An Internet-Based Education Program Improves Breastfeeding Knowledge of Maternal

Abstract

Background and Objectives:

Breastfeeding rates in the United States remain below the Surgeon General's Healthy People 2010 goals. Encouragement of breastfeeding and education by maternal–child healthcare (MCH) providers (physicians, residents, and midlevel providers) improves breastfeeding initiation and duration. Surveys of MCH providers show lack of knowledge about breastfeeding. This study evaluated the effect of usage of “BreastfeedingBasics,” a free Internet-based educational course, on the knowledge of MCH providers and evaluation of the baseline knowledge of course users.

Methods:

A before and after intervention study was done of MCH providers using the “BreastfeedingBasics” website between 1999 and 2008. Baseline knowledge and change in knowledge were assessed by computer-scored pretests and posttests.

Results:

Of 3,456 MCH providers enrolled, 2,237 (65%) completed one or more pretest. Total mean pretest/posttest scores were as follows: midlevel providers, 81%/89%; residents, 84%/93%; and physicians, 85%/92% (p < 0.001 among groups and between pretests and posttests). Mean pretest/posttest scores of the modules were as follows: Anatomy/Physiology, 79%/93%; Growth/Development, 72%/91%; Mother–Infant Couple (normal newborn), 82%/92%; and Breastfed Infant with Problems, 77%/91% (p < 0.001 for all). Specific topics with the lowest pretest scores and subsequent posttest scores were as follows (pretest/posttest): supplementation with vitamin D, 61%/93%; breastfeeding physiology, 38%/65%; growth of breastfed infants at 10 days, 80%/95%, 14 days, 72%/91%, and 3–4 months, 39%/84%; and stopping breastfeeding for maternal problems when not indicated, 69%/93% (p < 0.001 for all).

Conclusions:

Use of an Internet-based educational program improved knowledge of MCH providers as measured by pretest and posttest scores. Knowledge of the growth of breastfed infants is particularly poor. Increasing knowledge is the first step in improving clinical practice that is necessary for increasing breastfeeding rates and duration.

Introduction

Breastfeeding is recognized as the ideal method of infant feeding. Breastmilk is formulated specifically for human infants. Breastfed infants have fewer infections, including meningitis, bacteremia, diarrhea, and otitis media, and lower rates of asthma and other chronic diseases. Benefits to the mother include more rapid uterine involution, postpartum weight loss, and decreased rates of breast cancer.¹

Overall breastfeeding rates in the United States have not reached the Surgeon General's Healthy People 2010 goals: 75%, 50%, and 25% of infants being breastfed at hospital discharge and at 6 and 12 months of age, respectively, with 40% and 17% being exclusively breastfed at 3 and 6 months of age, respectively. Final data for infants born in 2005 reported in the 2007 Centers for Disease Control and Prevention National Immunization Survey showed 74%, 43%, and 21% of infants were receiving any breastfeeding at hospital discharge, 6 months, and 12 months, respectively, and 31% and 12% were exclusively breastfed at 3 and 6 months, respectively.² Although the United States has almost reached the goal for breastfeeding at hospital discharge, it has not reached any of the other goals.

Mothers and newborns infants have reflexes that help initiate and establish breastfeeding; however, support and guidance are usually needed to maintain breastfeeding.³ This support and education can come from the baby's father, grandparents, other family members, friends, healthcare professionals, and hospitals or health systems with breastfeeding-supportive practices (including minimization of use of human milk substitutes) and help to achieve successful breastfeeding.^4–9 Encouragement of breastfeeding, supportive hospital policies, and education by healthcare professionals have improved breastfeeding initiation and duration.^{5–7,10–12} When problems or questions about breastfeeding occur, mothers often ask healthcare professionals for help. If support and/or help is not received, mothers may discontinue breastfeeding because of these unresolved issues.

