Capturing changes in HIV-infected breastfeeding mothers' cognitive processes from before delivery to 5 months postpartum: An application of the pile-sorting technique in Haiti

Elizabeth L. Fox*, Gretel H. Pelto, Haim Bar, Kathleen M. Rasmussen, Sera L. Young, Marie Guerda Debrosse, Vanessa A. Rouzier, Jean William Pape, David L. Pelletier

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: The cognitive processes involved in individuals' perceptions and prioritization of information, and how these change with experience or exposure to interventions, are rarely examined in the evaluation of nutrition interventions. Exclusive breastfeeding counseling is a common infant and young-child feeding intervention and is used to promote HIV-free survival in the prevention of mother-to-child transmission programs. However, it is often designed without adequate attention to the changes in mothers' perceptions over the course of their early breastfeeding experiences. Objective: The aim of this study was to identify HIV-infected breastfeeding mothers' cognitive structure (their organization of messages and ideas) of infant feeding messages and to characterize whether their cognitive organization of infant feeding messages changed from pregnancy through the first 5 mo postpartum. Methods: With the use of semistructured interviews and the cognitive mapping technique of pile sorting, we interviewed 30 HIV-infected breastfeeding mothers in Port-au-Prince, Haiti. We asked them to sort and rate 18 infant feeding messages 3 times (during pregnancy, 0- to 1-mo postpartum, and 3- to 5-mo postpartum). We analyzed their responses by using multidimensional scaling, property fitting, and partition analyses. Results: At all 3 visits, we found consistency in women's cognitive mapping of messages. For example, mothers consistently differentiated messages pertinent for exclusive breastfeeding compared with those that pertained to other practices. However, subtle variations in mothers' cognition over time were also evident, particularly at 0- to 1-mo postpartum, when message proximity was tightly clustered compared with the earlier and later periods. Conclusions: We conclude that mothers share a common cognitive organization of infant feeding messages and that this organization changes over time. Attention to variations in cognition can support context-sensitive, patient-centered counseling by practitioners and improve the effectiveness of nutrition interventions. Pile sorting is an efficient, systematic technique to examine cognitive processes related to health and nutrition.

Original languageEnglish (US)
Article numbernzy017
JournalCurrent Developments in Nutrition
Issue number6
StatePublished - Jun 1 2018


  • Breastfeeding
  • Cognitive mapping
  • HIV
  • Haiti
  • Infant and young child feeding
  • Maternal perceptions
  • Pile sorting
  • Pregnant and lactating women

ASJC Scopus subject areas

  • Food Science
  • Nutrition and Dietetics
  • Medicine (miscellaneous)


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