Are health science students' beliefs about infant nutrition evidence-based?

An Educational Intervention to Explore and Overcome Nursing Students' Breastfeeding Barriers: A Mixed-Methods Quasi-experimental Study

BACKGROUND

Nursing and midwifery students do not feel adequately prepared during their clinical training to support women who breastfeed, demanding more effective communication skills and knowledge.

AIM

The aim was to evaluate changes in students' breastfeeding knowledge.

METHODS

This was a mixed-methods quasi-experimental design. Forty students voluntarily participated. Using a 1:1 ratio, 2 groups were randomly created and completed the validated questionnaire ECoLaE (pre-post). The educational program consisted of focus groups, a clinical simulation, and a visit to the local breastfeeding association.

FINDINGS

The control group's posttest scores ranged from 6 to 20 (mean = 13.1, standard deviation [SD] = 3.0). The intervention group ranged from 12 to 20 (mean = 17.3, SD = 2.3). A Student's t test for independence samples was calculated ( P < .005, t = 4.5, median = 4.2). The intervention group had a mean difference of 10 points in improvement (mean =10.53, SD = 2.20, min = 7, max = 14), whereas the control group had a mean of 6 points (mean = 6.80, SD = 3.03, min = 3, max = 13). The multiple linear regression explained the intervention's effect. The regression model had statistical significance ( F = 4.87, P = 0.004), with an adjusted R2 = 0.31. The linear regression between the posttest scores and group variables after adjusting by age showed an increment of 4.1 points in the intervention posttest scores ( P < .005, 95% confidence interval [CI] = 2.1-6.1).

CONCLUSIONS

The educational program "Engage in breaking the barriers to breastfeeding" improved nursing students' knowledge.

Breastfeeding knowledge & attitudes: Comparison among post-licensure undergraduate and graduate nursing students

RESEARCH AIMS

The aims of this study are to compare the knowledge and attitude scores between undergraduate and graduate nursing students and to identify the variables associated with higher breastfeeding knowledge and attitudes.

BACKGROUND

Nurses' knowledge and attitudes towards breastfeeding greatly impact their roles in promoting and supporting breastfeeding. However, they may not have sufficient knowledge and/or positive attitudes to support and advocate for these families. Many studies focused on professional nurses or undergraduate students' knowledge, attitudes, and beliefs. Few studies included registered nurses enrolled in post licensure undergraduate and graduate nursing programs.

DESIGN

A cross-sectional, prospective, and descriptive study.

METHODS

A convenient sample of 95 nursing students (50 undergraduate and 45 graduate) was recruited from an ethnically diverse, urban university in Southern California. Students voluntarily completed an online survey adapted from Brodribb, et al. (2008). Bivariate analysis was conducted to identify relationships between study variables.

RESULTS

Compared to undergraduates, graduate students scored higher on knowledge and attitudes towards breastfeeding (p < 0.001). Students' perception of their prior academic breastfeeding preparation was not related to their current knowledge and attitudes. Age, having children, exclusively breastfed own baby, and duration of personal breastfeeding were positively associated with attitudes and knowledge (p < 0.05 for all variables). Years of nursing experience (p = .01) was positively associated with attitudes only.

CONCLUSIONS

Compared to academic preparation, age, having children, and personal breastfeeding experiences seem to be better indicators of breastfeeding knowledge and attitudes. Nursing programs should exert more effort in enhancing curricular evidence based breastfeeding education. More research is needed to support these efforts.

Educational Resources and Curriculum on Lactation for Health Undergraduate Students: A Scoping Review

BACKGROUND

Breastfeeding is a fundamental component of health care, and health professionals need to be adequately prepared. As part of the system, health care professionals have the ability to influence the establishment and maintenance of breastfeeding. The global literature regarding the curricular approach or established best practices for health professional education in lactation is inconclusive and lacking in rigor.

