1
|
McGovern LM, O'Toole L, Laws RA, Skinner TC, McAuliffe FM, O'Reilly SL. An exploration of prenatal breastfeeding self-efficacy: a scoping review. Int J Behav Nutr Phys Act 2024; 21:95. [PMID: 39223645 PMCID: PMC11367871 DOI: 10.1186/s12966-024-01641-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 08/09/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Breastfeeding self-efficacy is a woman's self-belief and confidence in her perceived ability to breastfeed. This modifiable determinant is strongly associated with breastfeeding initiation, exclusivity, and duration. It is unclear how important the timing of breastfeeding self-efficacy measurement and interventions are. The prenatal period appears underexplored in the literature and yet a prenatal focus provides increased opportunity for breastfeeding self-efficacy enhancement and further potential improvement in breastfeeding outcomes. This scoping review aims to synthesise the evidence on prenatal breastfeeding self-efficacy, describing for the first time the theoretical frameworks, measurement tools, and interventions used in the prenatal period. METHODS 8 databases were searched using the PCC framework (Problem: breastfeeding, Concept: self-efficacy, Context: prenatal period). From 4,667 citations and 156 additional sources identified through grey literature and snowballing, data were extracted from 184 studies and 2 guidance documents. All were summarised descriptively and narratively. RESULTS Just over half (57%) of included studies stated their theoretical underpinning, with Bandura's Self-Efficacy Theory / Dennis' Breastfeeding Self-Efficacy Framework predominant. Only half of intervention studies incorporated theory in their design. More intervention studies were undertaken in the past decade than previously, but the level of theoretical underpinning has not improved. Prenatal interventions incorporating theory-led design and using components addressing the breadth of theory, more frequently reported improving breastfeeding self-efficacy and breastfeeding outcomes than those not theory-led. Intervention components used less frequently were vicarious or kinaesthetic learning (52.5%) and involvement of social circle support (26%). The Breastfeeding Self-Efficacy Scales were the most common measurement tool, despite being designed for postpartum use. Overall, issues were identified with the late prenatal timing of breastfeeding self-efficacy investigation and the design, content and phraseology of measurements and interventions used in the prenatal period. CONCLUSION This review provides novel insights for consideration in the design and conduct of breastfeeding self-efficacy studies in the prenatal period. Future research should aim to be theory-led, commence earlier in pregnancy, and embed the breadth of self-efficacy theory into the design of interventions and measurement tools. This would provide more robust data on prenatal breastfeeding self-efficacy's role in impacting breastfeeding outcomes.
Collapse
Affiliation(s)
- Liz M McGovern
- UCD School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, D04 V1W8, Ireland
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin 2, D02 YH21, Ireland
| | - Laura O'Toole
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin 2, D02 YH21, Ireland
- UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, D04 V1W8, Ireland
| | - Rachel A Laws
- School of Exercise & Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, 3220, Australia
| | - Timothy C Skinner
- Institute of Psychology, University of Copenhagen, Copenhagen K, 1353, Denmark
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin 2, D02 YH21, Ireland
| | - Sharleen L O'Reilly
- UCD School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, D04 V1W8, Ireland.
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin 2, D02 YH21, Ireland.
| |
Collapse
|
2
|
Burton AE, Owen AL, Taylor J, Dean SE, Cartlidge E, Wright E, Gallagher N. Evaluation of environmental features that support breastfeeding: A photovoice study. Appetite 2024; 199:107397. [PMID: 38735307 DOI: 10.1016/j.appet.2024.107397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/04/2024] [Accepted: 05/03/2024] [Indexed: 05/14/2024]
Abstract
The United Kingdom (UK) has some of the lowest breastfeeding rates in the world, and Stoke-on-Trent has some of the lowest breastfeeding rates and highest infant mortality rates in the UK. Vicarious experience of formula feeding, formula feeding culture, and a lack of physical environments to support breastfeeding are known barriers to uptake and maintenance. Improving physical environments and increasing the visibility of breastfeeding in public would help to challenge these barriers. This research employs a participatory approach to understand the facilitators and barriers to breastfeeding in public. Nine breastfeeding peer supporters were recruited as co-researcher for a photovoice study. Co-researchers collated images of features in environments which they felt either supported or acted as a barrier to public breastfeeding. An analysis workshop was held to review the data collected and produce collaboratively agreed findings. Various environmental features were highlighted as facilitators to breastfeeding including family rooms, welcoming signage, supportive staff members, and displays of information about breastfeeding. In addition, poorly designed family rooms, lack of inclusivity within breastfeeding spaces, breastfeeding spaces within toilets and a lack of information were barriers to public breastfeeding. This research illustrates that while some environments are well designed to support breastfeeding many others are not. Environments often lack basic provision and/or make token gestures towards breastfeeding support, such as welcome signage, without providing the infrastructure needed to support breastfeeding. More education about breastfeeding friendly spaces and resources for putting this information into practice are needed for environment owners, managers, and policy makers.
Collapse
|
3
|
Ballesta-Castillejos A, Rodríguez-Almagro J, Gómez-Salgado J, Martínez-Galiano JM, Romero-Blanco C, Hernández-Martínez A. Preparation and validation of a predictive model of breastfeeding initiation in the first hour of life. Midwifery 2024; 134:104019. [PMID: 38718431 DOI: 10.1016/j.midw.2024.104019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 06/17/2024]
Abstract
OBJECTIVE The objective was to develop and validate a predictive model of initiation of breastfeeding in the first hour after delivery. METHODS Retrospective cohort study on women who gave birth between 2013 and 2018 in Spain. For data collection, an ad hoc questionnaire was designed to be filled in by the mothers, which was distributed to the different Spanish breastfeeding associations which, in turn, shared it with their associate partners. The development of the predictive model was made on a cohort of 3218 women (2/3) and was validated on a cohort of 1609 women (1/3). Mothers whose children were admitted to hospital at the time of birth were excluded. A multivariate analysis was performed by means of logistic regression, and predictive ability was determined by areas under the ROC curve (AUC). RESULTS 81.0 % (2608) women started breastfeeding in the first hour in the derivation cohort, and 80.1 % (1289) in the validation cohort. The predictive factors in the final model were: the highest number of children and skin-to-skin contact at birth as flattering factors, while dystocic delivery reduced the likelihood of the onset of breastfeeding. The predictive ability (ROC AUC) in the derivation cohort was 0.89 (CI 95 %: 0.87-0.90), while in the validation cohort it was 0.89 (CI 95 %: 0.87-0.92). CONCLUSIONS This three-variable predictive model has excellent predictive ability in both the derivation cohort and the validation cohort. This model can identify women who are at high risk of non-initiating breastfeeding within the first hour after delivery.
Collapse
Affiliation(s)
| | - Julián Rodríguez-Almagro
- Department of Nursing. Ciudad Real School of Nursing. University of Castilla La-Mancha, Ciudad Real, Spain.
| | - Juan Gómez-Salgado
- Deparment of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva 21071, Spain; Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil, Ecuador
| | - Juan Miguel Martínez-Galiano
- Department of Nursing, University of Jaén, Spain. Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Cristina Romero-Blanco
- Department of Nursing. Ciudad Real School of Nursing. University of Castilla La-Mancha, Ciudad Real, Spain
| | - Antonio Hernández-Martínez
- Department of Nursing. Ciudad Real School of Nursing. University of Castilla La-Mancha, Ciudad Real, Spain
| |
Collapse
|
4
|
White M, Griffin B, Phalen K, Patel S, Dudney G, Quinn M, Beatty K. Exploring Infant Feeding Experiences and Maternity Care Practices in Appalachia. South Med J 2024; 117:323-329. [PMID: 38830586 DOI: 10.14423/smj.0000000000001694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVES Our aim was to explore postpartum individuals' experiences and perceptions of breastfeeding and International Board Certified Lactation Consultants' (IBCLC) knowledge and perceptions of maternity care practices and perceived barriers to breastfeeding among their patient populations in Appalachia. METHODS Semistructured interviews were conducted with seven IBCLCs and seven postpartum individuals. Interviews were recorded and transcribed. Thematic analysis was conducted to determine emergent themes and subthemes related to knowledge/perceptions, experiences, and barriers to breastfeeding among postpartum individuals, as well as emergent themes associated with the knowledge and perceptions of maternity care practices, easy-/difficult-to-implement Baby-Friendly Hospital Initiative maternity care practices, and perceived barriers to breastfeeding among IBCLCs. RESULTS Postpartum individuals recruited from an Appalachian obstetrics/gynecology clinic were aware of the benefits of breastfeeding, but their infant feeding journeys were more stressful than they expected, and they had limited access to lactation support and breastfeeding education/information. IBCLCs identified the benefits of the Baby-Friendly maternity care practices but mentioned some risks, especially when there is a lack of communication and coordination among providers. Environmental and informational barriers were identified by both postpartum individuals and IBCLCs as breastfeeding challenges potentially amenable to change. CONCLUSIONS To support postpartum mothers in the Appalachian region, environmental barriers (eg, lack of lactation support) and informational barriers (eg, lack of prenatal education) need to be addressed.
