Realities of WIC Breastfeeding Mothers. A Photovoice Project

Transcription

1 Realities of WIC Breastfeeding Mothers A Photovoice Project

2 Introduction WIC has been increasing the support for breastfeeding for more than 7 years Delaware County WIC has seen a 10% increase in initiation Duration of breastfeeding has not increase proportionally

3 Healthy People 2010 Breastfeeding Goal 75% Breastfeeding Initiation 50% Breastfeeding at 6 months 25% Breastfeeding at 1 year Breastfeeding has enormous public health implications

4 Breastfeeding Impacts: Quality of Life for all segments of society: children and adults, male and female. Health disparity

5 Community Based Participatory Research Recognizing community as a unit of identity Building on strength of resources Facilitating collaborative research Integrating knowledge and action Promoting co-learning and an empowering process Maintaining cyclical and iterative process From Minkler and Wallerstein, 2003

6 Photovoice as a CBPR Method Improves the quality and validity of the research Illustrates the local knowledge Develops local theory Progresses towards action All features important to CBPR

7 Photovoice: inductive questioning Enabled 7 WIC participants in Muncie, IN to record and reflect on their personal strengths and concerns about breastfeeding support Promoted critical dialogue and knowledge concerning support for breastfeeding mothers Provided a medium for the presentation of community participant s lived experiences (Wang, 1999).

8 Who Participated

9 Photograph Assignment Question What are the supports you have received to be successful in breastfeeding? Photographs taken

10 Analysis Transcribing and Reading Text and Photographs using a software program, NVIVO 7

11 Analysis continued Reading transcriptions Identifying text with software program (NVIVO 7) Verifying text with participants Developing codes and verifying Research Collapsing codes into themes

12 Results Sense of Community Support Health Care Providers Public Space Workplace Church School Sense of Support from others Father of Child Friends Mother Children Importance of Role Models Sense of Strength Within

13 Community Support and Institutional Policy Strengths and Concerns La Leche League Daycare School Work Health Care Library

14 Sense of Receiving Support Most of my pictures I took were just family pictures; them doing things together or my husband and them or my parents and them because that is my real support.

15 Sense of Mutual Support We have been good support to one another, calling each other with random questions and concerns and all that just reaching out to somebody who had done it before was important We just have a really tight friendship and part of it was that we were nursing together

16 Sense of Emotional Support He has such high respect for me, for what I have done for his son. There is nothing else I could have done that would really make him appreciate me like he does.

17 Importance of Role Models Breastfeeding sets a certain role model in our family. Crystal

18 Importance of Role Models I think there is that eternal concept of breastfeeding and [it] is very welcoming, nurturing, soft, come here and cuddle, you don t turn them away. Crystal

19 Sense of Strength Within Finding and attending La Leche League Discovering how to talk to her mother about mother s negative attitude Her mother had said: if you don t want to starve your child you should use formula and the participant thought No way is she going to force this [giving formula] on us

20 Sense of Strength Within It s not what s important to me. It s what is important for them. That s the most natural way to feed them. Kathryn Breastfed her daughter and now her twin sons

21 Sense within and the natural way They were exploring and discovering. It s like breastfeeding. Crystal

22 Sense within of the natural way Its really relaxing sitting down and feeding them. They are really relaxed, you get really relaxed. Mother of twins Before Feeding After Feeding

23 Social Actions Ideas developed during second session 3 rd session participants developed the theme 5 out of 7 participants participated Follow up via or phone Unable to complete social action Participant moved for a job Too busy juggling work and parenting Participant working with husband s job Busy family activities Another pregnancy Compromised with community interactions Presented poster at County Fair Presented poster at Community Artwalk

24 What Makes Breastfeeding Successful Support from Family Support from Family Most of my pictures were just family pictures; them doing things together or my husband and them or my parents and them because that is my real support. Kara WIC Mothers Photo Project We are seven WIC mothers who have breastfed for at least 4-6 months and volunteered to take pictures of what we needed for success as breastfeeding mothers. We met with the Delaware County WIC lactation consultant three times to share our pictures and discuss our experience. The quotes and themes come from the discussions. This community based participatory research was funded by the Indiana University School of Nursing, Institute for Action Research in Community Health. Who we are: WIC Mothers Photo Project Hospital Conclusions Policy Ball Memorial Hospital has been making many positive. changes in the last few years. The changes have been a big support for breastfeeding mothers. When Kara had twins one of the boys was in Neonatal Intensive Care and one was with her. It was difficult getting started but I knew I could do it because I had breastfed my first child. Kara Community Support Community Programs I was determined to breastfeed Layla Workplace Policy My breast pump make it easier to still go to work. Parent to Parent Programs Helpful Professionals Library Resources Nutrition Education Childcare Policy School Curriculum for Health Savings Workplace of Breastfeeding Policy A Mother s Right to Breastfeed I love these cards.. Breastfeedin g is just taking care of your child and completely natural. Layla Blah, blah, blah. Blah, blah, blah. However, blah, blah, blah. This company has a written policy they have Acknowledgments been We thank I. Güor for laboratory assistance, Mary Juana for seeds, Herb really supportive. Isside for applying the greenhouse stress treatment, and M.I. Menter for statistical advice and scintillating discussions. Funding for this project was provided by the Swarthmore College Department of Biology, a Merck summer stipend, and my mom. [Note that people s titles are omitted.] For further information Please contact @swarthmore.edu. More information on this I take and my related projects can be obtained at (give the URL for general laboratory web site). A link to an online, PDF-version pump of the poster is nice, too. and bottles My best friend If you just must include a pretentious logo, to work she hide it down has here. encouraged But don t include a pretentious logo. and pump Use the space for something else. me at work on a break. Delaware County Fair, July 2007

