2
Executive Summary 3
Course and Internship Objectives 3
Key Findings 4
Introduction 6
Course Description 6
Internship Description 7
Data Collection and Quantitative Analyses 8
Materials 8
Data Collection 8
Assessment of Knowledge and Skills 8
Table 1: Knowledge and Skills 9
Assessment of Attitudes and Confidence 9
Table 2: Attitudes and Confidence 10
Assessment of Interest Toward Lactation Education 10
Table 3: Specific Interest Items 11
Qualitative Data Analysis 11
Reasons for Enrolling in Course 11
Table 4: Question 1 12
Knowledge, Skills, and Changes in Understanding 12
Table 5: Question 2 14
Table 6: Question 3 15
Table 7: Question 4 16
Overall Satisfaction 16
Table 8: Question 5 17
Table 9: Question 6 18
Table 10: Question 7 18
Structured Interviews with Internship Students 19
Questions on Skills, Knowledge, Competency, and Confidence 19
Questions on Career Plans and Interest Toward Lactation Education 21
Questions on Overall Satisfaction 22
Paired Samples t-Tests for Internship Students 23
Table 11 23
References 24
Appendices 25
Appendix A: Pretest and Posttest Questionnaire 25
Appendix B: Posttest Open-ended Questions 31
3
Research suggests that lack of basic knowledge and skills among future healthcare professionals
is linked with low breastfeeding rates. Improving the lactation education curriculum in
undergraduate and graduate programs that train future healthcare professionals may have a
positive impact on those entering the healthcare field, while leaving them better prepared to
integrate lactation education into their future practice. This report is an evaluation of a three-unit
lactation education course and lactation education internship which aims to increase students’
competencies in the area of lactation education. The evaluation also examined whether
participation in the course and internship had an impact on students’ interest toward integrating
lactation education into a future healthcare career, as well as students’ overall satisfaction with
the course and internship.
The evaluation utilized pretest and posttest assessments of students enrolled in the Health
Sciences (HSCI) 434 Lactation Education course in the Health Sciences Department at
California State University Northridge (CSUN). The assessments evaluated changes from the
beginning to the end of the semester in students’ 1) knowledge, attitudes, and skills needed to
serve as lactation educators in the community; 2) confidence in their ability to serve as lactation
educators in the community; and 3) motivation/interest to integrate lactation education into a
future healthcare career. The posttest assessments also included qualitative/open-ended questions
about the students’ overall satisfaction with the course.
The second component of the evaluation involved in-depth semi-structured phone interviews
with students who completed both HSCI 434 and a 120 hour lactation education internship. The
internship students were asked detailed questions about their experience with the internship,
including what they found beneficial about the internship and how the internship shaped their
desire to pursue lactation education as a full-time career. Presented below are findings on the
impact of the lactation education course and internship on students’ knowledge, attitudes, skills
and confidence needed to serve as lactation educators in the community, as well as future interest
in integrating lactation education into a future healthcare career. The report also highlights
findings on students’ overall satisfaction with the course and the internship experience.
Course and Internship Objectives
The assessments in the report were designed to measure the following objectives of the HSCI
434 Course and lactation education internship:
1) Students in the HSCI 434 Lactation Education course and lactation internship will
increase in their content knowledge, procedural knowledge, positive attitudes about
promoting and supporting breastfeeding, skills needed to implement lactation education
4
in the community, and confidence in their ability to provide lactation education, from the
beginning to the end of the semester.
2) Students in the HSCI 434 Lactation Education course and lactation internship will
increase in their level of interest either toward integrating lactation education into a
current or future healthcare career, or interest toward becoming International Board
Certified Lactation Consultants (IBCLCs).
3) Students in the HSCI 434 Lactation Education course and lactation internship will report
overall satisfaction with their experiences in the course/internship.
Key Findings
Changes in Students’ Competencies in the Area of Lactation Education Following the
Completion of the Lactation Education Course: The first objective of the course and
internship assessed by this report was to improve students’ lactation content and procedural
knowledge, lactation education skills, attitudes toward promoting breastfeeding, and confidence
in their ability to provide lactation education. Quantitative analysis of the questionnaires showed
statistically significant improvements in the students’ breastfeeding content knowledge,
breastfeeding procedural knowledge, attitudes toward promotion of breastfeeding, and
confidence in their ability to provide lactation education. While there was no statistically
significant improvement in the students’ scores on items assessing skills utilized by lactation
educators in the field, this only pertained to a subset of a larger assessment. Additionally, these
scores were higher at the end of the semester overall. Therefore, the first objective of the course
was supported by the evidence provided by this report.
Changes in Students’ Interest to Integrate Lactation Education into a Future Healthcare
Career Following the Completion of the Lactation Education Course: The second objective
of the course and internship assessed by this report was to improve students’ interest toward
integrating lactation education into a current or future career. Quantitative analysis of the
questionnaires showed statistically significant improvements in the HSCI 434 students’ level of
interest from the beginning to the end of the semester. Specifically, following completion of the
course, students reported significant increases in their interest to 1) participate in an internship
that would provide them with the opportunity to gain practical experience as lactation educators,
and 2) pursue a career as a lactation educator. Therefore, the second objective of the course was
supported by the evidence found in this evaluation.
Students’ Overall Satisfaction with the Lactation Education Course: Qualitative analysis of
students’ responses to open-ended questions about the course provided a nuanced look into the
students’ experience in the course. They found the content to be valuable, either for their
personal benefit when breastfeeding their children, for a related health-care career such as a
5
public health educator or registered dietitian, or for a general desire to learn more about the topic
of breastfeeding. While students enrolled in the course for a variety of reasons and from a variety
of backgrounds, they responded unanimously that the course met their expectations. The course
piqued the interest of several students toward considering a career as a Lactation Educator or
International Board Certified Lactation Consultant. Many students gained an appreciation for the
importance of breastfeeding and wished to advocate for it as a result, while several stated that the
course directly influenced them to exclusively breastfeed. Therefore, while not all students were
influenced to consider careers in lactation education, this increase in advocacy and desire to
promote breastfeeding may translate into more indirect interest in the field of lactation education.
Recommendations for Improving the Lactation Education Course: Based on the open-ended
responses collected from students, recommendations for future sections of the course are
summarized in the report. One common suggestion was that the HSCI 434 course be expanded to
a two-semester sequence in order to adequately cover all content. Another frequent suggestion
was that more information on post-partum breastfeeding be included in the curriculum. Other
than these suggestions, response to the course was extremely positive.
Changes in Students’ Competencies in the Area of Lactation Education Following the
Completion of the Lactation Education Internship: The internship students all agreed that
they felt more confident about their lactation knowledge and skills, as well as their ability to
serve as lactation educators in the community, as a result of the internship. The students all
agreed that participating in the internship helped them successfully develop skills used by
lactation educators in the field, including motivational interviewing, maintaining client
confidentiality, documentation, and understanding the lactation educator’s scope of practice.
