Maternal Breastfeeding Self‐Efficacy and the Breastfeeding Behaviors of Newborns in the Practice of Exclusive Breastfeeding

Hypnotherapy influence on maternal psychological, breastfeeding, mRNA-OXTR expression, and OXTR protein

Hypnotherapy has emerged as a potential alternative to improve exclusive breastfeeding rates, particularly in countries like Indonesia where they are below optimal levels. This study aims to evaluate the impact of audio hypnotherapy on the psychological, exclusive breastfeeding behavior, the OXTR protein and mRNA expression gene OXTR in mothers of infants aged 0-6 months. This study employed a Pragmatic Randomized Controlled Trial design, conducted from November 2022 to May 2023 in 11 primary health centers. The study population included breastfeeding mothers with infants aged 0-6 months, with a total sample size of 70 respondents who were randomly divided into intervention (received audio hypnotherapy) and control groups (received standard care). The psychological condition was measured using the Depression Anxiety Stress Scale. Exclusive breastfeeding behavior was assessed based on both quality and quantity. Genetic factors were evaluated through mRNA OXTR expression using real-time PCR and protein OXTR levels using ELISA. Analyzing data using linear and logistic regression models. Both bivariate and multivariate analyses revealed significant differences in psychological condition (p < .0001). There were big differences in the exclusive breastfeeding behavior (p < .0001), as well as in the amounts of protein OXTR and mRNA expression of the OXTR gene (p < .0001). We recommend the implementation of audio hypnotherapy as an effective complementary therapeutic approach to manage the psychological well-being, exclusive breastfeeding behavior, the mRNA expression of the OXTR gene and levels of OXTR protein in mothers of infants aged 0-6 months.

Building a baby-friendly community: Development, strategy, implementation and evaluation of a BFCI program

AIM

The aim of the study was to investigate the impact of the use of baby-friendly community initiative (BFCI) model on various stakeholders in the community.

DESIGN

Quasi-experimental research design.

METHOD

The study was conducted in public premises and online workshops from April 2019 to September 2022. Participants were followed up for a period of 1 month, except for those employed at public premises. The program involved training based on an accredited BFCI framework to cultivate a breastfeeding-friendly attitude and knowledge. A paired sample t-test was used to examine breastfeeding attitude and knowledge scores before and after BFCI training among staff employed from public premises. An analysis of variance was conducted to examine the breastfeeding self-efficacy and attitude scores, measured repeatedly at different timepoints over 1-month timepoint (T0, T1 and T2) among pregnant and postpartum women.

RESULTS

A total of 2340 perinatal women and 1339 staff from public premises were recruited. For staff, there was an increase in the mean score of breastfeeding knowledge and attitude by 5.8 and 6.1, respectively, at T1. Similarly, for perinatal women, there was an increase in the mean score of breastfeeding self-efficacy and attitude by 6.6 and 3.3, respectively, at T1.

CONCLUSION

In summary, a BFCI model, with active community participation, accreditation and an award system, has been effective in promoting breastfeeding. Adapting the baby-friendly hospital initiative to local contexts and employing a social theory model can enhance breastfeeding promotion and improve infant health outcomes. Prioritizing culturally sensitive breastfeeding education is crucial for successful BFCI implementation.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Healthcare professionals should consider clients' culture and socio-economic backgrounds when providing breastfeeding education to maximize effectiveness. The target audience for breastfeeding education should be expanded to include various community stakeholders beyond families.

IMPACT

What problem did the study address? This study addressed the problem of knowledge gaps among stakeholders in building a breastfeeding-friendly community, particularly in implementing a baby-friendly community initiative (BFCI) as part of a baby-friendly hospital initiative (BFHI). The research filled a service gap by providing effective interventions targeting community stakeholders and assessing the impact of a BFCI program on their knowledge and attitudes towards breastfeeding. What were the main findings? The findings highlighted the effectiveness of a BFCI program in enhancing breastfeeding knowledge and attitudes among frontline staff and increasing breastfeeding confidence among mothers. These findings contribute to the understanding of the program's impact on different stakeholders in the community. Where and on whom will the research have an impact? It impacts on global policymakers by providing insights for developing comprehensive guidelines for future BFCI implementations. It also contributes to the creation of a more baby-friendly community, benefiting breastfeeding families and their infants by promoting and supporting breastfeeding families.

REPORTING METHOD

This study has adhered to relevant EQUATOR guidelines using the TREND reporting guideline.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: This study provides an overview of the establishment of a localized BFCI program. It also opens up a new direction for the community to investigate BFCI strategies for community stakeholders. It also provides evidence to support other countries in following a similar process, as each country approaches becoming breastfeeding-friendly in its own unique way.

TRIAL AND PROTOCOL REGISTRATION

No protocol.

Reliability and validity of the Japanese Version of the Infant Breastfeeding Assessment Tool

OBJECTIVE

To translate the Infant Breastfeeding Assessment Tool (IBFAT) into Japanese and confirm the reliability and validity of the Japanese version of IBFAT.

DESIGN

The methodological study examining the reliability and validity of the Japanese version of the IBFAT.

SETTING

A maternity hospital in Tokyo.

PARTICIPANTS

Ten mother-newborn pairs were recruited for the reliability analysis. 101 mother-newborn pairs were recruited for the validity analysis.

MEASUREMENTS AND FINDINGS

Reliability was verified by video recording and direct observation. The observers are one researcher, and 11 evaluators consisting of midwives and nurses. Amongst the 11 evaluators, six evaluators directly observed breastfeeding behaviours and five evaluators observed breastfeeding behaviours through video viewing. Regarding the inter-rater agreement, the intraclass correlation (ICC) between the researcher and six direct evaluators was 0.985 (95% confidence interval [CI]: 0.941-0.996) and that amongst five video viewing evaluators was 0.827 (95% CI: 0.647-0.945). In the intra-rater agreement, the lowest ICC amongst all those investigating IBFAT scores was 0.810 (95% CI: 0.433-0.948). In concurrent validity, the correlation coefficients between the IBFAT and Breastfeeding behaviour Assessment (BBA) scores on the first day after birth and the fourth or fifth day after birth (at discharge) were 0.66 (p < 0.001) and 0.40 (p < 0.001), respectively. In predictive validity, the medians and interquartile ranges (IQRs) of IBFAT scores at discharge were 11.0 (IQR: 11.0-12.0) and 11.0 (IQR: 11.0-12.0) for the breast and mixed milk groups at one-month check-up, respectively. While both median values were the same, the Mann-Whitney U test showed a significant difference.

