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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 health care 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. They often have a growing body of recent, but limited research that documents effects. However, further study is needed to confirm effects, determine which types of health behaviors and conditions these interventions address, and gauge effectiveness across different population groups. (Clarifying Note: The WWFH database calls this "mixed 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 health care providers who complete breastfeeding best practices training. (Measures the reach and scale of training participation.)
  • Number of training hours delivered to health care providers on breastfeeding topics. (Quantifies the "dose" and intensity of training provided.)
  • Number of health care settings or practices represented in breastfeeding training. (Tracks the diversity of care environments engaged in training.)

OUTCOME MEASURES:

  • Number of providers who report increased knowledge of breastfeeding best practices after training. (Assesses the educational impact and knowledge gains from training.)
  • Number of patient consultations where providers use skills learned in breastfeeding training. (Links training to application in real-world practice.)
  • Number of providers who train additional staff in their practice setting on breastfeeding support. (Measures dissemination and spread of training beyond direct participants.)

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

PROCESS MEASURES:

  • 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.)
  • Percent of providers completing training who serve predominantly low-income or minority populations. (Measures focus on practitioners serving high-need communities.)

OUTCOME MEASURES:

  • Percent of providers who report feeling more confident in providing breastfeeding support after training. (Captures impact on provider self-efficacy, a key driver of practice.)
  • Percent of training participants who receive post-training follow-up support or resources. (Assesses extended learning and reinforcement to enhance application.)
  • Percent of providers trained who report positive feedback from patients on their breastfeeding support. (Measures patient perceptions of provider competency post-training.)

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

PROCESS MEASURES:

  • Number of health professional schools and training programs adopting breastfeeding curricula. (Tracks upstream integration of breastfeeding training.)
  • Number of provider champions identified and engaged to lead breastfeeding practice changes. (Measures activation of key influencers to drive improvements.)
  • Number of health care organizations establishing provider breastfeeding training requirements. (Captures systemization and sustainability of training.)

OUTCOME MEASURES:

  • 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 providers reporting improved patient-provider communication around breastfeeding after training. (Assesses broader impact on care interactions and relationships.)
  • Number of regional health systems that see improvements in breastfeeding initiation after provider training. (Tracks the population health impact of training initiatives.)

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

PROCESS MEASURES:

  • - Percent of provider breastfeeding training that addresses implicit bias and equitable care practices. (Evaluates attention to providing culturally responsive support.)
  • - Percent of providers trained who serve a patient population with breastfeeding disparities. (Assesses strategic focus on providers who can reduce inequities.)
  • - Percent of training participants who create an individualized post-training action plan for their practice. (Measures customization and planning for context-specific application.)

OUTCOME MEASURES:

  • - Percent increase in breastfeeding initiation among low-income women after provider training initiative. (Tracks impact on a population experiencing socioeconomic disparities.)
  • - Percent of providers maintaining breastfeeding best practices adherence at 6 and 12 months post-training. (Assesses durability and sustainment of practice changes over time.)
  • - Percent reduction in racial/ethnic disparities in breastfeeding duration after training providers serving diverse populations. (Measures ultimate impact on health 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 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.