They attributed these improvements to being able to put into practice the skills they learned, as
well as being able to actually apply information they had previously read about in the HSCI 434
class. Each of the students felt they left the internship with enough preparation to begin working
as a Lactation Educator immediately. Therefore, the first objective of the internship was
supported by the results.
Changes in Students’ Interest to Integrate Lactation Education into a Future Healthcare
Career Following the Completion of the Lactation Education Internship: The internship
facilitated the students’ pre-existing interest in the field of lactation education and provided them
with further understanding of what a career in lactation education entails. Having addressed first-
hand the breastfeeding concerns of actual mothers, each of the students agreed that the internship
dramatically increased their interest toward incorporating lactation education into their future
careers. At least one internship student was influenced to change the course of her career to
become a full-time Lactation Educator as a direct result of participating in the internship.
Another student said she was strongly considering becoming an IBCLC, which was something
she had not given much thought to prior to the internship. Therefore, the second objective of the
internship was supported by the results.
6
Students’ Overall Satisfaction with the Lactation Education Internship: The third objective
of the internship that was evaluated by this report was that students would be satisfied with their
internship experience. Overall, the lactation education internship was well-received. Each of the
students responded enthusiastically that their objectives for enrolling in the internship were met.
Therefore, the third objective of the internship was supported by the results of this evaluation.
While the students felt the internship was a valuable learning experience, they expressed
frustrations with the challenges associated with delivering breastfeeding education via phone.
Those challenges included finding available times to schedule the phone intervention, as well as
clients’ failure to pick up their phones during scheduled appointments.
Recommendations for Improving the Lactation Education Internship: Based on the
internship students’ feedback, recommendations for future iterations of the internship are to
explore collaborations with community organizations that would be able to provide students with
the opportunity to gain face to face experience implementing breastfeeding education. For
instance, some students suggested having more time in the clinic interacting with the clients
face-to-face. Other sites to consider include the hospital setting where students could deliver
face-to-face breastfeeding education to new mothers prior to them being discharged from the
hospital. Aside from these suggestions, each of the students felt their experience with the
internship was very positive. According to one student, “I gained much more knowledge about
breastfeeding, including things I had not even thought about. It really was an eye-opening
experience, and I was able to see where I would fit in when it comes to educating mothers, either
pregnant or after giving birth, on how to best feed their baby.”
Course Description
The objective of HSCI 434 is to provide students with the knowledge and skills needed to serve
as lactation educators in the community. Lactation Educators (sometimes also called lactation
counsellors or specialists) are individuals trained to provide basic education and support to
pregnant and breastfeeding women (Childbirth and Postpartum Professional Association, 2011).
Their job responsibilities may include: teaching prenatal breastfeeding classes, providing one-
on-one breastfeeding education to new mothers during their hospital stay, answering calls on
breastfeeding information lines, and renting or selling breast pumps. Students who successfully
complete the HSCI 434 Lactation Education course receive a certificate of completion. After this
point they may call themselves “certificated” Lactation Educators (CLE), but this does not
constitute a certification, credential, or license.
7
Students planning to enter a variety of healthcare professions, including public health, dietetics,
childcare, and nursing, may utilize the knowledge and skills gained in the course to educate
mothers on how to breastfeed effectively and responsibly. For example, following completion of
the lactation education course, a student pursuing a career as a public health educator will be
prepared to develop breastfeeding promotion programs, teach breastfeeding group classes, and
use motivational interviewing techniques to encourage more women to successfully breastfeed.
A student interested in pursuing a career as a dietetic professional will be prepared to integrate
lactation education into nutrition counseling sessions with pregnant and breastfeeding mothers.
A student interested in pursuing a career as an early childcare provider will be prepared to
support breastfeeding mothers maintain their milk supply upon returning to work. A student
interested in pursuing a career as a nurse will be better prepared to help new mothers properly
initiate breastfeeding during their hospital stay.
Some students may choose to use the lactation education course as a stepping stone to pursue the
training and education needed to become a more advanced clinical lactation professional (i.e., an
International Board Certified Lactation Consultant [IBCLC]). Students interested in earning the
IBCLC certification are required to complete education and training beyond the HSCI 434
lactation education course. They must complete 90 hours of lactation specific education (45 of
which are covered by the HSCI 434 course), eight undergraduate health science courses, six
continuing education courses, and 300 to 1000 clinical hours (depending on prior work
experience and whether the individual possesses a healthcare license) specific to lactation. They
must also pass the International Board of Lactation Consultant Examiners (IBCLE) exam.
Internship Description
The objective of the lactation education internship is to provide students who have completed
HSCI 434 with experience implementing breastfeeding education in the community. The
internship included two parts: 1) a post-course training and 2) a field training component. The
post-course training students received included the following topics: content knowledge needed
to facilitate prenatal breastfeeding education and support, counselling skills, phone manners,
understanding the lactation educator’s scope of practice, client confidentiality and
documentation, and key breastfeeding terminology in Spanish (not all internship students
undergo the Spanish-language training). The field training component of the internship gave
students the opportunity to gain practical experience providing phone-based prenatal
breastfeeding education to pregnant mothers.
Once the internship started, the students were required to provide phone-based prenatal lactation
education to approximately 10 mothers each. They first recruited pregnant mothers waiting to see
a doctor at a community health center. For mothers who expressed interest in participating and
signed a consent form, the students followed up with four to five phone calls in which they
addressed the mothers’ breastfeeding concerns and provided them with key information mothers
8
should know to breastfeed successfully. The students were required to document any
breastfeeding concerns the mothers may have had as well as all breastfeeding education that they
provided to the mothers. They were also required to submit their chart notes to the instructor,
complete a research project, and maintain a reflection journal about their experience.
Materials
The pretest survey consisted of 39 items created by a previous evaluation team, which itself was
based on several existing instruments (Jepson-Sullivan, 2010; Parker, 2005; Radcliffe & Payne,
2009). Additional items regarding attitudes toward lactation education were adapted based on the
Breastfeeding Competencies outlined by the United States Breastfeeding Committee (United
States Breastfeeding Committee, 2010). The posttest survey taken by the Fall 2014 cohort was
identical to the pretest survey. The posttest survey taken by the Spring 2015 cohort was slightly
revised. It contained the same 39 pretest items, but was adapted to include four additional
questions measuring students’ interest toward integrating lactation education into a future career,
as well as seven open-ended questions regarding their experience with the course.
Data Collection
Data for the present evaluation was collected from three groups of students taking HSCI 434:
one from the Fall 2014 semester and two from the Spring 2015 semester. Paper-and-pencil
surveys were distributed to the students at the beginning (pretest) and end (posttest) of each
semester. For the Fall 2014 class, a total of 32 students were surveyed. Among these, five
students either did not submit a pretest or posttest survey. Since their difference in scores from
the beginning to the end of the semester could not be assessed, these students were not included
in any analyses. For the Spring 2015 classes, a total of 60 students (30 students per class) were
surveyed. One student did not submit a posttest survey, and so was not included in any analyses.
