HLTH 6800 Week 2 Peer Counseling Capstone Proposal Example

Capstone Proposal: Where a Washington County, Mississippi, WIC Clinic Should Spend Its Next Peer Counselor Hours, and Why the Answer Is the First Six Weeks After Birth

Student Name

Walden University

HLTH 6800: Health Education and Promotion Capstone

Instructor Name

Month Day, Year

Capstone Proposal: Where a Washington County, Mississippi, WIC Clinic Should Spend Its Next Peer Counselor Hours, and Why the Answer Is the First Six Weeks After Birth

Problem Statement

In Washington County, Mississippi, about half of newborns leave the birth facility having received no breast milk. County birth certificate data for 2023 and 2024 put breastfeeding initiation at 51.2% across 988 births to county residents, a figure in the lowest tier of Mississippi counties (Centers for Disease Control and Prevention [CDC], 2026a). Statewide survey estimates for 2023 show the gap widening after birth: 74.0% of Mississippi infants were ever breastfed, 43.7% were still breastfed at 6 months and 38.0% were exclusively breastfed through 3 months, against national figures of 86.1%, 62.8% and 48.5% (CDC, 2026b). The county's population of 42,765 is 71.6% Black, and 26.4% of residents live below the poverty line (U.S. Census Bureau, 2025), which places a large share of mothers within reach of the WIC clinic.

For a health educator, the practical problem is not whether breastfeeding matters but how a small clinic should use a limited number of trained peer counselor hours. Those hours can go to group classes before birth or to individual contact after it. The capstone takes a position on that choice.

Claim

Peer counselor time at the Washington County WIC clinic will do more to keep infants breastfed if it is spent on scheduled one-to-one contact starting in the hospital and running through the sixth week after birth than if it is spent on additional prenatal classes.

The claim is comparative on purpose. It does not say prenatal contact is useless, and it does not promise a change in the county's initiation rate within a year. It says that, hour for hour, postnatal contact is the better investment for this population.

Scope

Population. WIC participants who live in Washington County, are 18 or older and deliver a healthy singleton infant at term.

Setting. Two sites: the WIC clinic serving county residents and the delivery hospital most of them use, since the claim depends on contact beginning before discharge.

Outcomes. Any breastfeeding at 6 weeks and exclusive breastfeeding at 3 months, both reported by the mother, with initiation tracked as a secondary outcome.

Exclusions. Newborns who need intensive care, any mother with a medical contraindication to breastfeeding and structural questions such as paid family leave or workplace lactation policy. These matter, but a clinic cannot change them, and including them would turn a practice question into a policy one.

Significance for the Field

Health educators are often asked to do more with the same staff. A capstone that compares two uses of one position, rather than proposing a new program, speaks to that situation directly. If the comparison holds, it gives WIC agencies in similar counties a reason to look at when their counselors meet mothers, not only how often. If it fails, the failure will also be informative, because it will show where national evidence stops applying to a rural Southern population. Either result produces something a clinic manager could bring to the next staffing review.

Framework

The argument will be organized around RE-AIM, which judges a health promotion intervention on five dimensions, reach, effectiveness, adoption, implementation and maintenance, instead of efficacy alone (Glasgow et al., 1999). The framework suits the claim because the comparison between classes and postnatal contact turns partly on reach, who actually shows up, and partly on implementation, whether contacts happen on schedule. A class can look efficient on paper and still miss the mothers who stop breastfeeding first. RE-AIM also forces the capstone to address maintenance, since a schedule of postnatal contacts is only worth defending if the clinic can sustain it.

Evidence Already Located

Searches so far covered PubMed, CINAHL and the Cochrane Library, limited to English and to publication years 2004 through 2025, combining terms for peer counseling, breastfeeding support, WIC and antenatal education. Three sources anchor the case. Pooling 116 trials, a Cochrane team found that support offered once the baby was born cut the share of women who stopped breastfeeding, that lay or peer supporters did as well as professionals and that four to eight scheduled contacts may work best (Gavine et al., 2022). A second Cochrane review found that antenatal education offered alone left 3-month exclusivity essentially unchanged (pooled risk ratio 1.06) and showed no clear benefit at 6 months (Lumbiganon et al., 2016). An updated evidence report prepared for the Task Force pooled 90 trials and found benefits for any and exclusive breastfeeding up to 6 months, but no relationship with initiation (Patnode et al., 2025).

A trial of peer counseling among low-income Latina mothers in Connecticut found lower rates of not starting and a trend toward fewer stopping by 3 months (Chapman et al., 2004). Studies of Black mothers enrolled in WIC are fewer, and locating them is the main task for the synthesis.

Deliverables

The finished capstone will be a single document of about 25 pages with these sections:

1. Abstract of about 250 words.

2. Introduction stating the problem, the claim and the scope.

3. Evidence synthesis organized by finding: support after birth, antenatal education alone, peer counselors in WIC and evidence specific to Black mothers.

4. Integration section rewriting the needs assessment, program plan and communication plan from earlier courses around the claim.

5. RE-AIM analysis comparing the two uses of counselor time.

6. Discussion, including the strongest objections and responses.

7. Limitations, implications for health education practice and a conclusion.

8. References.

Timeline

Weeks 3 and 4: outline and evidence synthesis. Week 5: integration of earlier work. Week 6: peer review of a classmate's draft. Week 7: an audit checking every section against the claim. Week 8: abstract. Week 9: full draft. Week 10: defense brief. Week 11: final paper.

Approvals

The capstone uses published studies and public data only, so it involves no human participants and needs no ethics board review. If the WIC clinic later wishes to test the schedule, that work would require its own approval and data agreement.

References

Centers for Disease Control and Prevention. (2026a). Nutrition, physical activity, and obesity: County level breastfeeding initiation rates [Data set]. https://data.cdc.gov/d/nqmd-cajs

Centers for Disease Control and Prevention. (2026b). Nutrition, physical activity, and obesity: National Immunization Survey (breastfeeding) [Data set]. https://data.cdc.gov/d/8hxn-cvik

Chapman, D. J., Damio, G., Young, S., & Pérez-Escamilla, R. (2004). Effectiveness of breastfeeding peer counseling in a low-income, predominantly Latina population: A randomized controlled trial. Archives of Pediatrics & Adolescent Medicine, 158(9), 897-902. https://doi.org/10.1001/archpedi.158.9.897

Gavine, A., Shinwell, S. C., Buchanan, P., Farre, A., Wade, A., Lynn, F., Marshall, J., Cumming, S. E., Dare, S., & McFadden, A. (2022). Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database of Systematic Reviews, (10), Article CD001141. https://doi.org/10.1002/14651858.CD001141.pub6

Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health impact of health promotion interventions: The RE-AIM framework. American Journal of Public Health, 89(9), 1322-1327. https://doi.org/10.2105/AJPH.89.9.1322

Lumbiganon, P., Martis, R., Laopaiboon, M., Festin, M. R., Ho, J. J., & Hakimi, M. (2016). Antenatal breastfeeding education for increasing breastfeeding duration. Cochrane Database of Systematic Reviews, (12), Article CD006425. https://doi.org/10.1002/14651858.CD006425.pub4

Patnode, C. D., Senger, C. A., Coppola, E. L., & Iacocca, M. O. (2025). Interventions to support breastfeeding: Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA, 333(17), 1527-1537. https://doi.org/10.1001/jama.2024.27267

U.S. Census Bureau. (2025). American Community Survey 5-year estimates, 2020-2024: Tables B01003, B02001 and B17001, Washington County, Mississippi [Data set]. https://data.census.gov/