RESEARCH AIM

To explore the literature for the educational resources, methods, and curriculum used in the education of undergraduate health students related to lactation.

METHODS

A scoping review examining the curricular programs of health professional students in lactation was undertaken exploring and summarizing evidence from peer reviewed and grey literature. A scoping review with a five-stage review process was followed. The database search between 1982-2018 generated 625 results, 79 full-text articles were reviewed, and 29 articles published in English met the inclusion criteria.

RESULTS

In general, educational resources, methods, curricular approaches, and foundational topics were based on best practice standards. Some authors incorporated a variety of learning methods and provided experiential learning, with evidence of translation of knowledge into clinical practice. In the studies examined, researchers reported that students had improved their: knowledge and attitudes (59%); breastfeeding support skills (45%); and confidence (10%). However, even in programs that focused on developing students' breastfeeding support skills, authors reported a lack of change in students' confidence.

CONCLUSIONS

Although only English articles met the inclusion criteria, this review was unique in its search of multidisciplinary, multilingual, and international studies. Consistency in teaching across disciplines is key and not evident in the studies reviewed.

Breastfeeding knowledge in university nursing students. A multicentre study in Spain

BACKGROUND

Exclusive breastfeeding is one of the main health and infant survival elements. To start and maintain breastfeeding, health professionals must receive culturally sensitive evidence-based breastfeeding training to offer future mothers the required information and support. While studying the nursing degree, acquiring the necessary knowledge and skills to successfully perform this work is essential.

OBJECTIVE

Study the level of nursing students' breastfeeding knowledge at three Spanish public universities; explore which variables are related to acquire this knowledge.

DESIGN

An observational, descriptive, cross-sectional multicentre study.

METHODS

Participants were the students registered for the 4 nursing degree years at the three participating universities (N = 1540). They were asked about their breastfeeding knowledge with the self-administered AprendeLact Questionnaire; breastfeeding-related socio-demographic variables were included.

RESULTS

The overall mean score of the 684 returned questionnaires was 4.659 (±2.377) out of 10. The year-4 students from the Castellón university obtained significantly higher mean scores and had been on practicals in maternity or neonatology units, belonged to breastfeeding associations and were artificially fed as infants. University belonged to, current academic year and placements in maternity or neonatology units were relevant factors for acquiring breastfeeding knowledge.

CONCLUSIONS

Syllabi based on progressive transversal learning, and participating in real maternity-related health settings, could be facilitating strategies to acquire a suitable level of breastfeeding knowledge.

Validation of the Spanish-Mexican Version of the Australian Breastfeeding Attitude Questionnaire in Higher Education Health Students

Positive attitudes towards breastfeeding in health professionals/students have been associated with increasing their confidence to provide support and accompaniment to mothers. In Mexico, there is no valid/reliable tool to assess attitudes towards breastfeeding in this population. The Australian Breastfeeding Attitudes (and Knowledge) Questionnaire (ABAQ) measures attitudes in the Australian population. We aimed to adapt and validate the ABAQ in Mexican health students. We included 264 health students (nursing, nutrition, and medicine) from the University of Guadalajara. Bilingual translators carried out the Spanish adaptation with a reverse translation into English. Experts evaluated the content validity. Reliability was evaluated through an internal consistency analysis (Cronbach’s alpha) and construct validity through convergent–divergent validation, item–total correlation, exploratory factor analysis (by principal components), and confirmatory factor analysis. According to the exploratory factor analysis, only one component was identified. Seven items were removed (low correlation between items ≤0.2 and low factor load ≤0.3). The Cronbach’s alpha was 0.78. According to the confirmatory factor analysis, the one-factor solution of the ABAQ-13Mx showed a good model fit (X² = 98.41, G = 62, p = 0.02, CFI = 0.940, and RMSEA = 0.048). The ABAQ-13Mx is a reliable and valid instrument for evaluating attitudes towards breastfeeding in Mexican health degree students.

