Human Immunodeficiency Virus status, parity, type of delivery, breast problem), employment (unemployed, formal, or informal sector worker), and sociocultural (ethnicity/region, family support, religious beliefs, cultural practices). CONCLUSION: Disparities in exclusive breastfeeding in Ghana warrant the collaborative efforts of stakeholders for successful mitigation. Future researchers should explore the role of religion and sociocultural practices to protect, promote, and support 6 months of exclusive breastfeeding in Ghana.

Breastfeeding Social Support Among African American Women in the United States: A Meta-Ethnography.

BACKGROUND: In the United States, there are racial disparities in 6 months of exclusive breastfeeding. Only, 25.8% of American infants were breastfed for the first 180 days of life, with African American infants least (19.8%) exclusively breastfed in 2018. PURPOSE: The meta-ethnography explored the breastfeeding support for African American women in the United States. DATA SOURCES: The online databases of American Psychological Association, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, PubMed, and Scopus were searched with key words, and the search was not limited by the year of publication. STUDY SELECTION: The inclusion criteria for the study selection entailed all qualitative studies conducted on breastfeeding support among self-identified African American women in the United States, written in English language, peer reviewed, or dissertation. The initial search produced 905 articles of which 8 met the eligibility criteria. DATA EXTRACTION: Data extraction and analysis were guided by Noblit and Hare's (1988) meta-ethnography approach. The analysis process was completed by a team of researchers, inclusive of breastfeeding experts. RESULTS: Five overarching themes emerged including trustworthy information; early postpartum support by key influencers; maternal culture; tangible resources, and Black mothers' empowerment. IMPLICATIONS FOR PRACTICE AND RESEARCH: Social support is a major determinant for the initiation and continuation of breastfeeding among African American women in the United States. Future longitudinal studies are warranted to explore the social support of breastfeeding among African American women in the United States.

Designing a Cloud-Based System for Affordable Cyberinfrastructure to Support Software-Based Research.

Interest in cloud-based cyberinfrastructure among higher-education institutions is growing rapidly, driven by needs to realize cost savings and access enhanced computing resources. Through a nonprofit entity, we have created a platform that provides hosting and software support services enabling researchers to responsibly build on cloud technologies. However, there are technical, logistic, and administrative challenges if this platform is to support all types of research. Software-enhanced research is distinctly different from industry applications, typically characterized by needs for lower reduced availability, greater flexibility, and fewer resources for upkeep costs. We describe a swarm environment specifically designed for research in academic settings and our experience developing an operating model for sustainable cyberinfrastructure. We also present three case studies illustrating the types of applications supported by the cyberinfrastructure and explore techniques that address specific application needs. Our findings demonstrate safer, faster, cheaper cloud services by recognizing the intrinsic properties of academic research environments.

African American Mothers' Decision to Discontinue Breastfeeding and Switch to Formula.

After initiating breastfeeding, some African American mothers find adjusting to the demands challenging and discontinue breastfeeding. To learn about decisions switching to formula, we conducted a secondary analysis of qualitative interviews with African American mothers ≥ 18 years old. Data were analyzed using thematic analysis guided by the social cognitive theory. We identified four key themes that reflect personal, behavioral, and environmental factors: (1) simplicity of formula, (2) diverse support networks, (3) early breastfeeding is most important, and (4) lack of access to breastfeeding support resources. To increase breastfeeding duration among African American mothers, it is essential for interventions to be comprehensive including various strategies such as education regarding the physical aspects of breastfeeding, exposure to African American breastfeeding mothers, and active involvement of support persons. More research among African American mothers is needed to identify effective opportunities for change in cultural, social, and structural systems that impede successful breastfeeding.

Infant Feeding Exposure and Personal Experiences of African American Mothers.

Background: Although exposure and personal experiences can guide breastfeeding decisions, the extant research on African American mothers is limited regarding the influence of infant feeding exposure. The persistent race-based breastfeeding disparities also underscore the lack of effective interventions to support breastfeeding among African Americans. Objective: To describe infant feeding exposure and personal experiences of African American mothers in the Midwestern United States with regard to decision making about breastfeeding behavior. Materials and Methods: Thirty individual qualitative interviews using a semistructured interview guide were conducted with African American mothers ≥18 years old with an infant 1-6 months of age. Interviews addressed participants' breastfeeding and formula feeding decisions. Data were coded line by line using thematic analysis. Results: Positive exposure to breastfeeding and health care providers' prenatal advice influenced nearly all participants to try breastfeeding. However, breastfeeding experiences were unexpected, they did not know how to handle challenges, and nearly half did not continue. Five central themes important to their decision-making processes were identified in the data including contact with breastfeeding mothers, guidance from health care providers, navigating the demands of breastfeeding, making the switch to formula, and my own research. Conclusion: Our findings support the importance of both prenatal and postnatal education, the influence of health care providers, and the impact of close social role models. Appropriate education about realistic breastfeeding information is needed to support African American mothers in their breastfeeding decision making. The high use of the Internet to access information also emphasizes the potential opportunity for breastfeeding interventions delivered through technology.

