Virtual delivery of evidence-based, person-centered breastfeeding peer counseling: a qualitative evaluation of...

Virtual breastfeeding peer counseling services have the potential to increase access to breastfeeding support and reduce breastfeeding inequities. However, little is known about how well these services can be implemented virtually. We conducted an implementation research study to evaluate virtual delivery of the Breastfeeding Heritage and Pride™ (BHP) program, which offers evidence-based, person-centered breastfeeding peer counseling for women with low incomes in the United States. This paper aims to explore women's experiences and perspectives on virtual counseling provided by trained BHP community health workers.

We conducted in-depth interviews in English and Spanish with 28 women participating in BHP. We used rapid qualitative analysis to identify themes, and then organized themes according to two implementation outcomes specified in the Implementation Outcomes Framework by Proctor and colleagues: acceptability, defined as the perception that virtual counseling is agreeable, palatable, or satisfactory; and appropriateness, defined as the perceived fit, relevance, or compatibility of virtual counseling for participants.

Themes related to acceptability included: (1) life fit, highlighting how the convenience of virtual counseling promoted engagement amidst competing demands; and (2) comfort with being seen on video. Themes capturing the appropriateness of virtual counseling were: (3) building relationships with peer counselors, which some women felt was best supported in person; (4) evolving needs across the breastfeeding journey, reflecting how perceptions of the suitability of virtual counseling varied by the stage of their breastfeeding journey and types of breastfeeding challenges encountered; and (5) fit between mode of communication and individual needs and preferences, capturing how different communication modes were more or less useful depending on women's needs, such as informational, emotional, or lactation management support. A cross-cutting theme was (6) access to technology, which influenced women's ability to engage with virtual counseling.

Women described benefits and limitations of virtual counseling. These findings indicate a need to work with women to co-design hybrid models that integrate telehealth with in-person counseling and can be tailored to meet diverse individual needs and preferences as breastfeeding support needs change dynamically over time. Such hybrid models should be evaluated for effectiveness, cost-effectiveness, and equity to guide future implementation.

Not applicable.