Prenatal Lactation-Focused Motivational Interviewing

1. Recruitment efforts will be made in the community via advertisements, online advertisements (e.g., Craigslist, Facebook), and in-person at various clinics and health fairs in the geographic area.
2. Prospective participants will contact the investigators via email or by calling the study phone number listed on the advertisements or verbally expressing interest in-person.
3. Once a participant indicates interest by contacting study personnel, a 5-minute screening interview will be conducted with the prospective participant using the screening questionnaire to ensure eligibility criteria are met. For those who do not qualify or agree to participate, the age and reason for non-qualification or declination to participate will be recorded; any other data will be destroyed by shredding or electronic shredding. For those who do qualify, name and contact information will be kept confidential and maintained in a locked room.
4. Participants will be asked to rate on a scale of -10 to +10 about the certainty that the participants will provide exclusive breastmilk to the babies for first six months. Responses from this item will be used as the covariate in the covariate adaptive randomization technique.
5. Eligible subjects will be invited to participate in the study, either in an exam room at West Virginia University's Family Medicine's clinic, participant's home, private room in the Quin Curtis Center for Psychological Services, or in another agreed-upon community location (e.g., church). The location of the study procedures is chosen by the participant.
6. At the start of this session, participants will be given an overview of the study, and the researcher will go over the consent form with the participant.
7. Following consent procedures, video-recording will begin, and all participants will complete the prenatal interview. After this interview, participants will complete five self-report measures, which include the Infant Feeding Knowledge Form, the Iowa Infant Feeding Attitudes Scale, Brief Breastfeeding Attitudes Questions, Perinatal Anxiety Screening Scale, and the Knowledge of Infant Development Inventory.
8. Intervention

1. Participants assigned to the MI condition will receive an approximately 45 minute intervention provided a masters-level supervised psychologist with training in Motivational Interviewing.
2. Participants who have been randomly assigned to participate in the attention-control group session will receive approximately 45 minutes of psychoeducation on typical developmental stages and infant feeding methods.

• Motivational Interviewing (Behavioral): Motivational Interviewing (MI) is a psychosocial intervention designed to help individuals increase readiness for behavior change by increasing intrinsic motivation and resolving ambivalence. MI founders MI conversations help clients change behavior through identifying and resolving discrepancies between goal behaviors and actual behaviors. Behavior change is promoted through the elicitation of "change talk," or client-verbalized arguments for change. In MI, change talk is elicited through two major components: the therapeutic relationship, or the embodiment of the "spirit" of MI, and technical skill.
• Psychoeducation Control (Behavioral): Psychoeducation on infant development, age 0-15 months, brief education on breastfeeding.

Primary outcomes

• Breastfeeding status at 1 month postpartum, participant self-report via telephone interview [1 month]

Secondary outcomes

• Confidence (scale of 0-10) [1 day]: Participant self-report of confidence in breastfeeding, scale of 0-10
• Importance (scale of 0-10) [1 day]: Participant self-report of importance of breastfeeding, scale of 0-10
• Knowledge of breastfeeding-Breastfeeding Knowledge Questionnaire (survey) [1 day]
• Attitudes towards breastfeeding- Iowa Infant Feeding Attitudes Scale (survey) [1 day]
• Knowledge of infant development- Knowledge of Infant Development Inventory (survey) [1 day]
• Intention to breastfeed Self-reported intention to breastfeed at prenatal time point [1 day]
• Initiation Whether participant initiated breastfeeding, participant self-report via telephone interview [1 month]

Sex: Female, ages: 18 Years to 99 Years, accepts healthy volunteers

Inclusion Criteria:

1. Age 18 years or older
2. Female
3. Pregnant
4. At least 27 weeks pregnant
5. Able to read, write, speak, and understand English
6. Has access to a phone (either mobile or landline)
7. Lives within driving distance of Morgantown, WV, or is willing to travel to a location that is within driving distance to Morgantown, WV

Exclusion Criteria:

1. Multiple pregnancy
2. Within one week of due date
3. Has any of the following conditions:

   * Developmental or intellectual disability
   * Schizophrenia
   * Untreated, active tuberculosis
   * Human immunodeficiency virus (HIV)/Acquired immunodeficiency syndrome (AIDS)
   * Human T-cell lymphotropic virus type I or type II
   * History of lumpectomy or radiation to breast
4. Uses or is dependent upon any of the following substances (Moretti, Lee, \& Ito, 2000):

   * Heroin
   * Cocaine
   * Methamphetamines
   * Marijuana
   * Phencyclidine (PCP)
   * Non-prescription opioids (e.g., morphine, oxycodone, hydrocodone)
5. Undergoing any of the following medications/treatments (American Academy of Pediatrics, 2001):

   * Antiretrovirals
   * Cancer chemotherapy (e.g., antimetabolites)
   * Radiation therapy
   * Acebutolol
   * Atenolol
   * Bromocriptine
   * Aspirin (salicylates)
   * Ergotamine
   * Lithium
   * Phenobarbital
   * Primidone
   * Sulfasalazine (salicylazosulfapyridine)

• Daniel W McNeil, PHD, Principal investigator, West Virginia University