Employing a User-Centered Design to Engage Mothers in the Development of a mHealth Breastfeeding Application.

Breastfeeding has numerous health benefits; however, many mothers do not continue breastfeeding to the recommended 6 months of age. Breastfeeding support after discharge from the hospital is often lacking in the communities with the greatest need. Therefore, the Mother's Milk Connection mHealth application was designed to improve breastfeeding duration and access to support. This article describes a user-centered design process to engage mothers in the development of the Mother's Milk Connection application. Two phases of stakeholder and user studies were conducted. Phase 1 involved concept generation, prototype development, and usability testing. Phase 2 focused on prototype redesign and usability testing. We used a descriptive mixed-method approach with data collected using a demographic questionnaire, System Usability Scale, exit survey, and focus groups. Final features of the Mother's Milk Connection application included resources and education, peer support, automated activity tracking, and professional support via video conference. Stakeholder and user engagement indicated the integration of four distinct features is acceptable for use as a comprehensive mHealth intervention to improve access to breastfeeding support. mHealth has the potential to be a useful strategy for providing breastfeeding support, and a clinical trial regarding the efficacy of the Mother's Milk Connection application is needed.

Pearls and Pitfalls of Team Science.

Formidable health problems are often best addressed by teams of scientists with varied expertise. This diversity among team members and complexities in managing teams can lead to challenges in designing, funding, conducting, and reporting research. Team science difficulties can be addressed by sophisticated planning, frequent reassessment and realignment of team strategies with goals, and consistent transparent communication. This article addresses specific strategies to build and sustain research teams, manage team meetings, strategically develop publications and grants, thrive in the midst of disciplinary and individual team member differences, embrace new ideas and change to maintain creativity, and build future team scientists and projects. The potential value in team science justifies the effort required to build and maintain efficient and effective research teams.

A Breastfeeding Algorithm to Guide Bedside Health Care Practice for Term Newborns.

Many women experience challenges with breastfeeding. The early postpartum period is a critical time to set a foundation for successful initiation of breastfeeding and to promote continued breastfeeding. Nurses need a quick reference guide for implementation of evidence-based strategies to promote breastfeeding for all mother-newborn dyads. This article describes the development and implementation of a breastfeeding algorithm based on clinical practices outlined in the revised 2018 Ten Steps to Successful Breastfeeding to guide bedside care for term newborns.

Launching Successful Beginnings for Early Career Faculty Researchers.

Junior faculty follow a research path replete with challenges as they strive to create knowledge in their area of interest while balancing new responsibilities. Unlike graduate school, where students focus inward on personal development, junior faculty must add responsibilities in ways that hold them accountable as members of a university. This special article deals with three themes of interest to new junior faulty launching research programs: personal development, collaboration and team development within university settings, and funding advice. Strategies in these areas provide guidance on navigating early careers and finding success in the academic setting.

Breastfeeding Exposure, Attitudes, and Intentions of African American and Caucasian College Students.

BACKGROUND: African American mothers lag behind in breastfeeding initiation. Research is needed to gain an understanding of potential reasons for breastfeeding disparities. Research aim: This study explored breastfeeding exposure, attitudes, and intentions of African American and Caucasian college students by race and gender. METHODS: Women and men (696) attending college, who were younger than 45 years and without children, were included in this study. Survey data were collected using a demographic questionnaire and the Iowa Infant Feeding Attitude Scale. RESULTS: Overall, students demonstrated favorable attitudes regarding breastfeeding but viewed formula feeding as more practical. Students who were Caucasian and female and experienced breastfeeding exposure demonstrated higher breastfeeding attitudes and intent. Breastfeeding exposure and attitudes contributed 32% of the variance in breastfeeding intentions. The odds of experiencing breastfeeding exposure and positive breastfeeding attitudes were approximately 3 times higher for Caucasian students than for African American students. CONCLUSION: External factors demonstrated a stronger association with breastfeeding intentions. The link with race and gender appears to operate through their effect on attitudes and exposure. More research is needed to identify strategies to improve breastfeeding exposure and attitudes among African Americans.