Collapse
Affiliation(s)
- Melissa White
- From the Departments of Health Services Management and Policy
| | | | | | | | | | - Megan Quinn
- Biostatistics and Epidemiology, East Tennessee State University, Johnson City
| | - Kate Beatty
- From the Departments of Health Services Management and Policy
| |
Collapse
|
5
|
Rodríguez-Gallego I, Corrales-Gutierrez I, Gomez-Baya D, Leon-Larios F. Effectiveness of a Postpartum Breastfeeding Support Group Intervention in Promoting Exclusive Breastfeeding and Perceived Self-Efficacy: A Multicentre Randomized Clinical Trial. Nutrients 2024; 16:988. [PMID: 38613021 PMCID: PMC11013075 DOI: 10.3390/nu16070988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
There are numerous recognized benefits of breastfeeding; however, sociocultural, individual, and environmental factors influence its initiation and continuation, sometimes leading to breastfeeding rates that are lower than recommended by international guidelines. The aim of this study was to evaluate the effectiveness of a group intervention led by midwives supporting breastfeeding during the postpartum period in promoting exclusive breastfeeding, as well as to assess the impact of this intervention on perceived self-efficacy. This was a non-blind, multicentric, cluster-randomized controlled trial. Recruitment started October 2021, concluding May 2023. A total of 382 women from Andalusia (Spain) participated in the study. The results showed that at 4 months postpartum there was a higher prevalence of breastfeeding in the intervention group compared to formula feeding (p = 0.01), as well as a higher prevalence of exclusive breastfeeding (p = 0.03), and also at 6 months (p = 0.01). Perceived self-efficacy was similar in both groups for the first two months after delivery, which then remained stable until 4 months and decreased slightly at 6 months in both groups (p = 0.99). The intervention improved the average scores of perceived self-efficacy and indirectly caused higher rates of exclusive breastfeeding (p = 0.005). In conclusion, the midwife-led group intervention supporting breastfeeding proved to be effective at maintaining exclusive breastfeeding at 6 months postpartum and also at increasing perceived self-efficacy.
Collapse
Affiliation(s)
- Isabel Rodríguez-Gallego
- Foetal Medicine, Genetics and Reproduction Unit, Virgen del Rocío University Hospital, 41013 Seville, Spain;
- Red Cross Nursing University Centre, University of Seville, 41009 Seville, Spain
| | - Isabel Corrales-Gutierrez
- Surgery Department, Faculty of Medicine, University of Seville, 41009 Seville, Spain
- Foetal Medicine Unit, Virgen Macarena University Hospital, 41009 Seville, Spain
| | - Diego Gomez-Baya
- Department of Social, Developmental and Educational Psychology, Universidad de Huelva, 21007 Huelva, Spain
| | - Fatima Leon-Larios
- Nursing Department, School of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain;
| |
Collapse
|
6
|
Wu Q, Ngien A, Jiang S. Descriptive Norms and eHealth Use Among Older Adults: A Cross-Country Comparative Study. HEALTH COMMUNICATION 2023:1-12. [PMID: 38148390 DOI: 10.1080/10410236.2023.2297120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
eHealth use enables older adults to access and manage healthcare resources, and benefits their health; however, older adults' uptake of eHealth remains low across societies. Social influences such as descriptive norms may be of critical importance in promoting the elderly's usage of eHealth. Based on the Integrative Model of Behavioral Prediction, this study investigates how descriptive norms relate to eHealth use among the elderly in China and the United States. Analysis of the combined sample (N = 1,070) showed that descriptive norms were positively related to eHealth use. Also, descriptive norms were indirectly associated with eHealth use via injunctive norms, attitudes and self-efficacy. Moderated mediation analysis indicated that these direct and indirect relationships differed across the two countries. This study highlights the important role of descriptive norms in promoting older adults' eHealth use behavior and addresses potential country differences in how the elderly respond to descriptive norms. Several important theoretical and practical implications are also discussed.
Collapse
Affiliation(s)
- Qiaofei Wu
- Department of Communications and New Media, National University of Singapore
| | - Annabel Ngien
- Department of Communications and New Media, National University of Singapore
| | - Shaohai Jiang
- Department of Communications and New Media, National University of Singapore
| |
Collapse
|
7
|
Doan DTT, Binns C, Lee A, Zhao Y, Pham MN, Dinh HTP, Nguyen CC, Bui HTT. Factors associated with intention to breastfeed in Vietnamese mothers: A cross-sectional study. PLoS One 2023; 18:e0279691. [PMID: 38085730 PMCID: PMC10715656 DOI: 10.1371/journal.pone.0279691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 12/13/2022] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Breastfeeding has many benefits for mothers, children, and the environment over both the short and longr-term. Prenatal intention to breastfeed is a powerful predictor of short-term breastfeeding outcomes. OBJECTIVE This study aims to analyze breastfeeding intentions, including the intention to feed infants with breastmilk only and to continue exclusive breastfeeding to 6 months among pregnant mothers in Hanoi, Vietnam. METHODS The analysis included 1230 singleton mothers, between 24- and 36-weeks' gestation, who attended antenatal clinics in two hospitals in Hanoi in 2020. RESULTS The proportion of mothers with an "breastfeeding intention" (i.e., intention to feed an infant with breastmilk only) and "exclusive breastfeeding intention" to 6 months was 59.9% and 41.7%, respectively. Mothers who were 25 years or older (aOR = 1.35, 95%CI:1.00-1.81), had an undergraduate educational degree or higher (aOR = 1.38, 95%CI: 1.08-1.76), had observed another woman breastfeeding (aOR = 1.43, 95%CI: 1.03-2.00), were not living with parents-in-law (aOR = 1.34, CI: 1.05-1.70), and were multiparous (aOR = 1.60, 95%CI: 1.16-2.19) had higher odds of "exclusive breastfeeding intention" to 6 months. Among primiparous women, those who thought their husbands support breastfeeding were more likely to intend to feed an infant with breastmilk only. Among multiparous women, feeding the previous child with breastmilk exclusively before the introduction of complementary foods and not giving solid foods together with water until 6 months, were significant predictors for both breastfeeding intentions. CONCLUSION Mothers without exclusive breastfeeding experience should be provided with greater support to promote exclusive breastfeeding intention and outcomes.
Collapse
Affiliation(s)
- Duong Thi Thuy Doan
- Hanoi University of Public Health, Hanoi, Vietnam
- School of Public Health, Curtin University, Western Australia, Australia
| | - Colin Binns
- School of Public Health, Curtin University, Western Australia, Australia
| | - Andy Lee
- School of Public Health, Curtin University, Western Australia, Australia
| | - Yun Zhao
- School of Public Health, Curtin University, Western Australia, Australia
| | - Minh Ngoc Pham
- School of Public Health, Curtin University, Western Australia, Australia
- Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam
| | | | | | | |
Collapse
|
8
|
Grano C, Fernandes M, Conner M. Predicting intention and maintenance of breastfeeding up to 2-years after birth in primiparous and multiparous women. Psychol Health 2023; 38:1536-1552. [PMID: 35007452 DOI: 10.1080/08870446.2021.2025374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 10/12/2021] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Breastfeeding up to 2-years has been associated with short and long-term health benefits for both newborns and mothers. However, few women breastfeed up to 2-years after birth. This study extends previous research on the theory of planned behaviour (TPB) examining the predictors of intention and maintenance of breastfeeding up to 2-years in both primiparous and multiparous women. DESIGN 155 pregnant women participated in this longitudinal study. METHODS Expectant mothers completed a questionnaire and then 2-years after the child's birth were asked to report breastfeeding behaviour. Interactions among parity and TPB constructs were examined. RESULTS Attitudes, descriptive and injunctive norms, and perceived behavioural control (PBC) explained 58% of the variance in mothers' intention to breastfeed. Attitudes were the strongest predictor, followed by PBC, descriptive norms and parity. A significant interaction was found between parity and PBC, showing that PBC was only a significant predictor of intention to breastfeed at 2-years in multiparous women. Intentions predicted breastfeeding behaviour at 2-years. CONCLUSION Promoting intentions may be a useful way to increase breastfeeding duration to 2-years and targeting attitudes and norms may be one way to increase intentions. Further, targeting PBC may also be useful to increase intentions, but only in multiparous women.
Collapse
Affiliation(s)
- Caterina Grano
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Mark Conner
- School of Psychology, University of Leeds, Leeds, UK
| |
Collapse
|
9
|
Okhovat S, Janighorban M, Kazemi A. Development of an exclusive breastfeeding intervention based on the theory of planned behavior for mothers with preterm infants: Study protocol for a mixed methods study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:340. [PMID: 38144023 PMCID: PMC10743988 DOI: 10.4103/jehp.jehp_1257_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 12/22/2022] [Indexed: 12/26/2023]
Abstract
BACKGROUND Despite the significance and benefits of exclusive breastfeeding, its rate among infants, especially preterm infants, is not optimal. Based on evidence, the mother's attitude toward breastfeeding, the subjective norm, and the mother's perceived behavioral control play a role in initiation and continuation of breastfeeding; so the interventions that consider these factors may be useful for breastfeeding premature infants. The aim of this study is to design and develop an exclusive breastfeeding intervention based on the theory of planned behavior for mothers with preterm infants. MATERIALS AND METHODS This exploratory, sequential, mixed methods study will be conducted in three phases. In the first phase, a qualitative study will be conducted based on the theory of planed behavior, to describe the exclusive breastfeeding beliefs of the mothers with preterm infants, the barriers to breastfeeding, and to explain the ways to overcome them. Moreover, the items of the Predictors Of Exclusive Breastfeeding Questionnaire are prepared based on the theory of planned behavior. In the second phase, the intervention plan is designed based on the literature review and the findings of the qualitative study, and it is approved by a panel of experts. Additionally, the psychometric properties of the questionnaire are evaluated and confirmed qualitatively and quantitatively. In the third phase, the developed intervention is implemented and evaluated. CONCLUSION Implementation of supportive educational interventions based on scientific theories can be a step toward improving the rate of onset and continuation of breastfeeding in mothers with preterm infants. Development of interventions based on evidence, identified beliefs, and perceived barriers of the mothers with preterm infants can provide the foundation for more effective interventions according to cultural, social, and religious contexts.
