The World Health Organization has identified the importance of improving the rates of breast/chest feeding for population health. Canadian health organizations have put public health resources toward ...breast/chest feeding support. Despite statements of purpose describing health promotional interventions to be focused on improving overall population health, many times these methods are based only upon biomedical knowledge and fail to adequately address the needs of diverse populations. Thus, in this paper we critique a Canadian policy providing clinical guidance to care providers through the application of a relational inquiry framework. We draw on the first author’s experience as a Public Health Nurse delivering breast/chest feeding support within the scope of these guidelines to further illustrate the point. The results from published evidence are integrated within this critique to provide an evidence base for policy improvement recommendations to improve the social, cultural, and political components of breast/chest feeding typically overlooked in current standards.
Background:
Maternal breastfeeding self-efficacy (BSE) is reflective of a mother’s confidence in breastfeeding and is a modifiable factor that may improve breastfeeding rates. Breastfeeding ...self-efficacy theory purports that women with higher BSE will have better breastfeeding outcomes.
Research aim:
The aim of this systematic review was to explore the theoretical link between BSE and breastfeeding outcomes by investigating (a) if interventions to improve BSE were successful and (b) if improvements in BSE resulted in improved breastfeeding rates.
Methods:
The authors performed a systematic search of 10 databases for studies that investigated the effect of interventions for mothers of full-term infants on BSE and breastfeeding rates. They used an inverse-variance, random-effects meta-analysis.
Results:
Of 1,366 titles and abstracts identified, 58 full-text articles were screened and 11 met the study criteria. Compared with mothers in control groups, mothers in intervention groups had significantly higher BSE, scoring 4.86 points higher, 95% confidence interval 3.11, 6.61, at 2 months postpartum. Mothers in the intervention groups were 1.56 and 1.66 times more likely to be breastfeeding at 1 month and 2 months postpartum, respectively. Interventions that were implemented in the postpartum period, used combined delivery settings, or were informed by BSE theory had the greatest influence on breastfeeding outcomes. Meta-regression indicated that for each 1-point increase in the mean BSE score between the intervention and control groups, the odds of exclusive breastfeeding increased by 10% in the intervention group.
Conclusion:
Breastfeeding self-efficacy is a modifiable factor that practitioners can target to improve breastfeeding rates in mothers of full-term infants.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK, VSZLJ
One of the factors contributing to the disparities still present by race in the United States may be inequitable access to lactation education. In order to ensure that all parents receive the ...education they deserve to make informed infant feeding decisions, two checklists were created for patient and healthcare professional use, respectively. This paper describes the process of creating and validating the healthcare professional and patient checklists. The authors completed a review of the most recent literature surrounding barriers to lactation initiation and retention in the Black community to create the initial version of the checklists. Expert consultation was then utilized to assess their content validity. Local healthcare providers unanimously agreed that pregnant and postpartum parents need more education and support than currently provided. The consulted experts described the two checklists as useful and comprehensive and offered feedback for their revision and optimization. Implementing these checklists offer the possibility of increasing provider accountability in delivering adequate lactation education and enhancing client lactation knowledge and self-efficacy. Further research is needed to assess the effect of implementation of the checklists in a healthcare setting.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK, VSZLJ
Human lactation has evolved to produce a milk composition that is uniquely-designed for the human infant. Not only does human milk optimize infant growth and development, it also provides protection ...from infection and disease. More recently, the importance of human milk and breastfeeding in the programming of infant health has risen to the fore. Anchoring of infant feeding in the developmental origins of health and disease has led to a resurgence of research focused in this area. Milk composition is highly variable both between and within mothers. Indeed the distinct maternal human milk signature, including its own microbiome, is influenced by environmental factors, such as diet, health, body composition and geographic residence. An understanding of these changes will lead to unravelling the adaptation of milk to the environment and its impact on the infant. In terms of the promotion of breastfeeding, health economics and epidemiology is instrumental in shaping public health policy and identifying barriers to breastfeeding. Further, basic research is imperative in order to design evidence-based interventions to improve both breastfeeding duration and women’s breastfeeding experience.