The pretest and posttest surveys that were able to be matched left a total sample size of 86.
Assessment of Lactation Knowledge and Skills
The first 18 survey items were true/false statements designed to measure basic knowledge
students need to serve as lactation educators in the community. The first 10 of these pertained
to content knowledge (i.e., the understanding of the advantages and disadvantages of
breastfeeding). Topics here included health benefits of breastfeeding for the breastfed baby and
the breastfeeding mother, and how the composition of breastmilk differs from formula. These
items were averaged to form a Content Knowledge subscale. A sample item is “True or False:
9
Infants who are formula-fed are less likely to develop diabetes or become obese later in life
compared to infants who are breastfed.” The next 8 items concerned procedural knowledge
needed to successfully breastfeed. These items were averaged to form a Procedural Knowledge
subscale. A sample item is “True or False: A woman can produce more milk by increasing the
frequency of breastfeeding.” The next five items were multiple choice questions regarding skills
that lactation educators would need to possess in practice. These items were averaged to form a
Skills subscale. A sample item is “All of the following situations are within a lactation educator’s
scope of practice EXCEPT: A) Mother has question about breastfeeding positions she can use at
night so she can get more sleep. B) Exclusively breastfeeding mother is concerned about her
milk supply. Her baby was just seen (i.e., early that day) by a pediatrician who reported that her
baby’s weight gain is normal. C) Mothers reports that her six day old baby’s bowl movements
are green. D) Older baby is refusing to breastfeed.”
Scores for the preceding subscales were derived by first scoring individual items as correct or
incorrect, and then calculating the percentage correct. For instance, the average subscale score
for the Knowledge items at pretest was .83, meaning that participants on average answered about
83% of those items correctly. Paired samples t-tests were run comparing the change in students’
scores from pretest to posttest. As seen in Table 1, the average score on the Content Knowledge
subscale increased from 83% to 96% for a mean difference of 13%. This difference was
statistically significant (p < .001). Next, the average score on the Procedural Knowledge subscale
increased by 24% from pretest to posttest, and this difference was statistically significant (p <
.001). While the average score on the Skills subscale increased from pretest to posttest, this
difference was not statistically significant (p > .05). In other words, students on average
performed better on these items at the end of the semester compared to the beginning, but the
magnitude of the increase in scores was negligible.
Table 1: Paired Samples t-Tests for Lactation Core Competencies
Subscale
# of
Items
Pretest Posttest
Difference t-value (df) M SD M SD Content Knowledge 10 .83 .16 .96 .06 .13 7.99 (85)***
Procedural Knowledge 8 .68 .17 .92 .09 .24 14.50 (85)***
Skills 5 .77 .18 .78 .16 .01 .28 (85)
**p < .01.; ***p < .001. Scores are reported in terms of percentage correct.
Assessment of Attitudes that Protect, Promote and Support
Breastfeeding and Confidence to Implement Lactation Education
Following the knowledge section were multiple-choice items designed to measure students’
attitudes toward providing care that protects, promotes, and supports breastfeeding, as well as
students’ level of confidence in their ability to utilize basic knowledge and skills need to serve as
10
lactation educators in the community. Response choices for items in this section were: 1 =
strongly disagree, 2 = disagree, 3 = agree, 4 = strongly agree. The first eight items pertained to
students’ personal attitudes toward lactation education. A sample item is: “I value breastfeeding
as an important health promotion and disease prevention strategy.” These items were averaged to
form an Attitudes subscale. The next eight items assessed students’ confidence in their own
ability to act as lactation educators. These items were averaged to form a Confidence subscale. A
sample item includes: “I am confident in my ability to address most concerns a pregnant mother
may have about breastfeeding.”
Scores for the preceding subscales were derived by computing the mean of the individual items
within each scale. For instance, the average subscale score for the Confidence subscale at pretest
was 2.72, meaning that participants on average responded to those items with a moderate amount
of agreement on a one to four scale. Next, paired samples t-tests were run comparing the change
in students’ scores from pretest to posttest. As seen in Table 2, the average score on the Attitudes
subscale increased from 3.68 to 3.86 for a mean difference of .18. This difference was
statistically significant (p < .001). Next, the average score on the Confidence subscale increased
by .96 from pretest to posttest, and this difference was statistically significant (p < .001).
Table 2: Paired Samples t-Tests for Attitudes and Confidence
Subscale
# of
Items
Pretest Posttest
Difference t-value (df) M SD M SD Attitudes 8 3.68 .30 3.86 .38 .18 4.28 (83)***
Confidence 8 2.72 .68 3.68 .44 .96 11.39(85)*** **p < .01.; ***p < .001. 1 = Strongly Disagree, 2 = Disagree, 3 = Agree, 4 = Strongly Agree.
Assessment of Interest to Integrate Lactation Education into a Future
Healthcare Career
The last four items were multiple choice questions assessing students’ interest toward integrating
lactation education into their current/future careers. These last four items were added for the
Spring 2015 semester data collection as part of several modifications to the survey. Hence, these
items were not asked of the students from the Fall 2014 semester. A sample item is “I am
interested in integrating lactation education into my future career.” These items were averaged to
form an Interest subscale, and then paired samples t-tests were run to assess students’ change in
scores from pretest to posttest. As seen in Table 3, the average score on the Interest subscale
increased by .22 from pretest to posttest. This difference was statistically significant (p < .01).
Additional paired samples t-tests were run on the four individual items comprising the Interest
subscale. As seen in Table 3, the average score on the item relating to students’ interest toward
11
participating in a lactation internship increased by .45, and this increase was statistically
significant. Scores for the item concerning interest toward integrating lactation education into a
future career did not increase from pretest to posttest. Scores for the item relating to interest
toward pursuing a career as a lactation educator increased by .60 from pretest to posttest, and this
increase was statistically significant. Scores for the item relating to interest toward becoming a
board certified lactation consultant (IBCLC) increased by .01 from pretest to posttest, but this
difference was not statistically significant.