In the 1990s Schanler et al.¹³ and Freed et al.^14,15 reported on two national questionnaire surveys of pediatricians, family physicians, obstetrician/gynecologists, and residents in these fields that showed knowledge deficits in the management of mothers with mastitis and poor milk supply and infants with poor weight gain and jaundice. A national survey of pediatricians in 2004 reported improved knowledge of management of infants with poor weight gain and jaundice, persistent deficits in management of maternal mastitis, and deficits in knowledge of recommended follow-up care for breastfeeding newborns and vitamin D supplementation.^13,16 A 2003 national survey of obstetrician/gynecologists reported that >75% of obstetricians did not feel “well qualified” to give prenatal counseling/education about breastfeeding.¹⁷ In a 2009 report of focus group evaluation of breastfeeding knowledge of pediatric and obstetric health professionals in an Indiana inner city healthcare system, the allied health professionals reported, “I don't think our physicians feel comfortable or know a lot about breastfeeding….”¹⁸ A 2000 nationwide survey of pediatricians in practice for 2 years reported that 21% felt poorly prepared by residency training to care for problems with breastfeeding and that 75% of male and 64% of female pediatricians felt only somewhat or not confident handling problems related to breastfeeding.¹⁹ Knowledge of midwives and nurse practitioners in Oregon was assessed by a mail questionnaire; 91% reported correct management of insufficient milk supply and mastitis, but only 49% reported correct management of a breast abscess.²⁰

Multidisciplinary education of hospital staff and changes in hospital policy, such as implementation and certification as a Baby Friendly hospital, have been shown to improve breastfeeding initiation rates in the hospital.^5–7 A randomized controlled trial of a 5-hour education and training program for pediatricians combined with an early visit after discharge increased exclusive breastfeeding and breastfeeding duration.²¹ Education of maternal–child healthcare (MCH) providers to improve breastfeeding knowledge is the first step in improving clinical practice that can change outcomes.

The challenge of providing appropriate breastfeeding education to those who need it most is significant. Classroom learning and interactive workshops can be hard for practitioners to attend and require the teachers to spend a significant amount of their time in teaching activities. The online format has advantages for learners in terms of the flexibility of timing of usage, ease of access, lower cost, and easier updates of information. It is also advantageous to those who would otherwise have to teach this material face-to-face. Reviews of electronic Continuing Medical Education (CME) have shown either equivalent or increased gains in knowledge compared to non-electronic CME.^22,23 A 2008 study demonstrated a large improvement in knowledge, skills, and patient care when Internet interventions were compared to non–computer-based interventions.²⁴ Lam-Antoniades et al.²⁵ evaluated randomized controlled trials of online CME and concluded that electronic continuing education that included interactive components shows the most promise in improving healthcare professionals' knowledge and clinical practice.

This study evaluates the effect of “BreastfeedingBasics,” a free self-learning Internet-based educational course that has been available since 1999 at www.breastfeedingbasics.org, on the knowledge of MCH providers as measured by pretest and posttest scores. It compares the knowledge differences between provider groups and identifies specific breastfeeding topics with low pretest scores.

Subjects and Methods

The “BreastfeedingBasics” website content was developed by the physician authors (M.E.O., who has expertise in breastfeeding, and L.O.L., who has expertise in education) with help from other physicians, lactation consultants, nurses, dieticians, and other healthcare professionals from Case Western Reserve University, Rainbow Babies and Children's Hospital, and University Hospitals of Cleveland (Cleveland, OH). The website is programmed by a professional computer programmer (E.W.B.) in Hypertext Mark-up Language (HTML) and PERL and runs on a Linux^® server (Linux is a registered trademark of Linus Torvalds). The website was designed in 1998–1999. Updates to the content have occurred in 2000, 2002, 2003, 2005, 2008, and 2010.

The course has seven modules: Breastfeeding Benefits and Barriers, Anatomy and Physiology, Growth and Development of Breastfed Infants, Breastfeeding around the World, The Mother–Infant Couple, the Breastfed Infant with Problems, and Breastmilk and Drugs. Each module has two or three learning objectives and a three-question pretest and identical posttest. Content consists of didactic information, pictures, x-rays, graphs, and charts. Case histories are given, which require the learner to type in a free text answer in order to receive immediate feedback. References to the medical literature are given so that learners can study topics in more detail.

All users are requested to register for the course by answering several anonymous demographic questions. The questions include: profession (from a dropdown list); age in the following ranges, <25, 26–40, 41–65, and >65 years; gender; and yes/no answers to the following questions, “Are you registering as part of a course or job requirement? Have you or a partner ever breastfed an infant?” All users are required pick a password, which allows them to complete the course in several sessions, to review past material and past test results, and to have their posttest scores sent to a teacher who has set up a specified course. Answering the demographic questions is voluntary. However, data are only stored for analysis on users who answer the demographic questions. The registered user is assigned a computer-generated anonymous random identification number, and the date of the registration is collected. The identification number is matched to pretest and posttest scores in a database. There is no cost for use of the course.

