A quality improvement initiative to develop and implement an infant feeding strategy for healthy start

Thesis (D.P.H.)--Boston University PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.Background: Disparities in breastfeeding rates may contribute to poor health outcomes among Black infants and mothers. There is strong evidence associating breastfeeding with improved health outcomes of conditions that disproportionately affect Black women and children; improving breastfeeding rates among Black women is a potential strategy to address health disparities. Healthy Start, a federally-funded initiative, provides case management and home visiting services to pregnant and postpmtum women in 104 communities nationwide. Boston Healthy Start Initiative (BHSI) offers services to self-identified Black women and children and has identified breastfeeding initiation, exclusivity. and duration as areas for improvement. Objective: To use quality improvement (QI) methods to improve perinatal case manager knowledge and self-efficacy to promote breastfeeding among Black women participating in a national program to improve birth outcomes. Methods: We used a QI learning collaborative and rapid Plan Do Study Act (PDSA) cycles to develop an infant feeding strategy that included a training program and Infant Feeding Toolkit. QI activities occurred from May 2011 to April 2012 and were implemented at 4 Boston Healthy Start Initiative sites: 2 community health centers and 2 community-based nonprofit organizations. To assess changes in case manager knowledge and behaviors. we used the Breastfeeding Self-Efficacy Scale and developed an Infant Feeding Knowledge Self-Assessment Tool. Additionally, a Site Supervisor Observation Worksheet was created to assess case manager-client interactions to promote and support breastfeeding. Results: The QI learning collaborative successfully standardized the training and assess rnent of Healthy Start case managers to support breastfeeding. The training resulted in a positive change in infant feeding knowledge and case manager self-efficacy to promote breastfeeding, which was observed in all participating BHSI sites. The implementation of an Infant Feeding Toolkit for Case Managers improved breastfeeding outcomes. Among 24 BHSI participants who delivered infants during the project period, 100% initiated and continued breastfeeding at one week postpmium, and 92% were breastfeeding at 2 weeks postpartum. Conclusion: The QI learning collaborative proved effective as an approach to improve the quality of perinatal case management through the development and implementation of an infant feeding strategy that was feasible to implement at a marginal cost and well received by pm1icipants