Collapse
Affiliation(s)
- Shirin Okhovat
- Department of Reproductive Health, Student Research Committee, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojgan Janighorban
- Reproductive Sciences and Sexual Health Research Center, Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ashraf Kazemi
- Department of Reproductive Health, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
10
|
De La Cruz D, Lee RP, Gallagher J. Infant feeding choices among Panamanian mothers: A qualitative study. Food Sci Nutr 2023; 11:6010-6019. [PMID: 37823146 PMCID: PMC10563682 DOI: 10.1002/fsn3.3535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 03/27/2023] [Accepted: 06/19/2023] [Indexed: 10/13/2023] Open
Abstract
Infant and child nutrition practices are among the most critical determinants of infant health and breastfeeding is considered the gold standard of infant feeding. Despite extensive public health interventions to promote breastfeeding, its prevalence has decreased in recent years in Panama, particularly in urban settings. There has been a nearly 20% drop in breastfeeding in the 10 years leading to 2020. Current literature often fails to elucidate the factors underpinning Panamanian mothers' decision making in relation to breastfeeding. This article explores the experiences, views, and decision making related to infant feeding choices of mothers in Panama City. The study used a qualitative approach, involving online semistructured interviews with seven participants. Utilizing the socioecological model enabled an understanding of the influence of the various, nested levels of a mother's social environment on behaviors and practices. Five themes were developed following analysis: "practical, bodily, and emotional challenges"; "workplace influences"; "family and friends' support"; "the role of health care and healthcare professionals"; "the influence of social and cultural norms on decisions and practices." The main barrier to breastfeeding was the lack of family support, especially from grandmothers. In contrast, private lactation consultation and partners' support were perceived as the best approaches for breastfeeding success, suggesting an urgent need for publicly available lactation support. This study demonstrates the importance of understanding the complexity of the social norms surrounding infant feeding, showing the challenges that mothers face in this process, and sheds light on the (public) interventions necessary to improve breastfeeding initiation and continuation.
Collapse
Affiliation(s)
| | - Richard Philip Lee
- Faculty of Health & Life SciencesNorthumbria University, Coach Lane Campus (West)Newcastle upon TyneUK
| | - Justine Gallagher
- Faculty of Health & Life SciencesNorthumbria University, Coach Lane Campus (West)Newcastle upon TyneUK
| |
Collapse
|
11
|
Ferguson L, Chervonsky A, Fogel J, Jacobs AJ. Association of Maternal Preferred Language with Breastfeeding Attitudes, Intentions, and Knowledge. JOURNAL OF MOTHER AND CHILD 2023; 27:209-216. [PMID: 37991976 PMCID: PMC10664786 DOI: 10.34763/jmotherandchild.20232701.d-23-00026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 10/19/2023] [Indexed: 11/24/2023]
Abstract
INTRODUCTION Assessing intentions, attitudes, and knowledge about breastfeeding among different language groups is important because the languages reflect cultural differences. We compared attitudes, subjective norms, perceived behavioural control, intentions, and knowledge of breastfeeding among mothers with the five most common preferred languages spoken at a New York City hospital. MATERIALS AND METHODS This cross-sectional study surveyed women (n = 448) in the prenatal clinic and the post-partum unit of a New York City hospital. The survey questions were about breastfeeding attitudes, subjective norms, perceived behavioural control, and intentions, based on the Theory of Planned Behavior. We also administered the Iowa Infant Feeding and Attitude Scale and measured the knowledge of the mothers about breastfeeding. The preferred language spoken by the mother was the main predictor variable. English, Russian, Spanish, Urdu, and Uzbek were the languages studied. RESULTS Multivariate linear regression analyses showed that Russian (B = 2.24, SE = 1.09, p = 0.04), Urdu (B = 2.90, SE = 1.45, p = 0.046), and Uzbek (B = 4.21, SE = 1.35, p = 0.002) speakers all had significantly more positive attitudes toward breastfeeding than did English speakers. Spanish and English language speakers did not differ from each other in their attitudes towards breastfeeding. The language groups did not differ significantly for subjective norms, perceived behavioural control, intention to breastfeed, the Iowa Infant Feeding and Attitude Scale, nor in knowledge regarding breastfeeding. CONCLUSIONS Urdu, Uzbek, and Russian speakers had significantly more positive attitudes towards breastfeeding than did English speakers. To the extent that preferred language is a proxy for culture, clinicians can use this parameter as a basis for directing approaches toward lactation education.
Collapse
Affiliation(s)
- Lincoln Ferguson
- Department of Obstetrics and Gynecology, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
- Department of Obstetrics and Gynecology, South Brooklyn Health, Brooklyn, New York, USA
| | - Alexandra Chervonsky
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York, USA
| | - Joshua Fogel
- Department of Obstetrics and Gynecology, South Brooklyn Health, Brooklyn, New York, USA
- Department of Business Management, Brooklyn College, Brooklyn, New York, USA
| | - Allan J. Jacobs
- Department of Obstetrics and Gynecology, South Brooklyn Health, Brooklyn, New York, USA
- Department of Obstetrics and Gynecology, Downstate Medical Center, Brooklyn, New York, USA
| |
Collapse
|
12
|
The effectiveness of prenatal breastfeeding education on breastfeeding uptake postpartum: A systematic review. Midwifery 2023; 118:103579. [PMID: 36580847 DOI: 10.1016/j.midw.2022.103579] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 09/29/2022] [Accepted: 12/11/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The decision to breastfeed is influenced by physiological, psychological, and emotional factors. However, the importance of equipping mothers with the necessary knowledge for successful breastfeeding practice cannot be ruled out. Studies suggest that the decline in global breastfeeding rate can be linked to lack of adequate breastfeeding education during prenatal stage. Therefore, this review aims to determine the effectiveness of prenatal breastfeeding education on breastfeeding uptake postpartum. METHOD A systematic review of the studies identified by electronic database search (Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Psych INFO, and Sociological Abstracts and Applied Social Sciences Index and Abstracts (ASSIA) published between 2014 - 2021. RESULTS A total of 14 studies met the inclusion criteria. Results showed an increase in breastfeeding uptake, breastfeeding knowledge, increase in positive attitude to breastfeeding and an increase in maternal breastfeeding self-efficacy among mothers who participated in breastfeeding educational programs during prenatal care. CONCLUSION Prenatal breastfeeding education increases women's knowledge of breastfeeding. Mothers who are knowledgeable about breastfeeding and hold a positive approach towards breastfeeding have the tendency to initiate breastfeeding and continue for a lengthened period. Findings demonstrates a general correlation between prenatal breastfeeding education and increased breastfeeding uptake postpartum. The high level of positive breastfeeding outcome inherent in all the studies can be attributed to prenatal breastfeeding education.
Collapse
|
13
|
The Effect of Parenting Peer Education Interventions for Young Mothers on the Growth and Development of Children under Five. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020338. [PMID: 36832465 PMCID: PMC9954868 DOI: 10.3390/children10020338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Abstract
One of the contributing factors in the growth and development of children under five is the mother's ability to provide childcare, but young mothers do not have enough parenting skills. The goal of the current study was to examine the effect of the parenting peer education (PPE) programme on young mothers' parenting self-efficacy and behaviour, and the growth and development of children under five. There were two groups, which were a control group (without intervention) and an intervention group, in which there were 15 participants in each group. Analysis covariance with the pre-test scores as covariates was used in this study. The results showed that, compared with the control group, the intervention group reported significantly better parenting self-efficacy, parenting behaviour, children's growth, and children's development, including cognitive, language, and motoric aspects. The PPE programme can exchange the young mothers' experiences on how their children grow and develop, and the mothers will also receive psychological support. In conclusion, the PPE programme affected the young mothers' parenting self-efficacy and parenting behaviour and the children's growth and development.
Collapse
|
14
|
Alkhaldi SM, Al-Kuran O, AlAdwan MM, Dabbah TA, Dalky HF, Badran E. Determinants of breastfeeding attitudes of mothers in Jordan: A cross-sectional study. PLoS One 2023; 18:e0285436. [PMID: 37146024 PMCID: PMC10162564 DOI: 10.1371/journal.pone.0285436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/20/2023] [Indexed: 05/07/2023] Open
Abstract
Breastfeeding provides the optimal nutrition for an infant. However, breastfeeding practice is on decline globally. Attitude toward breastfeeding may determine the practice. This study aimed to examine postnatal mothers' attitude to breastfeeding and its determinants. A cross-sectional study was conducted, and data on attitude were collected using the Iowa Infant Feeding Attitude Scale (IIFAS). A convenience sample of 301 postnatal women were recruited from a major referral hospital in Jordan. Data on sociodemographic characteristics, pregnancy and delivery outcomes were collected. SPSS was used to analyze the data and identify the determinants of attitudes to breastfeeding. The mean total attitude score for participants was 65.0 ±7.15, which is close to the upper limit of the neutral attitude range. Factors associated with attitude that is positive to breastfeeding were high income (p = 0.048), pregnancy complications (p = 0.049), delivery complications (p = 0.008), prematurity (p = 0.042), intention to breastfeed (p = 0.002) and willingness to breastfeed (p = 0.005). With binary logistic regression modelling, determinants of attitude positive to breastfeeding were highest income level and willingness to breastfeed exclusively (OR = 14.77, 95%CI = 2.25-99.64 and OR = 3.41, 95%CI = 1.35-8.63 respectively). We conclude that mothers in Jordan have neutral attitude to breastfeeding. Breastfeeding promotion programs and initiatives should target low-income mothers and the general population. Policymakers and health care professionals can use the results of this study to encourage breastfeeding and improve breastfeeding rate in Jordan.
Collapse
Affiliation(s)
- Sireen M Alkhaldi
- Department of Family and Community Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Oqba Al-Kuran
- Department of Obstetrics and Gynecology, School of Medicine, The University of Jordan, Amman, Jordan
| | - Mai M AlAdwan
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Tala A Dabbah
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Heyam F Dalky
- Department of Community and Mental Health Nursing, School of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Eiman Badran
- Department of Pediatrics, School of Medicine, The University of Jordan, Amman, Jordan
| |
Collapse
|
15
|
Impact of the Infant Formula Shortage on Breastfeeding Rates. J Pediatr Health Care 2022; 37:279-286. [PMID: 36528487 DOI: 10.1016/j.pedhc.2022.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/11/2022] [Indexed: 12/16/2022]
Abstract
INTRODUCTION This study aimed to determine the impact of the infant formula shortage on breastfeeding rates. METHOD The sample included infants attending newborn through 2-month visits at a rural pediatric practice. Preshortage data was compared with postshortage data from newborn (pre: n = 302; post: n = 302), 1-month (pre: n = 273, post: n = 259), and 2-month (pre: n = 255; post: n = 234) visits. RESULTS Data analysis using Pearson's χ2 and Mann-Whitney tests found a significant increase in breastfeeding rates postshortage compared with preshortage. Breastfeeding initiation increased by 10.6% compared with preshortage. DISCUSSION Many factors contributed to the significant increase in breastfeeding initiation during the formula shortage. Reports of illnesses associated with the ingestion of infant formula made breastfeeding more appealing. Furthermore, breast milk was readily available, whereas formula was not. Positive breastfeeding experiences during the formula shortage may lead to a sustained increase in breastfeeding.