Table 3: Paired Samples t-Tests for Career Interest and Individual Interest Items
Subscale/Individual Interest Item
Pretest Posttest
Difference t-value (df) M SD M SD Interest Subscale (4 items in total) 3.31 .55 3.53 .54 .22 2.66 (57)**
Interest to participate a lactation education internship 3.47 .57 3.72 .45 .26 3.24 (57)**
Interest in integrating lactation education into future career. 3.44 .63 3.44 .68 0.00 1.0(57)
Interest in pursuing a career as a lactation educator. 3.10 .74 3.71 .53 .60 5.36 (57)***
Interest in becoming an IBCLC. 3.21 .71 3.22 .80 .01 .08(57)
**p < .01.; ***p < .001. 1 = Strongly Disagree, 2 = Disagree, 3 = Agree, 4 = Strongly Agree.
The posttest surveys distributed to the Spring 2015 class included an additional seven open-
ended questions. Responses were analyzed by first identifying recurring themes across all cases,
and then coding each response based on whether or not it matched one or several of the themes
that were identified. The responses were matched to each theme on a spreadsheet, and then
percentages were calculated to determine the frequency of respondents mentioning each theme.
If a participant left the space blank, his or her response was not included when calculating the
frequencies for that question. For instance, four participants left the question about useful skills
blank, so the frequencies for that question were calculated proportional to 55 instead of 59
participants.
Question Relating to Motivation for Enrolling in the Lactation
Education Course
The first open-ended question concerned participants’ reasons or motivations for taking the
HSCI 434 course. Eleven common themes were determined across 56 responses. As seen in
Table 4, the most commonly mentioned reason for taking the course was to gain general
knowledge about breastfeeding, or otherwise having a general interest or curiosity about the
12
topic. The next most frequently cited motivation was to obtain information as a current mother or
mother-to-be. Participants’ third most frequently mentioned motivation for taking the course was
to obtain knowledge that they could then use to help educate mothers and families about
breastfeeding. Other commonly mentioned motivations include wanting to learn more about the
field of lactation education for a current or potential career, wanting to learn about the benefits of
breastfeeding, wanting to gain experience to be used in a related health-care field, wanting to
earn the certificate of completion or otherwise be able to put the experience on their resume,
having taken the instructor previously, gotten a recommendation, or heard about the course
through word of mouth, wanting to learn about the importance of breastfeeding, taking it for
elective credit, and wanting to learn about breastfeeding barriers.
A representative response to this question is “I wanted to find out more info about breastfeeding
for when I have children. I'm also a public health student so it wouldn't hurt to have knowledge
on this subject, plus I can put it on my resume.” This response would be coded with the
following themes: 1) “Learn more as a current/future mother;” 2) “Learn more for application in
related health field;” and 3) “Desire to add “Certificated Lactation Educator” to their resume.”
Table 4: Frequency of Responses to Open-ended Question #1 (N = 56)
“What were your primary motivations for taking this course?”
Theme % Mentioned
General knowledge/interest/curiosity about breastfeeding 33.93%
Learn more as a current/future mother 23.21%
Gain knowledge to help educate other parents about breastfeeding 19.64%
Learn more about current/future career in lactation education 14.29%
Learn about health benefits of breastfeeding 10.71%
Learn more for application in related health field (e.g., nutrition, pediatrics) 10.71%
Desire to add “Certificated Lactation Educator” to their resume 10.71%
Word of mouth/recommendation/took professor previously 8.93%
Learn about importance of breastfeeding 7.14%
Elective 5.36%
Learn more about barriers to breastfeeding 3.57%
Questions Related to Knowledge and Skills Students Hoped to Gain
From the Course
The second open-ended question asked participants what knowledge or skills they hoped to
obtain when they first enrolled in the course. Twelve common themes were determined across 54
responses. As seen in Table 5, the most frequently cited skill or topic participants wished to learn
was how encourage or promote breastfeeding. The next most commonly mentioned skill or topic
13
was information on how to actually breastfeed, including techniques such as positioning and
pumping. Participants’ third most frequently mentioned skill or topic they hoped to learn about
was overall knowledge of breastfeeding. Other commonly mentioned skills or topics participants
wished to learn about include the health benefits of breastfeeding, the science behind lactation
(e.g., biological, anatomical, physiological); barriers to breastfeeding and how to overcome
them, skills to gain professional competence in a health-care field, learning about lactation
education as a career, information for working mothers, what mothers could expect either before,
after, or during breastfeeding, and clarification of pre-existing beliefs or questions. Several
participants also responded that they weren’t sure or had no specific skill or content area they
wished to learn. Other skills or topics mentioned include counseling skills and cultural
competency skills.
One participant’s response to being asked what she hoped to learn prior to starting the course:
“How to breastfeed and the physiology behind milk production and maintenance. Also, I wanted
learn about lactation for incorporation into my future practice in the nutrition field.” This
response would be coded with the following themes: 1) “Procedural knowledge relating to how
to breastfeed successfully;” 2) “Anatomy and physiology of lactation;” and 3) “Gain skills for
professional competence.”
Participants were also asked if they felt their objectives for taking the course were met. While
frequencies for this question are not presented here, participants were almost unanimous in
replying that their objectives were in fact met. Some representative responses include
“Absolutely. I even feel confident enough to teach other mothers” and “Overall, this course is
more than what I was expecting. The information is simple enough to understand and
communicate.”
14
Table 5: Frequency of Responses to Open-ended Question #2 (N = 54)
“What specific skills or knowledge did you hope to gain prior to taking this course?”
Theme
%
Mentioned
Learn how to motivate, encourage, or promote breastfeeding to others 40.74%
Procedural knowledge relating to how to breastfeed successfully, including: latching and positioning, how to pump to maintain milk supply 37.04%
General information 22.22%
Learn about health benefits for mother and/or child 12.96%
Anatomy and physiology of lactation 12.96%
Learn common breastfeeding barriers and strategies to overcome those barriers 11.11%
Lactation information relevant to working mothers 7.41%
Nothing specific/not sure 7.41%
What to expect before/during/after breastfeeding 5.56%
Gain skills for professional competence 5.56%
Clarification 3.70%
Learn about career in lactation education 3.70%
The third open-ended question asked participants how their understanding of breastfeeding had
changed upon completing the HSCI 434 course. Ten common themes were determined across 56
responses. As seen in Table 6, the most commonly mentioned change in understanding was of a
general change or overall improvement in knowledge about breastfeeding. The next most
frequently cited change was an increased appreciation for the importance of breastfeeding.
Participants’ third most frequently mentioned change in understanding was in regards to
increased knowledge of the health benefits of breastfeeding. Another common change in
understanding was an increased level of advocacy (i.e., becoming more pro-breastfeeding) or
otherwise an increased desire to promote breastfeeding. One response which is representative of
the theme of advocacy is: “Lactation education is important and since there are several myths
regarding breastfeeding, lactation education needs to be promoted more and more families need
to take advantage of lactation education.”
Several participants also replied that the course gave them an appreciation for the complexity of
the issues surrounding breastfeeding. Others replied that before taking the course they hadn’t
realized many of the difficulties and barriers some mothers may face when trying to breastfeed
or that they hadn’t realized many mothers lack the support necessary to breastfeed. Several
participants also mentioned that they gained either further interest or awareness for the field of
lactation education. A few responses which typify this change in understanding: “At the
beginning I did not know the difference in the lactation educator job and lactation consultant
other than the exam, but this course changed a lot of the information I had before” and “I had no
idea there was a position called a lactation educator. Taking this course gave me insight in the
15
way breast milk is produced, and how the lactation educator is able to assist the mother in
establishing good milk supply.”
