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 A

Guide for in-depth interviews with WIC breastfeeding peer counselors

Objectives

• Understand the perceptions of WIC breastfeeding peer counselors regarding WIC moms’ knowledge and beliefs about breastfeeding

• Learn about the nature and context of interactions about breastfeeding between WIC peer counselors and WIC moms

• Explore peer counselors’ 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 peer counselors find to be most and least valuable in supporting WIC moms

• Learn about barriers, motivations, and opportunities for peer counselors to work successfully with 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 peer counselor. Specifically, we are interested in your perceptions of the WIC moms to whom you provide support. We will be asking you questions about how much the WIC moms you support 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. You are not required to participate, and you can stop participating at any time. There are no penalties for not participating in whole or in part. If there are any questions that you are not confident in answering, 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 participants 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. Finally, as a token of our appreciation, we will give you $25.

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 Peer Counselor with WIC moms (15 minutes)

1. How long have you been a WIC peer counselor?

2. What made you want to be a peer counselor?

3. What made you want to breastfeed your own infant(s)?

1. How long did you breastfeed?

2. What could have helped you breastfeed longer?

4. What do you like about promoting and supporting breastfeeding?

5. On average, how many WIC moms do you see in a week?

1. How many of the WIC moms you support are first-time breastfeeding moms? How many are moms that have tried breastfeeding without success previously?

2. Describe how long you follow/support a WIC mom as a peer counselor. (For example, third trimester to 6 months postpartum?) Does this timeframe vary from one person to another? [provide Prompts, if necessary]

   • Ex: How long do you follow if they are first time moms? What about for second time breastfeeding moms? What about for older moms?

6. Now I’d like to ask you to briefly tell me about the WIC moms you support in your community:

1. Are there particular racial/ethnic groups that make up the majority of women you support?
   
   

2. What is the age range of the majority of WIC moms you support?

3. In your opinion, what is the most effective way to encourage WIC moms to seek and/or use peer counseling support?

4. Under what circumstances do you have the most success contacting WIC moms? What is the best way to reach WIC moms (e.g., via telephone, Facebook, text, etc.)?

7. What direct contact do you have with 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?

8. Do you 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 do you most often rely upon?

2. Are there any resources, tools, or other supports within your scope of practice that 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. How do WIC moms prefer to get their information (printed materials, in-person consultations, online, social media, etc.)?

1. Why are these channels more effective/appealing?

9. What helps you to succeed in your role as peer counselor?

1. When do you feel like your efforts to help a WIC mom with breastfeeding have been successful?

2. How have you helped WIC moms overcome challenges to breastfeeding?

3. Are there any community partners that help you in providing support to WIC moms? [provide prompts, if necessary]

   • Ex: maternal/child health organizations, community health centers, health care provider organizations (nurses/midwives/doulas), etc.

10. What resources or support do WIC moms need most to initiate and continue exclusive breastfeeding?

1. What would help you support more WIC moms to successfully breastfeed?

2. What would help you support more WIC moms to successfully breastfeed exclusively?

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 to whom you provide support.

11. Using a scale of 1 to 5 (with 5 being the highest), in your experience, how much do the WIC moms to whom you provide support 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: break time 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.)?

12. 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., a combination of formula and human milk).

13. Among the WIC moms that you support, how typical is it that they originally plan to initiate breastfeeding? [PROVIDE PROMPTS, IF NECESSARY: Not at all typical, somewhat typical, typical, very typical, etc.]

1. Of those who intend to initiate breastfeeding, how typical is it that they actually do so?

2. How typical is it that they plan to breastfeed exclusively?

3. How typical is it that they plan to continue—exclusively or in combination with formula—to six months? To a year?

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?

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

13. Do 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 formula)?

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?

13. 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?

13. 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?

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

13. In your community, what are some factors that affect a mother’s belief that she can succeed (self-efficacy) in initiating breastfeeding?

13. In your community, what are some factors that affect a mother’s belief that she can succeed (self-efficacy) in continuing exclusive breastfeeding?

13. How do the WIC moms you support describe their feelings/experience about…?

1. Breastfeeding in public?

2. Pumping and storing breast milk?

3. Returning to work/school?

4. Asking for breastfeeding help?

13. What, if anything, do you believe could be done 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)

13. 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?

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

Thank you so much; your help has been invaluable.