Collapse
|
16
|
Lee DC, Gefen D. The Interplay of Trust and Subjective Norms in Telemedicine Adoption by a Minority Community at Einstein Medical Center Philadelphia. DATA BASE FOR ADVANCES IN INFORMATION SYSTEMS 2022. [DOI: 10.1145/3571823.3571828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Telemedicine is not released into a social vacuum. In some communities - such as the underserved, low income, mostly minority community served by Einstein Medical Center Philadelphia (EMCP) - the social context presents the medical center with unique challenges centered on a strong community sense of historical discrimination. That context is manifested in people being less inclined to trust symbols of external authority and in their strong reliance on subjective norms. Analyzing 540 survey responses by EMCP emergency department (ED) patients shows that trust in the EMCP portal was the strongest predictor of its acceptance. Being an African American had no effect on portal acceptance compared to others in the community. Importantly, there was a negative interaction effect of subjective norms and trust on portal acceptance - meaning that increasing this trust can reduce the importance of subjective norms or, alternatively, that lower subjective norms may increase the importance of trust in determining acceptance. This moderation may have very practical implications for EMCP because, while it might be challenging for EMCP to change long established subjective norms, it is within their power to increase trust in the portal. Theoretical and practical implications are discussed.
Collapse
Affiliation(s)
- Diane C. Lee
- Einstein Healthcare Network, Philadelphia, PA, USA
| | | |
Collapse
|
17
|
Philip RK, Worobetz A, Byrt H, Beirne I, Zutshi R, Cassidy T, Dunne CP. A repeated cross-sectional analysis of breastfeeding initiation rates in Ireland for two decades and 10 recommended priorities for improvement. MATERNAL & CHILD NUTRITION 2022; 19:e13424. [PMID: 36147028 PMCID: PMC9749595 DOI: 10.1111/mcn.13424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/21/2022] [Accepted: 07/29/2022] [Indexed: 12/15/2022]
Abstract
Despite a number of public health and policy-based initiatives, Ireland's national breastfeeding rates are among the lowest globally. Regionally, the Mid-West of Ireland has historically had low breastfeeding initiation rates, and parts of its major urban area such as Limerick City suffer the highest levels of economic deprivation in the country. In that context, this repeated cross-sectional study analysed breastfeeding initiation trends in the Mid-West of Ireland for two decades, from 2001 to 2020 inclusively. Statistical analysis revealed persistently low percentages of women initiating breastfeeding in the region. Time series analyses of the data demonstrated that overall breastfeeding rates are increasing, but continue to be lower than Irish national averages. From these findings and a narrative review of published research, we determined 10 plausible reasons for these consistently low breastfeeding rates. Arising from these, we propose '10 Priorities' to increase the breastfeeding initiation rates in Ireland.
Collapse
Affiliation(s)
- Roy K. Philip
- Division of Neonatology, Department of PaediatricsUniversity Maternity Hospital LimerickLimerickIreland,School of MedicineUniversity of LimerickLimerickIreland
| | | | - Helen Byrt
- Lactation Division, Department of Nursing MidwiferyUniversity Maternity Hospital LimerickLimerickIreland
| | - Irene Beirne
- Neonatal Nursing, Department of MidwiferyUniversity Maternity Hospital LimerickLimerickIreland
| | | | - Tanya Cassidy
- Sociology and Anthropology, School of Nursing, Psychotherapy and Community HealthDublin City UniversityDublinIreland
| | - Colum P. Dunne
- School of MedicineUniversity of LimerickLimerickIreland,Centre for Interventions in Infection, Inflammation and Immunity (4i)University of Limerick School of MedicineLimerickIreland
| |
Collapse
|
18
|
Serrano-Alvarado K, Castro-Porras LV, Astudillo-García CI, Rojas-Russell ME. Sociodemographic and Personal Predictors of Exclusive Breastfeeding in Pregnant Mexican Women Using Public Health Services. Healthcare (Basel) 2022; 10:healthcare10081432. [PMID: 36011089 PMCID: PMC9408730 DOI: 10.3390/healthcare10081432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022] Open
Abstract
Exclusive breastfeeding (EBF) is a cost-effective healthy behavior for the mother–child dyad. Globally, rates of EBF are low. Little research has been conducted on the joint role of modifiable and nonmodifiable variables in pregnant women’s decision-making. The aim was to develop and test a model that used personal and sociodemographic factors to predict whether pregnant women who use public healthcare services plan to breastfeed. In a nonprobabilistic sample of 728 pregnant Mexican women, self-efficacy, the planned behavior theory constructs, and the intention to breastfeed (BFI) were measured. A total 60% of the sample was randomly chosen to develop a predictive multivariate logistic regression model. The model was validated in the remaining 40%. Women in the highest tertiles of attitudes and self-efficacy had fourfold increased chances of having a high BFI (OR 4.2, 95% CI [2.4, 7.4]). Working was associated with a decreased intention to exclusively breastfeed (OR 0.61, 95% CI [0.37, 0.98]). The model predicted BFI with a sensitivity of 38.3% and specificity of 82.2%. While personal variables predict the BFI, working decreases women’s chances of breastfeeding. The results can be utilized to develop primary prevention strategies to help mothers who use public health services to breastfeed.
Collapse
Affiliation(s)
- Karina Serrano-Alvarado
- School of Higher Studies (F.E.S.) Zaragoza, National Autonomous University of Mexico, Mexico City 09230, Mexico;
| | - Lilia V. Castro-Porras
- Centre for Policy, Population and Health Research, National Autonomous University of Mexico, Mexico City 04510, Mexico;
| | | | - Mario E. Rojas-Russell
- School of Higher Studies (F.E.S.) Zaragoza, National Autonomous University of Mexico, Mexico City 09230, Mexico;
- Correspondence: ; Tel.: +52-55-3988-0168
| |
Collapse
|
19
|
Thomson G, Ingram J, Clarke J, Johnson D, Jolly K. Who Gets to Breastfeed? A Narrative Ecological Analysis of Women's Infant Feeding Experiences in the UK. FRONTIERS IN SOCIOLOGY 2022; 7:904773. [PMID: 35938089 PMCID: PMC9352850 DOI: 10.3389/fsoc.2022.904773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/21/2022] [Indexed: 06/15/2023]
Abstract
The early post-natal period is a critical period in women's infant feeding journeys, often marked by high levels of unintended breastfeeding cessation. Previous research has argued that infant feeding should be perceived within a complex system whereby factors operating at different ecological levels (i.e., individual, social/community networks, cultural/institutional) interact to affect individual behaviors. However, currently, more work needs to be done to implement an ecological approach in breastfeeding programs. We adopted a complex-systems lens approach to explore how multi-level factors-individual, mother-infant dyad, health service, family and social networks, and wider community infrastructure-interacted with women's motivations and experiences of breastfeeding. We undertook a secondary analysis of 24 women's interviews; all the women had a strong antenatal intention to breastfeed and were expecting their first baby. The interviews were collected during the UK-based Assets-based feeding help Before and After birth (ABA) feasibility trial when their infant was aged between 4 and 21 weeks. Categorical content analysis was used to explore the interrelationships between key factors and to identify different infant feeding typologies. Two different typologies emerged: "disappointed" (n = 7) and "by hook or by crook" (n = 17). "Disappointed" women had stopped breastfeeding early; women classified as "by hook or by crook" continued breastfeeding despite facing challenges. Sociodemographic, social, and service level differences between the typologies were noted. "Disappointed" women were more likely to be younger, White-British, to have considered mixed-feeding antenatally and experienced negative breastfeeding support from healthcare professionals and personal networks. Infants of "disappointed" women were more likely to have received unexpected "top-ups" and to be perceived as having infant feeding difficulties. Women classified as "by hook or by crook" were just as likely as "disappointed" women to experience birth-related complications, but demonstrated more proactive help-seeking behaviors, had positive experiences of personal/professional support and accessed wider support. While further research is needed to consolidate and/or refute the typologies, the ecological approach shifts the focus away from mothers' decisions to consider the multi-level factors that need to be in place to enable women to breastfeed successfully. Further work to encourage help-seeking behaviors and toward improving facilities, support, and services is needed.
Collapse
Affiliation(s)
- Gill Thomson
- School of Community Health & Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Jenny Ingram
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Joanne Clarke
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Debbie Johnson
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
20
|
Yazdanpanah F, Molazem Z, Rakhshan M, Fallahi MJ, Sadaf AMA. Application of the Extended Theory of Planned Behavior to Predict Exclusive Breastfeeding Intention, In Pregnant Nulliparous Women. A Cross-Sectional Study. INVESTIGACION Y EDUCACION EN ENFERMERIA 2022; 40:e04. [PMID: 36264692 PMCID: PMC9714990 DOI: 10.17533/udea.iee.v40n2e04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 06/06/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE. This study investigated the effect of Extended Theory of Planned Behavior (ETPB) extended theory of planned behavior in comparison with the Theory Of Planned Behavior (TPB) in explaining the intention of Exclusive Breastfeeding Intention (EBF) in Pregnant nulliparous women of Kerman (Iran). METHODS. In this descriptive study, 249 pregnant women in Kerman participated via simple random sampling. The research instruments included Questionnaire related to the structures of the theory of planned behavior, breastfeeding self-efficacy and social support questionnaire for breastfeeding. RESULTS. The results of the correlation test showed a significant relationship between all constructs of the theory of extended planned behavior and the intention of EBF. The highest correlation belonged to the construct of subjective norms (r=0.49). Path regression coefficients in the second model showed that the Self-Efficacy mediator variable is fully capable of meaningful mediation between Social Support and Intention (p<0.001; B=0.383). The conceptual diagram of Structural equation modeling showed a higher explained variance or R2 index for the intention variable for the developed model compared to that of the first model, i.e. (the first model: R2=0.37, the second model: R2=0.46). The goodness-of-fit index had a better status for the developed model. CONCLUSION. Extended TPB with social support and breastfeeding self-efficacy constructs can be appropriate model for predicting the intention and behavior of EBF.