Data collection and analysis

This evaluation included only MCH providers in the following fields—midwife (CNM), nurse practitioner (NP), physician assistant (PA), and physician and resident physician in pediatrics, family medicine, obstetrics/gynecology, and other specialty—who registered for the course between April 13, 1999 and December 31, 2008. These professions were divided into three categories: midlevel care provider (CMN, NP, PA), resident, and physician. Age data were combined into two categories: ≤40 years or ≥41 years.

Each question of the pretest and identical posttest is multiple choice with a varying number of correct answers. Each individual answer is computer-scored, resulting in 12–16 possible correct answers for each pretest and posttest. Users receive their pretest score, but incorrect questions are not identified. Correct answers to all questions are given after completion of the posttest. Baseline knowledge was assessed by pretest scores. The total mean pretest scores were calculated by summing the total number of correct answers for all pretests completed by the student and dividing by the total number of possible correct answers in these pretests. Because of low mean pretest scores and the clinical importance of the modules of Anatomy/Physiology, Growth and Development, Mother–Infant Couple, and Breastfed Infant with Problems, we analyzed the individual questions on the pretests by calculating the mean percentage correct for each individual answer to determine particular knowledge gaps.

During the 10-year study period, there were three different versions of the pretests and posttests. Although all questions were pilot-tested before use, versions 2 and 3 replaced several questions or answers that were thought to be unclear or poorly worded because almost all users had incorrect answers. One complete question was replaced with a more relevant question based on the learning objectives. Answer changes have been made when information changed in the website; however, the answers are worded in the same way as the previous answer, and if the answer was correct in the old version, the new answer is correct also.

Categorical variables were compared by χ² test. Continuous variables were compared by Student's t test, paired Student's t test, and analysis of variance. Multivariate linear regression was used to assess the effect of multiple demographic variables on the total pretest score. Analysis was performed using SPSS for Windows version 14 (SPSS, Inc., Chicago, IL). This project has been classed as exempt research by The Colorado Multiple Institutional Review Board.

Results

Between April 1999 and December 31, 2008, 15,374 users registered for “BreastfeedingBasics.” Data were analyzed on the 3,456 MCH providers. Of the MCH providers, 2,237 (65%) completed at least one pretest, 2,002 (58%) completed at least one posttest, and 1,838 (53%) completed at least one paired pretest and posttest. All seven pretests, posttests, and paired pretests and posttests were completed by 713 (21%), 812 (24%), and 674 (20%) users, respectively. The 1,104 users who completed demographic information but no pretests or posttests were statistically significantly more likely to be midlevel providers or physicians, to be ≥41 years of age, to be male, to not be required to take the course by work or school, or to have personal or partner breastfeeding experience (Table 1). Ages, gender, breastfeeding experience, and being required to take the course differed significantly among the three groups of professionals (Table 2). The physicians were 1,170 (67%) pediatricians, 330 (19%) family medicine, 154 (9%) obstetrics/gynecology, and 104 (6%) other physicians. The residents were 612 (80%) pediatric, 89 (12%) family medicine, 22 (3%) obstetrics/gynecology, and 44 (6%) other residents. There were 401 (43%) midwives, 400 (43%) NPs, and 130 (14%) PAs.

Table 1.

Comparison of Users Who Did not Complete Any Pretests or Posttests with Those Who Completed at Least One Pretest or Posttest

	Completed ≥1 pretest or posttest (n = 2,352)	Completed 0 pretests or posttests (n = 1,104)	Statistical significance ^a
Professional category
Midlevel	617 (26%)	314 (28%)	p < 0.001
Resident	634 (27%)	133 (12%)
Physicians	1,101 (47%)	657 (59%)
Age
≤40 years	1,797 (76%)	643 (58%)	p < 0.001
≥41 years	555 (24%)	461 (42%)
Gender
Female	1,792 (76%)	744 (67%)	p < 0.001
Male	560 (24%)	360 (33%)
Required
Yes	1,666 (71%)	432 (39%)	p < 0.001
No	686 (29%)	672 (61%)
Breastfeeding experience
Yes	947 (40%)	677 (61%)	p < 0.001
No	1,395 (60%)	427 (39%)

By χ² test.

Table 2.

