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Columbia University

Evaluating the outcomes of lactation rooms 

The Breastfeeding Support Program is an initiative managed by the Office of Work|Life at Columbia University. The purpose of this program is to help women focus on their academic and professional goals while managing their parental responsibilities. This program supports women by providing private lactation rooms equipped with hospital-grade breast pumps, which allow women to express, store, and collect breast milk in privacy while on campus. The Breastfeeding Support Program was created in 2008 to satisfy the New York State Labor Law § 206-C which requires employers to provide private lactation rooms and to allow women to use unpaid break time or paid meal time to nurse their babies.

Using the CDC Program Evaluation Framework, my team and I created strategic recommendations that solve for key process and outcomes evaluation pain points for the program, to ensure accuracy and veracity for evaluation measures. We successfully delivered and presented to program stakeholders.

In our planning phase, my team and I actively followed a human-centered design process embedded with the CDC's framework for evaluation, which included: engage stakeholders, describe the program, focus evaluation design, gather credible evidence, justify conclusions, understand and share lessons learned. Although we did not have access to working moms, we started with empathizing with the program leaders who have conducted numerous surveys and key informant interviews with the program beneficiaries. From our discovery process, we discovered the key pain points in evaluation is that the program did not have in place any success metrics measured throughout the customer and program's journey. This in return made evaluation benchmarked against university grants difficult to prove the veracity of impact. 

 

Our target population was any woman who works or studies at Columbia University. In 2017, 363 women actively used private lactation rooms. The most frequent users of the lactation rooms are officers of administration, Non-Union, and Union staff and they represent approximately 32 percent of the active user population. Doctoral, Masters, and Professional students are the second-largest active user group and they represent 26% of the active user population.

To respond to these challenges, my team and I collaborated to create a logic model, which essentially is a visual snapshot of a program or service that communicates the intended relationship between program goals, activities, outputs, and intended outcomes. Logic models are an iterative tool useful for planning and evaluation purposes and represent the backstage of a service blueprint. 

I found that a process evaluation would be appropriate and valuable for the Breastfeeding Support Program because Office of Work|Life staff at Columbia University and lactating women are directly invested in the success of the program. A process evaluation would provide insight into the efficacy of the individual program components and lactating women’s engagement with the program. We learned that there are three key components of the Breastfeeding Support Program in our interviews and research:

  1. The private lactation rooms that are equipped with hospital-grade breast pumps

  2. Breast pump accessories that can be purchased at a discounted rate

  3. Educational breastfeeding-related materials and workshops

My team and I created three main recommendations that emerged during the evaluation plan development, which includes:

  1. Evaluation timeline, that includes the first three months to implement the usage log, if desired, conduct the document analysis, and review the interview guide and train all interviewers on this format.

  2. The next four to six months will focus on piloting the evaluation plan and recruiting participants.

  3. The subsequent 6 months are dedicated to analyzing interview and survey results, and implementing changes as necessitated.

 

We also recommended the active use of digital tools. For example, we recommended that program staff invest in qualitative data analysis software, train an interviewer, fund recruitment materials, secure venue space to perform interviews and continue financing a subscription to SurveyMonkey.

 

Another recommendation is for program staff to select the option of implementing a usage log to assist with monitoring traffic flow, then they will also have the expense of paying for a subscription package of scheduling software. We learned that some of the proposals presented in the evaluation plan may not be compatible with the program’s current infrastructure and resources. Therefore, we recommend that the program staff use this plan as a general framework and iteratively modify it to enhance its feasibility according to their resources and needs. 

I enjoyed working on this evaluation project. What was rewarding is being to capture data at key touchpoints that women access the lactation pods in order to provide meaningful services for them. This, in essence, is evidence-based program design. What my team and I found is that beyond the program's outcome in health impact is that the program increased breastfeeding among the sample of women who traditionally didn't, reduced the prevalence of gastrointestinal disorders among infants, and increased well-baby visits. We also found improvements in other health outcomes associated with breastfeeding such as women's reported levels of decreased shame and stigma of breastfeeding in the workplace.

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I believe that empathy and a life-centered approach drive meaningful healthcare services and powerful digital health experiences.