Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Lactation Consultant, Home Visits, Telephone Support, Provision of Breastfeeding Item, PROVIDER/PRACTICE, Other (Provider Practice)

Intervention Description: Determined the effectiveness of primary care-based, and pre- and postnatal interventions to increase breastfeeding.

Intervention Results: In Best Infant Nutrition for Good Outcomes (BINGO) at 3 months, high intensity was greater for the LC+EP (odds ratio [OR] = 2.72; 95% confidence interval [CI] = 1.08, 6.84) and LC (OR = 3.22; 95% CI = 1.14, 9.09) groups versus usual care, but not for the EP group alone. In PAIRINGS at 3 months, intervention rates exceeded usual care (OR = 2.86; 95% CI = 1.21, 6.76); the number needed to treat to prevent 1 dyad from nonexclusive breastfeeding at 3 months was 10.3 (95% CI = 5.6, 50.7).

Conclusion: LCs integrated into routine care alone and combined with EP guidance from prenatal care providers increased breastfeeding intensity at 3 months postpartum.

Study Design: RCT

Setting: Urban, prenatal clinic in the Bronx, NY

Population of Focus: Women who spoke English or Spanish, ≥ 18 years old, in the first or second trimester of a singleton pregnancy, without risk factors for a premature birth or maternal/infant condition that would prevent or complicate breastfeeding

Data Source: Mother self-report

Sample Size: Best Infant Nutrition for Good Outcomes (BINGO) • Lactation Consultant (LC) (n=77/73) • Electronically Prompted (EP) Guidance by Prenatal Care provider (n=236/223) • LC + EP (n=238/226) • Control (n=77/73)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Lactation Consultant, Telephone Support, Hospital Policies, PROVIDER/PRACTICE, Other (Provider Practice)

Intervention Description: The purpose of this study was to determine whether implementing a program based on a clinical protocol affects breastfeeding rates within a pediatric primary care setting. Increasing breastfeeding rates is an important public health initiative identified by multiple agencies.

Intervention Results: The results of this evaluation were positive for exclusive breastfeeding, with group comparisons showing a statistically significant increase in exclusive breastfeeding rates at all 5 time points.

Conclusion: Our diverse patient population within a pediatric practice had increased initiation rates and exclusive breastfeeding rates after implementation of the ABM's breastfeeding-friendly protocol. Families who receive care in a pediatric primary care setting that has implemented the ABM clinical protocol may have increased rates of exclusive breastfeeding.

Study Design: QE: pretest-posttest

Setting: 2 locations (1 suburban, 1 rural) of a single practice in northern VA

Population of Focus: Women with healthy, singleton births of ≥ 37 GA , who entered the practice within the first week of birth and returned for health maintenance visits at 2, 4, and 6 months

Data Source: Medical record review

Sample Size: Pre-Intervention (n=376) Post-Intervention (n=381)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Peer Counselor, Assessment (PATIENT_CONSUMER), Professional Support, HEALTH_CARE_PROVIDER_PRACTICE, Other (Provider Practice), COMMUNITY, Social Supports, Individual Supports,

Intervention Description: In 2014, the New York State WIC program launched the You Can Do it (YCDI) initiative in 12 WIC clinics. This multicomponent intevention, which was originally developed by the Vermont WIC program, was designed to improve participants' knowledge, attitudes, confidence, and social support to breastfeed exclusively through a screening and tailored counseling protocol combined with peer counselor and professional support spanning the prenatal and early postpartum periods. This multicomponent intervention paired with a yearlong learning community in the 12 clinics.

Intervention Results: Prevalence of exclusive BF at 7 and 30 days was significantly higher among BAPT women compared with non-BAPT or baseline cohorts. Non-Hispanic black and Hispanic women in the BAPT cohort achieved significantly higher exclusive BF rates at 30 and 60 days compared with those in non-BAPT and baseline cohorts.

Conclusion: The initiative seems to be effective at increasing exclusive BF, particularly among non-Hispanic black and Hispanic women in the New York State WIC program.