Collapse
|
21
|
An online questionnaire study investigating the impact of psychosocial factors on the duration of breastfeeding. Midwifery 2022; 109:103314. [DOI: 10.1016/j.midw.2022.103314] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 02/19/2022] [Accepted: 03/15/2022] [Indexed: 11/18/2022]
|
22
|
Yi K, Wang Q, Xu J, Liu B. Attribution Model of Travel Intention to Internet Celebrity Spots: A Systematic Exploration Based on Psychological Perspective. Front Psychol 2022; 12:797482. [PMID: 35035373 PMCID: PMC8754157 DOI: 10.3389/fpsyg.2021.797482] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/29/2021] [Indexed: 11/18/2022] Open
Abstract
Previous studies have shown that the empathy process is the main driving factor that triggers tourists’ intention to visit Internet celebrity spots. However, the academic community has not yet formed a unified understanding of the concrete mechanism. Based on this, this study combines the connotations of meme theory and empathy theory and applies Structural Equation Modeling (SEM) to empirically analyze 340 valid samples of Internet celebrity spots visitors to explore the influence mechanism of attributional factors on travel intention. The result shows that mechanism of travel intention can be presented as a psychological model in which travel attribution of tourists to visit Internet celebrity spots is the independent variable, the travel intention is the dependent variable, and the empathy process is the intermediary variable. The influence intensity of internal attribution on affective empathy is higher than that of external attribution, while the influence intensity of external attribution on cognitive empathy has a comparative advantage, and there is a significant difference between them. Empathy process has a significant mediating effect on the relationship between travel attribution and travel intention of tourists to visit Internet celebrity spots, and the mediating effect of affective empathy is significantly greater than that of cognitive empathy. Overall, this study reveals the segmentation elements with strong explanatory power in the behavior of “internet celebrity spots punch in,” examines the practical effect of empathy process in the behavioral intention of traveling, and provides a theoretical reference for the transformation and upgrading of tourist destinations and marketing planning of online communication in the future.
Collapse
Affiliation(s)
- Kui Yi
- School of Economics and Management, East China Jiaotong University, Nanchang, China
| | - Qingqing Wang
- School of Economics and Management, Beijing Jiaotong University, Beijing, China
| | - Jun Xu
- School of Statistics, Jiangxi University of Finance and Economics, Nanchang, China
| | - Bin Liu
- School of Economics and Management, Jiangxi Science and Technology Normal University, Nanchang, China
| |
Collapse
|
23
|
Vázquez-Osorio IM, Vega-Sánchez R, Maas-Mendoza E, Heller Rouassant S, Flores-Quijano ME. Exclusive Breastfeeding and Factors Influencing Its Abandonment During the 1st Month Postpartum Among Women From Semi-rural Communities in Southeast Mexico. Front Pediatr 2022; 10:826295. [PMID: 35252066 PMCID: PMC8894443 DOI: 10.3389/fped.2022.826295] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/24/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION In this study we describe breastfeeding practices among women from semi-rural communities in southeast Mexico, and explore which factors, modifiable or not, are associated with such practices. MATERIALS AND METHODS This was a formative cross-sectional study that included 143 mothers with infants 4-6 months old, from semi-rural communities in Tabasco, Mexico. We collected data on two categories of factors: (1) women's sociodemographic characteristics, and (2) maternal / infant factors. We first analyzed the frequency of various breastfeeding practices. Then, we classified participants into the up to 1 month of exclusive breastfeeding group ( ≤ 1 m-EBF) and the beyond 1 month EBF group (>1 m-EBF), if they practiced EBF for less or more than 1 month, respectively. We compared the two categories of factors between groups and then, using logistic regression models, explored which factors were associated with practicing >1 m-EBF. RESULTS By the end of the 1st month postpartum, 51.7% of participants had abandoned EBF, introduced milk formula (35%), other food (9.1%), non-nutritive liquids (7.7%), or had stopped breastfeeding completely. In the next months, EBF practice fell sharply and mixed feeding grew importantly.Logistic regression models showed that women were more likely to be in the >1 m-EBF group if they lived with the baby's father, had complications during pregnancy, delivered vaginally and attended a health center at least three times postpartum. To the contrary, women were less likely to be practice >1 m-EBF if they gave infants other liquids during their hospital stay; experienced pain or discomfort in breasts/nipples, or used a pacifier after hospitalization; had larger bodies (i.e., higher BMI); and believed that you should give the infant powdered milk or some other food when the baby is not full. CONCLUSION Many factors associated with abandoning EBF, particularly in the early postpartum period, are modifiable and can be altered through timely interventions that include giving correct information and ensuring its comprehension; assertive personal counseling and accompaniment must be provided to mothers; and reinforcement during the early postpartum at health facilities and other settings.
Collapse
Affiliation(s)
- Inocente Manuel Vázquez-Osorio
- Licenciatura de Nutrición, División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Mexico.,Jurisdicción Sanitaria 4 del Municipio de Centro, Secretaría de Salud, Villahermosa, Mexico
| | - Rodrigo Vega-Sánchez
- Departamento de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Eric Maas-Mendoza
- Licenciatura de Nutrición, División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Mexico
| | - Solange Heller Rouassant
- Departamento de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Mexico City, Mexico.,Private Practitioner, Naucalpan, Estado de México, Mexico, Mexico
| | | |
Collapse
|
24
|
Simpson DA, Carson C, Kurinczuk JJ, Quigley MA. Trends and inequalities in breastfeeding continuation from 1 to 6 weeks: findings from six population-based British cohorts, 1985-2010. Eur J Clin Nutr 2022; 76:671-679. [PMID: 34773096 PMCID: PMC9090631 DOI: 10.1038/s41430-021-01031-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 09/26/2021] [Accepted: 10/11/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Understanding inequalities in breastfeeding practices may help to explain the UK's persistently low breastfeeding rates. A recent study using the quinquennial UK Infant Feeding Surveys (IFS) found that sociodemographic inequalities in breastfeeding initiation persisted between 1985 and 2010. The present study investigates the sociodemographic inequalities in breastfeeding continuation at 6 weeks after birth among mothers who initiated and maintained breastfeeding at 1 week in 1985-2010. METHODS Data were drawn from the 1985 to 2010 IFS and restricted to mothers who were breastfeeding at 1 week after birth. Time trends in the proportion of mothers in each sociodemographic group were examined. Logistic regression was used to estimate associations between breastfeeding at 6 weeks and sociodemographic factors, adjusting for confounders. Heterogeneity test was used to assess changes in these associations over time. RESULTS Sociodemographic inequalities in breastfeeding continuation at 6 weeks persisted over the 25-year period. In most survey years, mothers were most likely to breastfeed at 6 weeks if they were 30 or older versus under 25 (OR 1.49-1.99 across survey years, I2 = 0%, heterogeneity P = 0.45); completed full-time education over age 18 compared to 18 or younger (OR 1.56-2.51, I2 = 58.7%, P = 0.03); or of Black, Asian, Mixed, or other ethnicity compared to White (OR 1.45-2.48, I2 = 44.8%, P = 0.16). CONCLUSIONS Among mothers breastfeeding at 1 week, those who were younger, White or had fewer years of full-time education were at greatest risk of discontinuing before 6 weeks. This risk persisted over time and was independent of their high risk of not initiating breastfeeding.
Collapse
Affiliation(s)
- Deon A. Simpson
- grid.4991.50000 0004 1936 8948National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Claire Carson
- grid.4991.50000 0004 1936 8948National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jennifer J. Kurinczuk
- grid.4991.50000 0004 1936 8948National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Maria A. Quigley
- grid.4991.50000 0004 1936 8948National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| |
Collapse
|
25
|
Yi QF, Yang GL, Yan J. Self-Efficacy Intervention Programs in Patients with Chronic Obstructive Pulmonary Disease: Narrative Review. Int J Chron Obstruct Pulmon Dis 2021; 16:3397-3403. [PMID: 34955635 PMCID: PMC8694112 DOI: 10.2147/copd.s338720] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/14/2021] [Indexed: 11/23/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a common chronic disease whose development is irreversible, which leads to more than six million deaths each year. There is no treatment confirmed effective for the improvement of impaired lung function, but the combination of drug therapy with non-drug therapy such as pulmonary rehabilitation training has demonstrated a great potential in reducing the occurrence of complications and delaying the progression of COPD. Self-efficacy is the core of cognitive theory, which is crucial for chronic disease management. It has been proposed as an important component of disease management to help people develop skills to manage diseases more effectively. This study reviewed the development of self-efficacy and its application in patients with COPD, with the purpose of providing a better clinical reference for the treatments of COPD.
Collapse
Affiliation(s)
- Qi-Feng Yi
- Nursing Teaching and Research Department, Third Xiangya Hospital of Central South University, Changsha, People's Republic of China
| | - Guo-Li Yang
- Department of Respiration, Third Xiangya Hospital of Central South University, Changsha, People's Republic of China
| | - Jin Yan
- The Nursing Department, Third Xiangya Hospital of Central South University, Changsha, People's Republic of China
| |
Collapse
|
26
|
Werdani KE, Arifah I, Kusumaningrum TAI, Gita APA, RamadhaniRamadhani S, Rahajeng AN. Intention to Practice Exclusive Breastfeeding and its Associated Factors among Female College Students. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: The breastfeeding intention of female students plays an important role in the formation of breastfeeding behavior in the future. Lack of attention to this, both owned by students and those around them, can reduce breastfeeding practices when they become mothers later. Moreover, the process of forming intentions to manifest into behavior takes a long time. Students are considered as an educated group who are expected to be role models in breastfeeding practices in the community.
AIM: This study intended to examine the relationship between knowledge, subjective norms, and perceptions (benefits, barriers, and vulnerabilities) toward exclusive breastfeeding intention on female college students of the Public Health department on Universitas Muhammadiyah Surakarta.
