Grandmother and health care professional breastfeeding perspectives provide opportunities for health promotion in an American Indian community

Bailey Houghtaling, Carmen Byker Shanks, Selena Ahmed, Elizabeth Rink, Bailey Houghtaling, Carmen Byker Shanks, Selena Ahmed, Elizabeth Rink

Abstract

Rationale: While breastfeeding is well recognized as beneficial, rates of breastfeeding among American Indian women are below average and contribute to health inequities. Culturally specific approaches to breastfeeding research are called for to inform appropriate interventions in American Indian communities. Specifically, a grandmother's role in breastfeeding promotion is of great import particularly in American Indian (AI) groups, although is an understudied topic to date.

Objective: This research seeks to fill a prominent literature gap by utilizing a grounded theory and community-based research approach to inform breastfeeding practices from the voices of grandmothers and health care professionals in a rural AI community in the United States.

Methods: A community-based approach guided the research process. Convenience and snowball sampling was used to recruit for semi-structured and follow up member checking interviews with AI grandmothers (n = 27) and health care professionals (n = 7). Qualitative data were transcribed, characterized into meaning units, and coded by a review panel. Data were reconciled for discrepancies among reviewers, organized thematically, and used to generate community-specific breastfeeding constructs.

Results: Three major themes emerged, each with relevant subthemes: (1) importance of breastfeeding; (2) attachment, bonding, and passing on knowledge; and (3) overburdened health care system. Multiple subthemes represent stressors and impact breastfeeding knowledge, translation, and practice within this community including formula beliefs, historical traumas, societal pressures, mistrust, and substance abuse.

Conclusions: Interventions designed to raise breastfeeding rates in the study site community would ideally be grounded in tribal resources and involve a collaborative approach that engages the greater community, grandmothers, health care professionals, and scientific partners with varying skills. More research is needed to determine stressors and any potential impact on infant feeding practices among other AI groups. Application of the research approach presented here to other AI communities may be beneficial for understanding opportunities and challenges to breastfeeding practices.

Keywords: American Indian; Breastfeeding; Infant feeding; Qualitative research; Rural health.

Conflict of interest statement

Conflicts of interest

There are no conflicts of interest in regard to funding sources and the conclusions drawn from this article.

Copyright © 2018 Elsevier Ltd. All rights reserved.

Figures

Fig. 1
Fig. 1
The role that stressors play on emergent themes based on qualitative interviews with participant grandmothers and health care professionals in an AI community.
Fig. 2
Fig. 2
Thematic importance of breastfeeding and sub-thematic quotes from breastfeeding interviews with AI grandmothers and community health care professionals (HCP).
Fig. 3
Fig. 3
Thematic attachment, bonding, and passing on knowledge and sub-thematic quotes from breastfeeding interviews with AI grandmothers and community health care professionals (HCP).
Fig. 4
Fig. 4
Thematic overburdened health care system and sub-thematic quotations from breastfeeding interviews with AI grandmothers and community health care professionals (HCP).

