Evidence Review Summary
Underlying Theory/Logic: This intervention uses the social capital theory and the social marketing process as well as the Transtheoretical Model (stages of change).
Intervention strategy: This intervention employs the evidence based strategy of support for breastfeeding in the workplace. The intervention uses programs and policies that provide staff information and education, flexible work schedules, a safe, clean place for the expression and storage of breast milk, and a culture of support for employees’ continued breastfeeding after return to work from childbirth.
Formative evaluation: Initial assessment included: labor market analysis; review of literature and review of best practices in workplace lactation support; and more.
Key informant interviews were conducted with 102 individuals including key outreach partners, experts in worksite lactation, and business representatives. This was followed by fifteen focus groups with a total of 119 participants to explore experiences and attitudes related to working and breastfeeding mothers, fathers who had supported a breastfeeding partner, and employers around the state. Several sources of data were used to inform the program, communication and advertising strategies: the key informant interviews and focus groups discussed above, process and impact data collected during the Mother-Friendly Employer Technical Assistance Pilot Project, and pilot employers’ own baseline worksite assessment data. Campaign messages and materials were market-tested in five focus groups with mothers and employers and in four in-depth interviews with Spanish-speaking mothers.
Process evaluation at the state level: Google analytics was used to assess website use; market reports summarized media reach; and tallies were kept of contacts with key business influencers at conference exhibits (473 contacts made) and through direct outreach (153 phone calls and emails). There were over 200 million media impressions. The website logged approximately 40,000 visitors between May 1 and September 30, 2012. There were also at least 58 communication and planning resources developed or adapted, including 8 webinars.
Process evaluation at the worksite level: The tools, resources, and technical assistance were piloted in 30 worksites. The final versions of the tools and resources are available on the TexasMotherFriendly.org website. Evaluation of the pilot included review of the 30 worksites’ operating plans (submitted by 55% of the pilot worksites) and progress reports, as well as interviews with 108 individuals representing all 30 sites, among other data sources.
Process evaluation findings:
- All 30 pilot sites completed the following steps: gain buy-in and develop a committee, provide human resources data, conduct worksite assessments (environmental scan, employee survey, findings summary), draft, adopt, and begin to implement an operation plan (description of program activities, breastfeeding facilities, and promotion plans), draft, adopt, and plan to implement a written workplace lactation policy, apply for MFWP designation, and evaluate efforts and progress (monthly and final reports, sustainability/tracking plans).
- In the interviews with 108 representatives from the pilot sites, participants reported that they found the technical assistance, tools, and resources helpful.
Outcome evaluation at the state level: The state is tracking worksites that submit and receive designation and has added questions related to breastfeeding to statewide surveillance systems. From 2010 to 2012, the number of adopting worksites increased from 233 to 1,120. Data on awareness, attitudes, and practices related to women breastfeeding at work is being collected through questions added to the BRFSS and the biennial Texas WIC IFPS. Data on the impact of the policy in those areas is not yet available.
Outcome evaluation at the worksite level: Evaluation of the pilot included review of the 30 employer policies, operating plans (submitted by 55% of the pilot worksites), and progress reports and in-person or phone interviews with 108 individuals representing all 30 employers. A number of employers also submitted photographs to document their breastfeeding support activities. Findings from outcome evaluation include:
- 100% of employers adopted formal mother-friendly policies.
- 100% of employers had functional lactation rooms and/or plans for flexible provision of lactation space for all of their worksites.
- 73% of employers explicitly addressed provision of education and support in their Mother-Friendly policies.
- 100% of employers had work plans and activities for enhanced education and support.
Although some of these data are self-reported, reports were verified through site visits to most locations and many worksites provided photographs of the new lactation space.