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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. Provider Training. (Stand-Alone)

Approach. Provide training to health care providers around breastfeeding best practices

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Overview. Studies demonstrate that many clinicians lack the basic breastfeeding knowledge needed to support breastfeeding successfully. Training programs recognize the powerful role that healthcare workers have in successful breastfeeding and the need for competent, hands-on skills to support lactation.[1] There has been promising research to show that intensive breastfeeding education for health care practitioners may increase breastfeeding initiation rates. This training for providers may have less of an impact on exclusive breastfeeding rates.[2]

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential to work...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

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 or aligned components.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

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

  • Number of health care providers who complete breastfeeding best practices training. (Measures the reach and scale of training participation) Number of health care settings for practices represented in breastfeeding training. (Measures different care settings engaged in training)

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

  • Percent of breastfeeding training content that is evidence-based and aligned with current guidelines. (Evaluates the quality and validity of training information) Percent of provider training that includes hands-on skill development and practice opportunities. (Assesses the use of effective adult learning and skills transfer approaches)

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

  • Number of health professional schools and training programs adopting breastfeeding curricula. (Measures upstream integration of breastfeeding training) Number of healthcare organizations establishing provider breastfeeding training requirements. (Shows systemization and sustainability of training) Number of mothers who receive breastfeeding best practices support from trained providers and breastfeed for 6+ months. (Measures impact on long-term breastfeeding outcomes) Number of regional health systems that see improvements in breastfeeding initiation after provider training. (Measures the population health impact of training initiatives)

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

  • Percent of provider breastfeeding training that addresses care practices to address different community needs. (Evaluates attention to providing responsive support) Percent of providers trained who serve a patient population experiencing breastfeeding challenges. (Assesses strategic focus) Percent increase in breastfeeding initiation among women experiencing socio economic challenges after provider training initiative. (Measures impact on a population experiencing socioeconomic challenges) Percent increase in breastfeeding duration after training providers serving a variety of populations. (Measures ultimate impact on health access and reach)

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 Grossman X, Chaudhuri J, Feldman-Winter L, et al. Hospital Education in Lactation Practices (Project HELP): does clinician education affect breastfeeding initiation and exclusivity in the hospital? Birth. 2009; 36(1):54-59.

2 Ballou, J., Wiseman, C., Jackson, L., Godfrey, R., & Cagle, D. (2017). Lactation skills workshop: a collaboration of the City of Dallas WIC and local hospitals. Journal of nutrition education and behavior, 49(7), S202-S206.

3 Rosen-Carole, C., Allen, K., Thompson, J., Martin, H., Goldstein, N., & Lawrence, R. A. (2019). Prenatal Provider Support for Breastfeeding: Changes in Attitudes, Practices and Recommendations Over 22 Years. Journal of Human Lactation, 0890334419830996.

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.