A Comparison of Breastfeeding Exposure, Attitude, and Knowledge Between Collegiate African American and White Males with no Biological Children

BACKGROUND

Human milk is the preferred source of infant nourishment; yet, acceptance of human milk as the norm for infant feeding is debated. In the United States there is a disparity in breastfeeding rates, which are significantly lower in African Americans compared to Whites. Multiple variables appear to influence breastfeeding, including the male partner.

OBJECTIVES

To assess and compare breastfeeding exposure, attitude, and knowledge between African American and White college males with no biological children. A second objective was to explore the relationship between breastfeeding variables and educational attainment, academic major, and sibling presence.

METHODS

A subset of responses from a larger cross-sectional survey were analyzed. African American and White collegiate males aged 18-40 years without biological children were included in the study. The questionnaire included demographic, exposure, attitude, and knowledge items.

RESULTS

A total of 117 African American and 713 White males were included and represented all academic colleges on campus. African American participants documented less exposure to breastfeeding, a more positive attitude, and similar poor knowledge scores compared to their White counterparts. Sibling presence was linked with exposure, and exposure was linked to attitude. Both African American and White science majors scored higher on all factors than humanities or business majors.

CONCLUSIONS FOR PRACTICE

Breastfeeding exposure influences males' attitudes toward breastfeeding. Future research should consider types of exposure to identify the sources most influential. Furthermore, tailoring breastfeeding interventions to increase exposure and knowledge in core wellness courses may improve attitudes and social acceptance among collegiate males.

Awareness of Breastfeeding Laws and Provisions of Students and Employees of Institutions of Higher Learning in Georgia

BACKGROUND

Over the past 2 decades, southern states in the United States have recorded the lowest breastfeeding rates. It is not known whether awareness of breastfeeding laws and provision of resources play any role in their breastfeeding practices.

RESEARCH AIMS

The aims were (a) to describe awareness of breastfeeding laws and provisions by students and employees of institutions of higher learning in the state of Georgia, (b) to describe awareness by race and ethnicity, and (c) to determine factors associated with awareness of breastfeeding laws and provisions among students and employees within Georgia institutions of higher learning.

METHODS

A cross-sectional online survey of students ( n = 1,923) and employees ( n = 1,311) associated with five institutions within the University System of Georgia ( N = 3,271) was completed. Convenience sampling was used. Data were collected through Qualtrics. Chi-square test was used to examine differences between groups, while logistic regression was used to examine associations.

RESULTS

Participants included 33.3% undergraduate, 26.2% graduate students, 24.6% staff, 14.2% faculty, and 1.7% administrators. Over two thirds were female and white. Almost one third reported having a child or children. Awareness of breastfeeding laws and provisions was very low among respondents, with 26.6 and 9.6% aware of federal and state provisions, respectively. While less than 10% were familiar with the Baby Friendly Hospital Initiative program, 52.6% reported their institution provides a supportive environment for breastfeeding. Being a student and being a minority were negatively associated with awareness of laws and provisions that support breastfeeding.

CONCLUSION

The need for focused efforts on increasing awareness of legislative and institutional provisions and support for breastfeeding exists.

Impact of Key Workplace Breastfeeding Support Characteristics on Job Satisfaction, Breastfeeding Duration, and Exclusive Breastfeeding Among Health Care Employees

