Date of Award

Summer 8-2020

Document Type

Thesis

College

College of Arts and Sciences

Degree Program

Human Nutrition

Degree Name

Master of Science

Thesis Advisor

Dr. Hope Lima

Committee Member

Dr. Ashley Licata

Committee Member

Dr. Katherine Knop

Keywords

Breastfeeding education, Breastfeeding support, Breastfeeding medical management, Primary care, Provider perceptions, Provider roles

Committee Member

Karin Evans

Abstract

Background: Human milk is recommended as the exclusive source of nutrition for all infants in the first six months of life. Current rates of exclusive breastfeeding at six months are well below the public health recommendations (24.9% as of 2015). New mothers may experience many challenges which impact both breastfeeding initiation and duration rates in the postpartum period. Studies indicate that breastfeeding rates improve when women receive a combination of prenatal education coupled with postnatal support. Primary care practitioners in outpatient settings have a unique opportunity to provide lactation education, support, and medical management for their patients to improve outcomes. Research aim/question(s): To develop and validate a survey questionnaire used to assess healthcare provider perceptions and roles related to lactation practices in a primary care setting. Subsequently, to describe the perceptions and roles of practitioners involved in primary care for pregnant, postpartum, and infant populations. Materials and Methods: This research created a cross-sectional survey questionnaire targeting primary care and ancillary providers in outpatient settings. The pilot instrument was both content and face validated through an electronic method using a panel of 18 experts known to work with pregnant and iii lactating populations. The final 58-item instrument was distributed to primary care providers in the Southeastern United States. A total of 38 questions have been reported on in this analysis. The final results for the sample (n = 40) are described utilizing descriptive statistics and frequencies. Results: The pilot instrument consisted of 49 questions while the final instrument expanded to include 58 questions. Results of the survey highlight the majority of primary care providers (76%) believe it is the role of the physician to deliver lactation education, support, and medical management. However, 40% of the respondents reported referring patients to lactation professionals most of the time. Additional analysis of survey variables focused on reasons for referral and clinical barriers to lactation care suggest that integrated care models may be necessary to properly support pregnant, postpartum, and infant populations. Conclusion: Healthcare providers in outpatient settings believe lactation education, support, and medical management is important to provide to their patients. Time is a consistent barrier for point-of-care practices yet the reason for referral are clinically significant for breastfeeding success. Future research is necessary to adequately assess the coordination of care across primary and ancillary providers. Finally, standardized evidence-based practices should be developed for implementation in outpatient care settings.

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