Comparison of Professional Level with Age, Gender, Being Required to Take “BreastfeedingBasics,” and Personal or Partner Breastfeeding Experience

	Midlevel (n = 931)	Resident (n = 767)	Physician (n = 1,758)	Statistical significance ^a
Age
≤40 years	500 (54%)	745 (97%)	1,195 (68%)	p < 0.001
≥41 years	431 (46%)	22 (3%)	563 (32%)
Gender
Female	873 (94%)	547 (71%)	1,163 (63%)	p < 0.001
Male	58 (6%)	220 (29%)	642 (37%)
Required
Yes	588 (63%)	605 (79%)	905 (51%)	p < 0.001
No	343 (37%)	162 (21%)	853 (49%)
Breastfeeding experience
Yes	575 (62%)	143 (19%)	916 (52%)	p < 0.001
No	356 (38%)	624 (81%)	842 (48%)

By χ² test.

The total mean pretest scores for the 2,237 MCH providers was 84%, with mean scores of 81% for the midlevels, 84% for residents, and 85% for physicians. Mean test scores rose to 89%, 93%, and 95%, respectively, after completing the course. The bivariate and multivariate analyses of total mean pretest scores compared to demographic factors and version number are listed in Table 3. Being required to take the course was associated with a 3.8 percentage point lower mean pretest score. Being a physician or resident compared to a midlevel provider was associated with a higher pretest score of 5.0 and 5.4 percentage points, respectively, in mean total pretest score. Being female or having personal or partner breastfeeding experience was associated with a 3.0 and 1.8 percentage point higher mean total pretest score, respectively.

Table 3.

Analysis of Total Mean Pretest Scores by Demographic Factors and Pretest Version

Demographic factor	Number of pretests	Mean total pretest scores ± 1 SD	Bivariate significance	Multivariate significance ^a
Profession
Midlevel	559	81 ± 10.7%	p < 0.001^b	5.44 (4.24–6.63)^c
Resident	609	84 ± 8.4%		4.97 (3.94–5.99)^d
Physician	1,069	85 ± 9.7%
Age
≤40 years	1,717	84 ± 9.6%	p < 0.1^e	NS
≥41 years	520	84 ± 10.4%
Gender
Female	1,705	84 ± 9.7%	p < 0.002^e	3.01 (2.07–3.96)
Male	532	83 ± 10.0%
Required
Yes	1,599	83 ± 9.3%	p < 0.001^e	−3.75 (−4.70 to −2.81)
No	638	87 ± 10.2%
Breastfeeding experience
Yes	894	85 ± 10.3%	p < 0.001^e	1.76 (0.85–2.67)
No	1,343	83 ± 9.5%
Version
1	65	85 ± 10.4%	p < 0.001^f	NS
2	376	86 ± 9.5%
3	1,796	83 ± 9.8%

Beta (95% confidence interval).

Analysis of variance, p < 0.001 comparing midlevels to residents and physicians; no difference between residents and physicians.

Compares resident to midlevel.

Compares physician to midlevel.

By Student's t test.

Analysis of variance, p < 0.001 comparing version 2 to version 3; no difference between version 1 and versions 2 and 3.

NS, not significant.

The mean pretest and posttest scores for all modules are in Table 4. Only the Benefits/Barriers module had a mean pretest score above 90%. All mean posttest scores were ≥89% and were significantly increased from the pretest scores (p < 0.001). Table 5 lists the individual topics in which MCH providers had low mean pretest scores. All mean posttest scores increased statistically significantly.

Table 4.

Comparison of Scores for All Maternal–Child Healthcare Providers Who Completed Both the Pretest and Posttest of the Modules

		Mean score ± 1 SD
Module	Number (% completing)	Pretest	Posttest	Statistical significance ^a
Benefits/Barriers	1,629 (47%)	91 ± 8.2%	96 ± 6.4%	p < 0.001
Anatomy/Physiology	1,280 (37%)	79 ± 14.1%	93 ± 9.1%	p < 0.001
Growth/Development	1,072 (31%)	72 ± 15.1%	91 ± 11.0%	p < 0.001
Breastfeeding Around the World	962 (28%)	84 ± 12.1%	93 ± 8.5%	p < 0.001
Mother–Infant Couple	1,021 (30%)	82 ± 13.6%	92 ± 8.7%	p < 0.001
Breastfed Infant with Problems	918 (27%)	77 ± 15.7	91 ± 10.4%	p < 0.001
Breastmilk and Drugs	928 (27%)	81 ± 11.8%	89 ± 11.3%	p < 0.001

By paired Student's t test.

Table 5.

