Parkdale Infant Nutrition Security Targeted Evaluation Project (PINSTEP): Formative Research
Bibliographic record
Abstract
Background: Socially and/or economically vulnerable women in Canada have lower rates of breastfeeding. Skilled lactation support is one key strategy for improving practices, but it is less accessible to vulnerable women. The Canada Prenatal Nutrition Program (CPNP) aims to support breastfeeding among vulnerable women, but investigation of the potential to integrate postnatal lactation support has not been explored. Objectives: Formative research was conducted with participants at one Toronto CPNP site with separately funded postnatal lactation support services to determine (1) maternal sociodemographic/psychosocial characteristics and their association with CPNP participation; (2) experiences with breastfeeding and the lactation support program (in-home lactation consultant visits, breast pumps); (3) utilization of the lactation support program, infant feeding practices, and associations between maternal sociodemographics and six-month breastfeeding practices. Methods: (1) retrospective chart review of registered clients from 2013-2016 (n=339); (2) focus groups and interviews with 46 clients; (3) prospective cohort study collecting infant feeding data to six months postpartum (n=199). Results: CPNP clients at this site demonstrated a variety of vulnerabilities (e.g. 80% were born outside of Canada, 65% had incomes below the Low-Income Cut-Off), with few differences in CPNP participation based on maternal characteristics. Qualitative participants reported that the lactation support program helped to mitigate some physical, practical, and self-efficacy breastfeeding challenges. The most valued elements were the in-home services delivered by skilled, non-judgmental providers. Seventy-five percent of prospective cohort study participants received at least one lactation consultant visit. All participants initiated breastfeeding, 84% continued for six months, and 16% exclusively breastfed for six months. In univariate analyses, food insecurity was associated with lower rates of any breastfeeding at six months (p=0.014) and ≤ high school education with lower exclusive breastfeeding for six months (p=0.034). Conclusions: Results indicate that this CPNP site serves vulnerable women, their lactation support program is well-accepted and utilized, and a high proportion of women continued breastfeeding to six months. Mixed methods implementation research is needed to evaluate the effectiveness and feasibility of delivering postnatal lactation support within other CPNP sites across Canada and further investigation of preceding and contextual barriers to breastfeeding, such as food insecurity, is required.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.070 | 0.049 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.003 | 0.005 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.010 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".