Effects of breastfeeding counseling for women at primary care centers in Tijuana, Mexico.

The intervention consists in providing breastfeeding interpersonal counseling (IC), focusing on solving the main breastfeeding obstacle identified by the mother. The information provided includes brochures and posters explained by a medical intern to the mother before the infant is immunized. There are 5 brochures for obstacles with more practical information - Pain: How to get a good latch, when do you need to ask for professional support - PIM: How do you know you are producing enough milk for your baby - Infant dissatisfaction: Understand 3 normal infant behaviors: Crying and hunger-satiety cues, sleep, breastfeeding on demand (No schedule setting) - Family support: How Dad/Grandparents can support a breastfeeding mother - Work: Rights and regulations, milk expression For the other 5 obstacles with a more psychological-social content we used posters with a main message and a picture with a “real breastfeeding mom” from Tijuana. These images were taken with permission from a local campaign and were pre-tested. All the educational material is based on a previous formative research conducted in a similar population in Tijuana, Mexico. Five medical interns were trained for interpersonal counseling. First, a 4-hour session was held, in which 2 graduate students (Nutrition Masters and Doctorate) provided general background on breastfeeding, as well as information about the 10 main obstacles to breastfeeding identified from previous formative research. A second 4-hour session was held guided by a community promoter focused on the WHO breastfeeding counseling training course. The focus of this session was to develop communication skills for “Listening and Learning” (open questions, empathize, avoid judging words) and “Building Confidence and Give Support” (accept what a mother thinks and feels, recognize and praise what she is doing right; give small bits of relevant information; use simple language; make suggestions, not commands). To evaluate medical interns´ counseling performance, supervised practice sessions were conducted with mothers from the target population, until consistency between trainees was determined This intervention was planned to be conducted in 10 primary care health centers, however, it was modified to 5 health care centers due to the pandemic contingency. The five medical interns were assigned to one health care center and at 2 months rotates to another one (in order to not conduct follow-up data recollection in the same population) Mothers with infants requesting immunization services are approached in the waiting room of the health center and given the necessary information about the study. If mothers showed interest in participating, informed consent is presented to be read and signed. Subsequently, a questionnaire is applied to obtain sociodemographic data, as well as instruments to assess attitudes, self-efficacy and breastfeeding practices. The following step is to identify their main obstacle to breastfeeding from a list with the 10 obstacles established in previous formative research. Two additional options are available: adding another obstacle or expressing not having a breastfeeding problem. Participants assigned to the intervention group receive one face to face session of breastfeeding IC by the medical intern lasting between 5 and 10 min. Participants assigned to the control group received counseling on immunizations by the medical intern also. Both groups are scheduled for their next vaccination dose for 2 months afterward. Follow-up data is obtained by a medical intern (who did not collect baseline data and conducted counseling with that participant) at the subsequent visit service. If participants do not attend the 2 month follow-up, they are contacted by telephone to assess attitudes, self-efficacy, and breastfeeding practices. To assess and monitor adherence to or fidelity of the intervention the information about breastfeeding interpersonal counseling completion and duration is registered. The medical interns are under supervision of the graduate students, promotora and PI along all intervention. Medical interns report to principal investigator every week and any time a special case or question is encountered. All the team have meetings every week to discuss incidences.