Further research gaps exist in relation to the promotion of breastfeeding. Robust scientific evidence obtained by a meta-analysis would provide objectively summarized data while enabling the ...assessment of consistency of findings. This review includes the first documented meta-analysis done on the effectiveness of targeting fathers for promoting breastfeeding (BF). Assessments have been done for a primary outcome and for six more secondary outcomes.
PubMed, EMBASE, Google Scholar, CENTRAL databases and unpublished researches were searched. Selections of randomized-controlled trials and quasi-experimental studies were done in three rounds. Heterogeneity and potential publication bias were assessed. Eight studies were included in meta-analysis and others in narrative synthesis of the outcomes. Pooling was done with the Mental- Haenszel method using risk ratio (RR). Summary-of-Findings table was composed by Review-Manager (version 5.3) and GRADEproGDT applications. Subsequent sensitivity analysis was done.
Selected eight interventional studies included 1852 families. Exclusive BF at six months was significantly higher (RR = 2.04, CI = 1.58-2.65) in the intervention groups. The RR at 4 months was 1.52 (CI = 1.14 to 2.03). Risk of full-formula-feeding (RR = 0.69, CI = 0.52-0.93) and the occurrence of lactation-related problems were lower in the intervention groups (RR = 0.24, CI = 0.10-0.57). More likelihood of rendering support in BF-related issues was seen in intervention groups (RR = 1.43, CI = 1.22-1.68). Increase of maternal knowledge and favorable attitudes on BF were higher in the intervention groups (P ≤; 0.001). The quality of evidence according to GRADE was "low" (for one outcome), "moderate" (for four outcomes), and "high" (for two outcomes).
Targeting fathers in promotion of BF has provided favorable results for all seven outcomes with satisfactory quality of evidence. This review was registered in the PROSPERO-registry (ID: 2017-CRD42017076163) prior to its commencement.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background:
Breastfeeding confers significant maternal and infant benefits; however, breastfeeding rates remain suboptimal in the United States. A parent’s decision to breastfeed is influenced by ...non-modifiable and modifiable factors, including breastfeeding knowledge and self-efficacy. There is a positive correlation between high maternal self-efficacy and breastfeeding duration. Parents increasingly rely on technology for health information.
Research Aim:
To determine if a smartphone application affected maternal self-efficacy and breastfeeding exclusivity rates.
Method:
This study was a randomized, controlled pilot study examining the effect of an educational program, included in a smartphone application, on breastfeeding self-efficacy (assessed in postpartum Week 1 and Weeks 4–6) and breastfeeding rates (assessed in postpartum Weeks 4–6). Forty participants were recruited using block randomization to intervention (17 of 20 completed the study) and usual care (19 of 20 completed the study) groups. To examine the pre-test/post-test difference in the Breastfeeding Self-Efficacy Scale – Short Form total scores, a change in score (post-intervention minus pre-intervention) was calculated for each parent.
Result:
The intervention group (phone application and usual care) showed greater change in self-efficacy scores (M = 7.6, SD = 7.8) compared to the control group (usual care; M = 1.2, SD = 3.7, p = .001). The rate of exclusive breastfeeding was nearly twice as high in the intervention group as in the control group, but did not reach statistical significance (p = .093).
Conclusion:
The investigators found enhanced breastfeeding self-efficacy and breastfeeding rates among postpartum women receiving a smartphone educational program in the first 6 weeks postpartum. Further studies on smartphone interventions will develop our understanding of this technology in improving breastfeeding rates.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK, VSZLJ
Aims
To evaluate the effects of a breastfeeding intervention on primiparous mothers' breastfeeding self‐efficacy, breastfeeding duration and exclusivity at 4 and 8 weeks postpartum.
Background
Few ...studies have examined the effects of breastfeeding self‐efficacy on improved breastfeeding outcomes among primiparous mothers in China.
Design
An experimental pre‐test and posttest, two‐group design was used in the study.
Methods
A total of 74 participants were recruited to the study from a tertiary hospital in central China, from June–October 2012. An individualized, standardized nursing intervention based on the Self‐Efficacy Theory was delivered to enhance mothers' breastfeeding self‐efficacy, breastfeeding duration and exclusivity at 4 and 8 weeks postpartum. Participants were randomly assigned to an intervention or referent group. Participants in the intervention group received three individualized, self‐efficacy‐enhancing sessions. Participants in the referent group received standard care.
