Initiative to Increase Breastfeeding Rates in Kansas Communities

2012 Kansas Public Health AssociationAnnual ConferenceOctober 1 - 3, 2012

Lisette T. Jacobson, MPA, MA, PHR, PhD(c)Ruth E. Wetta, RN, PhD, MPH, MSN Sonalli Kurlekar, BS

Overview

• Breastfeeding rates in Kansas compared to the United States• Purpose of the research studies• Study #1 – Process Evaluation (completed)

– Purpose: To evaluate whether program goals and objectives are met– Research Design & Methodology– Analysis– Findings

• Study #2 – Outcome Evaluation (on-going)– Purpose: To evaluate program effectiveness– Preliminary findings

Breastfeeding Rates in Kansas

2007 2008 2009 2010 2011 20120.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

United States vs. Kansas Breastfeeding Rates

US Ever BF KS Ever BF US BF at 6 Mos. KS BF at 6 Mos. US BF at 12 Mos.

KS BF at 12 Mos. HP 2010 & 2020 Ever HP 2010 & 2020 6 mos. HP 2010 & 2020 12 Mos.

(in years)

(in p

erce

ntag

es)

Source: Centers of Disease Control and Prevention National Immunization Survey, 2004 - 2009 births

HP 2010

HP 2020

Exclusive Breastfeeding Rates in Kansas

2007 2008 2009 2010 2011 20120.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0

United States vs. Kansas Exclusive Breastfeeding Rates

US Exclusive BF at 3 Mos. KS Exclusive BF at 3 Mos. US Exclusive BF at 6 Mos. KS Exclusive BF at 6 Mos.

HP 2010 & 2020 Exclus. 3 mos. HP 2010 & 2020 Exclus. 6 mos.

(in years)

(in p

erce

ntag

es)

Source: Centers of Disease Control and Prevention National Immunization Survey, 2004 - 2009 births

HP 2010

HP 2010

HP 2020

HP 2020

Purpose of Research

• 2011 and 2012 Breastfeeding Initiatives in Kansas – To increase initiation and duration rates of breastfeeding in

communities across the state of Kansas– Collaborative partners:

• United Methodist Health Ministry Fund, Hutchinson, Kansas (UMHMF)

• Kansas Public Health Association (KPHA)• University of Kansas School of Medicine-Wichita, Department of

Preventive Medicine and Public Health (KUSM-W)• 19 to 23 Local public health departments (LHDs)• Kansas Department of Health and Environment (KDHE)

Purpose of Research

• Two research studies1. Process Evaluation Study of Breastfeeding Programs

• Intent of process evaluation: To inform administrators and stakeholders on the progress of a program while it is running so that program enhancements can be made

2. Outcome Evaluation Study of Breastfeeding Programs• Intent of outcome evaluation: To inform administrators and

stakeholders on the effectiveness of a program• Addresses the question: “Does my program work?”

Grant Application Process

• United Methodist Health Ministry Fund (UMHMF), Hutchinson, Kansas, provided up to $10,000 for each breastfeeding grant to a total of about $200,000 per funding period

• Funding period: January 1 – December 31• Local public health departments (LHDs) across Kansas applied

for the grant through a competitive process• Kansas Public Health Association (KPHA) administers grant• 19 Local public health departments received funds in 2011• 23 Local public health departments received funds in 2012

Study #1: Evaluation of Program Goals and Objectives

Purpose of the study –A goal-based, process evaluation that addressed the extent to

which each breastfeeding program met its goals and objectives The study consisted of two phases:1) Evaluation of program goals and objectives after the first

quarter of the funding period (conducted in spring 2011)

2) Evaluation of program goals and objectives after the last quarter of the funding period (conducted in spring 2012)

Study #1: Evaluation of Program Goals and Objectives

The study examined:• How well program goals and objectives were met• Progress made by grantee toward achieving the grant’s purpose • Problems encountered in an effort to achieve the grant’s

purpose, and• Evaluation measures implemented to determine improvement

Research Design and Methodology

• Data was collected from 18 funded health departments in 2011 and 10 funded health departments in 2012

• Eligibility requirements for participants– Local public health departments that received funding for their

breastfeeding program through KPHA between January 1, 2011 and December 31, 2011

• Study consisted of a scripted telephone interview lasting 30 to 45 minutes with one or two representatives from each participating health department

• Approval secured from Human Subjects Committee with University of Kansas School of Medicine-Wichita

Research Design and Methodology

• All interview questions were open-ended (qualitative data)• Telephone interview consisted of 3 main components :

(1) Program goals and objectives (2) Program involvement, use, and satisfaction (3) Available resources and projected program impact

• Due to the different nature of goals and objectives for each health department, survey items selected were of a general nature so that findings could be standardized

Survey Instrument

Three Main Components

Statistical Analysis

• Data set was qualitative in nature and implementation, procedures, and data management was guided by Berg (2004)

• Following completion of interviews and transcripts, underlying themes and consensus opinions were explored by research team members

• Themes were utilized to assess whether program goals and objectives were met

• A final report assessing convergence and divergence of themes across groups was assembled and reported to UMHMF and KPHA

Findings

Themes were categorized based on program strength, recommendations, and sustainability

Sustainability Issues

* Funding for breastfeeding programs

* Funding for training and travel

* Capturing and retaining business community support

* Succession planning of key personnel involved in breastfeeding

Recommendations

* Survey instrument that measures program effectiveness and satisfaction – study commenced in 2011 and is on-going