KEY CONCLUSIONS

The Japanese version of the IBFAT is valid and reliable for measuring feeding behaviour amongst newborns in the first week of life.

IMPLICATIONS FOR PRACTICE

The Japanese version of the IBFAT can be available both in a clinical setting and in research to help support breastfeeding.

The COVID-19 pandemic's impact on breastfeeding self-efficacy: A path analysis

Aims

The COVID-19 pandemic has impacted breastfeeding self-efficacy directly or indirectly. This is likely due to the adverse effect of movement and community activity restrictions to prevent virus transmission. This study aims to measure how breastfeeding self-efficacy has been affected by the COVID-19 pandemic.

Method

This study uses a cross-sectional design with participants consisting of mothers giving birth from June to July 2021 in Bekasi, Indonesia. The recruitment used a consecutive sampling method. The data were collected using the breastfeeding self-efficacy scale-short form, the postpartum bonding questionnaire, the Zung self-rating anxiety scale, and the multidimensional scale of perceived social support. The COVID-19-related factors, i.e., anxiety, bonding and social support on breastfeeding self-efficacy, were measured using the Path Analysis.

Results

The results showed that anxiety, bonding, and social support affected breastfeeding self-efficacy among the 118 respondents. While anxiety had a negative effect on breastfeeding self-efficacy, bonding and social support had a positive effect. The effect of anxiety was more direct (β -0.239; p 0.00) than indirect (β -0.076; p 0.04). Social support also had a more direct (β 0.248; p 0.00) than indirect effect (β 0.118; p 0.046). Likewise, bonding had a significant impact on breastfeeding self-efficacy (β 0.235; p 0.039). However, the effect of anxiety and social support indirectly on breastfeeding self-efficacy via bonding was less significant than their direct impacts.

Conclusion

The factors related to breastfeeding self-efficacy affected by the COVID-19 pandemic are anxiety, bonding, and social support. Interventions during a crisis such as the pandemic could aim to reduce anxiety and improve social support. Health education and counselling are essential to enhance competence and self-efficacy in breastfeeding their babies and build more positive interactions with their children.

Effect of Face-to-Face and WhatsApp Communication of a Theory-Based Health Education Intervention on Breastfeeding Self-Efficacy (SeBF Intervention): Cluster Randomized Controlled Field Trial

Background

The exclusive breastfeeding rate in Malaysia is still not satisfactory. Previous studies have shown that breastfeeding self-efficacy is one of the determinants of exclusive breastfeeding, and it can be improved using social cognitive theory. WhatsApp, which is widely used among Malaysians, could be leveraged as a platform to deliver health education interventions.

Objective

This study aimed to develop, implement, and evaluate the effect of using a face-to-face and WhatsApp-based health education intervention based on social cognitive theory, namely the Self-Efficacy in Breastfeeding (SeBF) module, on mothers' self-efficacy, knowledge, and attitudes in a district in Selangor state.

Methods

This study was a 2-arm, parallel, single-blind, cluster randomized controlled field trial with an intervention and a control group involving primigravida or multigravida mothers who reside in a district in Selangor state and did not exclusively breastfeed during their previous pregnancy. All 12 maternity and pediatric clinics in this district were randomly divided into 6 intervention and 6 control groups. A total of 172 pregnant mothers were randomly assigned to the intervention group (n=86) or the control group (n=86). The control group received usual routine care. The primary outcome was breastfeeding self-efficacy, while secondary outcomes were knowledge and attitude toward breastfeeding. Each subject was assessed at 4 time points: at baseline, immediately after the intervention, 4 weeks post partum, and 8 weeks post partum. Generalized mixed model analysis was applied to measure the effect of health education on breastfeeding self-efficacy, knowledge, and attitude after the intervention.

Results

The response rate was 81% (139/172), with the dropout rate being 7% (6/86) in the intervention group and 31% (27/86) in the control group. In the intent-to-treat analysis, the intervention group showed a significant increase in the mean total breastfeeding self-efficacy score 8 weeks after delivery compared with the control group (F_21,601=111.73, P<.001). In addition, the mean total score for breastfeeding knowledge increased significantly in the intervention group after the intervention compared to the control group (F_21,601=8.33, P<.001). However, no significant difference was found in the mean total score for breastfeeding attitude after the intervention (F_21,602=5.50, P=.47).

Conclusions

Face-to-face and WhatsApp-based participation in the SeBF program, designed on the basis of social cognitive theory, contributed to improved self-efficacy and knowledge about breastfeeding. Further studies need to be conducted with a longer duration (until 6 months post partum) to evaluate its effectiveness in increasing exclusive breastfeeding. Furthermore, new strategies in health education need to be developed to improve breastfeeding attitudes.

Trial Registration

Thaiclinicaltrials.org TCTR20200213004; https://www.thaiclinicaltrials.org/show/TCTR20200213004

Breastfeeding Self-Efficacy for Mothers at the Bulili Health Center, City Palu, Indonesia

Background: Breastfeeding plays an important role in building the relationship between mother and baby, also the baby's growth and development. Improving the mother's self-confidence during breastfeeding is a key to the success of breastfeeding. Exclusive breastfeeding in the working area of the Bulili Health Center is still low, about 37.17%. Breastfeeding self-efficacy (BSE) is a mother's self-confidence in her ability to breastfeed her baby. Objective: This study aimed to analyze the factors related to breastfeeding self-efficacy in the working area of the Bulili Public Health Center, Palu City. Method: This research design was quantitative with a cross-sectional design, involving 82 mothers who have babies aged 6-12 months in the working area of the Bulili Health Center. The instrument used in this study was a Breastfeeding Self-Efficacy Scale-Short Form questionnaire containing demographic data, breastfeeding experience data, observations of others, verbal persuasion, physical and emotional conditions. The data were analyzed using SPSS and Fisher's Exact Test with a significant level of p <0.05. Results: The sample with good breastfeeding experience was 62.9%, those who got the experience of others in the good category were 61.0%, those samples with verbal persuasion were in a good category of 75.6%. All samples (100%) were in good physiological and emotional condition. Breastfeeding Self-efficacy with a good category was 90.2%. The statistical test showed that the respondent's breastfeeding experience, other people's experiences, and verbal persuasion did not significantly correlate with Breastfeeding Self-efficacy with a p-value <0.05. Conclusion: Breastfeeding experience factors, experiences of other people, physiological and emotional conditions, and verbal persuasion did not significantly relate to the breastfeeding self-efficacy (BSE) of mothers and babies in the Bulili Health Center Work Area, Palu City.

