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 D

Guide for in-depth interviews with breastfeeding subject matter experts who conduct research and develop programs to promote breastfeeding.

Objectives

• Understand the perceptions of breastfeeding subject matter experts regarding WIC moms’ knowledge and beliefs about breastfeeding

• Learn about the nature and context of interactions about breastfeeding between WIC moms and their supporters

• Explore breastfeeding subject matter experts’ 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 breastfeeding subject matter experts find to be most and least valuable in supporting WIC moms and their supporters

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 perspectives as a breastfeeding subject matter expert. Specifically, we are interested in your perceptions of WIC moms eligible to receive breastfeeding support. We will be asking you questions about how much WIC moms generally know about breastfeeding, what factors encourage or motivate them to breastfeed, what challenges they face in starting and continuing to exclusively 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 are not applicable, 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 breastfeeding subject matter experts 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. Is it okay with you if I record our conversation? [TURN RECORDING ON]

2. Your Role in Supporting Breastfeeding Among WIC Moms (15 minutes)

1. How long have you been engaged in work related to promoting and supporting breastfeeding?

1. What is your specific area of expertise within this field?

2. In what ways, if any, does your work impact or bring you into contact with WIC moms?

2. In a few sentences, can you briefly tell me about your role as it relates to promoting and supporting breastfeeding?

3. In working with WIC moms, 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?

As you know, the WIC program serves women who are pregnant through the first six months after birth and up to one year postpartum if they are breastfeeding. Participants must also meet residency, income, and nutrition risk requirements. The following questions focus on breastfeeding support for WIC moms.

4. Do you or other supporters of breastfeeding with whom you work currently use any materials or resources to explain the benefits of breastfeeding initiation, exclusivity, and duration that could be used with WIC moms? If so, please describe.
   
   

   1. Which resources are most used by you or other supporters of breastfeeding with whom you work?

2. Are there any effective resources, tools, or support that you wish were available (at free or limited cost) to help WIC moms with breastfeeding? [provide prompts, if necessary]

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

5. Based on your knowledge of the population served by the WIC program, what supports for breastfeeding does this population of mothers enjoy, as compared with the population as a whole?

1. What barriers to breastfeeding does this population of mothers face, as compared with the population as a whole?

2. In your view, what factors are most critical to the success of WIC moms with regard to exclusively breastfeeding?

3. Are there specific individuals and/or organizations acting at the state or local levels to foster the presence of these factors for success?

3. Knowledge of Breastfeeding (10 minutes)

Now I’d like to ask you some questions about areas of knowledge about breastfeeding that are most important for WIC moms to have.

6. Using a scale of 1 to 5 with 5 being the highest, how important is it for WIC moms to have specific knowledge about breastfeeding? For example:
   
   

   1. How important is it for them to 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 important is it for them to 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. How important is it for them to 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. How important is it for them to be 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 important is it for them to be knowledgeable about potential sources of support (e.g., emotional – fathers, partners, family, etc.; informational – health care providers, WIC support, etc.)?

7. In your experience, which area that we’ve discussed (i.e., biology, benefits, skills, rights, sources of support) is most important for WIC to address through 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 your knowledge of factors that encourage or motivate WIC moms to breastfeed and what challenges these mothers might face in starting and continuing to exclusively breastfeed and/or combination feed (combination feed is the feeding of infant formula with human milk).

8. What knowledge can you share about specific reasons why WIC moms typically want to initiate breastfeeding?

9. What knowledge can you share about reasons why WIC moms might not intend to breastfeed?

10. What knowledge can you share about reasons why WIC moms, in particular, might be motivated to continue breastfeeding?

1. What different motivations exist for exclusive breastfeeding versus breastfeeding with supplementation?

1. What knowledge can you share about reasons that lead WIC moms to start formula feeding when they are already breastfeeding?

11. 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?

12. Are you aware of specific concerns about breastfeeding that WIC moms may face at different stages of breastfeeding? For example:

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?

13. Are you aware of specific challenges that WIC moms may face in initiating breastfeeding? [PROVIDE PROMPTS/EXAMPLES, IF NECESSARY]

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

2. What knowledge can you share about ways that WIC moms may overcome these challenges?

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

14. What are some factors that affect a mother’s belief that she can succeed (self-efficacy) in initiating breastfeeding?

15. What are some factors that affect a mother’s belief that she can succeed (self-efficacy) in continuing exclusive breastfeeding?

1. How does a WIC mom’s support system (e.g., fathers, partners, family members, health care providers, employers, other lactation support providers) affect her belief that she can successfully initiate breastfeeding?

2. How does it affect her belief that she can successfully continue exclusive breastfeeding?

16. 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)

17. 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?

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

Thank you so much; your help has been invaluable.