HLTH 6800 Week 9 Full Capstone Draft Example

Bedside to Week Six: Why a Washington County, Mississippi, WIC Clinic Should Move Peer Counselor Time From Prenatal Classes to Early Postnatal Contact (Full Draft)

Student Name

Walden University

HLTH 6800: Health Education and Promotion Capstone

Instructor Name

Month Day, Year

Bedside to Week Six: Why a Washington County, Mississippi, WIC Clinic Should Move Peer Counselor Time From Prenatal Classes to Early Postnatal Contact (Full Draft)

Abstract

Breastfeeding in Washington County, Mississippi, falters twice: at the hospital, where roughly half of newborns receive no breast milk, and in the first months at home. This paper asks how a WIC clinic with a fixed amount of peer counselor time should use it, and it argues for one-to-one contact that begins at the bedside and continues to six weeks postpartum in place of additional group classes during pregnancy. Systematic reviews, U.S. trials enrolling low-income mothers and studies conducted within WIC were weighed using the RE-AIM framework. Support after delivery lowered the share of mothers who stopped, and peers matched professionals; teaching confined to pregnancy did not lengthen exclusive breastfeeding. The nearest trial population showed a gain at six weeks that did not persist, and no study has been done among rural Black Delta mothers. The paper concludes that early, scheduled individual contact is the better use of limited counselor hours for this clinic.

Introduction

Of the 988 infants born to Washington County residents across 2023 and 2024, 51.2% received breast milk before discharge from the birth facility, placing the county near the bottom of Mississippi's distribution (Centers for Disease Control and Prevention [CDC], 2026a). Statewide survey estimates suggest that the losses continue after discharge. In 2023, 74.0% of Mississippi infants had ever been breastfed, but only 43.7% were still receiving breast milk at 6 months, and exclusive breastfeeding through 3 months stood at 38.0%, while the national estimates for the same three measures were 86.1%, 62.8% and 48.5% (CDC, 2026b). Pediatric guidance recommends exclusive breastfeeding for about the first 6 months (Meek et al., 2022), so both the early drop and the low start matter.

The paper assumes the WIC clinic serving the county has, or can fund, a half-time breastfeeding peer counselor: a woman from the community who has breastfed and has been trained to support participants. Those hours are limited. This paper argues that those hours should go to scheduled individual contact lasting from the hospital stay until six weeks postpartum, in preference to additional prenatal classes. The paper tracks two outcomes, whether the infant receives any breast milk at 6 weeks and whether feeding is exclusive through 3 months, with initiation as a secondary outcome. Hospital practices, workplace policy and infants needing intensive care fall outside the scope, because the clinic cannot change them.

The Evidence

Support After Delivery

The most extensive evidence concerns support offered after the baby arrives. Pooling 116 trials, Gavine et al. (2022) found with moderate certainty that support focused on breastfeeding reduced stopping at both early and later time points, including exclusive breastfeeding in the first 4 to 6 weeks, where the risk ratio for stopping was 0.83, and any breastfeeding at 6 months, where it was 0.93. Effects did not differ by whether the supporter was a professional or a trained lay person, and schedules of four to eight contacts may work best. The evidence report for the US Preventive Services Task Force, drawing on 90 trials, likewise found more any and exclusive breastfeeding through 6 months, though no effect on initiation (Patnode et al., 2025).

Teaching Confined to Pregnancy

Trials of education given only before birth tell a different story. Across 24 trials, antenatal breastfeeding education left exclusive breastfeeding at 3 months without a clear change, with a pooled risk ratio of 1.06, or at 6 months (Lumbiganon et al., 2016). Because that review excluded programs pairing prenatal and postnatal parts, it does not show that prenatal contact is wasted when follow-up exists. It shows that a class standing alone is a poor bet.

Peer Counseling in Populations Like the County's

In Hartford, low-income Latina mothers randomized to peer counseling, which began with a prenatal home visit and continued with daily perinatal and three postpartum home visits, were less likely to not start breastfeeding than controls, 9% against 23%, and tended to stop less often by 3 months (Chapman et al., 2004). In Baltimore, a nurse and peer counselor team for WIC-eligible mothers, 87% of them African American, raised breastfeeding at 6 weeks from 56.9% to 66.7%, but differences at 12 and 24 weeks were not significant (Pugh et al., 2010). Within WIC, peer counselor contact in the hospital showed the strongest association with initiation among first-time Texas mothers (Campbell et al., 2014), and a 26-publication review judged that peer counseling programs can be brought to scale (Chapman et al., 2010).