Anti-Inflammatory and Restorative Effects of Olives in Topical Application

METHODS

A literature search was conducted (1990-2021) in Medline, Embase, CINAHL, Google Scholar, Science Direct, SID, IranDoc, and Magiran databases. From the 102 reviewed articles, 17 articles were selected to be included in the current article.

RESULTS

Various forms of olive have long been used to accelerate the healing of various wounds and skin damage such as diabetic foot ulcers, atopic dermatitis, diaper dermatitis, episiotomy wound, and nipple ulcer but there are still no credible documents or articles that provide reliable evidence of topical use.

CONCLUSION

According to the information obtained from the articles reviewed, olive oil appears to be an effective, safe, and available treatment. This study suggests that olive oil is an alternative remedy to minimize the frequent use of chemical-based treatments. More research may be beneficial to reach certainty in terms of curative properties of olive oil in similar or different injuries in different populations.

The association of breastfeeding self-efficacy with breastfeeding duration and exclusivity: longitudinal assessment of the predictive validity of the Greek version of the BSES-SF tool

INTRODUCTION

While breastfeeding self-efficacy (BSES) is an important modifiable determinant of breastfeeding, a structured assessment is not standard practice in Cyprus. We assessed the Greek version of the Breastfeeding Self-Efficacy Scale (BSES-SF), including its predictive validity in terms of Breastfeeding (BF) and Exclusive Breastfeeding (EBF) up to the sixth month.

METHODS

A methodological study with longitudinal design among 586 mother-infant dyads, as part of the "BrEaST Start in Life" project. BSES was assessed 24-48 h after birth and at the first month. Breastfeeding status was assessed at the clinic, the 1st, 4th and 6th month. The association between BSES and breastfeeding was estimated in logistic regression models and its diagnostic ability in ROC analysis.

RESULTS

With Mean = 3.55 (SD = 0.85), BSES was moderate, and lower among Cypriot women, primiparas and those who delivered by Cesarean Section (C/S). There was good internal consistency across the 14 items (Cronbach's α = 0.94) while factor analysis revealed a two-factor structure. BSES scores were higher among mothers who initiated exclusive breastfeeding (M = 3.92, SD = 0.80) compared to breastfeeding not exclusively (M = 3.29, SD = 0.84) and not breastfeeding (M = 3.04, SD = 1.09; p-value < 0.001). There was a stepwise association with exclusivity (40.5% in the highest vs 7.9% lowest quartile of self-efficacy). The association between in-hospital BSES and long-term EBF persisted in multivariable models. Women in the upper quartile of BSES at 48 h were more likely to breastfeed exclusively by adjOR = 5.3 (95% CI 1.7-17.1) at the 1st and adjOR = 13.7 (95% CI 2.7-68.6) at the 4th month. Similar associations were observed between self-efficacy at the 1st month and BF at subsequent time-points. High first month BSES (> 3.96 as per ROC) had 58.9% positive and 79.6% negative predictive value for breastfeeding at 6 months which reflects higher sensitivity but lower specificity.

CONCLUSIONS

The Greek version of BSES-SF showed good metric properties (construct, know-group, concurrent and predictive validity). In the absence of community support structures or programmes in Cyprus, prevalence of breastfeeding remains low. This suggests a need for policy, educational and community support interventions, including the systematic use of BSES scale as a screening tool to identify those at higher risk for premature BF discontinuation.

Positive Effects of Kangaroo Mother Care on Long-Term Breastfeeding Rates, Growth, and Neurodevelopment in Preterm Infants

Background and Objectives: Kangaroo mother care (KMC) benefits preterm infants' health through increasing breastfeeding, but the longitudinal effects of KMC remain unknown. This study investigates the impact of KMC on breastfeeding and health outcomes in Chinese preterm infants. Methods: A longitudinal randomized controlled study was conducted with 79 preterm infant-mother dyads. The KMC group (n = 36) was provided 2.5 hours/day KMC during the neonatal intensive care unit (NICU) hospitalization, while the control group (n = 43) received standard care. Infant's feeding regimens and physical growth were documented daily at NICU. Physical growth and Neonatal Behavioral Neurological Assessment were measured at 40 weeks, 3 months, and 6 months of corrected age (CA). Breastfeeding outcomes were documented at 6 months of CA. Results: Compared with the control group, KMC infants received higher mothers' milk proportion during hospitalization (B = 0.16, confidence interval [CI] = [0.11-0.21]) and less feeding intolerance at discharge (odds ratio [OR] = 0.11, CI = [0.02-0.43]); and higher exclusive breastfeeding proportion (OR = 14.6, CI = [3.5-60.9]) at 6 months CA. KMC infants also had significant increased body weight and body length at hospital discharge; and more increases of body weight, body length, and head circumference in follow-ups. The neurobehavioral score was also higher in the KMC group compared to the control group over time. Conclusions: Longitudinal KMC effects are significant in promoting preterm infants' breastfeeding outcomes, growth, and neurodevelopment. Early initiation of KMC practice is highly recommended to the parent-infant population in Chinese NICUs to promote breastfeeding and developmental outcomes.

Mixed milk feeding: a systematic review and meta-analysis of its prevalence and drivers

CONTEXT

Extensive literature is available on exclusive breastfeeding and formula-feeding practices and health effects. In contrast, limited and unstructured literature exists on mixed milk feeding (MMF), here defined as the combination of breastfeeding and formula feeding during the same period in term infants > 72 hours old (inclusion criterion).

OBJECTIVE

A systematic review and meta-analysis were performed, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, on the global prevalence of MMF (primary outcome) and related drivers and practices (secondary outcomes).

DATA SOURCES

The search of MMF in generally healthy populations was conducted across 6 databases, restricted to publications from January 2000 to August 2018 in English, Spanish, French, and Mandarin.

DATA EXTRACTION

Two reviewers independently performed screenings and data extraction according to a priori inclusion and exclusion criteria.

DATA ANALYSIS

Of the 2931 abstracts identified, 151 full-text publications were included for data extraction and 96 of those were included for data synthesis (the majority of those were cross-sectional and cohort studies). The authors summarized data across 5 different categories (feeding intention prenatally, and 4 age intervals between > 72 hours and > 6-23 months) and 5 regional subgroups. The overall prevalence of MMF across different age intervals and regions varied between 23% and 32%; the highest rate was found for the age group 4-6 months (32%; 95% confidence interval, 27%-38%); regional comparisons indicated highest MMF rates in Asia (34%), North and South America (33%), and Middle East and Africa together (36%), using a random effects meta-analysis model for proportions. Some drivers and practices for MMF were identified.