Background: Although national breastfeeding rates have improved across recent decades, women continue to face barriers to achieving recommended breastfeeding targets. Returning to work presents a unique set of challenges for breastfeeding continuation, even in health care settings tasked with promoting breastfeeding among patients. This study examined the association between key workplace breastfeeding support characteristics, job satisfaction, and breastfeeding outcomes among health care employees. Materials and Methods: We used data from a cross-sectional survey of employees in a large integrated health care system. The study sample included female employees who had breastfed in the past 3 years (n = 165). The Employee Perceptions of Breastfeeding Support Questionnaire (EPBS-Q) measured organization, manager, and coworker support for breastfeeding. Regression analyses tested the association between workplace support factors and breastfeeding duration, breastfeeding exclusivity, and job satisfaction. Results: Managerial support increased median job satisfaction by 0.39 standard deviations (p < 0.001), and increased the odds of prolonging exclusive breastfeeding (odds ratio [OR] 1.47; confidence interval [CI] 1.03-2.09). Organizational support increased median job satisfaction by 0.27 standard deviations (p < 0.001), and increased the odds of exclusive breastfeeding by nearly twofold (OR 1.80; CI 1.05-3.09). No significant associations were found between workplace support factors (organizational, managerial, and co-worker support) and overall breastfeeding duration. Conclusions: Organizational and managerial support are key aspects of workplace lactation support, which may positively impact job satisfaction, rates of exclusive breastfeeding, and duration of exclusive breastfeeding among female health care employees. This intersection of outcomes salient for the business community and public health practitioners highlights opportunities for collaborations to improve workplace and breastfeeding outcomes.

Validation of the Chinese Version of the Australian Breastfeeding Attitude Questionnaire

BACKGROUND

The Australian Breastfeeding Knowledge and Attitude Questionnaire-Short Form (ABKAQ-SF) was designed to measure breastfeeding knowledge and attitudes of health professionals. To date, a Chinese version of the attitude component of the ABKAQ-SF (ABAQ) is not yet available and has not been cross-validated with nursing students. Research aims: This study aimed to examine (a) the psychometric properties of the ABAQ and (b) group differences and responsiveness of the revised 12-item ABAQ (ABAQ12) among nursing students in Taiwan.

METHODS

Using a cross-sectional two-cohort study design, nursing students in Years 2 and 3 of a 4-year bachelor of nursing program ( N = 205) completed the Chinese version of the ABAQ, translated using forward and backward translations. Content validity, internal consistency reliability, construct validity, group differences, and responsiveness of the Chinese version of the ABAQ were assessed.

RESULTS

Using the principal axis factoring procedure of exploratory factor analysis to examine the dimensionality of the ABAQ, a one-component structure was identified. Six items were deleted, based on the average interitem correlation (< 0.2), low corrected item-total correlation (< 0.35), and low factor loading (< 0.3). Confirmatory factor analysis of the ABAQ12 supported a one-factor solution, with good overall model fit (goodness-of-fit index = 0.949, Tucker-Lewis index = 0.951, comparative fit index = 0.965, root mean square error of approximation = 0.042). Responsiveness of the ABAQ12 scores indicated a positive change in breastfeeding attitude between the pre- and postclinical placement period.

CONCLUSION

The Chinese version of the ABAQ12 is valid, reliable, and responsive and is suitable for assessing the breastfeeding attitudes of nursing students in the Taiwanese higher education settings.

Breastfeeding knowledge and attitudes of health professional students: a systematic review

Background

Breastfeeding support from health professionals can be effective in influencing a mother’s decision to initiate and maintain breastfeeding. However, health professionals, including nursing students, do not always receive adequate breastfeeding education during their foundational education programme to effectively help mothers. In this paper, we report on a systematic review of the literature that aimed to describe nursing and other health professional students’ knowledge and attitudes towards breastfeeding, and examine educational interventions designed to increase breastfeeding knowledge and attitudes amongst health professional students.

Methods

A systematic review of peer reviewed literature was performed. The search for literature was conducted utilising six electronic databases, CINAHL, MEDLINE, ProQuest, PubMed, Scopus, and Cochrane, for studies published in English from January 2000 to March 2017. Studies focused on nursing students’ or other health professional students’ knowledge, attitudes or experiences related to breastfeeding. Intervention studies to improve knowledge and attitudes, were also included. All papers were reviewed using the relevant Critical Appraisal Skills Programme (CASP) checklist.