Study Design: Quasi-experimental study

Setting: 12 WIC clinics in New York State

Population of Focus: Prenatal women enrolled in WIC during the first trimester of pregnancy who intended to breastfeed or were undecided

Sample Size: Baseline cohort of 688 mother-infant dyads and two intervention cohorts: Breastfeeding Attrition Prediction Tool (BAPT) (n=362 monther-infant dyads) and non-BAPT (n=347 mother-infant dyads); 12 WIC clinics; 47 WIC staff members

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State), Expanded Insurance Coverage, Other (Provider Practice),

Intervention Description: The intervention described in the study involved the implementation of two policy changes in Nova Scotia, Canada: 1) the implementation of a publicly-funded universal influenza vaccination program in the 2010–2011 influenza season, and 2) the addition of pharmacists as immunizers in 2013. The aim of these changes was to improve vaccine uptake by eliminating cost as a barrier and increasing convenience and possibly access ,[object Object],. The study aimed to investigate any changes in influenza vaccine coverage following the implementation of each policy change ,[object Object],. The study compared influenza vaccine coverage between the pre-universal program period, the universal publicly funded program period, and the universal publicly funded program with the addition of pharmacists period ,[object Object],.

Intervention Results: The results of the study showed an increase in influenza vaccine coverage immediately following the implementation of the two studied policy changes. Vaccine coverage increased from 36.4% to 38% following the implementation of the universally funded vaccine policy. Following the implementation of pharmacists as immunizers, coverage increased from 35.7% to 41.7% ,[object Object],. Despite the initial increase in coverage observed, a reduction in coverage was observed in the two years following the addition of pharmacists as immunizers ,[object Object],. The study also found that coverage in individuals aged 65 years and older remained relatively consistent with the addition of a universally funded vaccination program compared to the pre-universal study years ,[object Object],.

Conclusion: The addition of a universally funded vaccination policy and the addition of pharmacists as providers of the influenza vaccine resulted in increases in vaccine coverage initially. Additional research is needed to determine the long-term impacts of the policy changes on vaccination coverage and to identify other important factors affecting vaccine uptake.

Study Design: the main study discussed in the file aimed to compare influenza vaccine coverage between three different policy periods: 1) pre-universal influenza vaccination program; 2) universal publicly funded program; and 3) universal publicly funded program with the addition of pharmacists 6. The study used census data and aggregate immunization data obtained from the Nova Scotia Department of Health and Wellness 6. The study design was observational, as it analyzed existing data rather than conducting a randomized controlled trial or other experimental study.

Setting: Nova Scotia, Canada

Population of Focus: The target audience of the PDF file is likely researchers, healthcare professionals, and individuals interested in public health and related topics. The scientific literature and resources included in the file are intended for those with a background in the field and may contain technical language and data analysis.

Sample Size: The PDF file contains multiple studies and reports related to public health, and each study may have a different sample size. Without a specific study or report in question, it is not possible to provide a definitive answer regarding the sample size.

Age Range: The PDF file contains information related to influenza vaccination coverage for Nova Scotia residents aged six months of age and older ,[object Object],. Additionally, the study discusses influenza vaccine coverage in infants, which was found to have been steadily increasing throughout the pre-universal program period, with a large increase with the addition of the universal policy in 2010–2011 after which coverage declined for the remainder of the study period ,[object Object],.

Intervention Components (click on component to see a list of all articles that use that intervention): Other (Provider Practice), Prenatal Care Access, Non-Traditional Providers

Intervention Description: The intervention in this study was the provision of obstetric care, specifically prenatal care and delivery services, by family physicians (FPs) in a rural county in Alabama. The FPs provided full-time prenatal care and delivery services at a local hospital, with high-risk pregnancies and infants referred to a regional medical center located 38 miles away. The FPs were trained through an obstetrics fellowship and had experience in managing high-risk deliveries. The study examined the impact of the availability of local obstetric services, particularly prenatal care provided by FPs, on infant mortality rates in the county