Other changes cited as a result of the course include a greater confidence to help mothers with
breastfeeding goals, clarification of misconceptions and myths, and increased knowledge of
biological and physiological aspects of breastfeeding. Several participants replied that they
experienced no change or that they were not sure how their understanding had changed as a
result of this course.
Table 6: Frequency of Responses to Open-ended Question #3 (N = 56)
“How has your understanding of lactation and/or lactation education changed as a result
of taking this course?”
Theme % Mentioned
General change for the better 33.93%
Greater appreciation for importance of breastfeeding 25.00%
Increased knowledge of health benefits 16.07%
Promotion/advocacy 14.29%
Greater appreciation for complexity/barriers/difficulty for mothers with no support 10.71%
Further interest/awareness toward career in lactation education 7.14%
Greater confidence to help mothers 5.36%
Clarification of previously held misconceptions 5.36%
Knowledge of physiology/biology/anatomy 3.57%
No changes 3.57%
The fourth open-ended question asked participants to share what skills or content learned in the
course they found especially useful. Twelve common themes were determined across 55
responses. As seen in Table 7, the most commonly mentioned skill or content area was learning
about breastfeeding techniques such as positioning. The next most frequently cited useful skill or
content area was learning about breastfeeding myths and misconceptions. A response which
represents this theme follows: “I found the myths and conceptions segments especially useful
because I would be able to explain to a mother that yes, her body can produce enough milk, and
no, frequent feeding is not a sign that her baby is not getting enough to eat, and so on.” The third
most frequently mentioned skill or content area participants found useful was learning about the
health benefits of breastfeeding. Other useful skills or content areas commonly mentioned by
participants include barriers to breastfeeding, biological and physiological aspects of
breastfeeding, warning signs that a baby is still hungry or did not latch properly, learning about
hospital practices that may conflict with breastfeeding, practicing lactation techniques with a
doll or model breast, receiving information about a career in lactation education, learning about
the history of breastfeeding, and learning about milk production and storage. Although not a skill
16
or content area in and of itself, several participants mentioned visual aids such as videos and
diagrams as being particularly effective in helping them to engage with the material. Additional
useful skills or content areas include learning about colostrum, and biological nursing.
Table 7: Frequency of Responses to Open-ended Question #4 (N = 55)
“Are there any skills and/or content areas covered in this course that you found
especially useful? If so, can you please elaborate?”
Theme % Mentioned
Proper technique (latching, positioning, etc.) 37.50%
Breastfeeding myths/misconceptions 17.86%
Health benefits of breastfeeding 14.29%
Barriers to breastfeeding 12.50%
Anatomical/physiological/biological aspects 10.71%
signs that baby is getting enough to eat (i.e., signs of effective milk transfer) 8.93%
Visualization - slides, videos, graphics 7.14%
Hospital practices 7.14%
Practicing with a doll/model breast 5.36%
Information about careers in the field of lactation 5.36%
History of breastfeeding 5.36%
Learning about milk production/storage 3.57%
Questions Relating to Overall Satisfaction
The fifth open-ended question asked participants to share what they found most beneficial by
taking the course. Ten common themes were determined across 59 responses. As seen in Table 8,
the most commonly mentioned benefit was in gaining a general understanding or overall increase
in breastfeeding knowledge. The next most frequently mentioned benefit was that after taking the
course, the students were in a better position to help educate mothers and fathers about
breastfeeding. The third most frequently mentioned benefit was in learning skills and
information that mothers could use when breastfeeding their current or future children. Many
students also responded by saying they left the class with a greater appreciation or realization for
the importance of breastfeeding. Other benefits commonly mentioned by participants include
clarification of their own previously held misconceptions or questions regarding breastfeeding, a
favorable attitude toward breastfeeding or otherwise being influenced to breastfeed their own
children, learning about career opportunities in lactation education, earning the certificate of
completion, greater confidence to initiate breastfeeding their own children, skills or experience
they could apply to a related healthcare profession (e.g., dietetic professionals, public health
educators), and greater ability to encourage mothers to breastfeed or otherwise disseminate
information about its benefits.
17
A representative response to this question follows: “As a woman I now feel very confident I have
the knowledge and skills to exclusively breastfeed my own child someday. As a public health
student, this made me aware of the needs breastfeeding mothers have and I will be able to tailor
public health programs for them.” This participant’s response would be coded with four themes:
1) “Help for breastfeeding one’s own children;” 2) “Confidence to initiate breastfeeding;” 3)
“Better ability to educate other parents;” and 4) “Experience relevant to current/future career in
healthcare field.”
Table 8: Frequency of Responses to Open-ended Question #5 (N = 59)
“How do you believe you benefitted most by taking this course?”
Theme
%
Mentioned
General understanding (e.g., anatomy, how breastfeeding works, barriers) 52.54%
Better ability to educate other parents (knowledge, myths, concerns, etc.) 38.98%
Help for breastfeeding one’s own children 35.59%
Greater appreciation for importance of breastfeeding 27.12%
Clarification 23.73%
Become more favorable toward breastfeeding/influenced decision to breastfeed child 15.25%
Potential career opportunities/certification 13.56%
Confidence to initiate breastfeeding 11.86%
Experience relevant to current/future career in healthcare field 11.86%
Preparation to disseminate/encourage mothers to breastfeed 8.47%
The sixth open-ended question asked participants about any content or skills they wish had been
included in the course. Five common themes were determined across 54 responses. As seen in
Table 9, the most frequent response to this question was that the participant felt nothing was
lacking in terms of content. The next most frequently cited topic that participants wished would
have been included was more information on the post-partum stage of breastfeeding.
Participants’ third most frequent response was that they wished more hands-on activities were
included. A few participants also mentioned wanting more information on pumping and latching,
and more information on milk storage. Other topics that were not mentioned enough times to be
included in the frequency table that participants wish were covered include cultural views on
breastfeeding, diseases or infections that may occur with the mother or child, how to help when a
mother cannot be skin to skin immediately after birth, how to get a fussy baby to cooperate,
reading growth charts, counseling skills, information on the different types of nipples, life-long
benefits of breastfed babies, and disadvantages of breastfeeding.
18
Table 9: Frequency of Responses to Open-ended Question #6 (N = 54)
“Is there content or skills not covered in the course that you wish were included?”