References

    1. American Academy of Pediatrics. Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827–e841. Available at. .
    1. Bai YK, Middlestadt SE, Joanne Peng CY, Fly AD. Psychosocial factors underlying the Mother's decision to continue exclusive breastfeeding for 6 Months: an elicitation study. J Hum Nutr Diet. 2009;22(2):134–140.
    1. Burnette CE, Figley CR. Risk and protective factors related to the wellness of american indian and Alaska native youth: a systematic review. Int Public Health J. 2016;8(2):137–154.
    1. Byers L. Native american grandmothers- cultural tradition and contemporary necessity. J Ethnic Cult Divers Soc Work. 2010;19(4):305–316.
    1. Centers for Disease Control and Prevention. Racial and ethnic differences in breastfeeding initiation and duration, by state - national immunization survey, United States, 2004–2008. MMWR. 2010;59(11):327–334.
    1. Christopher S, Saha R, Lachapelle P, Jennings D, Colclough Y, Cooper C, Cummins C, Eggers MJ, FourStar K, Harris K, Kuntz SW, LaFromboise V, LaVeaux D, McDonald T, Bird JR, Rink E, Webster L. Applying indigenous community-based participatory research principles to partnership development in health disparities research. Fam Community Health. 2011;34(3):246–255.
    1. Corbin J, Strauss A. Grounded theory research: procedures, canons, and evaluative criteria. Qual Sociol. 1990;13(1):3–21.
    1. Creswell JW. Research Design. 4. SAGE Publications, Inc; Thousand Oaks, CA: 2014.
    1. Dodgson JE, Duckett L, Garwick A, Graham BL. An ecological perspective of breastfeeding in an indigenous community. J Nurs Scholarsh. 2002;34(3):235–241.
    1. Eckhardt CL, Lutz T, Karanja N, Jobe JB, Maupomé G, Ritenbaugh C. Knowledge, attitudes, and beliefs that can influence infant feeding practices in american indian mothers. J Acad Nutr Diet. 2014;114(1):1587–1593.
    1. Fleischacker S. Emerging opportunities for registered dietitian nutritionists to help raise a healthier generation of native american youth. J Acad Nutr Diet. 2016;116(2):219–225.
    1. Fort Peck Tribes. [Accessed February 25, 2017];Fort Peck Assiniboine & Sioux tribal history. n.d Available from .
    1. Goodkind JR, Gorman B, Hess JM, Parker DP, Hough RL. Reconsidering culturally competent approaches to american indian healing and well-being. Qual Health Res. 2015;25(4):486–499.
    1. Gray N, Oré de Boehm C, Farnsworth A, Wolf D. Integration of creative expression into community-based participatory research and health promotion with native americans. Fam Community Health. 2010;33(3):186–192.
    1. Guttman N, Zimmerman DR. Low-income mothers' views on breastfeeding. Soc Sci Med. 2000;50(10):1457–1473.
    1. Horodynski MA, Calcatera M, Carpenter C. Infant feeding practices: Perceptions of native american mothers and health paraprofessionals. Health Educ J. 2011;71(3):327–339.
    1. Houghtaling B, Byker Shanks C, Ahmed S, Smith T. Resources lack as food environments become more rural: Development and implementation of an infant feeding resource survey. Under Review. Journal of Hunger & Environmental Nutrition Unpublished Results.
    1. Houghtaling B, Byker Shanks C, Jenkins M. Likelihood of breastfeeding within the USDA's food and nutrition Service special supplemental nutrition program for women, infants, and children (WIC) population: a systematic review of literature. J Hum Lactation. 2017;33(1):83–97.
    1. Israel BA, Schulz AJ, Parker EA, Becker AB. Review of community-based research: assessing partnership approaches to improve public health. Annu Rev Publ Health. 1998;19:173–202.
    1. Kincheloe JL, Kincheloe TS. The cultural link: Sioux grandmothers as educators. JSTOR. 1983;57(3):135–137.
    1. Lichtman M. Qualitative Research in Education: a User's Guide. SAGE Publications, Inc; Thousand Oaks, CA: 2013. Making meaning from your data.
    1. MacVicar S, Humphrey T, Forbes-McKay KE. Breastfeeding support and opiate dependence: a think aloud study. Midwifery. 2017;50:239–245.
    1. Mancini F, Carlson C, Albers L. Use of the postpartum depression screening scale in a collaborative obstetric practice. J Midwifery Wom Health. 2007;52(5):429–434.
    1. Miller D, Smith D, McGeshik J, Shanley J, Sheilds C. The History of the Assiniboine and Sioux Tribes of the Fort Peck Indian Reservation, 1600–2012. Fort Peck Community College; Poplar, MT: 2012.
    1. Minkler M, Wallerstein N. Community-based Participatory Research for Health: from Process to Outcomes. Jossey-Bass; San Francisco, CA: 2010. Are academics Irrelevant? Approaches and roles for scholars in CBPR.
    1. National Center on Addiction and Substance Abuse. Addiction Medicine: Closing the Gap between Science and Practice. Columbia University; New York, NY: 2012.
    1. National Institute on Drug Abuse. [Accessed date: 1 October 2016];Drug Facts, Nationwide Trends [online] 2015 Available at. .
    1. Negin J, Coffman J, Vizintin P, Raynes-Geenow C. The influence of grandmothers on breastfeeding rates: a systematic review. BMC Pregnancy Childbirth. 2016;16(91) .
    1. Oré CE, Teufel-Shone NI, Chico-Jarillo TM. American indian and Alaska native resilience along the life course and across generations: a literature review. Am Indian Alaska Native Ment Health Res. 2016;23:134–157.
    1. Rhodes KL, Hellerstedt WL, Davey CS, Pirie PL, Daly KA. American indian breastfeeding attitudes and practices in Minnesota. Matern Child Health J. 2008;12(1):46–54.
    1. Robbins R, Scherman A, Holeman H, Wilson J. Roles of american indian grandparents in times of cultural crisis. J Cult Divers. 2005;12(2):62–68.
    1. Schultz DJ, Byker Shanks C, Houghtaling B. The impact of the 2009 special supplemental nutrition program for women, infants, and children food package revisions on participants: a systematic review. J Acad Nutr Diet. 2015;115(11):1832–1846.
    1. Simonds VW, Christopher S. Adapting western research methods to indigenous ways of knowing. Am J Publ Health. 2013;103(12):2185–2192.
    1. US Census Bureau. [Accessed date: 25 February 2017];QuickFacts Montana. 2015 Available from. .
    1. US Department of Agriculture. [Accessed date: 25 February 2017];Frontier and Remote Area Codes. 2015 Available from.
    1. US Department of Agriculture. Special Supplemental Nutrition Program for Women, Infants and Children (WIC): Revisions in the WIC Food Packages (Final Rule) Food and Nutrition Service; Washington, DC: 2014.
    1. US Department of Health and Human Services. The Surgeon General's Call to Action to Support Breastfeeding. Office of the Surgeon General; Rockville, MD: 2011.
    1. Villapiano NLG, Winkelman TNA, Kozhimannil KB, Davis MM, Patrick SW. Rural and urban differences in neonatal abstinence syndrome and maternal opioid use, 2004 to 2013. JAMA Pediatr. 2017;171(2):194–196.
    1. Whitbeck LB, Adams GW, Hoyt DR, Chen X. Conceptualizing and measuring historical trauma among american indian people. Am J Community Psychol. 2004;33(3–4):119–130.
    1. Wilhelm S, Rodehorst-Weber K, Aguirre T, Stepans MB, Hertzog M, Clarke M, Herboldsheimer A. Lessons learned conducting breastfeeding intervention research in two northern plains tribal communities. Breastfeed Med. 2012;7(3):167–172.
    1. Wright AL, Naylor A, Wester R, Bauer M, Sutcliffe E. Using cultural knowledge in health promotion: breastfeeding among the Navajo. Health Educ Behav. 1997;24(5):625–639.
    1. Zamora-Kapoor A, Omidpanah A, Nelson LA, Kuo AA, Harris R, Dedra S, Buchwald DS. Breastfeeding in infancy is associated with body mass index in adolescence: a retrospective cohort study comparing american Indians/Alaska natives and non-hispanic whites. J Acad Nutr Diet. 2017;117(7):1049–1056.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere