Final Program Plan

CMTakacs

Health Promotion Program Plan:

LatchedforLIFE

Colby M. Takacs, CHES

201520 Spring 2015 HLTH 634- D01 LUO
Liberty University
May 8, 2015
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Health Promotion Program Plan: LatchedforLIFE

Introduction: Need Statement

The importance and benefits of breastfeeding for both mother and child have been well
documented and range from disease prevention to over all better health and well-being.1,2,3 As a
result, numerous health organizations and agencies recommend exclusive breastfeeding for a
minimum of the first six months of life with continuation beyond that as able.2,4 Approximately
79% of newborn infants in 2011 started to breastfeed; however, durations of breastfeeding did
not continue per recommendations (exclusive for first six months and continuation through one
year as long as possible).3 Additionally, only 49% of infants born in 2011 were breastfeeding at 6
months and a drastically reduced rate of 27% were being breastfed at 12 months.3
Mothers represent the fastest- growing segment of the U.S. labor force with
approximately 70% of employed mothers working full-time with children younger than 3 years
of age.5,6,7 A rather large proportion of these mothers (one-third) return to work within three
months postpartum and an even larger proportion (two-thirds) return to work within six months
postpartum.5 The cessation of breastfeeding has been shown to coincide with the return to work
postpartum suggesting that working mothers are more likely to experience a shorter duration of
breastfeeding and full-time work is associated with lower rates of breastfeeding initiation, as well
as, shorter durations.4,5,6 Given the substantial presence of mothers in the work force, and the
focus of priority placed on breastfeeding initiation and continuation from major health agencies
and programs, there is a strong need to establish lactation support5 The LatchedforLIFE
Initiative seeks to improve the health and well-being of infants and families through education,
outreach, and advocacy in promotion and support of working mothers breastfeeding initiation
and continuation.

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Goals
Program Goal 1:
To promote and support breastfeeding initiation and continuation for mothers in Lynchburg, VA.
Program Objectives for Goal 1:
1. By June 2015, Initiative employees/volunteers will be able to provide any individual
that wants it with information regarding the benefits and realities of breastfeeding.
2. By December of 2015, the initiative will be able to report a minimum of 30% increase
in program participants.
3. Upon the completion of the program, 75% of program participants will be able to
state a minimum of five benefits to breastfeeding as measured through pre and posttests.
4. Upon the completion of the program, at least 50% of program participants will be
able to identify a minimum of one resource, not already in use, that can be utilized in
order to continue breastfeeding upon returning to work as measured through pre and
post-tests.
Program Goal 2:
To promote and support breastfeeding continuation for mothers returning to work postpartum in Lynchburg, VA as measured through mailed surveys at 6 and 12 months post-partum.
Program Objectives for Goal 2:
1. By June 2016, one year post program implementation, the initiative will be able to report
breastfeeding continuation rates among working mothers will have increased by 15% as
measured through the mailed surveys.
2. By the year 2020, 90% of babies in Lynchburg, VA will have been breastfed at the threemonth milestone as measured through the mailed surveys.

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3. By the year 2020, 75% of program participants will have report breastfeeding
continuation after returning to work as measured through the mailed surveys.
4. By the year 2020, 80% of babies in Lynchburg, VA will have been breastfed at the sixmonth milestone.
Sponsoring agency/Contact person
LatchedforLIFE is made possible through a number of partnerships and these
collaborations include sponsorship from the Women and Children's Services Department of
Centra Health. Women and Childrens Services believe our children deserve the best care we
can give, and LatchedforLIFE could not agree more. The initiative coordinator, Colby Takacs,
will be responsible for all program operations to include, but not limited to, final decisionmaking and crisis communication. The resource coordinator will be responsible for coordinating
all volunteers and other staff members providing services for the program. This individual will
work closely with the marketing design team in order to effectively engage community leaders
and business owners to take stock in the Initiatives drive for change.
For more information on the LatchedforLIFE Health Promotion Program and ways to
become involved, contact Colby M. Takacs at [email protected] or visit the website
at www.latchedforlife.weebly.com.
Primary target audience
The target population for this initiative will be young women of birthing age with the
intended target audience focusing on working mothers primarily. Further details of the target
population are as follows:

Behavioral (lifestyle characteristics)

o Pregnant women/new mothers considering returning to work after birth
Cultural (generational status)
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o The majority of women in recent past generations remained at home

postpartum, a large proportion (almost a majority) of women in most
recent and current generations are returning to work postpartum
Demographic (family situation)
o Marital Status not a factor single or married women
Physical (sex, age)
o Women of birthing age
Psychographic (outlook on life and health)
o Mothers wanting to provide the best nutritional options for their babies.

