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Exploring Acceptance and Understanding of Inclusive Language in the Breastfeeding Attrition Prediction Tool

Abstract Objectives Inclusive language has come to the forefront of the conversation in human lactation research as a way to increase the use of essential health services by marginalized groups. While there has been a call to action to adopt inclusive language in human lactation research, few studies have assessed understanding and acceptability of inclusive language. This pilot study, conducted in partnership with the Vermont Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) agency, sought to fill this gap. Methods The Breastfeeding Attrition Prediction Tool (BAPT) is a reliable, valid instrument to assess breastfeeding sentiment, social and professional support, and perceived behavioral control. In 2021, the study team revised original survey language primarily to limit the use of gender-exclusive terms; 7 out of the 27 questions were revised (e.g., ‘mothers’ became ‘parents’ and ‘breastmilk’ became ‘human milk’). The team intended to update language without interfering with the interpretation of survey items in a way that could affect BAPT scores. A convenience sample of WIC participants (n = 16) completed the 2021 Revised BAPT survey, then cross-cultural cognitive interviews assessed participants’ understanding of the revised language and explored reactions to other inclusive language terminology. Interviews were recorded and transcribed, and transcriptions were analyzed in NVivo using grounded theory principles. Results Cognitive interviews revealed that participants understood and accepted inclusive language in the 2021 Revised BAPT survey when it better reflected their own situation or when they believed it would better reflect the diversity of others’ situations. While the term ‘breastfeeding’ was preferred by most in comparison to gender-inclusive options, adding ‘chestfeeding’ alongside ‘breastfeeding’ in survey questions was generally well-understood by participants and may better support people who identify as LGBTQ + . Conclusions Cognitive interviews with Vermont WIC participants suggest that the updated inclusive BAPT language is generally understandable and accepted. Inclusive language may be especially important in increasing feelings of inclusivity and health-seeking behavior in the LGBTQ + population, and more research on this is recommended. Funding Sources USDA Food and Nutrition Service (FNS).