Intervention Results: The results of the study indicated that the availability of obstetric care, particularly prenatal care and delivery services provided by family physicians (FPs), was associated with lower infant mortality rates in the rural county of Pickens, Alabama. The study found that during the period when both prenatal care and delivery services were provided locally by FPs, the county achieved an infant mortality rate (IMR) that was lower than both the state and national IMRs during the same period. The closure of the local maternity unit coincided with a 50% increase in IMR, while the provision of full-time prenatal care by an FP trained through an obstetrics fellowship, even in the absence of local delivery services, contributed to an 11% decline in IMR compared to a period with no obstetric care available locally . Furthermore, the study observed a significant decrease in IMR in Pickens County between periods when no obstetric services were available and when full prenatal care and delivery services were provided locally by FPs. The results also highlighted the potential impact of FPs providing obstetric care, including lower rates of cesarean deliveries, forceps deliveries, and labor inductions in low-risk pregnancies compared to obstetricians/gynecologists (OB/GYNs), as well as higher rates of spontaneous vaginal deliveries and vaginal deliveries after cesarean. Despite the loss of local delivery services, the provision of full-time prenatal care by an FP trained through an obstetrics fellowship resulted in a decline in IMR, indicating the potential benefit of prenatal care alone in reducing infant mortality . Additionally, the study compared IMR trends in other rural counties with and without obstetric services and observed variations in IMR changes based on the availability of obstetric care. These findings supported the association between the provision of obstetric care, particularly by FPs, and changes in IMR in rural communities .

Conclusion: The study concluded that the availability of obstetric care, particularly prenatal care and delivery services provided by family physicians (FPs), can have a significant impact on infant mortality rates in rural areas. The study found that the provision of full-time prenatal care and delivery services by FPs was associated with lower infant mortality rates in a rural county in Alabama. The study also highlighted the potential impact of FPs providing obstetric care, including lower rates of cesarean deliveries, forceps deliveries, and labor inductions in low-risk pregnancies compared to obstetricians/gynecologists (OB/GYNs), as well as higher rates of spontaneous vaginal deliveries and vaginal deliveries after cesarean. The study suggested that properly trained FPs can have a profound impact on infant mortality in rural areas and that efforts should be made to maintain their competencies in managing high-risk deliveries. The study also emphasized the importance of access to prenatal care in reducing infant mortality rates, even in the absence of local delivery services

Study Design: The study utilized a natural experiment design to investigate the impact of the availability of obstetric services, particularly prenatal care provided by family physicians, on infant mortality in a rural county. The natural experiment involved variations in the availability of obstetric services in Pickens County, Alabama, over different time periods, allowing the researchers to assess the association between the closure and reopening of local obstetric units and changes in infant mortality rates . This design enabled the researchers to examine the potential impact of the availability of local obstetric services on infant mortality in a real-world setting.

Setting: The setting of the study was Pickens County, Alabama, a rural area where obstetric services, including prenatal care, were unavailable for a period of time . This rural setting allowed the researchers to examine the impact of the availability of obstetric care provided by family physicians on infant mortality in a specific geographic area.

Population of Focus: The target audience for this study includes healthcare professionals, policymakers, and researchers interested in maternal and child health, particularly in rural areas. The findings of the study are relevant to family physicians, obstetricians, public health officials, and policymakers involved in improving access to prenatal care and reducing infant mortality in rural communities

Sample Size: The study focused on a specific rural county, Pickens County in Alabama, and did not explicitly mention a sample size. The researchers likely used available data on infant mortality, prenatal care, and obstetric services within the county to conduct their analysis. Therefore, the "sample size" in this context would refer to the population of the county and the available data on births, infant deaths, and prenatal care services within that population.

Age Range: The study focused on infant mortality, which is defined as the number of deaths among infants less than one year of age . Therefore, the age range of interest in this study was from birth to one year of age.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Lactation Consultant, Other Education, Technology-Based Support, HEALTH_CARE_PROVIDER_PRACTICE, Other (Provider Practice),

Intervention Description: Telelactation is one tool that can be leveraged to increase access to International Board Certified Lactation Consultants (IBCLCs) in rural settings. Telelactation services connect breastfeeding women to remotely located IBCLCs through audio-visual technology. The Telehealth for Mothers to Improve Lactation Confidence (Tele-MILC) randomized controlled trial evaluated the feasbility and impact of telelactation via personal electronic devices on breastfeeding duration and exclusivity among rural mothers. Participants randomized to the telelactation arm were given an orientation to Pacify Health's telelactation app by hospital nurses. The nurses showed participants how to download the app on a personal device (smartphone or tablet), provided a coupon code for free, umlimited video calls, and encouraged participants to conduct a test call on their own device or on a demonstration device. After the orientation, participants could request umlimited, on-demand video calls with IBCLCs through the app for as long as they desired. The app used in the trial aimed to provide video calls within seconds of a visit request by a mother. The app is also HIPAA-compliant, and the telelactation services it provides involves a large network of geographically dispersed IBCLCs available to take video calls 24 hours a day.