Secondary target audience

The secondary target audience consists of those surrounding each mother; partners,
family members, friends, coworkers and employers. Several primary barriers to breastfeeding
initiation and continuation are influenced heavily by the secondary population (i.e. social norms,
inadequate family/social support, and feelings of embaressment5,6). In addition, attitudes of
family and friends, whether positive or negative, can pose barriers to breastfeeding.7,8 More
specifically, and in a majority of families, the fathers of the newborn also have a strong part in
the decision-making process and this role can be positive or negative in influencing a womans
decision to breastfeed.7,8
Key Strategies for reaching both primary and secondary audiences
1. Audience
a. Mothers and pregnant women (primary)
b. Family members, friends, co-workers/employers (secondary)
2. Action (Message)
a. Every mother can breastfeed, even if returning to work (primary)
b. Support and encouragement are necessary from all surrounding mom in order
for breastfeeding success (secondary)
3. Barriers (Perceived and Real)
a. Cost - The programs interventions will be free of charge. Breast pumps may
incur a nominal fee based on financial need.
b. Knowledge - The creative design team has developed a brochure to further
educate mothers on the benefits of breastfeeding continuation and to provide
resources and tips on breastfeeding ability.
c. Lack of Support from family, friends, or coworkers
d. Work schedule inflexibility
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e. Lack of adequate/comfortable accommodations to pump and/or store breastmilk

f. Lack of available breastfeeding equipment (pump, bags, bottles, etc.)
g. Real or perceived negative attitudes from employers and colleagues
h. Short-term postpartum leaves
4. Benefits
a. Best form of nutrition for infant
b. Improved health of infant and mother
c. Empowering women
d. Improved family health
5. Credentials
a. Utilization of Certified Lactation Consultants
b. Minimum of three years of experience working with women pre and post
pregnancy
c. Executive level staff hold a Masters degree in Public Health or related field.
d. All communication materials will be developed by public health professionals
e. Media experts will be utilized in the development and implementation of all
web-based efforts.
6. Channels
a. Newspaper, radio, and television
b. Web-based efforts (social media presence, Youtube advertisements, etc.)
Health communication efforts are expected to increase awareness as to the benefits and
realities of breastfeeding; as well as, to the available resources for working mothers.
Unfortunately, public awareness alone as to the benefits of breastfeeding does not seem to
outweigh the stigma that surrounds breastfeeding. The act of breastfeeding in public is deemed
inappropriate and scandalous and the additional need to express milk while at work can increase
this stigma. Additional barriers can be experienced as a result of positive or negative attitudes or
feelings towards breastfeeding from family, friends, coworkers, etc.7,8 Recognized barriers to
breastfeeding continuation for working mothers include work schedule inflexibility; a lack of
adequate/comfortable accommodations to pump and/or store breast-milk; lack of available
breastfeeding equipment (pump, bags, bottles, etc.); real or perceived negative attitudes from
employers and colleagues; and short-term postpartum leaves.3,4,5,6
This initiative is designed to increase a mothers self-efficacy through individual
identification with the associated benefits of breastfeeding continuation. These benefits include,
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but are not limited to, the reduction of anxiety, aiding in weight loss for mom, increases bonding
between mom and baby, reduces the risk of certain cancers for mom and baby, as well as, greater
job satisfaction and reduced absenteeism.3,5 It is anticipated that these benefits will outweigh the
potential fears associated with breastfeeding continuation.
Pretest strategy
The Initiatives communication design team sought out five adults consisting of three
women and two men who were asked to read a potential program brochure and provide their
feedback on its message, presentation, and appeal. Qualitative and quantitative data was gathered
with feedback being retrieved immediately on the individual level. Initially participants were
asked to state the first thing about the brochure that caught their eye; three of the participants
named the photo on the cover of the brochure, while the remaining two stated the color and
background design of the brochure was aesthetically pleasing and appropriate for the subject
matter. Participants were then asked to identify the overall message of the brochures content and
the general response was that working mothers should be able to continue breastfeeding after
returning to work. All of the participants confessed to prior general knowledge of the subject
matter with limited specific knowledge. Four of the participants stated a rise in their interest in
the subject matter. Wording, tone, and compatibility were deemed appropriate for the general
publics reading level by all participants. Two participants presented suggestions for reformatting
the brochures content and sentence structure. The order of the information presented was
questioned by one participant as potentially confusing and suggesting a reorder of information.
Consistent among all participants was that the Initiatives brochure would be an appropriate and
potentially effective channel to disseminate information about the benefits of breastfeeding
continuation for working mothers. The results of this pretest suggest a promising outcome from
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utilization of the presented brochure in the dissemination efforts of the health communication
message.
Theoretical foundation
The creative team for this initiative has chosen the Social Cognitive Theory (SCT) as the
health behavior theory to use as the framework for the program plan. What sets the SCT apart
from many other theories of behavior used in health promotion is the consideration of
maintenance of behavior which is the true goal in public health. SCT is designed to explain a
person regulates their behavior through control and reinforcement to achieve goal-directed
behavior that can be maintained over time.9 The construct of self-efficacy within the SCT will be
vital to the success of the initiative and is an important aspect of the SCT.9 Given that there is no
one best theory or model to follow, the utilization of each in combination often leads to more
efficient programming. Therefore, the design team will utilize the SCT within the PRECEDEPROCEED framework in order to also address the predisposing, enabling, and reinforcing
factors that affect behavior change.9

