Optimizing utilization of lay health workers to address maternal and child health disparities: A Comprehensive Evaluation of a clinically integrated Breastfeeding Peer Counseling Program - Breastfeeding provides unique and profound maternal and infant health benefits. If 90% of US parent- infant dyads breastfed exclusively for the first six months and supplemented through 12 months, 2600 excess maternal deaths and 721 infant deaths could be averted each year. Despite these substantial health benefits conferred by breastfeeding, only 45% of US birth parents meet this 6-month goal, and parents of color and those in low income families face additional barriers to breastfeeding success, resulting in double the risk of infant morbidity and mortality. Clinically-integrated breastfeeding peer counseling (ci-BPC) has been shown to effectively promote racial and economic equity in breastfeeding outcomes. Despite the demonstrated effectiveness of ci-BPC, there remain critical knowledge gaps regarding program design and costs. Thus, the scientific objective of this K01 application is to evaluate the implementation of an effective ci-BPC program and determine the essential program activities, identify significant patient-level and contextual factors relevant to implementation, and determine the economic impact of ci-BPC for patients, health systems, and society. Closing these gaps in knowledge will support wider adoption of ci-BPC by providing a framework for implementation and evaluation. My central hypothesis is that ci-BPC counselling increases patient breastfeeding knowledge and social support, leading to increased empowerment and reduced stress, and that the improvements in breastfeeding rates conferred by ci-BPC will be associated with lower cost of healthcare utilization for infants in the first 6 months post-delivery. Specifically, I aim: (1) To determine the essential program activities of an effective hospital ci-BPC program, identify relevant contextual factors, and adapt the program to optimize breastfeeding outcomes for Black and Latinx patients; (2) To determine whether the adapted ci-BPC program is more effective at improving breastfeeding outcomes, attitude, knowledge, and support compared to standard prenatal care, and (3) To determine patient, program, healthcare, and societal costs for ci-BPC. This project will evaluate an innovative hospital-based ci-BPC program at NorthShore University HealthSystem that has demonstrated significant reduction in breastfeeding disparities. My intimate role with this ci-BPC program and my expertise in mixed-methods field-based and clinical research has equipped me with the skills to undertake such a project, but I need additional mentorship and training in implementation science, clinical intervention research, and healthcare economics. The training and research are significant because disparities in maternal and child health in the US are growing, and an evidence-basis is essential to replicate and scale up interventions that promote health equity. This innovative research will generate novel data regarding ci-BPC program design and economic impact of ci-BPC that will inform broader implementation of this intervention. This application is responsive to SEN NOT-HS-21-014: AHRQ Announces Interest in Health Services Research to Advance Health Equity.