CONCLUSION

MMF is a widespread feeding reality. A shared and aligned definition of MMF will help shed light on this feeding practice and evaluate its influence on the duration of total breastfeeding, as well as on infants' nutrition status, growth, development, and health status in the short and long terms. PROSPERO registration number CRD42018105337.

The Anti-Inflammatory Properties of the Topical Application of Human Milk in Dermal and Optical Diseases

Methods

The various datasets including Ovid, PubMed, Google Scholar, Science Direct, Magiran, Irandoc, SID, and IranMedex were searched from 1990 to 2018. From the 119 reviewed articles, 20 articles were selected to be included in the current article.

Results

There is a consensus among the literature and ancient texts regarding the effectiveness of THM in curing the various types of skin damages, such as cord separation, atopic dermatitis, diaper dermatitis, conjunctivitis, scratches, insect bite, perineal ulcer, and nipple ulcer. However, the importance of its application has not been given much attention.

Conclusion

According to the information obtained from the articles reviewed, the THM appears to be an effective, safe, and available treatment compared to conventional chemical treatments. This study suggests THM as an alternative remedy to minimize the frequent use of chemical-based treatments. More research may be beneficial to reach certainty in terms of curative properties of THM in similar or different injuries in different populations.

Patterns and predictors of exclusive breastfeeding in Chinese Australian mothers: a cross sectional study

BACKGROUND

While exclusive breastfeeding is recommended to 6 months of age, just 15% of mothers in Australia achieve this. The rate appears to be even lower among mothers born in China, where 90% have introduced infant formula by this time. This study aimed to examine infant feeding patterns in the first 12 months of life and the factors associated with exclusive breastfeeding at 4 months of age and infant formula introduction by 1 month of age among Chinese Australian mothers.

METHODS

Chinese Australian women with a child aged 1 to 4 years born in Australia were recruited through social media and asked to complete an online survey. Chinese ethnicity was defined as the mother or her parents having been born in mainland China, Taiwan or Hong Kong. Infant feeding practices since birth and a range of psychosocial and cultural factors were assessed. A total of 289 Chinese Australian mothers completed the survey. The relationships between exposure variables and exclusive breastfeeding at 4 months or infant formula use by 1 month were examined using multivariable logistic regression.

RESULTS

Almost all (93%) mothers initiated breastfeeding, however by 1 month of age exclusive breastfeeding rates reduced to 44%, with a further decline to 33 and 18% at 4 and 6 months respectively. Concurrently, 7% of parents reported infant formula feeding at birth increasing to 55 and 63% at 1 and 6 months of age respectively. The rates of any breastfeeding were 81% at 6 months and 50% at 12 months of age. Breastfeeding intention, self-efficacy and awareness of the infant feeding guidelines were key factors associated with sustained exclusive breastfeeding to 4 months.

CONCLUSIONS

While Chinese Australian mothers had comparable exclusive breastfeeding rates at 6 months to the general Australian population, twice as many had introduced infant formula by 1 month of age. There is an urgent need to support Chinese Australian mothers in the perinatal period to strengthen their knowledge, intention and confidence to delay early introduction of infant formula and promote exclusive breastfeeding in the early postpartum period.

Enhancing Breastfeeding - Home-Based Education on Self-Efficacy: A Preventive Strategy

Background:

The aim of this study is to evaluate the effects of home-based education intervention on the exclusivity and promoting the rates of self-efficacy of breastfeeding.

Materials and Methods:

A randomized controlled trial was conducted Arak University of Medical Sciences in Takeghani Hospital in Iran between June 2015 and October 2015. A total of 130 eligible and voluntary women hospitalized in Arak University of Medical Sciences Hospital postpartum wards were randomized to receive usual care (n = 65) or education with CD and pamphlets (n = 65). Data regarding exclusive breastfeeding were collected using Denis and Fox's breastfeeding self-efficacy questionnaire. The primary outcome was collected by one assistant researcher during first postpartum visit. The secondary outcome was collected 4 weeks after birth of babies by telephone interviews. Data analysis was performed using descriptive (frequency, mean), independent samples t-test, Student's t-test, t²-test, and Chi-square test. All values of P < 0.05 were considered statistically significant.

Results:

There was no significant differences between the intervention and control groups with regard to age (P = 0.086) and gestational age (P = 0.741). The breastfeeding self-efficacy scores were higher in the intervention group (63.66 ± 6.11) than in the control group (57.04 ± 6.18) after 1 month of childbirth (P = 0.001). The exclusive breastfeeding rate in intervention group was 89.2 (n = 58) at 1^st month after education compared with 55.4% (n = 36) in control group (P = 0.001).

Conclusions:

In a setting, a high breastfeeding rate and self-efficacy scores were found in education group. Therefore, nurses and midwives are thus required to adopt various health education strategies, such as home education, encourage breastfeeding.

Do postpartum anxiety and breastfeeding self-efficacy and bonding at early postpartum predict postpartum depression and the breastfeeding method?

We investigated whether postpartum anxiety (PPA) and breastfeeding self-efficacy and bonding at the early postpartum period can be used to predict postpartum depression and the breastfeeding method, and we sought to identify factors related to postpartum depression. Of the 510 eligible women, 185 (36%) returned the questionnaire on all three occasions (1 day, 3 days, and 1 month after childbirth). The mothers' progress on the State-Trait Anxiety Inventory (STAI), Breastfeeding Self-Efficacy Scale Short Form (BFSES-SF), and Postnatal Bonding Questionnaire (PBQ) was observed over three periods. A repeated-measures ANOVA revealed that the mothers at high risk of developing postpartum depression (PPD) were those who did not show an increase in BFSES-SF score at early postpartum, and mothers whose bonding disorders have deteriorated rapidly. The results of the logistic regression analysis revealed a significant difference in employment as a factor related to postpartum depression. Compared to Regular, Part-time status was 4.4 times more likely and Unemployed status was 2.3 times more likely to cause postpartum depression. For the early detection of PPD, it is necessary to identify (1) mothers who do not show an increase in the BFSES-SF score, (2) mothers whose bonding disorders have deteriorated rapidly, and (3) part-time or unemployed mothers as characteristic of postpartum depression.

Women's experiences with breastfeeding in public: An integrative review

BACKGROUND

Much evidence around public breastfeeding does not reflect experiences of the key stakeholder, the breastfeeding woman, and focuses upon the audience. Selective evidence has explored breastfeeding experiences revealing challenges with public breastfeeding as a serendipitous finding. Although women's experiences have been explored in specific contexts, insight into commonalities reflective of an international perspective is unknown.