Results
Participants in the intervention group showed significantly greater increases in breastfeeding self‐efficacy, exclusivity and duration than participants in the control group at 4 and 8 weeks postpartum (except for duration at 4 weeks). High baseline breastfeeding self‐efficacy predicted higher breastfeeding self‐efficacy later and more exclusive breast‐feeding.
Conclusion
The findings in this study suggest that intervention aimed at increasing self‐efficacy has a significant impact on maternal breastfeeding self‐efficacy and short‐term breastfeeding outcomes.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK, VSZLJ
The World Health Organization recommends continued breastfeeding up to 2 years of age or beyond. This study assessed breastfeeding knowledge, attitudes, and practices among women residing on the ...island of Abu Dhabi and identified associated factors.
We conducted a cross-sectional study using a self-administered questionnaire among mothers visiting primary healthcare clinics in Abu Dhabi between November 2014 and 2015. Participants were women aged at least 18 years who had at least one child aged 2 years or younger at the time of the study. Breastfeeding knowledge, attitudes, and practices were assessed on the basis of experience with last child. Selected questions were used to develop a scaled scoring system to categorize these aspects as good, fair, or poor. Exclusive breastfeeding is defined as the act of feeding infants only breast milk since birth, without providing water, formula, or other liquid supplements.
The participants were 344 women. Exclusive breastfeeding for 6 months was reported by only 46 (16.9%, 95% CI 0.10, 0.17,
= 272). 79 (28.7%,
= 275) of the participants were breastfeeding and planning to continue after the child was ≥24 months. Multivariate logistic regression analysis revealed that the following factors were associated with exclusive breastfeeding: mothers with female children (adjusted OR AOR 2.42; 95% CI 1.18, 4.97) and better breastfeeding knowledge scores (AOR 1.25; 95% CI 1.04, 1.50). The following factors were associated with less likelihood of exclusively breastfeeding: working mothers (AOR 0.29; 95% CI 0.12, 0.72), living with relatives (AOR 0.21; 95% CI 0.05, 0.81), no past exclusive breastfeeding experience (AOR 0.23; 95% CI 0.09, 0.58) and being offered readymade liquid formula in hospital (AOR 0.33; 95% CI 0.15, 0.72). The most common reason for stopping breastfeeding was insufficient breast milk production (68/89, 76%), and the most common work related reason was inadequate maternity leave (24/89, 15%).
Although breastfeeding knowledge was generally good, breastfeeding practice was still suboptimal. Modifiable factors found to predict exclusive breastfeeding included breastfeeding knowledge and mothers' employment status.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Background:
Improving breastfeeding practices is a worldwide priority. Pharmacists have the opportunity to actively promote breastfeeding and educate parents as well as the general public about its ...benefits.
Research Aims:
The aims of this study are to investigate Jordanian pharmacists’ present breastfeeding support practices and perceptions regarding their need for education and training in breastfeeding support.
Methods:
To examine sociodemographic characteristics of community pharmacists in Jordan and their current breastfeeding support practices and educational needs, a descriptive cross-sectional online (self-report) survey was conducted. Through social media, pharmacists working in community pharmacies in Jordan were recruited between August 2021 and February 2022. The level of breastfeeding support participants had been provided with was measured using eight items in a 5-point Likert scale ranging from 5 (Always) to 1 (Never). Each participant self-reported the frequency of advice/information given to breastfeeding women in each of these areas. Univariate and multivariable linear regression models were used to identify factors associated with the level of breastfeeding support.
Results:
Participants (N = 381) reported a high level of breastfeeding support, but expressed a need for training and education for further improvement. The breastfeeding support score of female participants was found to be 0.12 higher than that of males (Beta = 0.12,
p
= .02), 0.16 higher in married participants compared to non-married participants (Beta = 0.16,
p
= .03), and 0.10 higher in participants working in rural areas compared to those working in urban areas (Beta = 0.10,
p
= .04).
Conclusion:
While community pharmacists generally report a high level of breastfeeding support, our findings revealed demographic differences. Attention to specific areas of need might enhance what pharmacists could offer; however, additional research would be required to guide the specific educational content.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK, VSZLJ
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