METHODS: A college basis cross-sectional study was conducted in March 2021. The samples were 187 female students who were willing to participate in the study. The selection of samples using a proportional random sampling technique. Data were collected online questionnaires through an online survey platform. A multi logistic regression test was deployed to examine the exclusive breastfeeding intention and its associated factors on a 95% confidence interval.
RESULTS: Results show that subjective norm is significantly associated with breastfeeding intention (p < 0.05). Students who had supportive subjective norm twice likely to had the intention to practice exclusive breastfeeding OR value 2.22 95% CI (1.07–4.06).
CONCLUSION: Overall, the intention to exclusively breastfed their child was related to the student’s subjective norm. The results of this study have an impact on female students to strengthen their intentions and increase their efforts to plan exclusive breastfeeding when they become mothers. Hence, educational communication is needed to the environment around young women regarding the importance of exclusive breastfeeding so that the social environment can provide support to adolescents in the success of exclusive breastfeeding.
Collapse
|
27
|
Li JY, Huang Y, Huang YY, Shen Q, Zhou WB, Redding SR, Ouyang YQ. Experience predicts the duration of exclusive breastfeeding: The serial mediating roles of attitude and self-efficacy. Birth 2021; 48:397-405. [PMID: 33884662 DOI: 10.1111/birt.12549] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 03/31/2021] [Accepted: 04/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS The relationship between prior breastfeeding experience and the duration of exclusive breastfeeding is of significant interest, but few studies have explored the mechanisms underlying this relationship. The purpose of this study is to address two hypotheses: (a) that attitude and self-efficacy mediate the relationship between previous breastfeeding experience and the duration of exclusive breastfeeding; and (b) that attitude and self-efficacy have serial mediation functions in this relationship. METHODS The data collection process was divided into two stages. The original stage included 394 women hospitalized after delivery who completed socio-demographic questionnaires (including previous breastfeeding experience), the Iowa Infant Feeding Attitude Scale (IIFAS), and the Breastfeeding Self-efficacy Short-Form Scale (BSES-SF). Follow-up data about duration of exclusive breastfeeding were obtained at six months postpartum. RESULTS Mediation analysis indicated that previous breastfeeding experience directly affected the duration of exclusive breastfeeding and that the rate of the total indirect effect was 22.878%. Self-efficacy mediated previous breastfeeding experience and duration of exclusive breastfeeding, whereas attitude and self-efficacy played the series mediational role between previous breastfeeding experience and duration of exclusive breastfeeding. Cluster analysis supported these results. CONCLUSIONS The duration of exclusive breastfeeding can be promoted by improving breastfeeding attitude and self-efficacy in women without breastfeeding experience.
Collapse
Affiliation(s)
- Jun-Yan Li
- School of Health Sciences, Wuhan University, Wuchang District, Wuhan, China
| | - Yi Huang
- School of Health Sciences, Wuhan University, Wuchang District, Wuhan, China
| | - Yi-Yan Huang
- School of Health Sciences, Wuhan University, Wuchang District, Wuhan, China
| | - Quan Shen
- School of Health Sciences, Wuhan University, Wuchang District, Wuhan, China
| | - Wen-Bin Zhou
- Department of Psychology, Hubei Provincial Corps Hospital, Chinese People Armed Police Forces, Wuhan, China
| | | | - Yan-Qiong Ouyang
- School of Health Sciences, Wuhan University, Wuchang District, Wuhan, China
| |
Collapse
|
28
|
Barnes C, Hauck Y, Mabbott K, Officer K, Ashton L, Bradfield Z. Influencers of women's choice and experience of exclusive formula feeding in hospital. Midwifery 2021; 103:103093. [PMID: 34311337 DOI: 10.1016/j.midw.2021.103093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 06/18/2021] [Accepted: 07/03/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Explore what influenced women's decision to exclusively formula feed, and their experiences with formula feeding within a maternity hospital environment. DESIGN This mixed methods study used a cross-sectional exploratory survey design. Short surveys were administered by telephone in the postpartum period. Content analysis revealed common themes for responses to open-ended questions on what influenced women's choice and experience with formula feeding. Descriptive statistics were used for demographic characteristics, and frequencies conducted on some themes. PARTICIPANTS AND SETTING English-speaking women who chose to exclusively formula feed, and attended a tertiary maternity hospital in Australia were invited to participate; 102 women were interviewed. FINDINGS Themes that influenced women to choose exclusive formula feeding were: 'Previous breastfeeding challenges', 'social and societal issues' including convenience, comfort, and trust in formula, and 'maternal health' including medical issues and medications, breast physiology and mental health. Themes from the formula feeding experience in hospital were: 'Supportive' elements such as midwifery care, convenience, and resources, and 'hindering' elements such as a perceived breastfeeding agenda and systemic barriers. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Previous breastfeeding difficulties were a common influence on exclusive formula feeding in subsequent pregnancies, highlighting the importance of adequate support during the primary lactation/infant feeding experience. Greater comfort and confidence levels with formula feeding and a sense of trust in formula were also influential. Some maternal medications, conditions, or physiological circumstances were perceived by women as impacting breastfeeding or breastmilk, signposting the importance of antenatal screening and assessment to support women's options and decisions regarding infant feeding. A perception of professional and organisational preferences for breastfeeding over formula feeding contributed to some women feeling judged for their choice. This reminds midwives to consider the complex intersection of factors that influence infant feeding decisions and ensure all mothers are respected and fully supported.
Collapse
Affiliation(s)
- Courtney Barnes
- Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Perth, Western Australia 6008, Australia.
| | - Yvonne Hauck
- School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Perth, Western Australia 6102, Australia
| | - Kelly Mabbott
- Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Perth, Western Australia 6008, Australia
| | - Kirsty Officer
- Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Perth, Western Australia 6008, Australia
| | - Liz Ashton
- Breastfeeding Centre, King Edward Memorial Hospital, Subiaco, Perth, Western Australia 6008, Australia
| | - Zoe Bradfield
- Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Perth, Western Australia 6008, Australia; School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Perth, Western Australia 6102, Australia
| |
Collapse
|
29
|
Atkinson L, Silverio SA, Bick D, Fallon V. Relationships between paternal attitudes, paternal involvement, and infant-feeding outcomes: Mixed-methods findings from a global on-line survey of English-speaking fathers. MATERNAL & CHILD NUTRITION 2021; 17 Suppl 1:e13147. [PMID: 34241959 PMCID: PMC8269144 DOI: 10.1111/mcn.13147] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 01/16/2023]
Abstract
The breastfeeding intention-behaviour gap remains wide in developed countries. Current studies have focused on maternal attitudes and behaviours concerning infant feeding in order to explore barriers to breastfeeding continuation. There has been limited consideration of the impact of paternal attitudes and behaviours, despite contemporary parenthood evolving and evidence indicating that there are greater levels of paternal involvement in routine childcare tasks. This mixed-methods study used a triangulation design to examine the associations between paternal attitudes towards parenthood and infant-feeding methods, levels of paternal involvement, infant-feeding outcomes, and father-infant relationships. Fathers of infants <52 weeks completed an online survey providing quantitative data (N = 212) and qualitative data (N = 208). For the quantitative data, fathers completed validated measures about their attitude towards parenthood and infant feeding, levels of paternal involvement, and infant-feeding history. For the qualitative data, questions explored influences on paternal attitudes towards infant feeding and the father-infant relationship. After controlling for covariates, regression analyses found egalitarian attitudes towards parenthood were positively associated with both attitudes towards breastfeeding and levels of paternal involvement. Positive paternal attitudes towards breastfeeding were significantly associated with increased likelihood of breastfeeding. A thematic framework analysis indicated fathers' attitudes towards infant feeding were largely influenced by their families and partners or healthcare professionals. Polarised views were expressed about the impact infant-feeding methods had on the father-infant relationship, although fathers were united in their desire to bond with their infant. Addressing paternal attitudes and the importance of father-infant involvement in domains other than feeding maybe beneficial in supporting breastfeeding and the father-infant relationship.
Collapse
Affiliation(s)
- Lydia Atkinson
- Department of PsychologyUniversity of LiverpoolLiverpoolUK
| | - Sergio A. Silverio
- Department of Women & Children's HealthKing's College LondonLondonUK
- Elizabeth Garrett Anderson Institute for Women's HealthUniversity College LondonLondonUK
| | - Debra Bick
- Warwick Clinical Trials Unit, Warwick Medical SchoolUniversity of WarwickCoventryUK
| | | |
Collapse
|
30
|
Miranda AR, Scotta AV, Cortez MV, Soria EA. Triggering of postpartum depression and insomnia with cognitive impairment in Argentinian women during the pandemic COVID-19 social isolation in relation to reproductive and health factors. Midwifery 2021; 102:103072. [PMID: 34218023 PMCID: PMC8437687 DOI: 10.1016/j.midw.2021.103072] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/10/2021] [Accepted: 06/15/2021] [Indexed: 11/29/2022]
Abstract
Objective The 2019 coronavirus disease pandemic (COVID-19) required strict confinement measures that differentially impacted the individual's daily life. Thus, this work aimed to study postpartum women's mental health in Argentina during mandatory social isolation. Design A cross-sectional survey was conducted from May to July 2020, which included five validated questionnaires to assess postpartum depression (Postpartum Depression Screening Scale‐Short Form), insomnia (Insomnia Severity Index), memory complaints (Memory Complaint Scale), metacognition (Brief Metamemory and Metaconcentration Scale), and breastfeeding self-efficacy (Breastfeeding Self-Efficacy Scale-Short Form). Sociodemographic variables, social isolation characteristics, and breastfeeding practices were also collected. This study was conducted in accordance with the Declaration of Helsinki. Statistical analysis included zero-order correlations, multiple logistic regressions, and a set of structural equation models (SEM) to test direct and indirect effects. Goodness-of-fit indices were calculated for SEM. Setting Postpartum women were recruited from public hospitals, private health clinics, and online community recruitment in the Cordoba province (Argentina). Participants 305 postpartum women from Argentina. Measurements and findings 37% of women reported postpartum depression, 46% insomnia, 42% memory impairment, 60% low metaconcentration, 50% low metamemory, and 23% low breastfeeding efficacy. Also, significant associations were found demonstrating that social isolation promoted postpartum depression and insomnia were reciprocally related, which compromised female cognition and efficacy. This situation was aggravated in women during late postpartum, with previous children, and by low social support (e.g., family, health professionals), with non-exclusive breastfeeding being increased. Key conclusions This is the first study addressing postpartum women's mental status during social isolation in Argentina, which was a promoting factor for postpartum depression and insomnia that were reciprocally related. This situation was also aggravated by reproductive factors, such as late postpartum, multiparity, breastfeeding frequency, and non-exclusive breastfeeding. Additionally, breastfeeding self-efficacy depended on mental health status, and euthymia therefore favoured the practice of exclusive breastfeeding.