25 Community Information at Artwalk Muncie, IN October 2007

26 Results WIC women identified self determination and a belief that breastfeeding was the natural way to feed their. These beliefs and attitudes appeared to be very important in their success of breastfeeding. Positive attitudes about breastfeeding by the family, a friend or a partners increased the duration Community attitudes that did not encourage breastfeeding were a deterrent to feeling comfortable breastfeeding in church and other public places Workplace policies that did not acknowledge the needs of the breastfeeding mother were the most difficult to overcome.

27 Conclusions Participation within a targeted community can inform stakeholders of local knowledge and beliefs that can be incorporated for more effective interventions that increase duration. Participation in the project increased the participants awareness and interests in being change agents in there own community

28 Limitations Adaptation of these findings to interventions is appropriate to this specific situation but should not be generalized Analyzing is time consuming for many programs Working in community is time consuming Community involvement of young mothers can be difficult because of family obligations and jobs

29 References American Academy of Pediatrics, (1997). Work Group on Breastfeeding: Breastfeeding and the use of human milk. Pediatrics, 100, Bartholomew, L., Parcel, G., Kok, G., and Gottlieb, N. (2001). Intervention Mapping: Designing Theory-and Evidence-Based Health Promotion Programs. New York: McGraw-Hill. Baumslag, N. and Michels, D. (1995). Milk, Money and Madness: The Culture and Politics of Breastfeeding Westport: Bergin & Garvey. Clark, MJ., Cary, M., Diemert, G., Ceballos, R., Sifuentes, M., Atteberry, I., Vue, F., and Trieu, S. (2003). Involving communities in community assessment. Public Health Nursing, 20, (6) Collaborative Group on Hormonal Factors in Breast Cancer. (2002) Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50,302 women with breast cancer and 96,973 women without the disease. Lancet, Ewald, W. (2000). Secret Games: collaborative works with children New York, Scalo. Furumoto, R. and Montano, T. (2003). Critical Consciousness and Humanization: Madres Unidas para la Justicia. Freire Online. Retrieved on March 24, 2006 at

30 References continued Gebbie,,K., Rosenstock, L. and Hernandez, L. (2003). Who will keep the public healthy? Educating public health professionals for the 21st century. Washington DC: Institute of Medicine National Academy of Sciences. Israel, B., Schulz, A., Parker, E., and Becker, A. (1998). Review of community-based research: Assessing partnership approaches to improve public health. Annuals Review of Public Health, 19, Imaginis. (2005). Breast cancer: statistics on incidence, survival, and screening. Retrieved on March 1, 2006 at Hening, M. (2001). Host defense benefits of breastfeeding for the infant: effect of breastfeeding duration and exclusivity. Pediatric Clinics of North America, 48(1), Klein J. (2001). The burden of otitis media. Vaccine, 19, S2-S8. Labbok, M. (2001) Effects of breastfeeding on the mother. Pediatric Clinics of North America, 48(1), Lindsey, E. and Mc Guinness, L. (1998). Significant elements of community involvement in participatory action research: Evidience from a community project. Journal of Advanced Nursing, Minkler, M and Wallenstein, N. (2003). Community-based participatory research for health San Francisco: Jossey-Bass. US Census Bureau. (2000). American Factfinder. Retrieved on March 23, 2006 at U.S. Department of Health and Human Services. Healthy People nd ed. 2 vols. Washington, DC: U.S. Government Printing Office, November (

31 References continued U.S. Department of Health and Human Services. Healthy People nd ed. 2 vols. Washington, DC: U.S. Government Printing Office, November ( U.S. Department of Health and Human Services. (2000). HHS blueprint for action on breastfeeding. (Office of Women s Health). Washington, DC. Wang, C. (1997). Concept, methodology, and use for participatory needs assessment. Health education and behavior, 24(3), Wang, C. (1999). Photovoice: A Participatory Action Research Strategy Applied to Women's Health. Journal of Women's Health & Gender-Based Medicine, 8 (2) Wang, C. and Pies, C. (2004). Family, maternal, and child health through photovoice. Maternal & child health, 8 (2)

32 Thank You so much This was a wonderful opportunity for me. It advanced my understanding of research It increased my understanding of qualitative work needed for assessing the community needs I have shared the methodology of photovoice with others at the International Lactation Consultant Association Meeting, 2007 American Public Health Association Meeting ILCA San Diego, 2007 APHA Washington DC, 2007