OBJECTIVE

to explore, review and synthesise published literature on women's experience with public breastfeeding.

METHODS

An integrative review allows inclusion of findings beyond empirical evidence. Whittemore and Knafl's approach was used to capture and analyse evidence from varied sources to provide understanding of a phenomenon from diverse methodologies. PubMed, Medline, Ovid emBase, Scopus, Science Direct, the Cumulative Index of Nursing and Allied Health Literature and PsychINFO were searched. Inclusion criteria included publications in English after 2005 offering descriptions of women's experiences. Data evaluation included assessment of literature quality. A constant comparison approach involved comparing, analysing and drawing similar concepts into themes.

FINDINGS

Integration of women's experience with public breastfeeding from 27 publications covering 12 countries revealed two key themes, what women shared as 'enhancing' and 'challenging'. Challenges included four subthemes: 'drawing attention', 'sexualisation of breasts', 'awareness of others' discomfort', and 'efforts not to be seen'. Enhancing incorporated subthemes: 'supportive audience' and 'confidence'.

CONCLUSION

Challenges confirm an international commonality that women encounter during public breastfeeding suggesting a multilayered approach addressing community and societal behaviours is required. Insight to enhance public breastfeeding experiences offers direction to improve support.

"The sweet and the bitter": mothers' experiences of breastfeeding in the early postpartum period: a qualitative exploratory study in China

Background

In China, the prevalence of exclusive breastfeeding at 6 months was only 20.8%. In promoting breastfeeding for newborns, a number of strategies have been initiated by Chinese government. These actions facilitated a high breastfeeding initiation of 77 to 99.9% in different regions. However, the exclusive breastfeeding rates remained low at 6 months resulting from a high rate of perceived insufficient breast milk and complementary feeding during the early days after childbirth. The aim of this study was to understand the experiences of women in Shenzhen with regard to breastfeeding in the first 6 weeks after giving birth, to identify the facilitators and barriers impacting their breastfeeding decisions and to identify their perceived support needs that might facilitate breastfeeding in the future.

Methods

This was a qualitative exploratory study. Data were collected in November 2018 through semi-structured, face-to-face, in-depth interviews. A purposive sample of early postpartum women was recruited from a postpartum clinic of a tertiary maternal hospital in Shenzhen, China. The dataset was analysed using inductive content analysis.

Results

A total of 22women were interviewed within the first 6 weeks after delivery. Three themes related to breastfeeding were identified from the transcribed interviews: “breastfeeding facilitators,” “breastfeeding barriers,” and “recommendations for breastfeeding promotion.”

Conclusions

Women experienced both joy and suffering in their journey of breastfeeding. Insufficient knowledge of breastfeeding, discomfort, intergenerational disagreements regarding nutritional supplements, and a lack of professional support contributed to difficulties and the threat of discontinuation. A supportive environment for breastfeeding is crucial for women’s decision on exclusive breastfeeding and the psychological wellbeing of breastfeeding women. Interventions that target to promote exclusive breastfeeding should include both new mothers and significant family members. Future studies could test the effectiveness of breastfeeding training for home visit nurses to promote exclusive breastfeeding in the early postpartum.

Predictors of breast milk substitute feeding among newborns in delivery facilities in urban Cambodia and Nepal

Introducing breast milk substitutes (BMS) in the first days after birth can increase infant morbidity and reduce duration and exclusivity of breastfeeding. This study assessed determinants of BMS feeding among newborns in delivery facilities in Phnom Penh, Cambodia, and Kathmandu Valley, Nepal. Cross-sectional surveys were conducted among mothers upon discharge from health facilities after delivery: 304 mothers in Kathmandu Valley and 306 mothers in Phnom Penh participated. On the basis of a conceptual framework for prelacteal feeding, multivariable logistic regression was used to identify factors associated with BMS feeding prior to facility discharge. In both Phnom Penh and Kathmandu Valley, feeds of BMS were reported by over half of mothers (56.9% and 55.9%, respectively). Receiving a health professional's recommendation to use BMS increased the odds of BMS feeding in both Kathmandu Valley and Phnom Penh (odds ratio: 24.87; confidence interval [6.05, 102.29]; odds ratio: 2.42; CI [1.20, 4.91], respectively). In Kathmandu Valley, recommendations from friends/family and caesarean delivery were also associated with BMS use among mothers. Early initiation of breastfeeding and higher parity were protective against the use of BMS in Kathmandu Valley. Breastfeeding support from a health professional lowered the odds of BMS feeding among newborns. Exposure to BMS promotions outside the health system was prevalent in Phnom Penh (84.6%) and Kathmandu Valley (27.0%) but was not associated with BMS feeds among newborns. Establishment of successful breastfeeding should be prioritized before discharging mothers from delivery facilities, and health professionals should be equipped to support and encourage breastfeeding among all new mothers.

Associations Between Breastfeeding and Mother-Infant Relationships: A Systematic Review

Introduction: Breastfeeding has been associated to an improved mother-child bond, although this link is lacking the sufficient empirical support. Aims: The aims of this study were to carry out a systematic review as a continuation to the one by Jansen et al., and to clarify the link between breastfeeding and mother-infant relationships. Materials and Methods: Data sources: A search was conducted using PsycINFO, MEDLINE, and CINAHL (2008-2018), using both free text words and subject headings. Additional hand-searching was performed. Study selection: The Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) framework guided (the reporting of) the study selection and data extraction. Eligible articles were subsequently selected by title, abstract, and full text review. Data extraction: Data regarding study setting, participants, breastfeeding, mother-infant relationships, and outcome measures were extracted in a systematic way. Results of Data Synthesis: Ultimately, 13 articles were included. Most studies were conducted in Europe (46.15%) and were nonexperimental studies (92.3%). Eight studies were longitudinal, using between two and five assessment time points. The instruments used to assess the bond between mother and child showed great variability. From the studies, 8 (61.5%) employed self-report measures and four assessed maternal perception. Others used open-ended questions regarding the maternal lactation process or about the mother's activity while breastfeeding. Other measures used were maternal perception of her baby and personality variables associated to breastfeeding. Five articles studied the bond using external observations of the interactions between mother-child. The quality of the studies (Medical Education Research Studies Quality Instrument [MERSQI]) was overall fair to good. Conclusion: It is complicated to extract generalizable results because of the conceptual and instrumental variability of the mother-child relationship. This association is complex and the way in which breastfeeding is carried out would appear to be a decisive factor, influenced in turn by additional variables that should also be taken into account. The relationship indicators most frequently associated to breastfeeding are maternal sensitivity and secure attachment.

