Effects of the implementation of a breastfeeding best practice guideline in a Canadian public health agency

Developing an Instrument to Measure Public Health Nurses' Competence Related to Breastfeeding Beyond 12 Months

BACKGROUND

Health professionals need adequate competence to support breastfeeding beyond infancy. There is no established instrument to measure health professionals' competence regarding long-term breastfeeding. To respond to this shortcoming, the Long-Term Breastfeeding Competence Scale (LBCS) was developed.

RESEARCH AIM

To develop and pilot an instrument that measures public health nurses' competence related to breastfeeding beyond 12 months in order to provide adequate breastfeeding counseling for families.

METHODS

This study was conducted as a cross-sectional online survey on public health nurses working in maternity and/or child health clinics. The relevance and clarity of the LBCS were assessed by an expert panel (N = 6). Public health nurses (N = 197) completed the LBCS, which consisted of a knowledge and skills dimension and an attitude dimension. Descriptive statistics were used to describe the characteristics of the study sample. The conceptual validity of the knowledge and skills dimension was assessed using the dichotomous Rasch analysis, and attitude dimension using the exploratory factor analysis. Internal consistency was evaluated using Cronbach's alpha. The distribution of the items was summarized by descriptive statistics.

RESULTS

According to expert panel evaluations, the LBCS was found to meet the requirements for relevance and clarity (S-CVI 0.90). The internal consistency of the instrument was at a good level (α = 0.796) and met the requirements set for a new instrument.

CONCLUSION

The LBCS is appropriate to determine public health nurses' competence related to breastfeeding beyond 12 months. The LBCS can be used to identify the need for education concerning breastfeeding beyond 12 months.

Health professionals' competencies regarding breastfeeding beyond 12 months: a systematic review

BACKGROUND

Breastfeeding up to two years and beyond supports the health and neurobiological development of a child. Nevertheless, mothers experience criticism from health professionals towards breastfeeding beyond 12 months. Competence related to breastfeeding counselling is defined as minimum knowledge, skills and attitudes that all health professionals should have to protect, promote and support breastfeeding. Professionals' education related to breastfeeding beyond 12 months is insufficient worldwide which challenges the competent and evidence-based support mothers wish for.

METHODS

This systematic review aimed to synthesize the existing literature on health professionals' competencies regarding breastfeeding beyond 12 months. The search was limited to peer-reviewed scientific papers published between 2000 and 2022 that focused on the competencies of health professionals regarding breastfeeding beyond 12 months. Seven databases were searched, and of the 884 studies retrieved, seven were included in the review. The studies were subjected to the Joanna Briggs Institute (JBI) critical appraisal checklists. The data were analyzed using deductive thematic analysis, driven by the concept of competence.

RESULTS

All the dimensions of competence could be found in the data. Health professionals' knowledge or skills related to breastfeeding beyond 12 months were explored in all seven studies, and attitudes towards breastfeeding beyond 12 months were explored in four studies. The main themes identified were Knowledge Combined with Skills, and Attitudes. The main theme, Knowledge Combined with Skills, was formed out of eight themes: perceptions regarding nutritional value, perceptions regarding economic value, perceptions regarding family interaction, perceptions regarding impacts on the mother's wellbeing, perceptions regarding impacts on the child's wellbeing, perceptions regarding suitable duration, perceptions regarding recommendations, and counseling skills. The attitudes varied and therefore the Attitudes main theme consisted of three themes: promotive attitudes, hostile attitudes, and passive attitudes towards breastfeeding beyond 12 months.

CONCLUSIONS

Health professionals' knowledge and skills include several dimensions and vary substantially. Health professionals' attitudes vary between hostile and supportive and influence professionals' advice regarding breastfeeding beyond 12 months. The results suggested that there is considerable variation in health professionals' competencies, which emphasizes the importance of education regarding breastfeeding beyond 12 months.

Factors associated with breastfeeding support from health care professionals by implementing a Clinical Practice Guideline

BACKGROUND

The prevalence and duration of breastfeeding are at low levels and may be improved by the support of health care professionals. Our objective was to determine the effect of implementing a breastfeeding clinical practice guideline on factors associated with breastfeeding support by health care professionals, adopting a Theory of Planned Behavior approach.

METHODS

We conducted an observational, cross-sectional study during 2016 in a health area with implemented clinical practice guideline on breastfeeding, comparing the results with data from a previous cross-sectional study (2011) in the same area, in a standard-care area, and in a Baby-Friendly Hospital Initiative (BFHI)-accredited area. A validated questionnaire (four scales: attitudes, beliefs, subjective norms, and behavioral intention) was completed by professionals in each area. Descriptive analysis was followed by comparisons among the different settings using the chi-square test.

RESULTS

In the area with the implemented clinical practice guideline, the professionals scored significantly higher in subjective norms and beliefs than had been recorded in 2011 (preimplementation), and their scores for all four scales were significantly higher than in the standard-care area. Professionals obtained significantly higher scores for subjective norms in the BFHI-accredited area than in the other settings.

CONCLUSIONS

Clinical practice guideline implementation improved the responses of professionals on breastfeeding support in subjective norms and beliefs scales. There is a need for activities to assist breastfeeding in a practical manner and for more effective measures to ensure compliance with the International Code of Marketing of Breast-milk Substitutes.

Relationships between types of father breastfeeding support and breastfeeding outcomes

Fathers' support can influence mothers' breastfeeding decisions and behavior. Potentially supportive behaviors have been reported in previous studies, but no studies have directly examined which, if any, of those actions are actually more likely to result in desired breastfeeding outcomes. The two studies reported in this paper address this gap by examining relationships between fathers' reported breastfeeding support and mothers' perceptions of received support and breastfeeding intentions, satisfaction, and duration. The Partner Breastfeeding Influence Scale (PBIS) was used in an online survey with 64 women and 41 men (34 couples) and a telephone survey with 80 mothers and 65 fathers (63 couples). Fathers' and mothers' reports of how often fathers engage in the types of support measured by the PBIS were used to predict breastfeeding intentions, satisfaction, and duration. In Study 1, responsiveness predicted breastfeeding success and satisfaction for men and satisfaction for women. However, mothers' intended breastfeeding duration was shorter when fathers both wanted them to breastfeed for a long time and were more appreciative and savvy about breastfeeding. In Study 2, when fathers reported being more appreciative and directly involved in breastfeeding, mothers reported shorter breastfeeding duration. In both studies, mothers' perceptions of their partners' responsiveness and fathers' reports of their own responsiveness predicted longer breastfeeding intentions and duration. These findings suggest that the most effective breastfeeding support is delivered using a sensitive, coordinated teamwork approach that is responsive to the mother's needs.