Theme
%
Mentioned
Nothing/everything was covered 50.00%
Post-partum 16.67%
More hands-on activities 5.56%
More information on pumping/latching 3.70%
Milk storage 3.70%
The seventh open-ended question asked participants to make suggestions for improving future
semesters of the course. As seen in Table 10, the most frequently appearing responses was that
the course did not need to be improved. The next most frequently appearing comment was that
the course was quite content-heavy. Several participants suggested either increasing the length of
the class meetings or expanding the course to be taken over two semesters instead of one. Other
suggestions included more interactive elements, more hands-on activities, more coverage of the
anatomical and biological aspects of lactation, spending less time on the history of breastfeeding,
less time on the decline and rise of breastfeeding, incorporating more visual aids (e.g., videos
and diagrams) into the lectures, making the full lecture slides available to the class, discussing
more real-life scenarios that mothers may go through, and incorporating more group work or
discussions into the class. Additional suggestions not mentioned often enough to appear in the
frequency table include recruiting more males into the class, having a more user-friendly module
than the Wellstart lactation competencies test, inviting guest speakers from breastfeeding
advocacy groups (e.g., La Leche League), and promoting the class to CSUN’s nursing
department.
Table 10: Frequency of Responses to Open-ended Question #7 (N = 46)
“Do you have any suggestions for improving the course? If so, please elaborate.”
Theme
%
Mentioned
N/A; course was good as is 39.13%
A lot of information in one semester; consider longer class or 2 semester sequence 10.87%
More interactive/hands-on activities 8.70%
More detail on anatomy/physiology 8.70%
Less on history of breastfeeding; decline/rise 4.35%
More visual components (e.g., images and videos) 4.35%
Provide full slides to students 4.35%
Discuss more real-life scenarios that mothers may go through 2.17%
19
More group work or discussions 2.17%
A total of two students completed the internship in the Fall 2014 semester, while two students
completed the internship in the Spring 2015 semester. These students agreed to participate in this
evaluation, for a total of four interviews. The students provided the instructor with their contact
information, who then provided this information to the evaluator. Shortly after the conclusion of
their respective semesters, each student was contacted individually and asked a series of open-
ended questions regarding their internship experience. Each student was asked the same series of
questions (with the exception of one question) and the interviews lasted approximately 45
minutes each on average. The questions covered students’ perceptions (in direct relation to their
internship experience) of their own confidence in their ability to disseminate lactation education
and their interest toward incorporating lactation education into their future health care career
and/or becoming an IBCLC. The internship students were also asked the same set of open-ended
questions that appeared at the end of the survey given to students in the Spring 2015 semester of
HSCI 434. The results of the interviews are presented below.
Questions Regarding Students’ Lactation Knowledge and Skills and
Confidence to Serve as Lactation Educators
The internship students all reported feeling competent about their lactation knowledge and skills
as well as their ability to apply their lactation knowledge and skills in the field. One student
thought it was very helpful having practiced the skills at length with case studies and situational
prompts, as she felt better prepared for actual questions that mothers asked her. Another said that
after the post-course training and especially after the field training component of the internship,
she felt very confident that she could teach pregnant women what to expect when breastfeeding.
The students seemed to feel overall the internship gave them valuable experience talking to
mothers, including motivational interviewing skills to uncover concerns a mother might not be
able to articulate at first, as well as experience dealing with actual mothers. In one student’s
words, “…Having an array of clients meant having different personality types and types of
women that you have to deal with, like women who are prescribed medication mid-pregnancy
that might no longer be compatible with breastfeeding. So you have to do your research and look
into it, and be able to educate them.” All four internship students were unanimous in their belief
that the internship prepared them for a career in lactation education, and all agreed they could
begin working as lactation educators with their present level of training. According to one,
“…By the end I felt much more sure and confident, not just actually speaking to the mothers but
also in the information I was providing.”
20
The internship students also responded to questions about their competency and confidence
specifically with regards to skills needed for the phone-based intervention. Key skills they
developed included motivational interviewing techniques, addressing concerns mothers may
have had about breastfeeding, maintaining client confidentiality and documentation,
understanding the lactation educator’s scope of practice, affirming and validating the mothers,
and successfully building rapport with the mothers. The students all agreed that they were
successful in developing these skills and felt that their experience in speaking with the mothers
over the phone was valuable for their careers. Three of the students were also asked about
their experiences using skills they had learned to educate Spanish-speaking mothers.
The students all felt confident they were able to successfully build rapport with their clients. Two
students found that building rapport was more difficult in the clinic than over the phone, since
time in the clinic was limited. The students shared some rapport-building techniques they found
useful, such as asking the clients how they were feeling, how their week was, or how their
pregnancy was going. One student shared a specific example of how she built rapport with a
mother who was slow to open up at first. The student kept encouraging the mother to ask her
questions until the mother felt more comfortable. The students also found it useful to talk about
themselves a little, so that the mothers would not see them as strangers. Another helpful
technique was to take note of what the mothers would say, and then try to tailor the conversation
based on that. One student shared an example: “I would repeat things they told me, for instance
‘You mentioned last week you were concerned about [xyz]’ and then discuss it with them. So
just making them feel they were being heard.”
Overall, the students found that their clients responded well to the affirmations and appreciated
the support they received. The students felt confident that they were successful in addressing
their clients’ concerns, and were comfortable acknowledging when a question was beyond their
scope of practice. In such cases, they would refer the patient to the appropriate practitioner, or
consult with the instructor to find the answer to a particular question. When responding to
mothers’ breastfeeding concerns, the students would explain that the concern was common so the
mothers did not feel alone. One student explained that being asked questions and having to
answer them over the phone forced her to think quickly on her feet and utilize many aspects of
the training she had received all at once. She felt this was an invaluable aspect of the internship.
The students were also asked about their thoughts regarding documentation and maintaining
confidentiality. It seemed the documentation took some getting used to but came naturally once
the students had enough practice. As for maintaining confidentiality, one student encountered an
incident where someone other than the client answered the phone and was frustrated that the
student could not share the client’s information over the phone. Otherwise, students did not
report any major concerns with maintaining confidentiality.
21
Three of the students had also taken a Spanish-speaking module to help them interact with
Spanish-speaking mothers. The students who took the Spanish-speaking module found it to be a
valuable resource, although not all were confident it fully prepared them to work with Spanish-
speaking clients. One student described the module as focusing on the kind of Spanish one would
learn in a classroom, whereas speaking with clients necessitated simpler, more informal
language. However, she did find it gave her useful ideas for translating topics into Spanish for
her clients. Another student learned enough to help her recruit Spanish-speaking mothers from
the clinic, but did not feel confident enough in her Spanish to take on these mothers for the
phone intervention. This student was not fluent in Spanish prior to the internship, while the other
two students were. So it is possible that the post-training confidence and competence the students
felt in implementing breastfeeding in Spanish was related to their pre-training fluency level.
