Facilitators and Barriers to Providing Breastfeeding and Lactation Support to Families in Appalachia: A Mixed-Methods Study With Lactation Professionals and Supporters

Abstract Objectives Breastfeeding rates in Appalachia are lower than the rest of the United States and contribute to poor health outcomes in the region. Lactation professionals and supporters are critical to improving low breastfeeding rates, but there is a lack of research on their experiences providing support to families, particularly in Appalachia. This implementation research explored the facilitators and barriers that lactation professionals and supporters in Appalachia experience when supporting breastfeeding. Methods This mixed-methods study included a survey with members of the Appalachian Breastfeeding Network and in-depth interviews with a sub-sample of survey participants. Survey data were descriptively analyzed in Stata and interview transcripts were analyzed thematically using an inductive approach in ATLAS.ti. Data from both phases were analyzed according to certification type and participants who worked in WIC vs. non-WIC settings. Results The survey was completed by 89 lactation professionals and supporters from 14 states; 33% were International Board Certified Lactation Consultants (IBCLCs) and 47% had other lactation certifications; 24% worked at WIC. Twenty participants from 7 states participated in in-depth interviews. Barriers identified in both phases included being the only lactation professional or supporter in several counties, cross-cultural communication, racism, feeling like their expertise is undervalued and counseling clients around drug use, with negative views of breastfeeding, or who lack family support. The qualitative phase revealed counseling around mental health/trauma, chest feeding, and re-lactation as issues they need more information about. Facilitators included the support from other lactation professionals and supporters, being able to refer clients to the Appalachian Breastfeeding Network help line, and including other family members in lactation counseling. Social media and telehealth were discussed as both barriers and facilitators. Conclusions More lactation professionals and supporters that reflect the population served are needed in rural areas. Additional training for providing support around mental health, chest feeding, drug use, etc. is essential. Lactation professionals and supporters must be included in future efforts to solve these challenges. Funding Sources N/A.

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Mixed Methods Study Of Stress, Mental Health, And The Work Environment In EMS Responders In The United States

PsycEXTRA Dataset ◽

10.1037/e507702017-001 ◽

2017 ◽

Author(s):

Jennifer A. Taylor ◽

Regan Murray ◽

TJ Risoli ◽

Andrea L. Davis ◽

Shannon Widman ◽

...

Keyword(s):

Mental Health ◽

United States ◽

Mixed Methods ◽

Work Environment ◽

The United States ◽

Mixed Methods Study

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Acculturation processes and mental health of Asian Indian women in the United States: A mixed-methods study.

American Journal of Orthopsychiatry ◽

10.1037/ort0000465 ◽

2020 ◽

Vol 90 (4) ◽

pp. 510-522

Author(s):

Anitha Joseph ◽

Sharon Rae Jenkins ◽

Brittney Wright ◽

Bini Sebastian

Keyword(s):

Mental Health ◽

United States ◽

Mixed Methods ◽

Asian Indian ◽

The United States ◽

Mixed Methods Study ◽

Indian Women ◽

Asian Indian Women

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SafeSpot: an innovative app and mental health support package for Scottish schools – a qualitative analysis as part of a mixed methods study

Child and Adolescent Mental Health ◽

10.1111/camh.12375 ◽

2020 ◽

Vol 25 (2) ◽

pp. 110-116

Author(s):

Mallika Punukollu ◽

Emma L. Leighton ◽

Anna F. Brooks ◽

Saoirse Heron ◽

Fiona Mitchell ◽

...

Keyword(s):

Mental Health ◽

Mixed Methods ◽

Qualitative Analysis ◽

Mixed Methods Study ◽

Mental Health Support ◽

Health Support

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Mental Health and Quality & Safety of Care in Czech Residential Institutions during the COVID-19 Pandemic: A Mixed-Methods Study

Psychiatric Quarterly ◽

10.1007/s11126-021-09912-z ◽

2021 ◽

Author(s):

Zoe Guerrero ◽

Akmal-Alikhan Aliev ◽

Lucie Kondrátová ◽

Bibiána Jozefiaková ◽

Natálie Nesázalová ◽

...