Results

Fourteen studies were included in the review. This review indicates that in some settings, health professional students demonstrated mid-range scores on breastfeeding attitudes, and their knowledge of breastfeeding was limited, particularly in relation to breastfeeding assessment and management. All of the studies that tested a specialised breastfeeding education programme, appeared to increase nursing students’ knowledge overall or aspects of their knowledge related to breastfeeding. Several factors were found to influence breastfeeding knowledge and attitudes, including timing of maternal and child health curriculum component, previous personal breastfeeding experience, gender, cultural practices and government legislation.

Conclusions

Based on this review, it appears that nursing curriculum, or specialised programmes that emphasise the importance of breastfeeding initiation, can improve breastfeeding knowledge and attitudes and students’ confidence in helping and guiding breastfeeding mothers.

Online Lactation Education for Healthcare Providers: A Theoretical Approach to Understanding Learning Outcomes

BACKGROUND

Breastfeeding competencies are not standardized in healthcare education for any of the health professions. A few continuing education/professional development programs have been implemented, but research regarding the efficacy of these programs is scarce. Research aim: After a 45-hour lactation course, (a) Does breastfeeding knowledge increase? (b) Do beliefs and attitudes about infant feeding improve? (c) Does perceived behavioral control over performance of evidence-based lactation support practices increase? and (d) Do intentions to carry out evidence-based lactation support practices increase?

METHODS

A nonexperimental pretest-posttest self-report survey design was conducted with a nonprobability sample of participants ( N = 71) in a lactation course. Theory of Planned Behavior variables were measured and a before-after course analysis was completed.

RESULTS

Significantly higher scores were found on the posttests for knowledge, beliefs about breastfeeding scale, and the perceived behavioral control scale. Participants' self-efficacy increased after the course; their beliefs about social norms and their ability to effect change in their workplaces did not change significantly. Participants' intention to perform actions that are consistent with the evidence-based breastfeeding supportive behaviors increased significantly. Positive beliefs about formula feeding significantly increased; this was unexpected.

CONCLUSION

The Theory of Planned Behavior provided a useful approach for examining more meaningful learning outcomes than the traditional knowledge and/or satisfaction outcomes. This study was the first to suggest that more meaningful learning outcomes are needed to evaluate lactation programs. However, it is not enough to educate healthcare providers in evidence-based practice; the places they practice must have the infrastructure to support evidence-based practice.

Psychometric testing of the Iceland Health Care Practitioner Illness Beliefs Questionnaire among school nurses

BACKGROUND

Beliefs have been found to have an effect on how people deal with illness. Therefore, knowing healthcare practitioners' beliefs about specific high frequency illnesses are vital when caring for vulnerable populations such as school-age children with chronic illnesses or disorders.

AIM

To psychometrically test the Iceland Health Care Practitioner Illness Beliefs Questionnaire for healthcare professionals who are working with families of school-age children with asthma and attention deficit/hyperactivity disorder.

DESIGN

The Iceland Health Care Practitioner Illness Beliefs Questionnaire is a 7-item Likert-type instrument with four additional open-ended questions that was developed from the Iceland Family Illness Belief Questionnaire. The questionnaire is designed to measure a provider's beliefs about their understanding of the meaning of the illness situation for families. The questionnaire was administered to 162 school nurses in Iceland and the state of Minnesota.

METHOD

Two condition-specific versions of the Iceland Health Care Practitioner Illness Beliefs Questionnaire were developed in this study: one to measure beliefs about families of children with asthma and one to measure beliefs about families of children with attention deficit hyperactivity disorder. Higher scores on the questionnaire indicate that healthcare professionals are more confident in their illness beliefs. After initial development, the questionnaire was translated into English. Participants completed the questionnaire using an online survey platform and parallel study procedures in both countries.

RESULTS

Based on exploratory factor analysis using principal component analysis, the Iceland Health Care Practitioner Illness Beliefs Questionnaire was found to have a one-factor solution with good construct validity (Cronbach's α = 0.91). Confirmatory factor analysis supported the one-factor solution (Cronbach's α = 0.91).

