Co-creating and Mapping an Exclusive Breastfeeding Framework among Latino Populations in the United States: An...

Increasing exclusive breastfeeding among Latino populations has the potential to reduce health disparities. There is a need for a multilevel and multidomain framework of exclusive breastfeeding determinants. This study aimed to co-create an exclusive breastfeeding determinants framework among Latino populations and map this framework using the current literature. Our community coalition convened in working groups to adapt a multilevel and multidomain determinants framework with 20 cells (4 levels × 5 domains) for exclusive breastfeeding among Latino populations. We documented all referenced determinants in working groups, and 2 independent raters deductively and inductively analyzed these specific determinants into themes by cell (level domain). An integrated scoping review mapped the determinants addressed in the literature of exclusive breastfeeding interventions among Latinos in the United States onto the framework cells. Two independent raters transcribed intervention descriptions verbatim and deductively analyzed the text using our list of determinants as the codebook. Inductive analysis allowed for emerging determinants. We mapped determinants that were addressed by theme. A total of 111 specific determinants were referenced in working groups that were categorized into 53 determinant themes. Most studies addressed Individual-level determinants at each domain (n = 11-16 studies) except for Built Environment (n = 3). At the Interpersonal level, Behavior (n = 11) and Health Care System (n = 16) domains were predominantly addressed. At the Community level, Built Environment (n = 14) and Health Care System (n = 15) domains were addressed. Most studies at the Societal level addressed the Health Care System domain but none addressed Biological, Behavior, or Built Environment domains. Extension of care, culturally relevant care, knowledge and skills, mother-infant bonding, and practitioner-dyad relationship were referenced the most of all 56 themes (n ≥ 13 each). Increasing exclusive breastfeeding among Latinos is a multifaceted challenge. Innovative areas for future work include Biological and Sociocultural domains beyond the Individual level as well as most domains at the Societal level.