Management Chart
Task
Pre-planning of program

Timetable
Completed by April 2015

Responsible Persons
Program planners/ Partnerships/
Key stakeholders

Final Program Plan

Procurement of funds

CMTakacs

Recruit staff/ educators

On-going/ Initial funds procured

by June 2015
August 2015

Design program sessions

May-August 2015

Train educators
Develop communication

September 2015
July-August 2015

Pretest communication

August 2015

Distribute communication

Initial Round September 2015/

On-going
2 months

Advertise program using preselected channels

Enroll program (consultation)
participants
Program/ Process Evaluation
(methods of data collection)
Outcome/ Impact evaluation

Initial enrollment October 2015/

On-going
3 months post program
implementation
(December 2015)
1 month, 3 months, 6 months,
and 12 months following
program implementation

Program planners/ Marketing

team
Program planners/ Partnerships/
Marketing team
Program planners/ Marketing
team
Program planners
Program planners/Marketing
team
Program planners/ Partnerships/
Marketing team
Marketing team
Marketing team
Program planners
Program planners

Program planners/ Marketing

team

Budget
The projected budget for the LatchedforLIFE Program:

Paid Personnel/Fees:
o Consultants/Health Professionals/Health Educators
Equipment:
o Breast Pumps (Initial- 30)
Advertising/Marketing
o Website & Search Engine Marketing
o Television, Radio, and Online Advertising
o Print Advertising (Flyers, Posters, Post Cards, Magazine)
o Marketing Products (pens, stickers, magnets)
Website and Social Media Maintenance
(maintained by program personnel)
Supplies and Materials

Total

$10,000
$9,000
$2,500
$1,000
$750
$450
$300
In-House Cost
$500
$22,000

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The estimated costs for this program remain relatively low due to the fact that the
program planners will be derived from existent staff within the Womens and Childrens Services
Department of Centra, as well as, the program location. The main expenses incurred include the
utilization of health professional/health educator consultants which are necessary for developing
and maintaining a true public health initiative with sustainability and effectiveness. The second
largest program cost will be that of the breast pumps under equipment. While being disbursed
based on financial need and timing, an effective breast pump is necessary in order to successfully
continue breastfeeding post-returning to work.
The advertising and promotions budget for the LatcheforLIFE Health Promotion Program
of $2,500 will be derived from partner contributions for marketing purposes ($1,500 Centra
Health; $500 La Leche League local chapter) and the remaining $500 will come from a portion
of the proceeds raised through program fundraising events. Further breakdown of the Marketing
budget includes the necessity of Search Engine Optimization (SEO). SEO is vital in ensuring the
programs website is seen by as many as possible. In this technology driven world the website
has become the initial point of contact for a large number of people and therefore, in order to
reach a large portion of the target audiences (primary and secondary) ease of access to the
programs website is vitally important. Website and Search Engine Marketing enables the
programs website to be easy for both users and search engine robots to locate and understand.
With such importance, SEO will incur the highest portion of the marketing budget.
Issues of concern/potential problems
One potential program concern is the lasting stigma of breastfeeding or lactation practices
being considered inappropriate and this issue will hopefully be addressed early on in the program
process through increasing awareness and knowledge of the benefits of breastfeeding.
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Evaluation strategies (Formative and process Summative (outcome and impact)

The purpose of evaluation is to find out how well a program or activity is working.
Ideally, evaluation will also identify ways to improve what, or how, people are doing what they
do.1 With this in mind, the LatchedforLIFE health communication program targets soon-to-be
and new mothers with initial efforts focusing on residents of the city of Lynchburg, VA and its
surrounding areas. Scientific research supports the fact that women are generally receptive to
learning about the benefits and realities of breastfeeding and therefore, the possibility exists that
a rise in breastfeeding continuation rates will result in an increase in the number of breastfed
babies after mothers return to work, represented by continuation of breastfeeding into the 3, 6,
and 9 month milestones.2,3
The design team will utilize a system similar to the Centers for Disease Control and
Preventions (CDC) Pediatric and Pregnancy Nutrition Surveillance System to track
breastfeeding initiation and continuation rates locally.2 The generated data will be reviewed with
the key stakeholders including all partners (Women and Children's Services of Centra, the Free
Clinic of Lynchburg, and the local chapter of the La Leche League); a select group of women of
child bearing age (with children or soon-to-be); as well as, a select group of various aged men
and women with the intent of obtaining the father, family, and friend perspective. Once the
data has been reviewed an evaluation report will be written delineating the effectiveness of the
campaign. The findings will be disseminated back to the stakeholders and seeking feedback
regarding any improvements that can be made to the communication message. The design team
will then be able to utilize the results of the feedback to revise the structure of the
communication message and/or the chosen channels of delivery.
The Social Cognitive Theory (SCT) has been chosen by the design team as the health
behavior theory to be utilized as the framework for the program plan. What sets the SCT apart
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from many other theories of behavior used in health promotion is the consideration of
maintenance of behavior which is the true goal in public health. The construct of self-efficacy
within the SCT will be vital to the success of the initiative and is an important aspect of the
SCT.4,5 Within the SCT, environment also plays a large role in the success or failure of the
individual behavior change4,5; the same is true with regard to breastfeeding initiation and
continuation.2 Use of the SCT in the evaluation process will allow the program designers to
determine if the health message is reaching the primary and secondary audience; as well as,
determine if the message has been understood and embraced resulting in a behavior change; in
this case, breastfeeding continuation post returning to work.

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References
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2

3
4

5
6

7
8

Healthy People 2020: Maternal, Infant, and Child Health. [Website] Available from
http://healthypeople.gov/2020/LHI/micHealth.aspx?tab=data. Accessed on April 1, 2015.
Ogbuanu C, Glover S, Probst J, Liu J, and Hussey J. The Effect of Maternity Leave
Length and Time of Return to Work on Breastfeeding. Available from website
http://pediatrics.aappublications.org/content/early/2011/05/25/peds.20100459.full.pdf+html. Accessed on April 1, 2015.
Center for Disease Control and Prevention (CDC): Breastfeeding Report Cards: 2014.
Available from website http://www.cdc.gov/breastfeeding/data/reportcard.htm. Accessed
on April 1, 2015.
Murtagh L and Moulton A. Working Mothers, Breastfeeding, and the Law. Am J Public
Health. February 2011. 101(2): 217223. doi: 10.2105/AJPH.2009.185280. Available
from website http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3020209/. Accessed on
April 1, 2015.
Center for Disease Control and Prevention (CDC): Support for Breastfeeding in the
Workplace. Available from website
http://www.cdc.gov/breastfeeding/pdf/BF_guide_2.pdf. Accessed on April 1, 2015.
Tsai S. Impact of a Breastfeeding-Friendly Workplace on an Employed Mothers
Intention to Continue Breastfeeding After Returning to Work. Breastfeed Med. Apr 2013;
8(2): 210216. doi: 10.1089/bfm.2012.0119. Available from website
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616406/. Accessed on April 1, 2015.
Office of the Surgeon General (US). Barriers to Breastfeeding in the United States. 2011.
Available from website http://www.ncbi.nlm.nih.gov/books/NBK52688/. Accessed on
April 3, 2015.
Tarrant RC, Younger KM, Sheridan-Pereira M, White MJ and Kearney JM. The
prevalence and determinants of breast-feeding initiation and duration in a sample of
women in Ireland. Public Health Nutrition: 13(6), 760770. September 2009.
doi:10.1017/S1368980009991522. Available from website
http://journals.cambridge.org/download.php?file=%2FPHN
%2FPHN13_06%2FS1368980009991522a.pdf&code=8596880bf8948152589a28152cc6
112a. Accessed on April 3, 2015.
U.S. Department of Health & Human Services Public Health Service. National Institutes
of Health National Cancer Institute. Making Health Communication Programs Work.
Available from website http://www.cancer.gov/publications/health-communication/pinkbook.pdf. Accessed April 9, 2015.

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