{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T18:42:14Z","timestamp":1786214534160,"version":"build-2736575974"},"reference-count":35,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Hum Lact"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Despite strong policy support, many Indian mothers discontinue breastfeeding early. Maternal confidence, rather than knowledge alone, predicts breastfeeding success, yet institution-based approaches to building confidence remain limited. We employed rapid mixed-methods research to identify barriers and co-design feasible support interventions within a teaching hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research Aims:<\/jats:title>\n                    <jats:p>To identify barriers influencing breastfeeding confidence, quantify barrier prevalence and associations with maternal confidence, and co-design and pilot-test an institutionally feasible intervention through participatory stakeholder engagement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      This was a sequential mixed-methods study (November 2024\u2013April 2025) at a teaching hospital in north-western India. Phase 1: Qualitative assessment (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 47) through interviews and focus groups. Phase 2: Cross-sectional survey (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 232) measuring breastfeeding self-efficacy (BSES-SF), barriers, social support, and depressive symptoms. Phase 3: Participatory co-design and micro-pilot (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 26) of intervention integrated into hospital workflows.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Qualitative analysis identified four barrier domains: early experiences (70%), social\/family influences (62%), healthcare interactions (55%), and emotional well-being (48%). Survey findings: 63% reported milk supply concerns, 58% pain, 49% conflicting family advice. Mean BSES-SF = 46.2 (\n                      <jats:italic toggle=\"yes\">SD<\/jats:italic>\n                      9.8); 32% scored low confidence. Early difficulties (\u03b2 = \u22125.8,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001), low social support (\u03b2 = \u22124.1,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001), depression (\u03b2 = \u22123.6,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001), and primiparity (\u03b2 = \u22122.3,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.005) were independently associated with lower confidence (R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.41). Stakeholders prioritized three components: peer support (94% endorsement), provider communication tools (89%), and family counseling (83%). The micro-pilot demonstrated high acceptability (88%) and feasibility (median delivery time 7\u2009min) with no additional staffing.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Teaching hospitals can rapidly identify breastfeeding confidence barriers and co-design contextually appropriate, low-cost interventions. This model offers a scalable pathway for strengthening breastfeeding support in resource-constrained settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08903344261461891","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T03:03:12Z","timestamp":1786071792000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Rapid Mixed-Methods Assessment and Institutional Co-Design of Breastfeeding Support to Enhance Maternal Confidence in a Teaching Hospital in North India"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-6330-5490","authenticated-orcid":false,"given":"Dilpreet","family":"Kaur","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Dr. S.S. Tantia Medical College, Hospital and Research Centre, Sriganganagar, RJ, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7317-441X","authenticated-orcid":false,"given":"Rakesh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of General Medicine, Dr. S.S. Tantia Medical College, Hospital and Research Centre, Sriganganagar, RJ, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6494-8978","authenticated-orcid":false,"given":"Inderdeep Singh","family":"Kochar","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Dr. S.S. Tantia Medical College, Hospital and Research Centre, Sriganganagar, RJ, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"crossref","unstructured":"Bandura A. (1977). 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