Comparison of breast-feeding knowledge, attitudes, and beliefs before and after educational intervention for rural Appalachian high school 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.

Enabling Nursing Students to Achieve Their Breastfeeding Goals

Introduction

US workplace law requires employers to provide reasonable break time and space other than a bathroom for breastfeeding women to express their milk. However, this law does not include students in higher education institutions who choose to breastfeed, as students are typically not employed by their schools. The purpose of this report is to describe the joint efforts of faculty members and students to successfully operationalize a lactation room and develop college-specific lactation guidelines in a university in central Kentucky.

Method

Students from a college of nursing (CON) participated in a survey (N=135), of which 30% were parenting at that time (n=41).

Results

Responses from this subset were used to make the case to CON leadership and faculty to develop college-specific guidelines entitled, "Guidelines for Lactation Support," which was included in students' handbooks, and to the designated space for a lactation room in the CON building.

Discussion

The combined effort of faculty, administrators, and students was crucial to promote a breastfeeding-friendly environment in the CON.

Effect of the board game as educational technology on schoolchildren's knowledge on breastfeeding1

Objective:

to evaluate the effect of the board game as an educational technology on schoolchildren’s knowledge on breastfeeding.

Method:

cluster-randomized clinical trial, held in nine schools, with 99 children in the third grade of elementary school (control group = 51 and intervention group = 48). The pretest was conducted in both groups; intervention consisted in the application of the educational technology immediately after pretest to the intervention group; and the post-test was applied on the 7th and 30th days to both groups. For the analysis of children’s knowledge on breastfeeding, we considered the pre- and post-test score means, using the Mann-Whitney test - for comparing the means between groups - and the Wilcoxon test - within the same group.

Results:

there was no statistically significant difference between the groups in the pretest. In the follow-up, when comparing the groups, there were higher means in the intervention group, on the 7th (19.68 ±1.788) and on the 30th (20.16±1.260) days, with statistically significant difference. Within the intervention group, there was significant increase of the means in the pretest (15.89±3.082) for the 30th day (20.16±1.260).

Conclusion:

such educational intervention has significantly contributed to the increase in scores of children’s knowledge on breastfeeding for the intervention group. UTN: U1111-1184-7386.

Educational intervention about breastfeeding among secondary school students

Purpose

Breastfeeding education in the school setting offers the opportunity to improve knowledge base and positively influence beliefs and intentions for students. The purpose of this paper is to analyze the effect of short education program among secondary school students on breastfeeding knowledge and intentions.

Design/methodology/approach

Total of 106 female and 155 male students from four different high schools in Bjelovar were given online questionnaire about intentions to breastfeed and test of knowledge about breastfeeding, both before and shortly after education. The effect of education and school on breastfeeding intentions and knowledge was examined using mixed design ANOVA. Univariate tests were used to examine relation of several independent variables to breastfeeding intention and knowledge scores before and after education.

Findings

Results showed statistically significant effect of education on both intentions and knowledge, whereas the effect of school was significant only for intentions. Students show more positive intentions and better knowledge about breastfeeding after education than before education.

Research limitations/implications

This paper does not entail validation of breastfeeding questionnaire and knowledge test. Due to comprehensiveness and report length, study on validity and reliability of measures is the subject of another paper.

Practical implications

The authors hope that results of the study will influence professional public in Croatia and encourage it to support implementation of breastfeeding education in curriculum.

Originality/value

This paper offers the first national intervention data in relation to breastfeeding intentions and knowledge among secondary school students. It provides an evidence for necessity of implementation of well-structured education module in regular curriculum of secondary education in Croatia.

Attitudes, Practices, and Knowledge About Human Lactation Among Nursing Students

Background

Nurses are on the front line of the healthcare system and should, therefore, have the evidence-based knowledge to manage breastfeeding.

Objective

The objective of this study was to assess the attitudes and knowledge about human lactation among a group of nursing students.

Methods

An anonymous online survey was sent to all College of Nursing students at a local university in Kentucky.

Results

Nursing students participating in the survey favored breastfeeding over formula-feeding for infants. Lack of knowledge and various misconceptions about breastfeeding were reported. Whether a nursing student has or has not completed a class about human lactation during the nursing program, and has had or not children, significantly influences their attitudes and knowledge towards breastfeeding.

Conclusion

Future studies should focus on identifying if nursing faculty members and nursing students recognize human lactation as a value and central knowledge for nurses.

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.

Construção e validação de instrumento avaliativo do conhecimento de escolares sobre amamentação

Resumo Objetivo: Validar um instrumento para avaliação do conhecimento de escolares acerca do aleitamento materno. Métodos: Pesquisa metodológica, desenvolvida em três etapas: construção do instrumento, validação de conteúdo com 22 juízes e de aparência com 10 escolares do ensino fundamental. Os dados foram analisados por meio de frequências absolutas, médias, desvios-padrão, teste binomial e Content Validity Index - CVI. As observações dos juízes foram analisadas e quando necessário o instrumento foi modificado. Resultados: Na validação de conteúdo, a primeira versão do instrumento continha 32 itens que na maioria foram considerados adequados e atingiram I-CVI igual ou acima de 0,80 entre os juízes. Após as modificações, o instrumento passou a ter 21 itens. Na validação de aparência, a maioria dos itens alcançou I-CVI igual ou acima de 0,80. Conclusão: O instrumento foi validado em conteúdo e aparência, podendo ser utilizado na avaliação do conhecimento de escolares sobre aleitamento materno.