The Effect of Information-Motivation-Behavioral Skills on Breastfeeding Success: A Hypothetical Model

Introduction: Although breastfeeding is a common practice in Turkey, there are problems with exclusive breastfeeding for the first 6 months of life or sustaining breastfeeding. The purpose of this study was to determine the variables that affect breastfeeding success of Turkish women by creating a hypothetical model based on the information-motivation-behavioral skills model. Methodology: This cross-sectional study was conducted with 229 women who gave birth at a public hospital. Data were collected using a questionnaire and through observation. Structural equation model was used for data analyses. Results: Information was found to directly affect behavioral skills and indirectly affect self-management behaviors and breastfeeding success (p < .05). The motivation was found to affect self-management behaviors directly (p < .05). Behavioral skills were found to directly affect self-management behaviors and indirectly affect breastfeeding success (p < .05). Discussion: The results can be used to develop culturally congruent nursing interventions and improve breastfeeding success.

Self-efficacy, infant feeding practices, and infant weight gain: An integrative review

It has been suggested that self-efficacy specific to parenting or feeding may influence the decisions parents make regarding infant feeding; however, a review of this topic has not been conducted. The purpose of this integrative review is to synthesize the literature regarding the potential role of self-efficacy in infant feeding practices or infant weight gain. A total of 40 articles were used to guide this review, which were classified into three categories examining an association with self-efficacy (1) breastfeeding; (2) infant feeding practices such as parental feeding style and dietary quality; and (3) infant weight gain. Evidence regarding breastfeeding self-efficacy (BFSE) and breastfeeding is extensive; mothers with a higher sense of BFSE more often initiate breastfeeding and breastfeed for longer durations. The evidence regarding self-efficacy and the association with infant feeding practices other than breastfeeding is sparse. However, several studies report that mothers who have a higher sense of self-efficacy are more likely to follow infant feeding practices which align with recommendations. The authors have speculated an association between self-efficacy and infant weight gain; yet, to date, no study has found a significant association. More research is needed on the topic, particularly in diverse populations and with fathers and mothers.

Breastfeeding Duration and the Theory of Planned Behavior and Breastfeeding Self-Efficacy Framework: A Systematic Review of Observational Studies

Introduction Numerous studies have shown that the constructs of the Theory of Reasoned Action (TRA), Theory of Planned Behavior (TPB) and Breastfeeding Self-Efficacy (BSE) Framework can effectively identify relationships between maternal psychosocial factors and breastfeeding initiation. However, the ability of these theories to predict breastfeeding duration has not been adequately analyzed. The aim of the review was to examine the utility of the constructs of TRA/TPB and BSE to predict breastfeeding duration. Methods We conducted a literature search using Pubmed (1980-May 2015), Medline (1966-May 2015), CINAHL (1980-May 2015), EMBASE (1980-May 2015) and PsycINFO (1980-May 2015). We selected studies that were observational studies without randomization or blinding, using TRA, TPB or BSE as the framework for analysis. Only studies reporting on breastfeeding duration were included. Results Thirty studies were selected, which include four using TRA, 10 using TPB, 15 using BSE and one using a combination of TPB and BSE. Maternal intention and breastfeeding self-efficacy were found to be important predictors of breastfeeding duration. Inconsistent findings were found in assessing the relationship between maternal attitudes, subjective norms, perceived behavior control and breastfeeding duration. Discussion The inadequacy of these constructs in explaining breastfeeding duration indicates a need to further explore the role of maternal self-determination in breastfeeding behavior.

Factors Affecting Breastfeeding Outcomes at Six Months in Preterm Infants

BACKGROUND:

Preterm mother-infant dyads often face many obstacles to breastfeeding. Preterm infants are at highest risk for low rates of exclusive breastfeeding.

RESEARCH AIM:

To determine the prevalence of breastfeeding at 6 months among preterm infants and to identify factors that influenced mothers' breastfeeding practices.

METHODS:

A longitudinal observational study was conducted in a metropolitan hospital in Beijing, China. Mothers ( N = 270) and their preterm infants ( N = 280) were included in the study. Characteristics of preterm mothers and their perceptions of breastfeeding self-efficacy, knowledge, social support, and postpartum depression symptoms were measured at the discharge of neonatal intensive care. Breastfeeding data were collected by phone interview at 6 months corrected age.

RESULTS:

At discharge, mothers of very preterm infants perceived a lower level of breastfeeding self-efficacy (measured with the Breastfeeding Self-Efficacy Scale-Short Form) and had a higher level of depression symptoms (measured with the Edinburgh Postnatal Depression Scale [EPDS]) than mothers of moderate and late preterm infants ( p < .05-.01). Nearly half of all mothers had an elevated EPDS score, considered to be symptomatic of postpartum depression. At 6 months, only 22.5% of all infants were exclusively breastfeeding. Factors associated with exclusive breastfeeding, including younger maternal age, previous breastfeeding experience, shorter mother-infant separation time during intensive care, older infant gestational age, and a higher level of breastfeeding self-efficacy, significantly predicted exclusive breastfeeding practice ( p < .05-.001).

CONCLUSION:

The prevalence of breastfeeding at 6 months for preterm infants in this sample was low. Strategies to improve breastfeeding duration for preterm infants are needed, including support and education of mothers while in the hospital.

Prenatal breastfeeding self efficacy scale: validity and reliability study

AIM

To determine the validity and the reliability of the Prenatal Breastfeeding Self-Efficacy Scale.

MATERIAL AND METHODS

This was a methodologic study. The sample of the research comprised 200 pregnant women who presented to the outpatient clinic of Gynecology between April and June 2015. An introductory information form and the Prenatal Breast Self-Efficacy Scale were used to collect the data. In the analysis of the data, descriptive statistics, content validity index for coverage validity, exploratory factor analysis, and confirmatory factor analysis for construct validity, and Cronbach-alfa α for reliability were used.

RESULTS

In the explanatory factor analysis of the scale, the Kaiser-Meyer-Olkin floor number was 0.84 and the Barlett's sphericity test results were χ2=1812.608; df=171; p<0.001. The contribution of the factors to total variance was 59.06%. According to confirmatory factor analysis of the scale, the Chi-square test result was as follows: χ2=254.23 (p<0.001, SD=146). The model fit indices were as follows: χ2/SD=1.74, Root Mean Square Error of Approximation=0.06, Comparative Fit Index=0.96, Normed Fit Index=0.92, Non-Normed Fit Index=0.96, Goodness of Fit Index=0.88 and Adjusted Goodness of Fit Index=0.85. The internal consistency reliability coefficient of Prenatal Breastfeeding Self-Efficacy Scale was 0.86.

