Program Overview
Lessons
The program will consist of 4 weeks of lessons at 24-28 weeks of pregnancy, with telephone follow-ups with the lactation consultant at 2 weeks and 3 months postpartum.
Week 1’s lesson will consist of a general overview: benefits of breastfeeding, how-to breastfeed and infant cues, and a DVD showing breastfeeding mother’s testimonies.
Week 2 will focus on tips and tricks: positioning and attachment, pumping, and nutrition to support adequate milk supply.
Week 3 will be a group discussion around common barriers to breastfeeding (i.e. returning to work), misunderstandings/misconceptions, and how to overcome these.
Finally, week 4 will focus on social support. Participants will be joined by their partners, a family member, or friend, etc. so they can learn how to best support the breastfeeding mother – thus, addressing multiple levels of influence.
Rationale & Strategy
Lesson 1 aims to increase knowledge on breastfeeding generally, as well as tactics for success. This will help increase motivation and self-efficacy among the group. The DVD with different mother’s testimonies will further increase motivation, as well as offer an opportunity for modeling. Increasing knowledge, motivation, self-efficacy, and modeling are all important components for successful behavior change (Taylor, 2021; Saunders et al., 2005).
As mentioned, Lesson 2 covers tips and tricks, so the main aim here is to increase self-efficacy.
Lesson 3 will aims to decrease perceived barriers, leading to higher rates of the desired behavior (McKenzie et al., 2017).
In the final lesson, Lesson 4, participants will be joined by someone in their social circle – their partner, a family member, a friend, etc. The lesson will focus on how these individuals can support the breastfeeding mother.
The lessons and postpartum telephone check-ins will reach the individual level of influence, according to the socio-ecological model (McKenzie et al., 20217). However, the lesson in week 4 will also reach the interpersonal level, so multiple levels of influence are targeted through our program.
See full program rationale on Program Rationale tab.
References
McKenzie, J, Neiger, B., & Thackeray, R. (2017). Planning, Implementing, and Evaluating Health Promotion Programs: A Primer. 7th ed. Pearson Education, Inc.
Saunders, R.P., Evans, M. H., & Joshi, P. (2005). Developing a Process-Evaluation Plan for Assessing Health Promotion Program Implementation: A How-To Guide. Health Promotion Practice, 6(2), 134-147.
Taylor, S. (2021). Health Psychology (11th ed.) McGraw-Hill.
Evaluation Plan
Complete and acceptable delivery of the program is outlined below to help program leaders understand if the program was delivered as intended. In regards to fidelity, this program, called Fed for the Future, will be led by a nutrition education specialist and a lactation consultant and will take place at the Eastside Chinatown WIC facility in New York City. The dose delivered will consist of 4 weeks of lessons (one per week) during weeks 24-28 of pregnancy. This will be followed by telephone calls with the lactation consultant at 2 weeks and 3 months postpartum. Here, the participants will be able to participate in guided practice with feedback, an important piece of fidelity (Saunders et al., 2005). Week 1’s lesson will consist of a general overview: benefits of breastfeeding, how- to breastfeed and infant cues, and a DVD showing breastfeeding mother’s testimonies. Week 2 will focus on tips and tricks: positioning and attachment, pumping, and nutrition to support adequate milk supply. This week will include another video showing how to position the baby to get it to latch properly, demonstrated on pregnant, minority women so that students can experience modeling - watching someone else, who they can identify with, practice the skill. This is another important strategy in fidelity (Saunders et al., 2005). Week 3 will be a group discussion around common barriers to breastfeeding and how to overcome these. Finally, week 4 will focus on social support and participants will be joined by their partners, a family member, or friend, etc. The dose received will be if at least 10 participants from WIC finish 100% of the program. In regards to reach, participation will be measured by showing up to all lessons and completing the postpartum phone calls with the lactation consultants.
Process Evaluation Questions
Recruitment: What recruitment methods were used to attract WIC participants to the program?
Knowing the recruitment methods used will help us determine if they were successful or not – based on how many people attended the program. There is a minimum of 10 people required for the program to run. This knowledge will help us tweak these in the future, if necessary.
Reach: What percent of participants attended all 6 lessons (4 in-person and 2 telephone calls)? If students dropped out or missed lessons, what were the circumstances surrounding the missed lessons?
Understanding the percent of participants that attended all sessions would give us a good understanding of if anyone dropped off, and where, so we can make any necessary changes in future iterations of the program. It will also help us know if we achieved our participation goals and understand the circumstances around missed lessons so we can help participants in future iterations.
Fidelity: Was the program implemented consistently with the underlying theories (the Theory of Planned Behavior, Social Cognitive Theory and Stimulus Response Theory, and the Health Belief Model)?
Understanding if the program was implemented based on the theories discussed will let us know if the content of the program was delivered as intended, with theory-based practices, and whether implementation was successful in that sense.
Context: Did family members or friends attend the lesson in week 4 on social support?
Learning whether participants were joined by their social network will help us understand if this portion of the intervention was successful – or whether we need to put more effort into recruiting these individuals to join.
Dose Delivered: Were all the intended lessons used? Was all of the intended information covered in the allotted time?
Knowing whether all the intended information was covered in the allotted time is very important. If it was, we had the right amount of information in each lesson. If some of the information had to be cut short because of time, we will need to rework the lessons.
Dose Received: Were participants engaged in the content and participating in group discussions?
This will help us understand if we need to create more engaging content and/or find new ways to engage participants. This could also help to explain the reasoning for why there was a behavior change or not. If participants were not engaged and there was no behavior change, we’ll need to look at the lessons again.
References
McKenzie, J, Neiger, B., & Thackeray, R. (2017). Planning, Implementing, and Evaluating Health Promotion Programs: A Primer. 7th ed. Pearson Education, Inc.
Saunders, R.P., Evans, M. H., & Joshi, P. (2005). Developing a Process-Evaluation Plan for Assessing Health Promotion Program Implementation: A How-To Guide. Health Promotion Practice, 6(2), 134-147.