Collapse
Affiliation(s)
- Agustín Ramiro Miranda
- Universidad Nacional de Córdoba, Facultad de Ciencias Médicas, Escuela de Fonoaudiología. Bv. de la Reforma, Ciudad Universitaria, 5014 Córdoba, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET, INICSA. Bv. de la Reforma, Ciudad Universitaria, 5014 Córdoba, Argentina
| | - Ana Veronica Scotta
- Universidad Nacional de Córdoba, Facultad de Ciencias Médicas, Escuela de Fonoaudiología. Bv. de la Reforma, Ciudad Universitaria, 5014 Córdoba, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET, INICSA. Bv. de la Reforma, Ciudad Universitaria, 5014 Córdoba, Argentina
| | - Mariela Valentina Cortez
- Universidad Nacional de Córdoba, Facultad de Ciencias Médicas, Escuela de Fonoaudiología. Bv. de la Reforma, Ciudad Universitaria, 5014 Córdoba, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET, INICSA. Bv. de la Reforma, Ciudad Universitaria, 5014 Córdoba, Argentina
| | - Elio Andrés Soria
- Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET, INICSA. Bv. de la Reforma, Ciudad Universitaria, 5014 Córdoba, Argentina; Universidad Nacional de Córdoba, Facultad de Ciencias Médicas, Cátedra de Biología Celular, Histología y Embriología, Instituto de Biología Celular. Bv. de la Reforma, Ciudad Universitaria, 5014 Córdoba, Argentina.
| |
Collapse
|
31
|
Gordon LK, Mason KA, Mepham E, Sharkey KM. A mixed methods study of perinatal sleep and breastfeeding outcomes in women at risk for postpartum depression. Sleep Health 2021; 7:353-361. [PMID: 33640360 PMCID: PMC9665349 DOI: 10.1016/j.sleh.2021.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/05/2021] [Accepted: 01/12/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Pregnant and postpartum women experience significant sleep disruption, but the role of perinatal sleep disturbances in breastfeeding is understudied. METHODS In this observational cohort study, we used mixed methods to examine associations between perinatal sleep and breastfeeding. Forty-eight women (mean age 28.2 ± 4.9 years) who were euthymic at enrollment but had a history of major depression (n = 43) or bipolar disorder (n = 5) had sleep recorded with wrist actigraphy. We determined feeding status through daily diaries and used semi-structured interviews to identify themes regarding participants' experiences, breastfeeding decisions, and behaviors. To examine whether sleep disturbance during pregnancy predicted breastfeeding (BF) rates, we defined "lower sleep efficiency" (LSE) and "higher sleep efficiency" (HSE) groups based on the median split of actigraphic SE at 33 weeks' gestation (cutoff SE = 84.9%) and classified mothers as No-BF, Mixed-BF (BF + formula), and Exclusive-BF at 2 weeks postpartum. RESULTS Percentages of women who did any breastfeeding were: Week 2 = 72.3%, Week 6 = 62.5%, Week 16 = 50%. LSE mothers were less likely than HSE mothers to initiate breastfeeding (percent No-BF: LSE = 45.8%, HSE = 16.7%, P < .05). Average actigraphic sleep onset, sleep offset, time in bed, sleep duration, and SE did not differ based on breastfeeding status at any time point. Qualitative themes included insufficient preparation for the demands of breastfeeding, interrupted and nonrestorative sleep, and unrelenting daytime tiredness. CONCLUSIONS In our sample, preserved actigraphic SE during pregnancy was associated with initiation and continuation of breastfeeding. Future work should examine whether improving sleep in pregnancy improves mothers' feeding experiences.
Collapse
Affiliation(s)
- Lily K Gordon
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; Sleep for Science Research Laboratory, Providence, Rhode Island, USA
| | - Katherine A Mason
- Department of Anthropology, Brown University, Providence, Rhode Island, USA
| | - Emily Mepham
- Sleep for Science Research Laboratory, Providence, Rhode Island, USA
| | - Katherine M Sharkey
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; Sleep for Science Research Laboratory, Providence, Rhode Island, USA; Rhode Island Hospital, Divison of Pulmonary, Critical Care, and Sleep Medicine, Providence, Rhode Island, USA.
| |
Collapse
|
32
|
Mostafavi F, Zamani-Alavijeh F, Mansourian M, Bastami F. The promotion of healthy breakfast and snacks based on the social marketing model: a mixed-methods study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2021; 40:22. [PMID: 33962686 PMCID: PMC8106147 DOI: 10.1186/s41043-021-00245-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 04/22/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Skipping breakfast and replacing it with non-nutritious snacks are progressively increasing among adolescents. This study aimed to develop an educational intervention based on the Social Marketing Model and evaluate its effects on healthy breakfast and snack consumption among female adolescent students. METHODS This mixed-methods study was conducted in 2016-2019 in two phases. In the first phase, a qualitative study was conducted through directed content analysis in guidance schools in Khorramabad, Isfahan, and Tehran, Iran, to explore factors affecting breakfast consumption. The results of this phase were set in the benchmarks of the Social Marketing Model. In the second phase, a randomized controlled trial was conducted based on the benchmarks of the Social Marketing Model on 94 students randomly recruited from guidance schools in Khorramabad, Iran. RESULTS The findings of the qualitative phase were categorized into the benchmarks of the Social Marketing Model, namely the social marketing mix, the intended behavior, internal and external competing factors for behavior modification, theoretical concepts related to the behavior, and the role of supporters. In the quantitative phase, the univariate analysis showed significant between-group differences concerning the product, price, promotion, and behavior (p < 0.05). CONCLUSION Healthy breakfast and snack consumption can be promoted through making acceptable the tastes, costs, preparations, and consumption places of breakfast and snack. TRIAL REGISTRATION The trial was registered in the Iranian Registry of Clinical Trials (code: IRCT20170201032347N1 ). The trial was registered in 11/07/2018 and is accessible on the Iranian Clinical Trial Registration website.
Collapse
Affiliation(s)
- Firoozeh Mostafavi
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fereshteh Zamani-Alavijeh
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Mansourian
- Department of Epidemiology and Biostatistic, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Bastami
- Department of Public Health, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| |
Collapse
|
33
|
McKinley EM, Knol LL, Turner LW, Burnham JJ, Graettinger KR, Hernandez-Reif M, Leeper JD. Enhancing Patient-Provider Breastfeeding Conversations: Breastfeeding Intention and Prenatal Breastfeeding Self-Efficacy among a Sample of Pregnant Women. South Med J 2021; 114:223-230. [PMID: 33787936 DOI: 10.14423/smj.0000000000001238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate and identify which sociodemographic factors may be associated with breastfeeding intention and breastfeeding self-efficacy among pregnant women. METHODS Pregnant women at a medical center in Alabama completed a cross-sectional survey. The Prenatal Rating of Efficacy in Preparation to Breastfeed Scale (PREP to BF) was used to assess prenatal breastfeeding self-efficacy. A valid 3-item breastfeeding intention scale and the Fetal Health Locus of Control Scale also were used. Nonparametric tests were used to assess differences in breastfeeding intention, locus of control subscales, and PREP to BF scores by history with breastfeeding, planned mode of delivery, and sociodemographic factors. RESULTS The participants in the final analysis (N = 124) had a mean prenatal breastfeeding self-efficacy score of 299.5 (±92.33), with a range of 0 to 390. Significantly lower scores related to intention and PREP to BF were found among Black women (P ≤ 0.05), those with a high school education or less (P ≤ 0.019), single women (P ≤ 0.028), and those who had no breastfeeding experience (P ≤ 0.035). CONCLUSIONS Identifying pregnant women with low breastfeeding self-efficacy and intention and recognizing the effects of social and cultural influences on breastfeeding are vital. Healthcare providers can engage in meaningful dialog to address ways to increase social support, communication, goal-setting skills, and overcoming mental and emotional barriers.
