[[alternative]]Development, Implementation, and Evaluation of the International Board Certified Lactation Consultant Service Models in Taiwan

Abstract

[[abstract]]國際認證泌乳顧問(International Board Certified Lactation Consultant, IBCLC)是泌乳照護的專家，對母乳哺育有正向影響。本研究為一縱貫性研究，依前驅研究結果於彰化及花蓮2家醫學中心、桃園及新北市2家區域醫院及高雄1家IBCLC個人諮詢工作室進行IBCLC服務介入進行四次重複性母乳哺育自我效能評量問卷調查與訪談，了解IBCLC服務現況與對母乳哺育成效的影響。總計回收有效樣本200份，實驗組53人，對照組147人。IBCLC資源與成效為：1.護理人員是提供哺育服務的主力：64.3% (54位)在職護理師-IBCLC秉持「服務熱誠」，提供「免費/義務」諮詢服務。2.IBCLC能提升母乳哺育表現：IBCLC服務介入隨時間增加母乳哺育自我效能量表(Breastfeeding Self-Efficacy Scale, BSES)分數也增加，且呈現時間與介入措施的交互作用，亦即隨著時間的增加，介入措施對BSES的效果愈明顯；且實驗組母乳哺育率都較對照組為高。3.滿意度高但使用率與普及性不足；服務滿意度在69-滿分90分間，平均值86.89分(SD=4.48)；個案主動求助者僅26.5%。IBCLC發展困境包括；1.資源不均且行銷不彰：仍有六縣境內均無任何IBCLC；且IBCLC缺乏自我行銷能力，形成專業服務滯銷；2.專業定位不明且認證初衷轉移：「非藥物性照護與持續支持」有違國人就醫經驗，且提供背部舒壓、家訪、電話/網路諮詢服務的收費方式及標準制定不易；透過與產後機構商業結盟，IBCLC專業出現「營利」偏移傾向。求助IBCLC服務個案的哺乳經驗呈現一個「內憂外患下的契機」的命題下，奶量議題是主要求助原因，呈現五個內在概念為：接收資訊混亂、支持系統薄弱、對自我能力與哺乳的不確定、尋求他人/專家認同及主動求助與改變的可塑性。如何將IBCLC服務建置於現行醫療體制的建議包括；1.建置全國「IBCLC」網絡：提供機構與消費者完整人力資源與收費標準、轉介系統及異業結盟資訊，及IBCLC間支持與資訊交換網絡，建構「服務可親、資源可及、資訊可近」之企業化經營模式，最終形塑「使用者付費」文化，創造「價值性、使命感與續航力」的專家形象。2.設置專職「IBCLC」編制：為提供完善且持續母乳哺育服務，鼓勵醫療機構聘用IBCLCs為專職母乳哺育照護與教育人員，或與個人執業IBCLC簽訂合作契約，創造消費者與經營者多贏局面。[[abstract]]International Board Certified Lactation Consultant (IBCLC) is a certified Lactation expert. This is a longitudinal study, based on source-position-performance framework. Five different IBCLC sercive models were provided to explore the influence of IBCLC services related to breastfeeding outcomes. Data was collected by four times questionnaires and face-to-face interviews. In sample size of 200, 53 of them was intervention group and 147 of them are control group. The study results included:The resources and outcomes were:1.Nurses were the main resourcers in utilizing for Breastfeeding management with free services: 54 out of 84 IBCLCs, Nurse-IBCLC took referrals from physician and provided free lactation services were the most popular way in Taiwan.2.IBCLCs services enhance breastfeeding performences: the experimental group had higher Brestfeeidng Self Effacy Scale score in each measure time point, and increased by time. Also the breastfeeding rate in experimental group was higher than control group significantly. Women, seeking help from IBCLCs expressed a service satisfaction of 86.1 points (out of 90). 3.The proposition derived from breastfeeding mother experience is” The hope came from a inside-out compression self：Confusion, Vulnerability, Uncertainity, Confirmation, Determining.4.Good user satisfacation, low penetration. Only 26.5% of sample seeked IBCLC help with a mean of 86.89 in 90.The recommendations will be; independent practicing is the last possibility to proceed, both commercial health insurance and employee benefits are quite possible to promote, and medical institutions to hire a full-time IBCLC is the most feasible IBCLC service model for Taiwan. If, a nationwide data network of IBCLCs has built. It includes human resources and paynment detail. In order to create counseling services model with characteristics of value, mission and endurance