Using the Social Ecological Model to Understand Breastfeeding Support for African American Women Öffentlichkeit

Abstract

Introduction: Breast milk provides optimum health benefits for mothers, infants and children. African American women have the lowest rates of breastfeeding within the United States. Support has been identified as a major contributing factor to African American breastfeeding outcomes. The purpose of this study is to understand the relationship between sources of support and breastfeeding outcomes among African Americans using a Social Ecological Model framework.

Methods: This study is a systematic review of the literature that includes empirical studies that explore sources of support among African American women. This study is guided by five steps to conducting a systematic review. Significant associations were determined by statistical tests and the corresponding p-value for sources of social support and breastfeeding outcomes. Studies that did not contain statistical tests listed relevant descriptive statistics.

Results: Ten studies explored the relationship between interpersonal sources of support and breastfeeding outcome. Significant findings on breastfeeding outcomes were found in 63% of studies. Five studies explored the relationship between community sources of support and breastfeeding outcomes. Four studies found community sources of support were significantly and positively associated with breastfeeding outcomes. Three studies explored the relationship between macrosystem sources of support and breastfeeding outcomes. All studies found at least one policy was significantly associated with breastfeeding, though one study found policy was significantly and negatively associated with breastfeeding duration.

Discussion: Sources of breastfeeding support for African Americans found in the systematic review include partner, mother, family, friends, healthcare system, and policy. This study suggests several recommendations that can improve breastfeeding support among African American using SEM. These include explore the relationship between interpersonal sources of support and breastfeeding duration; further explore the relationship between other community sources of support such as workplace environment and religion and breastfeeding outcomes; and further explore how the macrosystem can positively support breastfeeding among African Americans.

Table of Contents

CHAPTER I – INTRODUCTION ............................................................................ 1 Background .........................................................................................................1 Breastfeeding Disparity among African Americans .....................................................3 Factors Influencing Breastfeeding among African Americans .......................................4 Interventions Associated with Breastfeeding among African Americans .........................6 Sources of Breastfeeding Support among African Americans .......................................7 Theoretical Framework ..........................................................................................8 Purpose of Study ................................................................................................10 Research Questions .............................................................................................11 CHAPTER II – LITERATURE REVIEW .................................................................12 Interpersonal Breastfeeding Support ......................................................................12 Community Breastfeeding Support ........................................................................18 Macrosystem Breastfeeding Support ......................................................................24 CHAPTER III – METHOD ...................................................................................31 Framing Questions for Review ...............................................................................31 Identifying Relevant Work ....................................................................................31 Assessing the Quality of Studies ............................................................................34 Summarizing the Evidence ...................................................................................37 Interpreting the Findings ......................................................................................38 CHAPTER IV – RESULTS ....................................................................................39 Interpersonal Breastfeeding Support ......................................................................41 Community Breastfeeding Support ........................................................................47 Macrosystem Breastfeeding Support ......................................................................50 Systematic Review Summary ................................................................................53 CHAPTER V – DISCUSSSION .............................................................................55 Findings for Research Question 1 ...........................................................................55 Findings for Research Question 2 ...........................................................................57 Implications .......................................................................................................65 Recommendations for Future Research ...................................................................66 Conclusions ........................................................................................................66 REFERENCES ....................................................................................................68

About this Master's Thesis

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School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Stichwort	Breastfeeding African American Maternal and Child Health Social Ecological Model
Committee Chair / Thesis Advisor	Arriola, Kimberly R Jacob, Emory University
Committee Members	Thompson, Winifred Wilkins, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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