Strategies to Build Authorship Competence Among PhD Students.

Publication in refereed journals is an important responsibility of PhD-prepared nurses. Specialized writing skills are crucial for effective professional publication. The capacity to develop and publish articles is best learned during doctoral education. This Western Journal of Nursing Research Editorial Board Special Article addresses multi-dimensional strategies to develop authorship competence among doctoral students. The article outlines structured PhD program experiences to provide the context for students to develop authorship capacity. The authors identify multi-faceted faculty endeavors and student activities that are essential to foster authorship competence. Students who embrace opportunities to acquire authorship qualifications will be well prepared for their post-graduation role as stewards of the nursing discipline.

Four Years Later: Rural Mothers' and Employers' Perspectives on Breastfeeding Barriers Following the Passage of the Affordable Care Act.

For the working rural mother, one key source of support for breastfeeding is the employer. The purpose of this article was to examine workplace barriers and facilitators to breastfeeding in a small rural American community following the passage of the Affordable Care Act in 2010. We used a qualitative research design: semi-structured interviews with major employers and low-income working breastfeeding mothers, and a focus-group with another group of employed and unemployed breastfeeding low-income mothers. While some businesses accommodate breastfeeding mothers, few actively promote breastfeeding. Lack of compliance with the new law, inadequate breastfeeding information for mothers, and lack of support from co-workers and supervisors emerged as the main barriers to successful workplace breastfeeding. To improve workplace breastfeeding support significantly there is need for authentic collaboration among maternal-child and rural health agencies and businesses in creating breastfeeding-tolerant, flexible, and forward-looking work environments that, at a minimum, satisfy the law.

Breastfeeding Barriers and Support in a Rural Setting.

PURPOSE: Although various breastfeeding interventions have proven effective in increasing breastfeeding initiation and duration, there has been less success in rural areas. This article describes breastfeeding barriers and support in a rural setting. STUDY DESIGN AND METHODS: A community needs assessment was conducted with a sample of healthcare providers and breastfeeding mothers in a rural area of Missouri. In-depth interviews with 10 healthcare providers and 3 breastfeeding mothers and a focus group of 10 mothers who were breastfeeding or had recently breastfed were conducted. Interview and focus group questions were designed to capture a holistic perspective of breastfeeding issues. RESULTS: Gaps in hospital and community breastfeeding support were observed in the emerging themes: lack of realistic information about the breastfeeding experience, breastfeeding time constraint, and lack of continued support. CLINICAL IMPLICATIONS: From a community practice perspective, gaps in breastfeeding support illustrate an essential need for collective engagement of local stakeholders as the cornerstone to implement effective breastfeeding interventions.

Normalizing Rejection.

Getting turned down for grant funding or having a manuscript rejected is an uncomfortable but not unusual occurrence during the course of a nurse researcher's professional life. Rejection can evoke an emotional response akin to the grieving process that can slow or even undermine productivity. Only by "normalizing" rejection, that is, by accepting it as an integral part of the scientific process, can researchers more quickly overcome negative emotions and instead use rejection to refine and advance their scientific programs. This article provides practical advice for coming to emotional terms with rejection and delineates methods for working constructively to address reviewer comments.

Predictors of Breastfeeding Attitudes Among College-Educated African Americans.

Breastfeeding initiation among African American women has reached 60%; however, it is the lowest rate among all races. This racial disparity is a public health concern considering the impact of breastfeeding on infant morbidity and mortality. The purpose of this study was to explore breastfeeding exposure and determinants of breastfeeding attitudes among African Americans. The theory of planned behavior guided this study focusing on the impact of background factors on determinants of breastfeeding attitudes. This secondary analysis included 348 African American college students with a mean age of 22 years with no children. The Iowa Infant Feeding Attitude Scale and a demographic questionnaire were used to collect data. A significant association between knowing someone who breastfed her infant and being breastfed as an infant (p < .001) was observed. Although gender, education, and breastfeeding exposure explained 15% of the variance in breastfeeding attitudes, being breastfed as an infant had no significant (p = .611) contribution. Breastfeeding exposure to someone who has breastfed her infant is a modifiable factor that influenced positive breastfeeding attitudes. Therefore, it is essential to identify strategies in practice to increase breastfeeding exposure for vulnerable populations in efforts to improve breastfeeding attitudes, intentions, and initiation.