Questions Regarding Career Plans and Lactation Education Interest
The internship students had diverse career goals, as well as varying levels of interest toward
lactation education prior to the practicum. One student had worked previously as a food quality
assurance analyst and originally planned to continue working in the field of food safety. She had
also considered becoming a full-time lactation educator prior to the internship, but was certain
that she wanted to after completing the internship. Another student plans to work as a
nutritionist. She had considered the possibility of becoming an IBCLC prior to the internship, but
after the internship felt about 80% sure she wants to become an IBCLC. One student attributed
this change to gaining “Both the knowledge and practice. To be able to disseminate the
information to real-life people was something I wasn’t confident in and was preventing me from
considering becoming an IBCLC. Now that I actually have that knowledge and practice it seems
more feasible, like something I could do.” Another student was motivated by seeing how little
the mothers actually knew about breastfeeding and how important it was to make resources
available to them. Still another was motivated by her realization that some of the issues she
encountered during the phone-based intervention were out of her scope of practice as a lactation
educator, but would not be for an IBCLC. One student had been under the impression that
obtaining the IBCLC credential would be extremely difficult. After completing the internship,
she came to see obtaining an IBCLC credential as a much more obtainable goal.
The internship students who plan to work in the healthcare field all expressed a strong desire to
incorporate their knowledge of lactation into their careers. One who plans to become a registered
dietitian (RD) pointed out that nutrition and breastfeeding go hand-in-hand. She explained that
many of the benefits of breastfeeding are preventative in nature, much the same as nutrition is
often preventative. So she plans to encourage her future nutrition patients to breastfeed as a
preventative measure. Another student appreciated working with the local health clinic because it
primarily served a low-income, Spanish-speaking population. The internship gave her the
opportunity to provide health education to this population.
22
All students agreed that their interest in the field increased and that the internship convinced
them to incorporate more lactation education into their chosen field. According to one, “I think
the internship reaffirmed why I want to pursue my goal of providing nutrition education as a
registered dietitian, and I think it changed that goal in a positive way.” Another had previously
wanted to apply lactation education into a career as a nutritionist or food consultant, but
explicitly changed her career goal to wanting to become a lactation educator after the internship.
Overall Satisfaction
All students left the internship satisfied and grateful for the opportunity to gain practical
experience they might not otherwise been exposed to. One stated that it helped make up her mind
to become a lactation educator, while becoming an IBCLC was “Definitely a possibility.”
Another commented “I think it was a great opportunity. Being able to recruit clients from a
community health center was very beneficial to me. I would definitely feel more confident being
a lactation educator at a community health center. Also, I think establishing rapport, learning
how to do motivational interviewing, meeting a stranger and being able to assess their needs – I
feel like it prepared me for my future career.” The primary benefits cited by the students were the
opportunity to put their knowledge into practice, and getting a sense of what sorts questions
expectant mothers may have. One student described the benefits to her as “Actually interacting
with the moms – hearing the issues from the moms themselves, versus learning about them in the
classroom. It was really eye-opening.”
As for skills or content learned in the internship that the students felt were especially valuable,
several mentioned counseling and motivational interviewing skills – not only learning them but
putting them into practice. Others mentioned the Spanish training module, and learning about
anatomy in depth. Two students emphasized that the content on milk production was
indispensable to successful lactation education. The students also appreciated learning how to
address breastfeeding misconceptions, as well as learning answers to specific issues such as the
effect of drinking alcohol on breast milk. Each of the students responded enthusiastically that
they believed the internship met their specific objectives for enrolling in it. The internship was a
good refresher on the information they were first exposed to in the HSCI 434 course, and they
were able to start actually disseminating this information.
One student explained that she became more pro-breastfeeding as a result of taking the
internship. She learned many facts about the human body and the health benefits of breast milk.
She provided the following example: “Like when a mom gets a cold, it might occur to her that
she should stop breastfeeding so the baby won’t catch the cold. But the body starts making
antibodies to protect the baby even before she caught the cold. So the protection qualities of
breast milk are amazing…that was fascinating to me.”
23
All four students agreed that they were very satisfied with the internship experience overall. A
recurring issue was in regards to scheduling with the phone-based intervention. Each of the
students found it challenging to coordinate their phone calls with the mothers, either because it
was difficult trying to find times that were convenient for both themselves and the clients, or
because clients would frequently postpone their appointment or not answer the phone at all.
As for suggestions to improve the internship for the future, one was to have a component where
the students shadow a lactation consultant. Another student commented that the project
coordinator was uncommunicative at times and needed to be more responsive to emails and
questions. Lastly, several students suggested allowing for more time to conduct the interventions
on-site as opposed to almost exclusively over the phone. The students felt that the internship was
otherwise very rewarding and well-structured.
The internship students were also given the same pretest and posttest questionnaires as the
students in the HSCI 434 course. One student did not submit a posttest and so was not included
in this analysis. Though it would not be informative to conduct paired samples t-tests on a
sample size of only three students, it can be seen in Table 11 that the four internship students
increased their content knowledge by an average of 13% and their knowledge of lactation
education skills by an average of 15%. Their procedural knowledge did not increase from pretest
to posttest, but again the small sample size renders this change difficult to examine. The
internship students also increased in their attitudes toward breastfeeding by an average of .15 (on
a one to four scale) from pretest to posttest, as well as .66 (on a one to four scale) on their
confidence in their lactation education knowledge and ability.
Table 11: Paired Samples t-Tests for Individual Career Interest Items (n = 4)
Subscale
Pretest Posttest
Difference M M Content Knowledge .85 .98 .13
Procedural Knowledge .94 .94 0.00
Skills .75 .90 .15
Attitude 3.69 3.84 .15
Confidence 3.34 4.00 .66
**p < .01.; ***p < .001. 1 = Strongly Disagree, 2 = Disagree, 3 = Agree, 4 = Strongly Agree.
24
Jepson-Sullivan, R. M. (2010). Reliability and validity of a breastfeeding knowledge survey in
allied health students (unpublished master’s thesis). The University of Utah, Salt Lake
City, Utah.
Parker, J. (2005). HIPAA Quiz. Retrieved from http://www.proprofs.com/quiz-
school/story.php?title=hipaa-quiz
Radcliff, B. & Payne, J. (2011). Hearts and Minds Project: A breastfeeding curriculum
intervention to improve the education outcomes for nutrition and dietetics graduates.
Nutrition and Dietetics, 68, 201–207.
United States Breastfeeding Committee (2010). Core Competencies in Breastfeeding Care and
Services for All Health Professionals. Rev ed. Washington, DC: United States
Breastfeeding Committee.