Keyword(s):

Mental Health ◽

Mixed Methods ◽

Mixed Methods Study ◽

Residential Institutions

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Development of mental health indicators at the district level in Madhya Pradesh, India: mixed methods study

BMC Health Services Research ◽

10.1186/s12913-018-3695-4 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 1

Author(s):

Shalini Ahuja ◽

Petra C. Gronholm ◽

Rahul Shidhaye ◽

Mark Jordans ◽

Graham Thornicroft

Keyword(s):

Mental Health ◽

Mixed Methods ◽

Health Indicators ◽

Madhya Pradesh ◽

District Level ◽

Mixed Methods Study

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Six-year follow-up study of combined type ADHD from childhood to young adulthood: Predictors of functional impairment and comorbid symptoms

European Psychiatry ◽

10.1016/j.eurpsy.2015.08.007 ◽

2016 ◽

Vol 35 ◽

pp. 47-54 ◽

Cited By ~ 17

Author(s):

T Cadman ◽

J. Findon ◽

H. Eklund ◽

H. Hayward ◽

D. Howley ◽

...

Keyword(s):

Mental Health ◽

Young Adults ◽

Drug Use ◽

Mental Health Problems ◽

The United States ◽

Health Problems ◽

Population Norms ◽

Police Contact ◽

Dsm Iv

AbstractBackgroundADHD in childhood is associated with development of negative psychosocial and behavioural outcomes in adults. Yet, relatively little is known about which childhood and adulthood factors are predictive of these outcomes and could be targets for effective interventions. To date follow-up studies have largely used clinical samples from the United States with children ascertained at baseline using broad criteria for ADHD including all clinical subtypes or the use of DSM III criteria.AimsTo identify child and adult predictors of comorbid and psychosocial comorbid outcomes in ADHD in a UK sample of children with DSM-IV combined type ADHD.MethodOne hundred and eighteen adolescents and young adults diagnosed with DSM-IV combined type ADHD in childhood were followed for an average of 6 years. Comorbid mental health problems, drug and alcohol use and police contact were compared for those with persistent ADHD, sub-threshold ADHD and population norms taken from the Adult Psychiatric Morbidity Study 2007. Predictors included ADHD symptomology and gender.ResultsPersistent ADHD was associated with greater levels of anger, fatigue, sleep problems and anxiety compared to sub-threshold ADHD. Comorbid mental health problems were predicted by current symptoms of hyperactivity-impulsivity, but not by childhood ADHD severity. Both persistent and sub-threshold ADHD was associated with higher levels of drug use and police contact compared to population norms.ConclusionsYoung adults with a childhood diagnosis of ADHD showed increased rates of comorbid mental health problems, which were predicted by current levels of ADHD symptoms. This suggests the importance of the continuing treatment of ADHD throughout the transitional years and into adulthood. Drug use and police contact were more common in ADHD but were not predicted by ADHD severity in this sample.

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Transforming mental health services: a participatory mixed methods study to promote and evaluate the implementation of recovery-oriented services

Implementation Science ◽

10.1186/s13012-014-0119-7 ◽

2014 ◽

Vol 9 (1) ◽

Cited By ~ 20

Author(s):

Melissa M Park ◽

Hiba Zafran ◽

Janet Stewart ◽

Jon Salsberg ◽

Carolyn Ells ◽

...

