A scoping review of the evaluation and effectiveness of technical assistance.

BACKGROUND: Although the benefits of evidence-based practices (EBPs) for advancing community outcomes are well-recognized, challenges with the uptake of EBPs are considerable. Technical assistance (TA) is a core capacity building strategy that has been widely used to support EBP implementation and other community development and improvement efforts. Yet despite growing reliance on TA, no reviews have systematically examined the evaluation of TA across varying implementation contexts and capacity building aims. This study draws on two decades of peer-reviewed publications to summarize the evidence on the evaluation and effectiveness of TA. METHODS: Guided by Arksey and O'Malley's six-stage methodological framework, we used a scoping review methodology to map research on TA evaluation. We included peer-reviewed articles published in English between 2000 and 2020. Our search involved five databases: Business Source Complete, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education Resources Information Center (ERIC), PsycInfo, and PubMed. RESULTS: A total of 125 evaluation research studies met the study criteria. Findings indicate that publications have increased over the last two decades, signaling a growth in the recognition and reporting of TA. Technical assistance is being implemented across diverse settings, often serving socially vulnerable and under-resourced populations. Most evaluation research studies involved summative evaluations, with TA outcomes mostly reported at the organizational level. Only 5% of the studies examined sustainability of TA outcomes. This review also demonstrates that there is a lack of consistent standards regarding the definition of TA and the level of reporting across relevant TA evaluation categories (e.g., cadence of contact, and directionality). CONCLUSIONS: Advances in the science and practice of TA hinge on understanding what aspects of TA are effective and when, how, and for whom these aspects of TA are effective. Addressing these core questions requires (i) a standard definition for TA; (ii) more robust and rigorous evaluation research designs that involve comparison groups and assessment of direct, indirect, and longitudinal outcomes; (iii) increased use of reliable and objective TA measures; and (iv) development of reporting standards. We view this scoping review as a foundation for improving the state of the science and practice of evaluating TA.

Depiction of Breastfeeding in Newspapers in the United States: 2007-2016.

Introduction: Depictions of infant feeding practices in the media influence public attitudes toward breastfeeding and breastfeeding behaviors. Understanding how breastfeeding is represented in the media can provide insights into breastfeeding experiences and outcomes. This study describes trends in breastfeeding portrayals in the United States newsprint media between 2007 and 2016. Methods: We conducted a retrospective content analysis of 452 newspaper articles identified from the Nexis Uni database. Articles were coded for tone toward breastfeeding (supporting, neutral, or opposing), message frame, and region (Midwest, South, West, Northeast). We frequency weighted articles by publication circulation to account for differences in readership volume. Results: Findings indicate that breastfeeding has been positively portrayed and increasingly discussed. Among the four regions, the South had the most supportive tones, while the Midwest had the most opposing tones. The topics of Health Benefits and Breastfeeding Support and Resources received the most coverage. Positive portrayals surrounding Workplace/University Issues are increasing, while negative portrayals surrounding Indecent Exposure are decreasing. Conclusion: Positive portrayals of breastfeeding in newspapers may signify increased support for breastfeeding as a normal practice. Future research is needed to better understand the direct and indirect impact of newsprint messages on breastfeeding in the United States.

A Socioecological Approach to Understanding Workplace Lactation Support in the Health Care Setting.

Introduction: The percentage of working women with children under the age of 3 has nearly doubled since the 1970s, elevating the importance of understanding and improving workplace lactation support. This study aimed to examine employee perceptions of and experiences with workplace lactation support within a single health care system. We used a socioecological approach and included the views of a broad range of employees with and without lactation experience to capture diverse perspectives at multiple levels. Materials and Methods: Employees were recruited from an integrated health care system in the southeastern United States. Five focus groups were conducted during June to August 2017. Transcripts were analyzed using qualitative content analysis, with key themes organized at four levels of analysis: individual, interpersonal, departmental, and organizational. Results: Thirty-five clinical and nonclinical employees participated. Employees shared varied perspectives on workplace lactation support, which emphasized the: (1) importance of having a lactation policy, (2) critical role of leadership in setting the tone for workplace lactation, and (3) differential experience between clinical and non-clinical lactating employees. Conclusion: Employee experiences with lactation support in the health care setting are influenced by individual, interpersonal, departmental, and organizational factors that must be considered in the design of effective workplace lactation support programs. Policies and programs that align with organizational values and accommodate the needs of employees in varying roles are recommended. By using a socioecological perspective, this study identifies practical strategies for implementing, improving, and sustaining workplace lactation support across multiple levels of a large health care organization.