Intervention Results: Among participants in the telelactation arm, 50% (47/94) reported participating in video calls. At 12 weeks, 71% of participants in the telelactation arm versus 68% of control participants were breastfeeding in the ITT model (3% difference, P = .73), whereas 73% of participants in the telelactation arm versus 68% of control participants were breastfeeding in the IV model (5% difference, P = .74). Among participants who were still breastfeeding at 12 weeks, 51% participants in the telelactation arm were breastfeeding exclusively versus 46% of control participants in the ITT model (5% difference, P = .47), whereas 56% of participants in the telelactation arm were breastfeeding exclusively versus 45% of control participants in the IV model (11% difference, P = .48). In all models, participants in the telelactation arm were breastfeeding at higher rates; however, differences were not statistically significant.

Conclusion: This trial demonstrated that telelactation can be implemented with a rural underserved population. Though this trial was not powered to detect differences in breastfeeding duration and exclusivity, and none were observed, telelactation remains a promising approach for further investigation. ClinicalTrials.gov Identifier: NCT02870413.

Study Design: RCT

Setting: Critical Access Hospital in North-Central PA/Online

Population of Focus: Postpartum women who had initiated breastfeeding and planned to contine after hospital discharge

Sample Size: 203 women (102 for intervention and 101 for control)

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Materials, Lactation Consultant, Other Education, Professional Support, HEALTH_CARE_PROVIDER_PRACTICE, Other (Provider Practice),

Intervention Description: A team-based, integrated lactation consultant (LC) and primary care provider (PCP) program improves breastfeeding rates in some outpatient settings, but only a limited number of studies have assessed efficacy in socioeconomically and racially diverse communities. The study intervention implemented routine LC/PCP visits for families at their first newborn visit to the FQHC following hospital discharge. A typical team-based visit was scheduled for 40 minutes with the RN/LC present for the entire visit and the PCP joining for about 10 minutes to examine the infant and coordinate the plan of care. The remaining 30 minutes was dedicated to lactation support, including addressing latch, milk supply, decreasing maternal pain, and breastfeeding anticipatory guidance.

Intervention Results: Among patients who initiated breastfeeding, those who received a LC/PCP visit were significantly more likely to be breastfeeding at 2 weeks (94% versus 80%, p = 0.004) and 4 months (68% versus 45%, p = 0.01). However, breastfeeding rates for the whole practice were not significantly different before and after implementation. Seventy-two percent of breastfeeding families saw a LC (n = 204). Median LC visit per breastfeeding patient was 1.18 (standard deviation [SD] +1.2). Patient survey reported that the three most commonly helpful aspects of the visit were “latch instruction” (60%), “breastfeeding questions answered” (80%) and “learning about massage and hand expression” (50%).

Conclusion: Team-based LC/PCP care is feasible at a FQHC. Patients found it helpful. Among families who initiated breastfeeding, receiving LC/PCP care was associated with increased breastfeeding duration through 4 months.

Study Design: Retrospective chart review

Setting: Federally Qualified Health Center in Cleveland, OH

Population of Focus: Women and infants receiving care at a Federally Qualified Health Center

Sample Size: Pre (n=197 women) and post (n=245 women)

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Other Education, Provision of Breastfeeding Item, PROVIDER/PRACTICE, Hospital Policies, Other (Provider Practice), POPULATION-BASED SYSTEMS, COMMUNITY, Other (Communities), Provider Training/Education

Intervention Description: A breastfeeding promotion program conducted on the Navajo reservation.

Intervention Results: Based on medical records review of feeding practices of all the infants born the year before (n = 988) and the year after (n = 870) the intervention, the program was extremely successful.

Conclusion: This combination of techniques, including qualitative and quantitative research into local definitions of the problem, collaboration with local institutions and individuals, reinforcement of traditional understandings about infant feeding, and institutional change in the health care system, is an effective way of facilitating behavioral change.

Study Design: QE: pretest-posttest

Setting: Shiprock, NM

Population of Focus: All mothers with infants born at the Shiprock hospital

Data Source: Medical record review

Sample Size: Preintervention (n=988) Postintervention (n=870)

Age Range: Not specified