Perform Research for Loving Support Campaign Update (Phase 1)

OMB BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.  The valid OMB control number for this information collection is 0584-0524.  The time required to complete this information collection is estimated to average 60 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

OMB Control No.: 0584-0524

Expiration Date: 6/30/2016

USDA Food and Nutrition Service: WIC Loving Support Campaign

Attachment C

Guide for in-depth interviews with WIC local breastfeeding coordinators and Competent Professional Authority (CPA)/nutritionist staff

Objectives

• Understand the perceptions of WIC local breastfeeding coordinators/staff regarding WIC moms’ knowledge and beliefs about breastfeeding

• Learn about the nature and context of interactions about breastfeeding between local WIC staff, breastfeeding peer counselors, and the WIC moms they support

• Explore local breastfeeding coordinators’/staff views on the barriers, motivations, and opportunities for WIC moms who are making breastfeeding decisions

• Gain insight into the factors that influence and/or determine WIC moms’ self-efficacy to initiate and continue exclusive breastfeeding

• Explore what breastfeeding supports are most and/or least effective for WIC moms

• Understand what resources and tactics WIC local breastfeeding coordinators/staff find to be most and least valuable in supporting peer counselors and WIC moms

• Learn about barriers, motivations, and opportunities for local breastfeeding coordinators/staff to work successfully with peer counselors and WIC moms

1. Introductions/Setup (5 minutes)

Hi, I’m ______ with Hager Sharp, a social marketing firm working with the U.S. Department of Agriculture (USDA), Food and Nutrition Service (FNS) WIC program to update a campaign about breastfeeding. Is this still a good time for you? [IF NOT, RESCHEDULE]

Thank you for taking the time to speak with me today. We would like to ask you some questions about your experiences as a WIC local breastfeeding coordinator/staff. Specifically, we are interested in your perceptions of the WIC moms enrolled through your local agency and the support they receive from you and your local peer counselors. We will be asking you questions about how much the WIC moms in your community know about breastfeeding, what factors encourage or motivate them to breastfeed, what challenges they face in starting and continuing to breastfeed, and what opportunities may exist to support breastfeeding among these women.

This call will take no more than one hour. If we get interrupted, or we need to stop and resume later, we can do so. There are no penalties for not participating in whole or in part. If there are any questions that you do not feel confident to answer, just let me know and we will move on. Everything you say will remain private and will not be share with anyone outside the researchers involved in this data collection, except as otherwise required by law. We will combine your comments with those of other local breastfeeding coordinators/staff in a report that we will provide to the USDA Food and Nutrition Service. The USDA will not be able to attribute your comments to you personally.

Do you have any questions before we begin?

Please be candid and provide as much insight as you are comfortable sharing. Your feedback is important to us. I will be taking notes during our conversation and, because we want to make sure we don’t miss any comments, I would also like to record our conversation. [TURN RECORDING ON]

2. Your Role as Local Breastfeeding Coordinator/Staff (15 minutes)

1. How long have you been a breastfeeding coordinator/staff member at your local WIC agency?

2. In a few sentences, can you briefly tell me about your role as a breastfeeding coordinator/staff member at your local WIC agency?

3. How many WIC moms are currently receiving breastfeeding support through your local agency?

1. What city/county/region is served by your local agency?

2. Describe the length of time you generally follow/support a WIC mom. (For example, third trimester to 6 months postpartum?) Does this timeframe vary from one person to another?

4. Now I’d like to ask you to briefly tell me about the WIC moms served by your local agency:

1. What racial/ethnic groups make up the majority of WIC moms in your city/county/region?
   
   

2. What is the age range of WIC moms served by your local WIC agency?

3. Are there any qualities that make WIC moms served by your local agency different from other WIC moms around the U.S.? For example, are there unique cultural barriers or supports?

1. If so, is there anything that you do to address those specific differences/strengths/challenges in your role as a WIC local breastfeeding coordinator/staff member?

4. How are WIC moms typically referred to your agency for WIC breastfeeding support? What is the most effective way to encourage WIC moms to seek and/or use WIC breastfeeding support?

5. What is the best way to reach WIC moms (e.g., via telephone, Facebook, text, etc.)?

5. What direct contact do you have with the WIC moms’ support system (e.g., fathers, partners, family members, health care providers, employers, other lactation support providers)?

1. What, if any, challenges do you face in interacting with these individuals?

2. What changes, if any, might make these interactions more effective?

6. Does your local agency currently use any materials or resources to explain the benefits of breastfeeding initiation, exclusivity, and duration to WIC moms? If so, please describe.
   
   

   1. Which resources are used most often?

2. Are there any resources, tools, or support you wish you had available to help you talk to WIC moms about breastfeeding? [provide prompts, if necessary]

   • Ex: breastfeeding app, websites, listservs, etc.

3. Are there any community partners that help you in providing support to WIC moms? If so, which ones have been particularly effective?

4. How can your state’s WIC breastfeeding coordinator help you succeed in your role?

7. Are there aspects of promoting and supporting breastfeeding that you find frustrating? What obstacles or other problems related to promoting and supporting breastfeeding are a source of frustration for you?

8. What change(s) could help you support more WIC moms to successfully breastfeed?

3. Knowledge of Breastfeeding (10 minutes)

Now I’d like to ask you some questions about how much knowledge about breastfeeding is typically shown by the WIC moms served by your local agency.

