The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Original Article

Linking Breastfeeding Support Training and Certification to Knowledge, Self-Efficacy, and Attitudes among Alabama Healthcare Professionals

Authors: Xifan Yang, MPH, Jen Nickelson, PhD, RD, MCHES, Amy Lee, DNP, ARNP, WHNP-BC, Lisa Pawloski, PhD

Abstract

Objectives: This study aimed to determine whether healthcare professionals’ breastfeeding-related training and certification are associated with breastfeeding support knowledge, self-efficacy, and attitudes.

Methods: An online survey was created by modifying existing instruments. Items assessed Alabama healthcare professionals’ certification in breastfeeding support, breastfeeding support–related training experience, knowledge, self-efficacy, and attitudes. Participants were healthcare providers and administrators serving infants and expectant or new mothers in Alabama, recruited by e-mailing through Alabama professional organization listservs and personal contacts. Multiple linear regression models were used to examine the relationship between breastfeeding support–related variables.

Results: A total of 82 surveys were analyzed. Multiple linear regression showed that higher perceived training preparation was associated with higher self-efficacy (β = 0.53, P < 0.001) and attitudes (β = 0.27, P = 0.040), but not higher knowledge (β = 0.22, P = 0.072), after controlling for sex and experience in breastfeeding their own infant. Certification status was associated with higher knowledge (β = 0.34, P = 0.005) and higher self-efficacy (β = 0.32, P = 0.003).

Conclusions: Enhancing breastfeeding training for healthcare professionals in Alabama may help address the state’s low breastfeeding rates and improve health equity for mothers and infants. Certification in breastfeeding support provides an additional level of training and should be encouraged. These findings underscore the need for targeted training interventions among healthcare professionals in Alabama.
Posted in: Obstetrics and Gynecology95

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References

1. Centers for Disease Control and Prevention. Breastfeeding Benefits Both Baby and Mom 2025. Accessed February 27, 2026. https://www.cdc.gov/breastfeeding/features/breastfeeding-benefits.html.
2. Centers for Disease Control and Prevention. n.d. National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition, Physical Activity, and Obesity. Data, Trend and Maps [online]. Accessed March 10, 2026. https://dnpao-dtm.cdc.gov/.
3. Balogun OO, O’ EJ, McFadden A, et al. Interventions for promoting the initiation of breastfeeding. Cochrane Database Syst Rev 2016;11:CD001688.
4. Rollins NC, Bhandari N, Hajeebhoy N, et al. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016;387:491-504.
5. Ajzen I. The Theory of Planned Behavior. Organ Behav Hum Decis Process 1991;50:179-211.
6. World Health Organization, United Nations Children’ Fund. Global Strategy for Infant and Young Child Feeding. 2003. Accessed February 27, 2026. https://www.who.int/publications/i/item/9241562218.
7. Blixt I, Rosenblad AK, Axelsson O, et al. Breastfeeding training improved healthcare professional’ self-efficacy to provide evidence-based breastfeeding support: a pre-post intervention study. Midwifery 2023;125:103794.
8. Cassar L, Bauley C, Friesen M, et al. The Influence of Education and Specialty Certification on Nurses’ Intent to Support Breastfeeding Post-Birth. J Perinat Educ 2020;29:219-227.
9. IBCLC Commission. Start Your IBCLC Journey. Accessed February 27, 2026. https://ibclc-commission.org/how-to-become-an-ibclc.
10. Academy of Lactation Policy and Practice. The CLC-Certified Lactation Counselor. 2022. https://www.alpp.org/certifications/certifications-clc.
11. Anchondo I, Berkeley L, Mulla ZD, et al. Pediatricians’, Obstetricians’, Gynecologists’, and Family Medicine Physicians’ Experiences with and Attitudes about Breast-Feeding. South Med J 2012;105:243-248.
12. Centers for Disease Control and Prevention. Questionnaires for the Maternity Practices in Infant Nutrition and Care (mPINC TM ) Survey. 2025. Accessed February 27, 2026. https://www.cdc.gov/breastfeeding-data/mpinc/index.html.
13. Baby-Friendly USA. The Ten Steps to Successful Breastfeeding. Accessed February 27, 2026. https://www.babyfriendlyusa.org/for-facilities/practice-guidelines/10-steps-and-international-code/.
14. Pound CM, Williams K, Grenon R, et al. Breastfeeding Knowledge, Confidence, Beliefs, and Attitudes of Canadian Physicians. J Hum Lact 2014;30:298-309.
15. Francis J, Johnston M, Eccles M, et al. Constructing questionnaires based on the theory of planned behaviour: A Manual for Health Services Researchers. 2004. Accessed February 27, 2026. https://openaccess.city.ac.uk/id/eprint/1735/.
16. Osborne JW, Waters E. Four assumptions of multiple regression that researchers should always test. Pract Assess Res Eval 2002;8:1-5.
17. Lumley T, Diehr P, Emerson S, et al. The Importance of the Normality Assumption in Large Public Health Data Sets. Annu Rev Public Health 2002;23:151-169.
18. Watkins AL, Dodgson JE. Breastfeeding Educational Interventions for Health Professionals: A Synthesis of Intervention Studies. J Specialists Pediatr Nurs 2010;15:223-232.
19. Walsh A, McCluskey R, Cassidy D, et al. The Support Needs and Current Practices of Public Health Nurses in the Republic of Ireland Who Provide Support to Breastfeeding Mothers: A Cross-Sectional Survey. J Hum Lact 2023;39:733-742.