CONCLUSION

The Prental Breastfeeding Self-Efficacy Scale is a valid and reliable scale which is applicable to Turkish culture and an appropriate tool which can be used by all healthcare workers who wish to design and evaluate interventions to support breastfeeding in the prenatal period.

Concept Analysis

The literature is replete with references to the concept of breastfeeding self-efficacy. This concept is relevant to the nursing and lactation disciplines and requires analysis to gain a mutual understanding of the term. Clarification of the concept of self-efficacy as it relates to breastfeeding will standardize the use of this terminology in professional practice and research. The authors conducted a review of recent literature to identify the attributes, definition, antecedents, and consequences of breastfeeding self-efficacy. Model, related, borderline, and contrary cases further illustrate the concept. Several empirical referents for breastfeeding self-efficacy are identified and analyzed for validity, reliability, and adaptability.

What factors influence exclusive breastfeeding based on the theory of planned behaviour

OBJECTIVE

The primary objective is to investigate the related factors of exclusive breastfeeding based on the theory of planned behaviour (TPB) and identify the most influencing factor in first-time mothers at 4 postnatal months.

DESIGN AND PARTICIPANTS

A cross-sectional study was conducted and 400 first-time mothers at 4 months postnatal were approached.

MEASUREMENTS

Data on mothers' breastfeeding knowledge, attitude, subjective norm and practice control were collected at 4 months postnatal based on the TPB. The associations between these four factors and exclusive breastfeeding outcome were analysed using logistic regression and artificial neural network.

FINDINGS

Responses were acquired from 272 mothers. Exclusive breastfeeding rate was 34.4% at 4 months. About 66% and 79% mothers stopped breastfeeding their babies partially and absolutely during the first two postnatal months. Results showed that higher scores of breastfeeding knowledge (OR = 1.09, 95% CI = 1.04-1.14), attitude (OR = 1.04, 95% CI = 1.00-1.09), subjective norm (OR = 1.22, 95% CI = 1.11-1.34) and practice control (OR = 1.11, 95% CI = 1.02-1.20) were associated with a higher rate of exclusive breastfeeding. Among the four factors, breastfeeding knowledge was the utmost important factor contributing to exclusive breastfeeding.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Breastfeeding knowledge, attitude, subjective norm and practice control are positively related to exclusive breastfeeding based on the TPB. Future breastfeeding promotion intervention should target these four factors, especially breastfeeding knowledge, and continue for at least two postnatal months.

Women’s experiences of formula feeding their infants: an interpretative phenomenological study

Objective

This study aimed to explore the experiences of women in the process of formula feeding their infants. The World Health Organization has emphasized the importance of breastfeeding for infant health. After decades of breastfeeding promotions, breastfeeding rates in Hong Kong have been rising consistently; however, the low continuation rate is alarming. This study explores women’s experiences with formula feeding their infants, including factors affecting their decision to do so.

Methods

A qualitative approach using an interpretative phenomenological analysis (IPA) was adopted as the study design. Data were collected from 2014 to 2015 through individual in-depth unstructured interviews with 16 women, conducted between 3 and 12 months after the birth of their infant. Data were analyzed using IPA.

Results

Three main themes emerged as follows: (1) self-struggle, with the subthemes of feeling like a milk cow and feeling trapped; (2) family conflict, with the subtheme of sharing the spotlight; and (3) interpersonal tensions, with the subthemes of embarrassment, staring, and innocence. Many mothers suffered various stressors and frustrations during breastfeeding. These findings suggest a number of pertinent areas that need to be considered in preparing an infant feeding campaign.

Conclusions

The findings of this study reinforce our knowledge of women’s struggles with multiple sources of pressure, such as career demands, childcare demands, and family life after giving birth. All mothers should be given assistance in making informed decisions about the optimal approach to feeding their babies given their individual situation and be provided with support to pursue their chosen feeding method.

The Voices That Influence HIV-Positive Mothers' Breastfeeding Practices in an Urban, Ghanaian Society

BACKGROUND

The World Health Organization recommends that HIV-positive mothers should breastfeed for at least 1 year. There are people in the lives of these mothers who influence their decisions. Research aim: The aim was to explore the role of social persuasion in the decision-making processes of HIV-positive breastfeeding mothers.

METHODS

A qualitative, exploratory research design was employed ( N = 13). Participants were recruited from a public hospital in the Greater Accra Region of Ghana. One-on-one interviews were recorded and transcribed verbatim, and the contents of the transcripts were analyzed for emerging themes.

RESULTS

The perspectives of spouses, health workers, counselors, and siblings about breastfeeding affect the breastfeeding practices of mothers living with HIV in Ghana. Most of the women had negative experiences with their midwives. Because of complex social and cultural influences, the opinions of spouses, health professionals, siblings, and members of the communities in which breastfeeding mothers with HIV live influence breastfeeding practices.

CONCLUSION

This study described HIV-positive, breastfeeding mothers' perceptions of the role played by spouses, health professionals, siblings, and the community in breastfeeding decisions and practices. Influential people in the lives of breastfeeding mothers with HIV should be involved during interventions by HIV counselors to promote breastfeeding practices.

Autoeficácia na amamentação e duração do aleitamento materno exclusivo entre mães adolescentes

Resumo Objetivo Verificar a associação entre a autoeficácia na amamentação de mães adolescentes e a duração do aleitamento materno exclusivo. Métodos Estudo longitudinal e prospectivo. Para avaliação da autoeficácia na amamentação foi utilizada a versão brasileira da Breastfeeding Self-Efficacy Scale na maternidade, e para avaliação da alimentação da criança foi aplicado um questionário, por meio de contato telefônico, com 30, 60 e 180 dias pós-parto. Resultados 56,90% das participantes apresentaram alto nível de autoeficácia para amamentar. A prevalência AME foi de 62% em 30 dias, 52,59% em 60 dias e 16% em 180 dias pós-parto. Não houve associação significativa entre a confiança com a duração do aleitamento materno exclusivo. Conclusão A confiança não foi um fator preditivo da prevalência do aleitamento materno exclusivo. entre as mães adolescentes. No entanto, evidencia-se a necessidade de novas estratégias para que as adolescentes que passam por intercorrências nestes períodos sejam acolhidas e auxiliadas.

Qualitative exploration of psychological reactions and coping strategies of breastfeeding mothers living with HIV in the Greater Accra Region of Ghana

Background

Exploring the psychological reactions of breastfeeding mothers living with Human Immunodeficiency Virus (HIV) is an important step which may improve guidelines for counselling. The purpose of this study was to explore the psychological reactions and coping strategies of breastfeeding mothers living with HIV in the Greater Accra Region of Ghana.