Comparison of Mean Percentage Correct on Pretest Questions with Low Scores with Same Posttest Question When Both Questions Were Answered

	Mean % correct on ^a
Question	Pretest	Posttest
Breastfed term infants should be supplemented with which of the following:
400 IU of vitamin D starting at 2 weeks of age^b	61%	93%
Iron-rich foods starting at 6 months of age	63%	92%
Which of the following statements are true about milk production and let-down (milk ejection)?
Suckling at the breast stimulates prolactin secretion, which stimulates milk let-down	38%	65%
Oxytocin is needed to for milk ejection	77%	93%
Breastmilk composition is characterized by:
Having a low concentration of iron that is highly absorbable	73%	93%
Characteristics of the growth of breastfed infants includes which of the following aspects:
Breastfed infants are fatter during the first 3–4 months than infants fed formula	39%	84%
Infants breastfed for 12 months with the addition of solid foods at 4–6 months are slightly leaner at 12 months of age than infants fed formula	78%	96%
Breastfed infants may cross 1 or 2 weight percentile lines downward between 4 and 8 months of age	42%	70%
A woman needs to stop breastfeeding if she develops which of the following problems?
A Candida infection of the nipple	76%	95%
Mastitis	81%	96%
None of the above (other choices were a blocked milk duct and engorgement)^c	69%	93%
Which of the following is true about jaundiced breastfed infants:
Jaundice in the first week of life is due to decreased bilirubin excretion in the stool	64%	89%
Breastfed babies whose weight is a concern can be defined by which of the following:
Greater than 10–12% loss of birth weight	82%	95%
Babies who are not back to birth weight by 14 days of age	72%	91%
Babies still losing weight after 10 days of age	80%	95%

Using paired Student's t test, all posttest scores were significantly better than pretest scores with p < 0.001.

This correct answer is the present correct answer in the website but was changed as the American Academy of Pediatrics recommendations have changed over the past 10 years.

This answer had to be left incorrect in order to get a correct score on the answer.

Discussion

This is the largest evaluation of a breastfeeding educational intervention for MCH providers and the largest recently published study we have found of breastfeeding knowledge of MCH providers. We report previously unidentified gaps in breastfeeding knowledge for the MCH providers. Knowledge improved in all areas after completion of this Internet-based educational intervention. However, increase in knowledge is only the first step in improving the clinical practice of MCH providers.

When compared with previous studies, 89% of our MCH providers knew the correct management of jaundice in the breastfed infant compared to 44% of the MCH providers in the study of Freed et al.¹⁵ and 92% of the pediatricians studied by Feldman-Winter et al.¹⁶ A first follow-up visit for breastfed infants within 3–5 days of age was recommended by 87% of our users compared to 38% in the study of Feldman-Winter et al.¹⁶ from data obtained in 2005.

Knowledge deficiencies remain in important areas. Discontinuing breastfeeding when it is not needed for maternal problems of Candida infection of the nipple, mastitis, engorgement, or blocked milk duct was recommended by 31% of our users. This is similar to reports by others.^15,16,26,27 Only 61% of our users recommended the correct usage of vitamin D for breastfed infants compared to 55% of the pediatricians studied by Feldman-Winters et al.¹⁶ and 52% of the physicians in a Nebraska study.²⁸ Only 37% of our users knew that prolactin is required for breastmilk production, and 77% knew that oxytocin is needed for milk release. This is similar to results from a small study of Australian general practice registrars (similar to family medicine residents) where <50% knew the effect of prolactin on initiation of breastfeeding.²⁹

In the 1990s 42% of MCH providers could not appropriately manage the infant with low weight gain or with a mother with poor milk supply. The 2005 survey published in 2008 by Feldman-Winter et al.¹⁶ revealed only 11% of pediatricians would stop breastfeeding due to slow weight gain. This study found a significant lack of knowledge about normal weight gain for breastfed infants in the first 2 weeks of life. Of the MCH providers in this study, 18% were not worried about an infant who lost >10–12% of birth weight, 28% were not worried about a breastfed infant who was not back to birth weight by 2 weeks of age, and 20% were not worried about the breastfed infant who was still losing weight at 10 days of age. Slow weight gain or persistent weight loss in the first 2 weeks of life is a marker for insufficient milk supply or insufficient milk transfer. Intervening to correct these problems is more effective in the first 2 weeks of life than later. Lack of recognition of this problem early on can lead to continued poor weight gain, resultant supplementation, and early weaning.

