Date of Award

Fall 12-2015

Degree Type


Degree Name

Doctor of Philosophy (PhD)


Nutrition and Food Systems

Committee Chair

Jennifer Lemacks

Committee Chair Department

Nutrition and Food Systems

Committee Member 2

Kathy Yadrick

Committee Member 2 Department

Nutrition and Food Systems

Committee Member 3

Carol Connell

Committee Member 3 Department

Nutrition and Food Systems

Committee Member 4

Ray Newman

Committee Member 4 Department

Community Health Sciences

Committee Member 5

Hwanseok Choi

Committee Member 5 Department

Community Health Sciences


Mississippi continues to have one of the lowest rates and the weakest support in respect to breastfeeding in the nation (Centers for Disease Control and Prevention, 2014a). Hospital practices supporting breastfeeding such as the Ten Steps to Successful Breastfeeding (TSSB) can dramatically increase breastfeeding rates and duration (Rosenberg, Stull, Adler, Kasehagen, & Crivelli-Kovach, 2008). The aim of this study was to explore breastfeeding practices in Mississippi hospitals based on two levels of the Socio-Ecological Model: the organizational level (phase I) examined the hospital practices based on the level of implementation of the TSSB; the individual level (phase II) examined knowledge and practices related to breastfeeding, and interest to adopt the TSSB among maternity nurses in the hospitals. Correlations among the variables were also measured. Moreover, the researcher was interested in identifying the barriers and facilitators to implementing the TSSB in maternity practices.

In phase I, the researcher surveyed nurse managers of the maternity units of all 43 hospitals in Mississippi that provide maternity care; a response rate of 72% (n = 31) was obtained. In phase II, 302 nurses working in the hospitals’ maternity setting participated. Descriptive statistics were used to analyze the data and Chi-square and Spearman correlations tests were used to determine correlations among the variables.

Phase I finding indicated that TSSB level of implementation was partial in 22 hospitals and moderate in 9 hospitals. Phase II finding found that breastfeeding knowledge and practices of the nurses were good. Most of the nurses believed that they were effective in meeting the needs of the patients, and showed a positive interest towards adopting TSSB. Positive significant associations were noted among breastfeeding knowledge and practice, interest to adopt the TSSB, age, years of experience, and other variables.

Raising awareness about the importance of the TSSB and providing a lactation consultant in the unit were the main facilitators. The common barriers for TSSB implementation were routine practices, limited financial resources, and lack of support from the government. The findings suggested a need to improve the overall breastfeeding support in Mississippi. Future research should explore various ways to implement the TSSB in hospitals’ practices.