Keyword(s):

Mental Health ◽

Mixed Methods ◽

Mental Health Services ◽

Health Services ◽

Mixed Methods Study

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Women’s experiences of diagnosis and management of polycystic ovary syndrome: a mixed-methods study in general practice

British Journal of General Practice ◽

10.3399/bjgp20x708881 ◽

2020 ◽

Vol 70 (694) ◽

pp. e322-e329 ◽

Cited By ~ 1

Author(s):

Sarah C Hillman ◽

Carol Bryce ◽

Rachel Caleychetty ◽

Jeremy Dale

Keyword(s):

Mental Health ◽

General Practice ◽

Mixed Methods ◽

Polycystic Ovary Syndrome ◽

Mental Health Problems ◽

Polycystic Ovary ◽

Mixed Methods Study ◽

Ovary Syndrome ◽

Women’S Experiences ◽

Women's Experiences

BackgroundPolycystic ovary syndrome (PCOS) is a common lifelong metabolic condition with serious associated comorbidities. Evidence points to a delay in diagnosis and inconsistency in the information provided to women with PCOS.AimTo capture women’s experiences of how PCOS is diagnosed and managed in UK general practice.Design and settingThis was a mixed-methods study with an online questionnaire survey and semi-structured telephone interviews with a subset of responders.MethodAn online survey to elicit women’s experiences of general practice PCOS care was promoted by charities and BBC Radio Leicester. The survey was accessible online between January 2018 and November 2018. A subset of responders undertook a semi-structured telephone interview to provide more in-depth data.ResultsA total of 323 women completed the survey (average age 35.4 years) and semi-structured interviews were conducted with 11 women. There were five key themes identified through the survey responses. Participants described a variable lag time from presentation to PCOS diagnosis, with a median of 6–12 months. Many had experienced mental health problems associated with their PCOS symptoms, but had not discussed these with the GP. Many were unable to recall any discussion about associated comorbidities with the GP. Some differences were identified between the experiences of women from white British backgrounds and those from other ethnic backgrounds.ConclusionFrom the experiences of the women in this study, it appears that PCOS in general practice is not viewed as a long-term condition with an increased risk of comorbidities including mental health problems. Further research should explore GPs’ awareness of comorbidities and the differences in PCOS care experienced by women from different ethnic backgrounds.

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Predictors and Consequences of Veterans Affairs Mental Health Provider Burnout: Protocol for a Mixed Methods Study

JMIR Research Protocols ◽

10.2196/18345 ◽

2020 ◽

Vol 9 (12) ◽

pp. e18345

Author(s):

Kara Zivin ◽

Jennifer Kononowech ◽

Matthew Boden ◽

Kristen Abraham ◽

Molly Harrod ◽

...

Keyword(s):

Mental Health ◽

Mixed Methods ◽

Patient Outcomes ◽

Primary Care Physicians ◽

Quantitative Methods ◽

Expert Panel ◽

Veterans Affairs ◽

Mixed Methods Study ◽

Mental Health Provider ◽

Health Administration

Background In the Veterans Health Administration (VHA), mental health providers (MHPs) report the second highest level of burnout after primary care physicians. Burnout is defined as increased emotional exhaustion and depersonalization and decreased sense of personal accomplishment at work. Objective This study aims to characterize variation in MHP burnout by VHA facility over time, identifying workplace characteristics and practices of high-performing facilities. Methods Using both qualitative and quantitative methods, we will evaluate factors that influence MHP burnout and their effects on patient outcomes. We will compile annual survey data on workplace conditions and annual staffing as well as productivity data to assess same and subsequent year provider and patient outcomes reflecting provider and patient experiences. We will conduct interviews with mental health leadership at the facility level and with frontline MHPs sampled based on our quantitative findings. We will present our findings to an expert panel of operational partners, Veterans Affairs clinicians, administrators, policy leaders, and experts in burnout. We will reengage with facilities that participated in the earlier qualitative interviews and will hold focus groups that share results based on our quantitative and qualitative work combined with input from our expert panel. We will broadly disseminate these findings to support the development of actionable policies and approaches to addressing MHP burnout. Results This study will assist in developing and testing interventions to improve MHP burnout and employee engagement. Our work will contribute to improvements within VHA and will generate insights for health care delivery, informing efforts to address burnout. Conclusions This is the first comprehensive, longitudinal, national, mixed methods study that incorporates different types of MHPs. It will engage MHP leadership and frontline providers in understanding facilitators and barriers to effectively address burnout. International Registered Report Identifier (IRRID) PRR1-10.2196/18345

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