25
Appendix A: Pretest and Posttest Questionnaire
1. Since breastfeeding requires additional calories, women who breastfeed may take longer
to return to their pre-pregnancy weight.
o True
o False
2. Infants who are breastfed are less likely to develop allergies and asthma than children
who are formula fed.
o True
o False
3. Infants who are formula fed are less likely to develop diabetes or become obese later in
life compared to infants who are breastfed.
o True
o False
4. Women who breastfeed will likely decrease their risk for uterine, endometrial, breast and
ovarian cancer.
o True
o False
5. Breastfed infants will form a closer bond with the mother than formula-fed infants
because of the increased skin-to-skin contact between the mother and child.
o True
o False
6. Ear infections and diarrhea are less common in breastfed infants.
o True
o False
7. Breastfeeding can decrease an infant’s risk of sudden infant death syndrome (SIDS).
o True
o False
26
8. With the addition of ingredients such as docosahexaenoic acid (DHA), arachidonic acid
(ARA), and iron, formula has become almost identical in composition to breast milk.
o True
o False
9. Breast milk changes in composition and volume produced depending on the age and
needs of the infant.
o True
o False
10. Breast milk and formula are equal in their digestibility.
o True
o False
11. A woman can produce more milk by increasing the frequency of breastfeeding.
o True
o False
12. If a breastfeeding women does not eat the recommended servings for all food groups for
lactation, her breast milk will not be of adequate quality for infant growth.
o True
o False
13. A mother will not be able to continue exclusive breastfeeding once she goes back to work
or school.
o True
o False
14. To avoid a decrease in length of breastfeeding duration, it is recommended that pacifiers
be avoided until one week after birth.
o True
o False
15. Babies should be fed on demand.
o True
o False
16. The first sign a baby makes to communicate his or her hunger is crying.
27
o True
o False
17. Most babies who are breastfed will need supplemental formula during growth spurts.
o True
o False
18. The amount of milk removed from a mother's breasts influences the amount of milk a
mother produces.
o True
o False
19. What kind of personally identifiable health information is protected by the Health
Insurance Portability and Accountability Act privacy rule?
o Paper
o Electronic
o Verbal
o All of the above
20. Health Insurance Portability and Accountability Act security and privacy regulations
apply to:
o Attending physicians, nurses, and other healthcare professionals.
o Health information managers, information systems staff, and other personnel only.
o Anyone working in the facility.
o Only staff that have direct patient contact.
21. Copies of personally identifiable health information may be disposed of in any garbage
can in the facility.
o True
o False
22. All of the following are reasons a lactation educator would refer a mother to a health care
provider (e.g., pediatrician, lactation consultant, primary care provider) EXCEPT:
o Baby has a fever.
o Mother is using a nipple shield incorrectly.
o Mother is returning to work and needs resources for pumping.
o Baby has yellow skin and eyes.
28
23. All of the following situations are within a lactation educator’s scope of practice
EXCEPT:
o Mother has question about breastfeeding positions she can use at night so she can get
more sleep.
o Exclusively breastfeeding mother is concerned about her milk supply. Her baby was
just seen (i.e., early that day) by a pediatrician who reported that her baby’s weight
gain is normal.
o Mothers reports that her six day old baby’s bowl movements are green.
o Older baby is refusing to breastfeed.
24. I value breastfeeding as an important health promotion and disease prevention
strategy.
o Strongly Disagree
o Disagree
o Agree
o Strongly Agree
25. I understand the importance of tailoring information and services to the family's
individual needs (culture, knowledge, or language level).
o Strongly Disagree
o Disagree
o Agree
o Strongly Agree
26. I recognize the limitations of my own lactation knowledge and breastfeeding expertise.
o Strongly Disagree
o Disagree
o Agree
o Strongly Agree
27. I have the ability to recognize when personal values and biases may interfere with
breastfeeding care and services provided to families.
o Strongly Disagree
o Disagree
o Agree
o Strongly Agree
28. I encourage workplace support for breastfeeding.
o Strongly Disagree
o Disagree
o Agree
29
o Strongly Agree
29. I would support breastfeeding colleagues.
o Strongly Disagree
o Disagree
o Agree
o Strongly Agree
30. I would support family centered policies at federal, state, and local levels.
o Strongly Disagree
o Disagree
o Agree
o Strongly Agree
31. As a health professional, I believe it would be my responsibility to highlight the health
problems associated with the use of infant/artificial formula when giving advice about
infant feeding.
o Strongly Disagree
o Disagree
o Agree
o Strongly Agree
32. In my professional capacity, I will be able to, directly or indirectly, influence a woman's
decision to initiate breastfeeding.
o Strongly Disagree
o Disagree
o Agree
o Strongly Agree
33. In my professional capacity, I will be able to, directly or indirectly, influence a woman's
ability to reach her breastfeeding duration goal.
o Strongly Disagree
o Disagree
o Agree
o Strongly Agree
34. I am confident in my ability to educate others on the benefits of breastfeeding.
o Strongly Disagree
o Disagree
o Agree
30
o Strongly Agree
35. I am confident in my ability to educate others on strategies to breastfeed discretely in
public.
o Strongly Disagree
o Disagree
o Agree
o Strongly Agree
36. I am confident in my ability to help mothers develop a plan to maintain their milk supply
while they are separated from their baby.
o Strongly Disagree
o Disagree
o Agree
o Strongly Agree
37. I am confident in my ability to educate mothers on strategies to build and maintain a
good milk supply.
o Strongly Disagree
o Disagree
o Agree
o Strongly Agree
38. I am confident in my ability to address most concerns a pregnant woman may have
about breastfeeding.
o Strongly Disagree
o Disagree
o Agree
o Strongly Agree
39. I am confident in my ability to provide breastfeeding mothers with the knowledge
needed to meet their breastfeeding goals.
o Strongly Disagree
o Disagree
o Agree
o Strongly Agree
*Note: The following four questions were only asked at posttest, and only for students
in the Spring 2015 cohort.
31
40. I would like to participate in an internship focusing on lactation education, which would provide me with the opportunity to apply the knowledge I learned in the lactation education course.
o Strongly Disagree
o Disagree
o Agree
o Strongly Agree
41. I am interested in integrating lactation education into my future career.
o Strongly Disagree
o Disagree
o Agree
o Strongly Agree
42. I am interested in pursuing a career as a lactation educator.
o Strongly Disagree
o Disagree
o Agree
o Strongly Agree
43. I am interested in becoming an International Board Certified Lactation Consultant.
o Strongly Disagree
o Disagree
o Agree
o Strongly Agree
Appendix B: Posttest Questionnaire – Open-Ended Questions
44. What were your primary motivations for taking this course?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
45. What specific skills or knowledge did you hope to gain prior to taking this course?
__________________________________________________________________
__________________________________________________________________
32
__________________________________________________________________
__________________________________________________________________
46. How has your understanding of lactation and/or lactation education changed as a result of taking this course?”
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
47. Are there any skills and/or content areas covered in this course that you found especially useful? If so, can you please elaborate?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
48. How do you feel you benefitted most by taking this course?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
49. Is there content or skills not covered in the course that you wish were included?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
50. Do you have any suggestions for improving the course? If so, please elaborate.
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
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