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Koenig, Lydia Rose (2015)
Master's Thesis (97 pages)
Committee Chair / Thesis Adviser: Butler, Susan O
Committee Members: Howett, Maeve
Research Fields: Health Sciences, Public Health; Health Sciences, Education; Health Sciences, Health Care Management
Partnering Agencies: Does not apply (no collaborating organization)
Keywords: Breastfeeding; Education; Template; Communication
Program: Rollins School of Public Health, Career Masters of Public Health (Prevention Science)
Permanent url:


Breastfeeding is widely understood in public health to be beneficial for both mothers and children. It provides ideal nutrition, decreased risk of disease and natural birth spacing. Recommendations are exclusive breastfeeding for about six months, followed by continued breastfeeding alongside introducing complimentary foods for at least one year. Despite these recommendations, many mothers intending to breastfeed find it difficult to reach these goals due to a variety of barriers that can shorten the duration of breastfeeding.

Significant progress has been made in the United States in increasing the percentage of breastfeeding initiation, but increasing the amount of extended breastfeeding remains a challenge. This is a larger issue in certain locations, minorities, and low-income populations. To address this problem, a supplemental online educational strategy is proposed to extend the reach of current educational programs and provide patients with a guide on how to address breastfeeding barriers they encounter.

The proposed communication strategy is provided as a template that can be targeted to different populations. The program can be adjusted based on needs of the community, and local resources can be incorporated in the information provided. The template includes a review of suggested existing breastfeeding instructional resources to be adapted. Each source was reviewed for strengths and weaknesses, and suggestions for potential changes to the content are provided. Recommendations are also included on program implementation and evaluation methods to assure an effective strategic communication program.

When implemented alongside existing educational programs and resources with support from local partners, this program could provide a consistent and valuable source of information from an already trusted resource (hospitals, community centers, local breastfeeding organizations, or local health departments). Promoted effectively, the resource can provide valuable information to breastfeeding mothers in the community, giving them self-confidence in their ability to breastfeed, advice on how to overcome common problems, and information on who to contact if they find themselves facing trouble.

Table of Contents

  1. Chapter 1: Introduction, Problem Statement, Purpose, Goals 1
    1. Introduction and Rationale 1
      1. Healthy People Breastfeeding Objectives. 2
    2. Problem statement 3
      1. Infant Feeding Problems. 7
      2. Maternal Breastfeeding Problems. 9
    3. Health Communication Purpose 12
    4. Hypothesis 12
    5. Significance statement 12
    6. Health Communication Goals and Objectives 12
      1. Overall Goal. 12
      2. Goal 1. 13
      3. Goal 2. 13
    7. Objectives of the Online Breastfeeding Educational Strategy: 13
    8. Short term objectives. 13
    9. Long term objectives. 13
  2. Chapter 2: Audience Analysis 14
    1. Ethical Dilemmas 14
      1. Nonmaleficence 15
      2. Beneficence. 16
      3. Autonomy. 17
      4. Justice. 19
      5. Professional/Patient Relationship. 20
    2. Primary Audience: Breastfeeding mothers 21
      1. Audience Analysis. 21
      2. Cultural Considerations. 22
    3. Secondary Audience: Healthcare Educators, and Family members. 24
      1. Audience Analysis. 24
      2. Cultural Considerations. 26
  3. Chapter 3: Health Communication Theories 30
    1. Theoretical Framework 30
      1. Individual level- Health Belief Model. 31
      2. Intrapersonal Level- Social Cognitive Theory. 33
      3. Community Level- Diffusion of Innovation Theory. 35
      4. Planning Model Theories 38
      5. Strategic Framework 39
      6. Planning Model Framework 42
  4. Chapter 4: Health Communication Message Strategy, Implementation and Monitoring 47
    1. Health Communications Message Strategy 47
      1. Creative Brief for Breastfeeding Promotion for Mothers Experiencing Complex Breastfeeding Barriers 47
    2. Tailoring Existing Materials on Overcoming Breastfeeding Barriers and Establishing an Effective Breastfeeding Relationship 49
    3. Identifying Materials and Templates for Adaption 49
    4. Deciding on Changes to Make 67
    5. Completing the Necessary Changes 67
    6. Pretesting the Adapted Materials 67
    7. Producing the Revised Materials 68
    8. Retesting 68
    9. Channel Matrix 68
    10. Implementation and Monitoring 71
    11. Produce and Disseminate 72
    12. Train trainers and field workers 72
    13. Mobilize key participants 73
    14. Manage and monitor program 73
    15. Adjust program based on monitoring 73
  5. Chapter 5: Health Communication Evaluation Plan and Conclusions 75
    1. Health Communication Evaluation Plan 75
      1. Evaluation and Replanning 75
      2. Analysis of Data and Interpretation 81
      3. Data Dissemination 81
      4. Determine Future Needs 82
      5. Revise/redesign program 82
    2. Conclusions 82
  6. References 83


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