9. Using a scale of 1 to 5 with 5 being the highest, in your experience, how much do the WIC moms served by your local agency typically know about breastfeeding? For example:
   
   

   1. How much do they typically know about how the mother’s body makes breast milk? [Provide prompts/examples, if necessary]

      • Ex: lets down milk before or during a breastfeeding session, produces milk in response to supply and demand
        
        

   2. How much do they typically know about the benefits of breastfeeding? [Provide prompts/examples, if necessary]

      • Ex: nutritional value, maternal/infant bonding, cost savings, health benefits for mom and baby, convenience

3. How much do they typically know about the benefits of exclusive breastfeeding? [Provide prompts/examples, if necessary]

• Ex: protecting the baby from illnesses, protecting the baby from developing allergies, helping the baby to gain the right amount of weight

4. To what extent do they typically have knowledge/skills to successfully breastfeed? [Provide prompts/examples, if necessary]

   • Ex: positions, latch, how often to feed and for how long, baby’s hunger signs, signs of baby getting enough milk, pumping and storing milk

5. How knowledgeable are they about making breastfeeding fit into their lifestyle? [Provide prompts/examples, if necessary]

• Ex. School, work, social life, etc.

6. To what extent are they aware of their legal rights with regard to breastfeeding? [Provide prompts/examples, if necessary]

   • Ex: breaktime for nursing moms at work (how often and location), breastfeeding in public

7. How knowledgeable are they about potential sources of support (e.g., emotional – fathers, partners, family, etc.; informational – health care providers, WIC support, etc.)?

10. In your experience, which area that we’ve discussed (i.e., biology, benefits, skills, rights, sources of support) is most important to include in efforts to increase exclusive breastfeeding knowledge and skills among WIC moms?

4. Motivations and Barriers around Breastfeeding (15 minutes)

Now I’d like to ask a few questions about what factors encourage or motivate WIC moms to breastfeed and what challenges these mothers typically face in starting and continuing to exclusively breastfeed and/or combination feed (i.e. combination of formula and human milk).

11. What breastfeeding data is collected/monitored for your agency?

12. Approximately what percentage of the WIC moms you provide breastfeeding promotion and support to originally planned to initiate breastfeeding?

1. Approximately how many planned to breastfeed exclusively?

2. Approximately how many planned to continue breastfeeding—exclusively or in combination with formula—to six months? To a year?

3. Can you comment on approximately how many of these women actually initiated breastfeeding? How many continued to six months? How many continued to a year? [DETERMINE WHETHER THESE NUMBERS ARE ESTIMATES OR REFLECT TRACKING ACTIVITIES. IF TRACKING NUMBERS EXIST BUT ARE NOT IMMEDIATELY AVAILABLE, OFFER TO FOLLOW-UP By EMAiL TO OBTAIN NUMBERS.]

13. Do the WIC moms to whom you provide support mention specific reasons why they want to start/initiate breastfeeding?

1. What are these reasons?

2. Do you know why these reasons motivated/encouraged them to start breastfeeding?

14. If they don’t intend to breastfeed, what are the reasons?

15. Do the WIC moms to whom you provide support mention specific reasons why they are motivated to continue breastfeeding?

1. Do they mention different motivations for exclusive breastfeeding (i.e., feeding their child only breast milk) versus breastfeeding with supplementation (i.e., replacing a portion of breast milk with some other formula or food)?

1. What reasons lead them to start formula feeding when they are already breastfeeding?

2. Is it difficult to convince moms to exclusively breastfeed (versus combination feed)?

2. Do you know why these reasons motivated/encouraged them to continue breastfeeding?

3. Do you know why these reasons motivated/encouraged them to continue exclusive breastfeeding?

16. Who supports WIC moms in meeting their breastfeeding goal?

1. What role do partners, family members, or other supporters play in a WIC mom’s motivations or barriers to exclusive breastfeeding success?

17. What concerns about breastfeeding do WIC moms face…

1. Prenatally?

2. At birth?

3. In the first two weeks at home with the baby?

4. Upon a return to work/school?

5. Other?

18. What challenges do WIC moms face in initiating breastfeeding? [PROVIDE PROMPTS/EXAMPLES, IF NECESSARY]

    • Ex: pain, supply issues, engorgement, plugged ducts/infection, latch issues, lack of support, embarrassment

1. How do these challenges change over time for women who continue breastfeeding?

2. In what ways do WIC moms overcome these challenges?

5. Breastfeeding Self-Efficacy and Opportunities (10 minutes)

19. In your city/county/region, what are some factors that affect a mother’s belief that she can succeed (self-efficacy) in initiating breastfeeding?

20. In your city/county/region, what are some factors that affect a mother’s belief that she can succeed in continuing exclusive breastfeeding?

21. What, if anything, do you believe WIC could do to improve opportunities for mothers to breastfeed? [PROVIDE PROMPTS/EXAMPLES, IF NECESSARY]

    • Ex: in public, in the workplace, in hospital settings, in other settings

6. Overall Information & Wrap Up (5 minutes)

22. Now that we’ve spent some time talking about breastfeeding among WIC moms, where do you see the biggest opportunities to make a difference in encouraging WIC moms to initiate and continue exclusive breastfeeding?

1. What recommendations do you have for USDA to improve breastfeeding support to WIC moms?

23. Is there anything else you would like to discuss that didn’t come up?

Thank you so much; your help has been invaluable.