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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Breastfeeding.

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Strategy. Group Education

Approach. Promote the use of group education for pregnant women around breastfeeding practices

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Overview. Group education is an instrument used by professionals in primary care that favors the acquisition of skills and modification of already-acquired behavior making it a potential method of choice to improve rates of exclusive breastfeeding.[1] Group education may impact breastfeeding attitudes and perceptions, as well as on exclusive breastfeeding initiation and duration.[2]

Evidence. Mixed Evidence. Strategies with this rating have been tested more than once with results that sometimes trend positive and sometimes show little effect. These strategies still have potential to work; however, further research is needed to understand the components of the strategies that have the most potential in producing consistent positive results. (Clarifying Note: The WWFH database calls this "insufficient evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Health and Health Behaviors/Behavior Change. This strategy improves individuals' physical and mental health and their adoption of healthy behaviors (e.g., healthy eating, physical activity).
  • Environmental Health. This strategy improves the impact of physical, chemical, and biological factors in the environment on health.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Health Teaching (Education and Promotion) (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

PROCESS MEASURES:

  • Number of group breastfeeding education sessions offered to pregnant women. (Measures the quantity of educational opportunities provided.)
  • Number of pregnant women attending group breastfeeding education sessions. (Tracks the reach and participation in group education.)
  • Number of community locations where group breastfeeding education is delivered. (Assesses the accessibility and dispersion of group education.)

OUTCOME MEASURES:

  • Number of pregnant women who report increased breastfeeding knowledge after group education. (Evaluates the educational impact of group sessions.)
  • Number of group education participants who initiate breastfeeding after giving birth. (Links group education to a key short-term behavioral outcome.)
  • Number of women who attend group education and access breastfeeding support services postpartum. (Measures continuity from education to support utilization.)

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

PROCESS MEASURES:

  • Percent of group breastfeeding education sessions that are evidence-based or adhere to best practices. (Assesses the quality and validity of educational content.)
  • Percent of group education facilitators who receive training in adult learning principles and group dynamics. (Measures investment in facilitator skills and competencies.)
  • Percent of group education sessions that incorporate interactive activities and peer sharing opportunities. (Evaluates the engaging and participatory nature of sessions.)

OUTCOME MEASURES:

  • Percent of women who complete a full series or recommended "dose" of group breastfeeding education. (Assesses retention and exposure to complete educational curriculum.)
  • Percent of group education participants who report high confidence in their ability to breastfeed. (Measures an important attitudinal driver of breastfeeding behavior.)
  • Percent of pregnant women who hear about group education opportunities from trusted community sources. (Tracks the credibility and social reinforcement of group education.)

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

PROCESS MEASURES:

  • Number of referral pathways established between group education and other prenatal care services. (Assesses systems integration and care coordination.)
  • Number of MCH programs and stakeholders collaborating to deliver or promote group breastfeeding education. (Measures strategic alignment and collective impact.)
  • Number of group education sessions that address breastfeeding challenges for working mothers and students. (Evaluates tailoring of content to key population needs.)

OUTCOME MEASURES:

  • Number of women receiving post-discharge breastfeeding assistance from group education facilitators. (Tracks extended benefits and support beyond the sessions.)
  • Number of group education participants who exclusively breastfeed for 6 months. (Measures impact on a priority outcome and public health goal.)
  • Number of providers who recommend group breastfeeding education to their pregnant patients. (Assesses provider buy-in and perceived value of group education.)

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

PROCESS MEASURES:

  • - Percent of group breastfeeding education marketing materials in the languages spoken in the community. (Evaluates cultural relevance and linguistic accessibility.)
  • - Percent of group education sessions held in priority neighborhoods with lower breastfeeding rates. (Measures strategic deployment of resources to reduce disparities.)
  • - Percent of fathers and support partners of pregnant women who attend group breastfeeding education. (Assesses family-centered approach and partner engagement.)

OUTCOME MEASURES:

  • - Percent increase in breastfeeding initiation among Medicaid-insured women after group education implementation. (Measures impact on a population facing socioeconomic barriers.)
  • - Percent of group education participants still breastfeeding at 1 year postpartum. (Captures long-term behavior maintenance and child health benefits.)
  • - Percent reduction in the gap between local and state/national breastfeeding rates after group education rollout. (Assesses community-level progress toward equity.)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

1 Martin-Iglesias, S., Santamaría-Martín, M. J., Alonso-Álvarez, A., Rico-Blazquez, M., del Cura-Gonzalez, I., Rodríguez-Barrientosn, R. & Durand-Rincón, I. (2018). Effectiveness of an educational group intervention in primary healthcare for continued exclusive breast-feeding: PROLACT study. BMC pregnancy and childbirth, 18(1), 59.

2 Finch, C., & Daniel, E. L. (2002). Breastfeeding education program with incentives increases exclusive breastfeeding among urban WIC participants. Journal of the Academy of Nutrition and Dietetics, 102(7), 981.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.