Methods

Qualitative descriptive exploratory design was used to explore the psychological experiences and coping strategies of 13 breastfeeding mothers living with HIV in a main referral public hospital, at the greater Accra Region of Ghana. An interview guide was designed and piloted before it was used to collect data between November, 2014 and February, 2015. Data was content analyzed for themes and subthemes to emerge.

Results

The two major themes that emerged included psychological reactions and coping strategies. Some of the subthemes were fear, anxiety, blame, hope, denial, prayer and trust in positive situations of life.

Conclusion

The women used denial, prayer and hope in ART, among others to cope with their emotions. This highlights the need for HIV counsellors to detect signs of denial since it can lead to non-adherence to ART as well as relapse. Health workers should therefore put the coping strategies in context during counselling of mothers in this category.

The Effect of a Breastfeeding Motivation Program Maintained During Pregnancy on Supporting Breastfeeding: A Randomized Controlled Trial

BACKGROUND

Exclusive breastfeeding is the recommended breastfeeding method for infants during the first 6 postnatal months.

OBJECTIVE

This study aimed to increase breastfeeding duration and frequency using a breastfeeding motivation program (BMP), which was structurally based on Pender's Health Promotion Model (HPM) and administered during pregnancy and the postnatal period. The study was also designed to determine the BMP effectiveness in supporting exclusive breastfeeding.

MATERIALS AND METHODS

The sample of this randomized controlled trial included 100 pregnant women (50 in the BMP, 50 in the control group) who applied to the pregnancy preparation course in a state hospital located in Usak, western Turkey. Participants in the study were allocated into either the BMP group or control group through systematic sampling and randomization. The BMP was structured based on the HPM and was carried out with the BMP study group four times: during the antenatal period, on the first postnatal day, between the fourth and sixth postnatal weeks, and during the fourth postnatal month. Data were analyzed using the descriptive statistical test, Pearson's chi-square test, independent samples t test, and ANOVA.

RESULTS

The mothers in the BMP group started breastfeeding earlier than the mothers in the control group (97.1%) and had fewer problems with their first breastfeeding experience. The average score of perceived self-efficacy in breastfeeding and the rate of first breastfeeding experience (70.6%) were higher in the BMP group by a statistically significant amount.

CONCLUSION

BMP for breastfeeding, structurally based on Pender's HPM, can help in supporting and maintaining exclusive breastfeeding.

Factors associated with atopy in toddlers: a case-control study

In this case-control study the association between the approaches used to feed infants, together with known family and environmental factors, and the occurrence of atopic illness in toddlers between the ages of 4 months to 3 years in Hong Kong was examined. A total of 206 subjects were recruited from April to June of 2014. The results obtained by binary logistic regression indicated that atopy is associated with boys (OR 2.072, CI 1.089-3.941), the maternal use of antibiotics in utero or while breast feeding (OR 2.276, CI 1.151-4.504), the later commencement of mixed feeding (OR 2.497, CI 1.025-6.082), breast feeding exclusively for 3 months (OR 1.972, CI 1.009-3.857), and having a mother who was diagnosed with eczema (OR 4.510, CI 1.764-11.530). Although an exclusive reliance on breast feeding has been shown to be predictive of atopy among toddlers, the positive qualities of breast milk cannot be ignored. A further study of the contents and nutritional values of breast milk is warranted.

A clinic-based breastfeeding peer counselor intervention in an urban, low-income population: interaction with breastfeeding attitude

BACKGROUND

Whereas breastfeeding initiation rates have risen in all groups throughout the country, rates of breastfeeding duration have changed more slowly. Peer counseling has had some success in sustaining breastfeeding, but with intensive programs and variable effects.

OBJECTIVES

We aimed to improve rates of any and exclusive breastfeeding at 1 and 6 months using a low-intensity peer counseling intervention beginning prenatally. We also planned to study the interaction of breastfeeding attitude and self-efficacy with the intervention.

METHODS

One hundred twenty prenatal women underwent stratified randomization based on breastfeeding attitude, measured by the Iowa Infant Feeding Attitude Scale (IIFAS). The peer counselor contacted the intervention group by telephone or in clinic up to 4 months postdelivery. Study groups were compared on breastfeeding outcomes, adjusting for IIFAS strata, and on interactions with self-efficacy.

RESULTS

One hundred three women were followed to at least 1 month. Women with positive attitudes had significantly higher rates of initiation (93% vs 61%) and breastfeeding at 1 and 6 months (79% vs 25% and 12% vs 0%, respectively) than those with negative attitudes, regardless of intervention. After adjusting for self-efficacy, women who received peer counseling had significantly higher breastfeeding rates at 1 month (odds ratio = 3.2; 95% confidence interval, 1.02-9.8). The intervention group was marginally more likely to achieve their breastfeeding goal (43% vs 22%, P = .073).

CONCLUSION

Breastfeeding rates in all women improved during the study period. Breastfeeding attitude was more strongly associated with breastfeeding behavior than peer support. Peer counseling supported women with low self-efficacy and helped women achieve their breastfeeding goals.

The Effect of Interventional Program on Breastfeeding Self-Efficacy and Duration of Exclusive Breastfeeding in Pregnant Women in Ahvaz, Iran

Objective. This study aimed to determine the effect of educational program on Breastfeeding self-efficacy and duration of exclusive breastfeeding in pregnant women in Ahvaz, Iran. Methods. This randomized controlled trial was conducted on 120 nulliparous pregnant women who tended to breastfeed. The primary self-efficacy scores of samples were measured using Faux and Dennis breastfeeding self-efficacy questionnaire. Women were randomly recruited into two intervention and control groups. Educational program (two training sessions, each lasted two hours) with two days interval was performed for intervention group. One month after delivery, self-efficacy scores were determined. Six months after child birth, duration of exclusive breastfeeding was assessed. Data were analyzed by means of descriptive and inferential statistics. Findings. The breastfeeding self-efficacy in the intervention group increased significantly compared to the control group one month after delivery (123.6 versus 101.7, P < 0.001). The duration of exclusive breastfeeding was significantly higher in the intervention group (5.03 mo versus 2.7 mo, P < 0.001). Also, there was a significant relationship between breastfeeding self-efficacy and duration of exclusive breastfeeding (P < 0.001). Conclusion. The educational program could increase the self-efficacy and exclusive breastfeeding duration of mothers. These results can draw the attention of authorities to the importance of educational programs for mothers regarding the exclusive breastfeeding.