This study is the first national study to evaluate knowledge about the growth of breastfed infants over the first year of life. Only 34% of our MCH users were aware that breastfed infants can be fatter over the first 3–4 months of life, and 42% knew that infants could cross weight percentiles downward during the next 4–6 months of life when growth is assessed using the 2000 National Center for Health Statistics standard growth curves that are most commonly used in the United States. These knowledge deficits are similar to those found in a small study of pediatric residents in the United States²⁸ and a similar study of general practice registrars in Australia.²⁹ Lack of awareness of the normal growth pattern of breastfed infants may cause MCH providers to recommend supplementation when not needed and/or discontinuation of breastfeeding due to feared poor weight gain in a normally growing breastfed infant.

The pretest scores in this project were no different between physicians and residents but were lower in midlevel providers. We found no national published data on breastfeeding knowledge of midlevel providers. The knowledge of our midlevel providers was lower than that reported by Hellings and Howe.²⁰ Our sample is a national sample and may be more representative of the breastfeeding knowledge of midlevel providers. Course users with personal or partner breastfeeding experience had higher pretest scores by 1.8% points. Although this was statistically significant, the difference is probably not clinically significant. Prior research on the effect of personal and partner breastfeeding experience on breastfeeding knowledge has shown both positive and no relationship.^13,14,28 Another study found that personal breastfeeding experience led providers to give advice based on their experience that was contrary to evidence-based recommendations.¹⁸

Our project with 2,237 MCH providers completing at least one pretest and 674 completing both pretest and posttest of all seven modules is the largest evaluation of a breastfeeding intervention for MCH providers. Knowledge improved in all modules as measured by improved posttest scores (Table 4). Computer and Internet technology allowed this large audience to participate in “BreastfeedingBasics” and made the data collection possible. Another advantage of online breastfeeding education is that it allows rapid changes to content as knowledge changes. Information regarding vitamin D recommendations and corresponding answers were changed in the website in a timely manner to correspond with changing recommendations for usage of vitamin D in breastfed infants.

This project has limitations. This was not a randomized trial or a convenience sample of a known population. It reports data on all voluntary users and those required to complete all or part of the website by their job or school. However, the 72% of MCH providers who reported being required to take the course for a school or work requirement had lower mean pretest scores by more than 3 percentage points. This group more likely represents the overall knowledge of MCH providers because those who were not required to take the course may have found the website because of their interest in breastfeeding. Our pretest and posttests were identical. Users received a total pretest score for each module but were not notified which answers they got correct on the pretest. The identical pretests and posttests may have inflated posttest scores if the users remembered the questions from pretest to posttest.

This project addresses only the didactic portion of breastfeeding education. “BreastfeedingBasics” should be combined with hands-on education so users will be able to apply their newly gained information to clinical practice. Although educational interventions of healthcare professionals have improved breastfeeding initiation and/or duration, because this intervention was anonymous and Internet-based, we could not measure this in our study.^{5–7,30,31,32} We also were not able to measure whether the knowledge gained was sustained over time. Improving knowledge is the first step necessary in changing clinical practice. It is encouraging that studies by Beal et al.³³ and Short et al.³⁴ found that knowledge gained and reported practice changes that occurred after usage of Internet-based educational courses persisted for 6 and 12 months, respectively. Fordis et al.,³⁵ comparing Internet-based CME to a live CME workshop, found that both methods improved knowledge, the knowledge was retained at 12 weeks, and only the Internet intervention improved care as measured by chart audit.

Conclusions

Previously known gaps in breastfeeding knowledge of MCH providers persist, and new areas of knowledge deficits, particularly in the area of growth of the breastfed infant, have been identified. We have identified baseline knowledge deficits of midlevel MCH providers that have not been documented previously. Use of a free Internet-based educational program, “BreastfeedingBasics,” improved knowledge of a large number of MCH providers as measured by pretest and posttest scores both in overall knowledge and on individual questions. This is an important first step in improving clinical practice in the area of breastfeeding that is necessary for increasing breastfeeding rates and duration in the United States.

Footnotes

Acknowledgments

Funding for the website design was provided by the Northern Ohio Chapter of the March of Dimes and The University Center for Innovation in Teaching and Education of Case Western Reserve University.

Disclosure Statement

No competing financial interests exist.

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An Internet-Based Education Program Improves Breastfeeding Knowledge of Maternal–Child Healthcare Providers

Abstract

Abstract

Background and Objectives:

Methods:

Results:

Conclusions:

Introduction

Subjects and Methods

Data collection and analysis

Results

Discussion

Conclusions

Footnotes

Acknowledgments

Disclosure Statement

References