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Susan Wilhelm Biography & Abstract
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Susan wilhelm, phd, rn
Assistant Professor and Assistant Dean in the University of Nebraska Medical Center College of Nursing, West Nebraska Division







Dr. Wilhelm is an Assistant Professor and Assistant Dean in the University of Nebraska Medical Center College of Nursing, West Nebraska Division, where she has been a faculty member since 1990 teaching Maternal/Newborn courses. She received her bachelor’s degree in nursing from the University of Northern Colorado and her master’s and doctoral degrees from the University of Wyoming. Dr. Wilhelm’s clinical background includes all areas of obstetrics. She has held nursing leadership positions in several states in the mid-western region. She has taught Lamaze, NRP, AWHONN EFM and many regional workshop on Maternal/Newborn topics. In addition, she has been the Wyoming Section Chair for AWHONN since for 15 years.  She also serves on the Research Advisory Panel.  Her research background is using motivational interviewing to promote sustained breastfeeding in rural, Native American, and Hispanic women.  Mothers in the other studies have reported being overwhelmed at the onset of breastfeeding.  This grant will add the component of prenatal education and support including a motivational interviewing group to help overcome the challenges of initial breastfeeding.  



Background/Significance. Although breastfeeding is the most important first health promotion
strategy available for infants and provides many benefits for both mother and child, by 6
months about half of infants receive any breast milk with only 21.9% breastfed exclusively.
Rates of exclusive breastfeeding are even lower for Hispanic mothers because supplementation
is common, even within the first week after birth. Our previous pilot studies, testing a
motivational interviewing (MI) intervention to promote sustained breastfeeding, showed a
trend towards increased breastfeeding duration; however, mothers continued to report feeling
overwhelmed by the demands of breastfeeding in those first few weeks. In this study, we are
initiating the MI intervention sooner, during the prenatal period, and also ensuring that all
women are provided with usual prenatal care, to increase the duration of breastfeeding in rural
Hispanic women.

Purpose. The purpose of this pilot feasibility study is threefold: 1) to examine a clinic-based
motivational interviewing (MI) APRN-delivered intervention versus usual care in increasing the
duration of exclusive or any breastfeeding, breastfeeding self-efficacy, and intention to
breastfeed for six months in rural, Hispanic women; 2) to assess the feasibility of implementing
the MI intervention (in the clinic setting prenatally, via phone postpartum); and 3) to generate
data needed to estimate effect sizes to calculate the sample size needed for a larger study.

Methods. This study is a randomized controlled trial using a two-group repeated measures
design. A sample size of 60 Hispanic women, 30 per group, will be recruited from a large rural
women’s health clinic. Women in both groups will receive usual care (UC) which consists of
prenatal classes, access to a lactation consultant, and enrollment in Text4baby. Women in the
MI+UC group will receive 5 MI sessions starting at their 36-week prenatal visit and via phone at
days 3 and 7 days and weeks 2 and 6 postpartum. Data collection will take place in-person at 24
and 36 weeks prenatally, and by telephone, postnatally, at days 3 and 7, weeks 2 and 6, and
months 3 and 6. Variables that will be measured include duration of any and exclusive
breastfeeding (in days), self-efficacy to breastfeed, and intention to breastfeed for 6 months.
After completing the study, women participants and clinic staff will complete forms evaluating
their experiences with the intervention. Data will be analyzed using chi-square tests of equality
of proportions to test the proportion of women who are breastfeeding in each group at each
time point (six months is the primary endpoint).

Implications. The MI intervention is innovative because it is the first to test MI strategies to
increase breastfeeding duration in a Hispanic population. These new strategies have the
potential to increase the mother’s duration of exclusive breastfeeding which, in turn, provides
optimal nutrition for the healthy growth and mental and physical development of children and
protection against a variety of diseases. Breastfed infants also experience less diabetes and
obesity, conditions that tend to be more prevalent in rural and Hispanic populations.

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