Missed Opportunities in the Outpatient Pediatric Setting to Support Breastfeeding: Results From a Mixed-Methods Study

Breastfeeding Initiation, Duration, and Associated Factors Among People With Hepatitis C Virus Infection

OBJECTIVE

To characterize breastfeeding behaviors and identify factors associated with breastfeeding initiation among people with hepatitis C virus (HCV) infection.

METHODS

We conducted a secondary analysis of a multicenter observational cohort of pregnant people with singleton gestations and HCV seropositivity. This analysis includes individuals with data on breastfeeding initiation and excludes those with human immunodeficiency virus (HIV) co-infection. The primary outcome was self-reported initiation of breastfeeding or provision of expressed breast milk. Secondary outcomes included duration of breastfeeding. Demographic and obstetric characteristics were compared between those who initiated breastfeeding and those who did not to identify associated factors. Univariable and multivariable analyses were performed.

RESULTS

Overall, 579 individuals (75.0% of participants in the parent study) were included. Of those, 362 (62.5%) initiated breastfeeding or provided breast milk to their infants, with a median duration of breastfeeding of 1.4 months (interquartile range 0.5-6.0). People with HCV viremia , defined as a detectable viral load at any point during pregnancy, were less likely to initiate breastfeeding than those who had an undetectable viral load (59.4 vs 71.9%, adjusted odds ratio [aOR] 0.61, 95% CI, 0.41-0.92). People with private insurance were more likely to initiate breastfeeding compared with those with public insurance or no insurance (80.0 vs 60.1%; aOR 2.43, 95% CI, 1.31-4.50).

CONCLUSION

Although HCV seropositivity is not a contraindication to breastfeeding regardless of viral load, rates of breastfeeding initiation were lower among people with HCV viremia than among those with an undetectable viral load.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov , NCT01959321 .

Effectiveness of an optional breastfeeding course for multidisciplinary undergraduate healthcare students: A quasi-experimental study

AIMS

This study aimed to examine and quantify the effectiveness of an optional breastfeeding course for multidisciplinary undergraduate healthcare students and to provide advice for education improvement based on students' characteristics and learning feedback.

BACKGROUND

Breastfeeding has received global awareness and educating undergraduate healthcare students is a prospective way to promote breastfeeding. This is the first report from mainland China to verify the education effects and formulate a proposal for improvement.

DESIGN

A quasi-experimental study with a one-group pretest-posttest design.

METHODS

An optional breastfeeding course covering eight topics based on the Health Belief Model was conducted for multidisciplinary students in a medical college. The Breastfeeding Knowledge Questionnaire, Iowa Infant Feeding Attitude Scale and Breastfeeding Promotion Intention Scale were completed for pre- and post-education comparison. The Wilcoxon signed-rank test, MannWhitney U test, KruskalWallis test and chi-square test were used for statistical analysis. The class average normalized gain and individual students' normalized gain were calculated to quantify the effectiveness from the perspective of learning gain.

RESULTS

From March to November 2021, 102 students specialized mainly in nursing, clinical medicine, medical imaging technology and midwifery took the course. Knowledge, attitudes and intention scores improved significantly (Z = 8.70, 8.72, 7.64, respectively, p < .001) and the class average normalized gains were 81.0%, 52.3% and 70.6%, respectively. Insignificant differences were found for students of different genders and categories of specialties (p > .05). Students of first year had significantly higher individual normalized gains (p < .05). In learning feedback, the top-ranked advice for course improvement was to increase practice and experience (75.5%).

CONCLUSIONS

This optional breastfeeding course produced medium to high learning gains for multidisciplinary healthcare undergraduates. Independent breastfeeding education based on behavioral theory for multidisciplinary students is recommended to be conducted in medical colleges. The addition of practice and experience may add value to such education.

Long-Term Effectiveness of an E-Learning Program in Improving Health Care Professionals' Attitudes and Practices on Breastfeeding: A 1-Year Follow-Up Study

Introduction: In-service continuing education offers a unique opportunity to improve knowledge, skills, attitudes, and practices regarding breastfeeding. It has been shown that an online approach to in-service education is effective at improving practices and attitudes toward breastfeeding among health care professionals (HCPs) in the short term. Aim: To evaluate the long-term effectiveness of an online national program on infant nutrition for HCPs. Materials and Methods: We carried out a follow-up study using data from three time points: T0 (pretraining), T1 (immediately post-training), and T2 (1 year after training). The differences between T0, T1, and T2 were tested using repeated-measures ANOVA. Statistical analysis was performed using SPSS version 22.0. Results: The final sample was comprised of 4,582 participants, mainly women (87.4%). At T2, we observed a worsening of attitudes and practices (APs) as compared with T1, though those APs almost never reached the low levels observed at T0. The greatest changes over time concerned the use of drugs during breastfeeding (T0: 3.00 ± 1.33 versus T1: 1.74 ± 1.03 versus T2: 2.64 ± 1.35) and dietary restriction (T0: 2.77 ± 1.35 versus T1: 1.76 ± 1.12 versus T2: 2.57 ± 1.35). The differences between the means of APs at T0, T1, and T2 were significant (p < 0.01). Conclusion: This e-learning program was effective in improving APs regarding the protection, promotion, and support of breastfeeding. The improvement, higher immediately after training, decreased over time. E-learning project managers should propose strategies to facilitate the retention of knowledge related to the main training objectives.

Breastfeeding Support Interventions by International Board Certified Lactation Consultants: A Systemic Review and Meta-Analysis

BACKGROUND

International Board Certified Lactation Consultants (IBCLC) are healthcare professionals who are highly trained in lactation science; however, little is known about the efficacy of IBCLC-specific support on breastfeeding outcomes.

RESEARCH AIMS

This systematic review and meta-analysis aimed to describe interventions containing direct support by IBCLCs during the postpartum period and to analyze the association between study characteristics and the prevalence breastfeeding outcomes.

METHODS

Electronic databases were searched for studies published between January 2001 and December 2018. Meta-analysis and meta-regression were performed on studies containing breastfeeding prevalence data at 3 or 6 months postpartum.

RESULTS

Seventeen interventions met all inclusion and exclusion criteria and eight research teams reported the prevalence of any or exclusive breastfeeding at 3 and/or 6 months. For any breastfeeding at 6 months, the pooled difference was 0.08 [0.04, 0.12] meaning we'd expect to observe 1 additional case of any breastfeeding at 6 months postpartum for every 12 women who received an IBCLC intervention, 95% CI [8, 25] rather than control conditions. Results differed depending on which outcome variable was used to measure breastfeeding and the timing of that measurement.

CONCLUSIONS

Breastfeeding interventions that include IBCLC support in the postpartum period have potential for improving breastfeeding outcomes; however, when designing interventions, the timing and method of data collection for measures of breastfeeding are instrumental to study sensitivity and need to be based on the aims of the intervention itself.