* Continue support for breastfeeding after mother’s hospital discharge - Peer Support - Professional Support - Educational Classes & Materials - Workplace Support

* KPHA involvement in marketing benefits of breastfeeding - Connect breastfeeding to overall

health and wellness - Market the establishment of

specific breastfeeding clinics - Educate high school students on

breastfeeding

Strengths

* Adequate Resources

* Identified Program Outputs

* Best Use of Funds:- Purchase or rental of breast

pumps- Breastfeeding resource bags

- Educational classesand materials

- Professional trainingof staff

Findings - Program Goals and Objectives

Establishing Program Goals and

Objectives

• Program goals and objectives developed in coordination with OB staff/obstetricians at local hospital, primary care physician and pediatrician offices, WIC staff , and HSHV staff.

• No survey prior to establishing goals. • Use of CDC Breastfeeding Guide, Healthy

People 2010, or Healthy People 2020 to set program goals.

Process of Establishing Program Goals and Objectives

• Process of establishing program goals effective.• Most health departments identified various

stakeholders for their program in the community.• Geographical distance appeared to be

challenging for a few LHDs.

Accomplishing Program Goals and Objectives

• Most LHDs accomplished goals and objectives.• Employee turnover played a role for a few

LHDs.• Goals accomplished include professional

education of staff, breastfeeding classes, purchase of breast pumps and breastfeeding kits, promotion and dissemination of educational materials, establishing an on-call network for breastfeeding mothers, starting peer support groups, and establishing key partnerships with local hospitals and physicians.

Findings - Program Involvement, Use, and Satisfaction

Program Involvement

• Most LHDs reported the following key personnel involved in breastfeeding program: obstetricians/pediatricians/family physicians and their staff, local hospital, WIC personnel, Healthy Start Home Visitor program staff, and public health nurses.• Other parties include health department director, social workers, health promotion coordinator, certified breastfeeding educator, peer counselors, etc.

Program Use

• Marketing tools for participant recruitment included emails, flyers, traditional media (e.g., newspaper, radio, TV), social networking sites, hospital newsletters, letters to businesses, and informational booths at health fairs.• Target population includes all mothers interested in breastfeeding. Several LHDs targeted teen mothers, working mothers, young mothers, and/or first-time mothers.• Frequently used program components include face-to-face contact with a breastfeeding expert, use/rental of breast pumps, educational classes, and peer support groups.

Participant Satisfaction• Few LHDs measured participant satisfaction.• Most health departments participate in outcome evaluation study measuring program effectiveness and participant satisfaction.

Findings - Available Resources and Projected Program Impact

Available Resources

• Most local health departments reported that resources were adequate to accomplish their program goals and objectives.• A couple of health departments indicated that employee turn-over within their own organization as well as the organizations they collaborated with hindered them from accomplishing their goals and objectives.• Best use of funds include purchase of breast pumps, breastfeeding supplies, educational material, and professional training of staff.

Projected Program Impact

• Program output measures include number of educational classes offered, number of home visits, number of pumps rented, number of nurses receiving CBE training, class attendance, support group attendance, etc.• Program impact measured with outcome evaluation study.• Significance of relationship between breastfeeding mother and breastfeeding educator/lactation specialist.

Outcomes• Most LHDs reported more than one long-term outcome for their respective communities.• In addition to increasing breastfeeding rates, most health departments reported maternal and fetal health and wellness as significant outcomes including fewer allergies, enhanced mother/infant bonding, and reduced childhood obesity.

Findings - Overall Reflections

Future activities

• Most health departments desired continued breastfeeding support for mothers and infants through face-to-face professional support, educational classes and materials, peer support, and a continued collaborative relationship with their regional medical center.• Common concern: sustainability of breastfeeding programs.

Study #2: Evaluation of Program Effectiveness

Purpose of the study –An outcome evaluation that measures the effectiveness

of breastfeeding programsFocus is on: “Does my program work?”Purpose of study accomplished through examination of:

Exploration of mothers’ attitudes, knowledge, and beliefs toward breastfeeding

Perceived barriers toward breastfeedingCurrent breastfeeding practices

Study #2: Evaluation of Program Effectiveness

Preliminary findings – An increase in the awareness of the benefits of

breastfeeding positively influences initiation and duration rates of breastfeeding in Kansas communities

Concluding Remarks

Across both studies, we can conclude:• Uniqueness of breastfeeding programs among health

departments in Kansas• Due to program uniqueness, it is challenging to measure

program effectiveness• Common concern: Program sustainability• Follow up: 2012/2013 Quality Improvement Training

Focuses on teaching each health department how to evaluate effectiveness of their own program

Training conducted on-line by Ruth Wetta and Lisette Jacobson, Department of Preventive Medicine and Public Health, University of Kansas School of Medicine-Wichita

Questions???

Thank you!!!!Contact information:Lisette T. Jacobson, MPA, MA, PhD(c)Ruth E. Wetta, RN, PhD, MPH, MSNDepartment of Preventive Medicine and Public HealthUniversity of Kansas School of Medicine-WichitaPhone: (316) 293-3484 (Lisette), (316) 293-3544 (Ruth)Email: ljacobson@kumc.edu, rwettaha@kumc.edu