Community health workers: collaborating to support breastfeeding among high-risk inner-city mothers

Low breastfeeding rates persist as a health disparity among high-risk inner-city mothers. We sought to obtain input of community health workers (CHWs) in preparation for a breastfeeding intervention. We conducted audiotaped focus groups with CHWs of the Cleveland (OH) Department of Public Health's MomsFirst™, a federally funded Healthy Start program, which addressed interest in breastfeeding, positives and negatives of breastfeeding, perceived barriers, and an intervention concept. We used notes-based and tape-based analysis with a previously developed theme code modified for breastfeeding relevance. Seventeen (50%) of 34 actively employed CHWs participated in two focus groups. Issues that emerged were as follows: (1) breastfeeding is "hard" for young mothers, with multiple obstacles identified, including lack of support at home, pain with nursing, extra time required, incompatibility with medications and lifestyle, body image concerns, and "no equipment" (breast pumps); (2) expected supports such as postpartum hospital care have not been helpful, and in-home help is needed; (3) many CHWs' personal breastfeeding experiences were difficult; (4) CHWs requested additional breastfeeding education for themselves; and (5) while strongly endorsing "making a difference" in their clients' lives, CHWs worried that additional curricular mandates would create burden that could become a disincentive. CHWs who make home visits are in a unique position to impact their clients' breastfeeding decisions. A targeted intervention for high-risk inner-city mothers must meet the educational needs of the teachers (CHWs) while minimizing administrative burden, address issues identified by the clients (mothers), and provide hands-on help within the home.