A Quality Improvement Initiative to Improve Human Milk Feeding Intention Through the Implementation of a Prenatal Educational Toolkit

BACKGROUND: Tennessee's human milk feeding (HMF) initiation rates are lower than the national average, with 79.1% in Tennessee compared to 84.1% nationwide in 2021. This gap may result from limited healthcare provider knowledge, inadequate patient education, a lack of support for HMF, and reduced maternal confidence. Evidence indicates that understanding patient preferences and offering early prenatal education may improve mothers' intention, knowledge, and confidence in HMF.

LOCAL PROBLEM: An obstetric practice in East Tennessee identified gaps in provider knowledge and prenatal education about HMF. The project aimed to enroll 40% of pregnant individuals between 28- and 36-weeks gestation in five educational videos developed by BrightCourse to improve their intention, knowledge, and confidence before birth.

METHODS: The Evidence-Based Practice Improvement (EBPI) Model guided the project's implementation and evaluation. Patient surveys were collected before and after the education to evaluate changes in HMF intention, knowledge, and confidence.

INTERVENTIONS: At the 28-week appointment, the provider offered a survey to evaluate patients' intentions, knowledge, and confidence about HMF and interest in receiving education. Patients who chose to receive education were sent a text message with a link to five online videos. At the 36-week appointment, viewers completed the same survey, evaluating BrightCourse.

RESULTS: Thirty percent of patients (n=31) completed the initial survey and received educational videos, below the 40% aim. Seven patients viewed an average of three videos and completed a post-education survey, with 13% (n=1) showing improved intention, knowledge, and confidence in HMF. All video viewers expressed their intention to HMF.

CONCLUSIONS: Despite the small sample size, prenatal education improved one patient's intention, knowledge, and confidence in HMF. The type, quality and timing of HMF education may impact early infant feeding decisions. Therefore, exploring alternative HMF education strategies is recommended to ensure all pregnant individuals access essential information for informed feeding choices.