Integrating Earlier Work

Three documents from earlier courses were rewritten for this paper. The needs assessment from HLTH 6205 originally reported one "breastfeeding rate"; it now splits the low start from the losses that follow and names those losses as the clinic's most direct target. The program plan from HLTH 6475 originally centered on a four-session prenatal class series; its counselor hours are now reassigned to the schedule in Table 1, with one third-trimester introductory call retained. The communication plan from HLTH 6412 originally sent general tips; its texts now confirm each scheduled contact by the counselor's first name.

Table 1

Proposed Postnatal Peer Contact Schedule

Six postnatal contacts sit inside the four-to-eight range associated with better results; extra visits are added when a mother reports a problem.

Comparing the Two Uses of Time With RE-AIM

RE-AIM asks whether an intervention reaches the people who need it, works, is adopted by settings, is delivered as intended and lasts (Glasgow et al., 1999). On reach, classes depend on attendance during pregnancy, when transportation and work schedules limit who comes, while postnatal contact can reach mothers by phone. On effectiveness, the evidence above favors postnatal support. Adoption requires the delivery hospital to allow counselor bedside visits, which is the main dependency. Implementation can be tracked as the share of scheduled contacts completed. Maintenance is the weakest link: the scale-up review shows peer programs can be sustained within national systems (Chapman et al., 2010), but no evidence speaks to a single small clinic's schedule.

Discussion

The strongest objection is that classes reach more women per staff hour. That is true if reach means attendance, but the trial evidence counts mothers still breastfeeding, and by that measure an hour of postnatal contact appears more productive. A second objection holds that the county's main gap is initiation, which postnatal support did not change in the Task Force review. The answer lies in timing: the trials and WIC studies that did find effects on starting included contact at or before delivery, which the bedside visit provides. A third objection concerns transfer to rural Black mothers, which the evidence cannot fully answer, and the paper concedes that the Baltimore trial is an imperfect proxy.

Limitations

No trial has tested this schedule among rural Delta mothers. The Baltimore team provided more intensive contact than the proposed schedule, so its 6-week effect may overstate what lighter contact achieves. Most outcomes in the source studies were reported by mothers. The WIC studies were observational and cannot rule out that mothers who receive counseling differ from those who do not.

Implications for Health Education Practice

When staff time is fixed, the timing of individual contact may matter more than the volume of teaching delivered. Health educators planning breastfeeding programs can ask where in the sequence from pregnancy to the first months mothers most often stop and place their people there.

Conclusion

For a WIC clinic serving Washington County, the evidence supports moving peer counselor hours from added prenatal classes to scheduled contact from the bedside through week 6, while measuring whether the expected early gains appear locally.

References

Campbell, L. A., Wan, J., Speck, P. M., & Hartig, M. T. (2014). Women, Infant and Children (WIC) peer counselor contact with first time breastfeeding mothers. Public Health Nursing, 31(1), 3-9. https://doi.org/10.1111/phn.12055

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

Chapman, D. J., Morel, K., Anderson, A. K., Damio, G., & Pérez-Escamilla, R. (2010). Breastfeeding peer counseling: From efficacy through scale-up. Journal of Human Lactation, 26(3), 314-326. https://doi.org/10.1177/0890334410369481

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

Meek, J. Y., Noble, L., & Section on Breastfeeding. (2022). Policy statement: Breastfeeding and the use of human milk. Pediatrics, 150(1), Article e2022057988. https://doi.org/10.1542/peds.2022-057988

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

Pugh, L. C., Serwint, J. R., Frick, K. D., Nanda, J. P., Sharps, P. W., Spatz, D. L., & Milligan, R. A. (2010). A randomized controlled community-based trial to improve breastfeeding rates among urban low-income mothers. Academic Pediatrics, 10(1), 14-20. https://doi.org/10.1016/j.acap.2009.07.005