Stakeholder views of breastfeeding education in schools: a systematic mixed studies review of the literature

BACKGROUND

Breastfeeding provides numerous health benefits for mothers and infants, but worldwide breastfeeding rates fall below recommendations. As part of efforts to increase breastfeeding initiation and duration, the World Health Organization and UNICEF UK recommend educational interventions to increase awareness and positive attitudes towards breastfeeding beginning during the school years. Breastfeeding education in the school setting offers the opportunity to improve the knowledge base, address misconceptions, and positively influence beliefs and attitudes for students from a wide range of socioeconomic and cultural backgrounds. The purpose of this paper is to present a comprehensive narrative review of the literature regarding student and teacher (stakeholder) views of breastfeeding and breastfeeding education programs in schools to inform future research in the area.

METHODS

Articles were located through a systematic search of online databases and journals using the following keywords in various combinations: (1) breastfeeding, lactation, breast-feeding, "bottle feeding", "infant feeding" (2) student, educator, teacher, "school administrator" and (3) schools, "secondary education", "primary education", "K-12", "high school", "middle school", "elementary school", education, adolescents, curriculum, and a manual search of article references. Studies were screened for inclusion against specific criteria and included papers were assessed using the Mixed Methods Appraisal Tool (MMAT).

RESULTS

This review suggests that adolescents have a deficit in breastfeeding knowledge and express negative conceptions about breastfeeding. Breastfeeding is being discussed in some school environments, but the extent of lessons and the specific messages that teachers communicate have not been explored. Students appear to be interested in receiving more information about breastfeeding, especially if delivered by health professionals or breastfeeding mothers. The majority of teachers are supportive of incorporating breastfeeding education in family and consumer sciences, sexual education, and health classes; however, time constraints and limited knowledge of infant feeding recommendations may be barriers to implementation of appropriate lesson plans.

CONCLUSIONS

Students generally support and are receptive to breastfeeding education; however, research on educator attitudes, knowledge, and experiences are necessary for appropriate implementation of breastfeeding education in varying school settings around the world.

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.

Associations between perceived value of exclusive breastfeeding among pregnant women in the United States and exclusive breastfeeding to three and six months postpartum: a prospective study

BACKGROUND

Successful breastfeeding often starts with prenatally established intention. Yet, few mothers with the intention to exclusively breastfeed achieve their intended breastfeeding duration goal. This study examined the degree to which having a strong value of exclusive breastfeeding is associated with exclusive breastfeeding duration for at least 3 and 6 months postpartum among women who reported prenatal intention to exclusively breastfeed.

METHODS

Data were from the Infant Feeding Practices Study II, a longitudinal US national survey that followed maternal-infant dyads from pregnancy to 1 year postpartum. Bivariate and multivariate regression examined the degree to which strong maternal value of exclusive breastfeeding predicted exclusive breastfeeding duration.

RESULTS

Of the 1799 women who prenatally intended to exclusively breastfeed within the first few weeks postpartum, 34 and 9 % exclusively breastfed for at least 3 months and 6 months, respectively. Thirty-six percent of women reported strongly valuing exclusive breastfeeding out of which 46 % exclusively breastfeed to three months. In adjusted results, women who reported that they strongly value exclusive breastfeeding had more than twice the odds of exclusive breastfeeding for at least 3 months (Adjusted Odds Ratio [AOR] 2.29; 95 % confidence interval [CI] 1.84, 2.85) and for 6 months (AOR 2.49; 95 % CI 1.76, 3.53) compared to those who did not strongly value exclusive breastfeeding.

CONCLUSION

Valuing the benefits of exclusive breastfeeding during pregnancy is a strong independent predictor of actual exclusive breastfeeding duration. A minority of pregnant women strongly value exclusive breastfeeding and are able to exclusively breastfeed to 3 months even among women with established prenatal intention to exclusively breastfeed. Prenatal maternal education and environmental lactation support that extends into the postnatal period can promote longer duration of exclusive breastfeeding.

An Evaluation of the Effectiveness of School-Based Breastfeeding Education

School-based interventions aimed at modifying the knowledge, attitudes, social norms, and intended future practice regarding breastfeeding may be an effective way of improving breastfeeding rates. A systematic review of relevant literature was conducted to identify scientifically rigorous studies on school-based interventions and promotion activities that focus on breastfeeding. Of the 1990 citations reviewed, only 6 empirical articles on school-based interventions to promote breastfeeding were found and these interventions vary greatly in terms of format, duration, outcome measures, and significance of the results. Overall, these studies demonstrated positive effects on perceptions and attitudes toward breastfeeding and increased behavioral intention of breastfeeding later in life. School-based breastfeeding promotion programs hold promise for increasing knowledge of breastfeeding and support for breastfeeding, promoting positive attitudes, creating a culture where breastfeeding is the norm, and increasing future intentions to breastfeed.

Predictors of Breastfeeding Attitudes Among College-Educated African Americans

Breastfeeding initiation among African American women has reached 60%; however, it is the lowest rate among all races. This racial disparity is a public health concern considering the impact of breastfeeding on infant morbidity and mortality. The purpose of this study was to explore breastfeeding exposure and determinants of breastfeeding attitudes among African Americans. The theory of planned behavior guided this study focusing on the impact of background factors on determinants of breastfeeding attitudes. This secondary analysis included 348 African American college students with a mean age of 22 years with no children. The Iowa Infant Feeding Attitude Scale and a demographic questionnaire were used to collect data. A significant association between knowing someone who breastfed her infant and being breastfed as an infant (p < .001) was observed. Although gender, education, and breastfeeding exposure explained 15% of the variance in breastfeeding attitudes, being breastfed as an infant had no significant (p = .611) contribution. Breastfeeding exposure to someone who has breastfed her infant is a modifiable factor that influenced positive breastfeeding attitudes. Therefore, it is essential to identify strategies in practice to increase breastfeeding exposure for vulnerable populations in efforts to improve breastfeeding attitudes, intentions, and initiation.