CONCLUSION

This instrument is a promising tool for measuring illness beliefs among healthcare practitioners in clinical and research settings.

Breastfeeding Exposure, Attitudes, and Intentions of African American and Caucasian College Students

BACKGROUND

African American mothers lag behind in breastfeeding initiation. Research is needed to gain an understanding of potential reasons for breastfeeding disparities. Research aim: This study explored breastfeeding exposure, attitudes, and intentions of African American and Caucasian college students by race and gender.

METHODS

Women and men (696) attending college, who were younger than 45 years and without children, were included in this study. Survey data were collected using a demographic questionnaire and the Iowa Infant Feeding Attitude Scale.

RESULTS

Overall, students demonstrated favorable attitudes regarding breastfeeding but viewed formula feeding as more practical. Students who were Caucasian and female and experienced breastfeeding exposure demonstrated higher breastfeeding attitudes and intent. Breastfeeding exposure and attitudes contributed 32% of the variance in breastfeeding intentions. The odds of experiencing breastfeeding exposure and positive breastfeeding attitudes were approximately 3 times higher for Caucasian students than for African American students.

CONCLUSION

External factors demonstrated a stronger association with breastfeeding intentions. The link with race and gender appears to operate through their effect on attitudes and exposure. More research is needed to identify strategies to improve breastfeeding exposure and attitudes among African Americans.

'An exploration of the health beliefs of Chinese nurses' and nurse academics' health beliefs: A Q-methodology study'

Q-methodology was used to investigate the health beliefs of Chinese clinical nurses and nurse academics. Twenty-eight participants from one hospital and nursing school in China were involved. The four stages of this study included: (i) concourse development from literature review, Internet searches, and key informant interviews; (ii) A pilot study to develop the Q-sample from the concourse; (iii) participants sorted the Q-sample statements along a continuum of preference (Q-sorting); and (iv) PQ data analysis using principal component analysis and varimax rotation. Five viewpoints were revealed: (i) factor 1--health management and the importance of evidence; (ii) factor 2--challenging local cultural belief, and Eastern and Western influences; (iii) factor 3--commonsense; (iv) factor 4--health and clinical practice; and (v) factor 5--health and nursing education. This study presents a need for nurses and nurse academics to think critically, examine their long-held health beliefs, and promote the use of evidence-based practice.

Health beliefs and their sources in Korean and Japanese nurses: A Q-methodology pilot study

BACKGROUND

Many health beliefs do not have supporting scientific evidence, and are influenced by culture, gender, religion, social circumstance and popular media. Nurses may also hold non-evidenced-based beliefs that affect their own health behaviours and their practices.

OBJECTIVES

Using Q-methodology, pilot Q-cards representing a concourse of health beliefs for Japanese and South Korean nurses and explain the content and sources of health beliefs.

DESIGN

Qualitative.

SETTINGS

Two university campuses, one each in Japan and Korea.

PARTICIPANTS

A convenience sample of 30 was obtained, 14 clinical nurses and 16 academic nurses.

METHODS

Literature reviews and expert informants were used to develop two sets of 65 Q-cards which listed culturally appropriate health beliefs in both Japan and Korea. These beliefs were examined in four structured groups and five individual interviews in Japan, and five groups and two individual interviews in Korea.

RESULTS

Our unique study revealed six categories regarding sources of health beliefs that provide rich insights about how participants accessed, processed and transmitted health information. They were more certain about knowledge from their specialty area such as that from medical or nursing resources, but derived and distributed many general health beliefs from personal experience, family and mass media. They did not always pass on accurate information to students or those in their care, and often beliefs were not based on scientific evidence.

CONCLUSION

Findings highlight the dangers of clinical and academic nurses relying on health belief advice of others and passing this on to patients, students or others, without mindfully examining the basis of their beliefs through scientific evidence.