Collapse
Affiliation(s)
- Erin M McKinley
- From the School of Nutrition and Food Sciences, Louisiana State University (LSU) and the LSU AgCenter, Baton Rouge, the Departments of Human Nutrition & Hospitality Management, Health Science, Educational Studies in Psychology, Research Methodology, and Counseling, Human Development and Family Studies, and Community Medicine and Population Health, University of Alabama, Tuscaloosa, and the Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee
| | - Linda L Knol
- From the School of Nutrition and Food Sciences, Louisiana State University (LSU) and the LSU AgCenter, Baton Rouge, the Departments of Human Nutrition & Hospitality Management, Health Science, Educational Studies in Psychology, Research Methodology, and Counseling, Human Development and Family Studies, and Community Medicine and Population Health, University of Alabama, Tuscaloosa, and the Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee
| | - Lori W Turner
- From the School of Nutrition and Food Sciences, Louisiana State University (LSU) and the LSU AgCenter, Baton Rouge, the Departments of Human Nutrition & Hospitality Management, Health Science, Educational Studies in Psychology, Research Methodology, and Counseling, Human Development and Family Studies, and Community Medicine and Population Health, University of Alabama, Tuscaloosa, and the Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee
| | - Joy J Burnham
- From the School of Nutrition and Food Sciences, Louisiana State University (LSU) and the LSU AgCenter, Baton Rouge, the Departments of Human Nutrition & Hospitality Management, Health Science, Educational Studies in Psychology, Research Methodology, and Counseling, Human Development and Family Studies, and Community Medicine and Population Health, University of Alabama, Tuscaloosa, and the Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee
| | - Kristine R Graettinger
- From the School of Nutrition and Food Sciences, Louisiana State University (LSU) and the LSU AgCenter, Baton Rouge, the Departments of Human Nutrition & Hospitality Management, Health Science, Educational Studies in Psychology, Research Methodology, and Counseling, Human Development and Family Studies, and Community Medicine and Population Health, University of Alabama, Tuscaloosa, and the Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee
| | - Maria Hernandez-Reif
- From the School of Nutrition and Food Sciences, Louisiana State University (LSU) and the LSU AgCenter, Baton Rouge, the Departments of Human Nutrition & Hospitality Management, Health Science, Educational Studies in Psychology, Research Methodology, and Counseling, Human Development and Family Studies, and Community Medicine and Population Health, University of Alabama, Tuscaloosa, and the Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee
| | - James D Leeper
- From the School of Nutrition and Food Sciences, Louisiana State University (LSU) and the LSU AgCenter, Baton Rouge, the Departments of Human Nutrition & Hospitality Management, Health Science, Educational Studies in Psychology, Research Methodology, and Counseling, Human Development and Family Studies, and Community Medicine and Population Health, University of Alabama, Tuscaloosa, and the Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee
| |
Collapse
|
34
|
Russell PS, Smith DM, Birtel MD, Hart KH, Golding SE. The role of emotions and injunctive norms in breastfeeding: a systematic review and meta-analysis. Health Psychol Rev 2021; 16:257-279. [PMID: 33618626 DOI: 10.1080/17437199.2021.1893783] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Breastfeeding has many known benefits, but rates vary globally. We propose two main reasons why psychological theory and interventions have not been successful to date in explaining breastfeeding behaviours. Specifically, prior research underestimates the importance of (1) specific emotions and (2) wider injunctive influences (i.e., societal and moral norms about what women feel they ought to be doing) in the breastfeeding experience. Therefore, we conducted a systematic review of quantitative, qualitative, and mixed-methods studies that explored whether injunctive norms and/ or specific emotions are associated with breastfeeding behaviours (i.e., intentions, initiation and duration). Seventy-two papers were included in this review; data were extracted and quality appraisals conducted for all included studies. A meta-analysis of effect sizes was performed with the quantitative data. A convergent qualitative synthesis of the data was conducted, resulting in the following line of argument: Breastfeeding is a social behaviour and not a personal/individual behaviour. From this line of argument, three themes with associated sub-themes were developed, highlighting the importance of both specific emotions and injunctive norms on breastfeeding behaviours. These influences are discussed in relation to both theoretical and practical implications, as well as future research.
Collapse
Affiliation(s)
- Pascale Sophie Russell
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Debbie M Smith
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | | | - Kathryn H Hart
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Sarah E Golding
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| |
Collapse
|
35
|
Father's Knowledge, Attitude and Support to Mother's Exclusive Breastfeeding Practices in Bangladesh: A Multi-Group Structural Equations Model Analysis. Healthcare (Basel) 2021; 9:healthcare9030276. [PMID: 33802555 PMCID: PMC7998803 DOI: 10.3390/healthcare9030276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 11/28/2022] Open
Abstract
Despite worldwide initiatives, the exclusive breastfeeding (EBF) rate is low. The study aims to investigate the role of fathers’ knowledge, attitude and support in formulating mothers’ practice of breastfeeding taking Bangladeshi parental cases as a sample. The study uses a standard survey instrument following the theory of planned behavior (TPB). Responses from 332 couples are accepted following a standard criteria and used for analysis. The sample is divided into sub-groups based on delivery mode—vaginal (n = 211, 64%) and cesarean section (n = 121, 36%). Based on the sub-groups, a multi-group structural equation modelling (SEM) is applied to analyze the phenomena. The study finds that a father’s knowledge in EBF can, in one way, significantly enhance mother’s knowledge by sharing and, in another way, can enhance his own attitude to offer different support to his partner/wife which induces the chances of EBF practices by mothers. The enhanced EBF knowledge of a mother raises her attitude to practice EBF, which is also positively affected by the father’s attitude. Thus, fathers’ support, coupled with mothers’ positive attitude, the mother’s intention to practice EBF as per standard guidelines.
Collapse
|
36
|
Avery EJ, Kim M, Park S. Self-Efficacy and Other Considerations in Performance of Risk-Reducing Behaviors during a Major Disease Outbreak. JOURNAL OF HEALTH COMMUNICATION 2021; 26:112-120. [PMID: 33729093 DOI: 10.1080/10810730.2020.1821131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study uses the construct of crisis self-efficacy to examine the importance of different considerations in individuals' decisions to perform recommended safeguarding behaviors during the 2016 Zika virus outbreak. A national survey in the U.S. (n = 370) was administered using a validated crisis self-efficacy scale in late summer 2016, amidst the global crisis. Relationships between crisis self-efficacy and preparedness were assessed. Other considerations such as risk, proximity, and time/money resources required were examined for their importance in decisions to follow safeguarding protocol. Crisis self-efficacy significantly predicted evaluations of preparedness but not of perceived Zika risk. Also, advisories issued from state and federal health agencies influenced individuals' perceptions of preparedness. Results indicate public health information officers should assess publics' levels of crisis self-efficacy in strategic message design. State and federal advisories were important to individual assessments of preparedness. Further, results show the threat needs to be presented to audiences in clear, specific terms.
Collapse
Affiliation(s)
| | - Minsoo Kim
- School of Advertising and Public Relations, The University of Tennessee, Knoxville, TN, USA
| | | |
Collapse
|
37
|
Improving breastfeeding duration through creation of a breastfeeding-friendly pediatric practice. J Am Assoc Nurse Pract 2021; 33:1273-1281. [PMID: 33534287 DOI: 10.1097/jxx.0000000000000521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/18/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Breastfeeding is the gold standard for infant feeding. In the United States, 83.2% of women initiate breastfeeding on their infant's birth. When the infant reaches 6 months of age, however, only 57.6% of mothers are still breastfeeding, and a mere 24.9% are breastfeeding exclusively. LOCAL PROBLEM Breastfeeding rates in rural areas are below the national averages. The greatest disparities exist in minorities and individuals with lower educational and socioeconomic status. METHODS A preintervention/postintervention design was used for this quality improvement project. The Model for Improvement's Plan, Do, Study, Act cycle guided the project processes. Breastfeeding rates were obtained at each well-child visit from newborn through 4 months of age. On completion, mean preimplementation and postimplementation breastfeeding rates were compared to determine effectiveness. INTERVENTIONS A breastfeeding support initiative was implemented at a multisite rural Illinois pediatric practice. An evidence-based breastfeeding policy was developed, staff education sessions were conducted, private lactation rooms were created, and breastfeeding photographs/posters were displayed throughout the offices. Lactation support services were publicized via signs and social media postings. RESULTS Overall breastfeeding rates were higher at each time point after implementation. Statistically significant increases occurred at the newborn and 1-month visits, with a modest improvement at 2 and 4 months. CONCLUSIONS This project demonstrated an improvement in breastfeeding duration rates. It is anticipated that this practice-wide standard of care change will promote breastfeeding throughout the first 12 months of life.
Collapse
|
38
|
Path Model Validation of Breastfeeding Intention Among Pregnant Women. J Obstet Gynecol Neonatal Nurs 2021; 50:167-180. [PMID: 33465339 DOI: 10.1016/j.jogn.2020.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To validate a blended health belief model and integrated behavioral model of selected modifiable psychosocial constructs during pregnancy to seek the best-fit path model for breastfeeding intention. DESIGN A nonexperimental, cross-sectional study. SETTING A virtual online market research sample aggregator. PARTICIPANTS Women (N = 300) between 18 and 45 years of age in their second or third trimesters of pregnancy participated in the study in February 2018. METHODS Based on the health belief model and the integrated behavioral model, we proposed a theoretical framework, including self-efficacy for breastfeeding, knowledge, perceived benefits, perceived barriers, attitude toward breastfeeding, patient-provider interaction, and motivation to breastfeed, to predict breastfeeding intention. We administered a 98-item questionnaire modified from preexisting instruments. We conducted descriptive, bivariate, and regression analyses to help with the formation of the path model. RESULTS The best-fit path model with all significant paths and effect directions showed that intention to breastfeed is directly influenced by motivation to breastfeed, attitudes toward breastfeeding, and self-efficacy for breastfeeding, which together accounted for 56% (R2) of the variance in intention. We also identified indirect effects from knowledge about breastfeeding, patient-provider interaction, perceived benefits, and perceived barriers and their interrelationships with effect directions. CONCLUSION Through our findings, we contribute to the emerging body of evidence that shows the significant variables and their effect directions for breastfeeding intention. Incorporating these findings may provide support and evidence for clinical and community interventions focusing on modifiable psychosocial constructs during pregnancy to promote breastfeeding and further investigations using health behavior theories.
Collapse
|
39
|
Avery EJ, Park S. Perceived Knowledge as [Protective] Power: Parents' Protective Efficacy, Information-Seeking, and Scrutiny during COVID-19. HEALTH COMMUNICATION 2021; 36:81-88. [PMID: 33249853 DOI: 10.1080/10410236.2020.1847438] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
During the COVID-19 pandemic, parents were issued numerous, sometimes changing, safeguarding directives including social distancing, mask use, hygiene, and stay-at-home orders. Enacting these behaviors for the parent presented challenges, but the responsibility for children to follow protocol properly was an even more daunting undertaking. Self-efficacy is one of the most power predictors of health behavior and has been adapted to a context-specific crisis self-efficacy scale conducted on March20, 2020, captures real-time perceptions of parents as coronavirus anxieties peaked. The study reveals a relationship between self- and protective efficacy that is mediated by parents' assessments of how informed they are about COVID-19. It also examines the role of perceived knowledge on information-seeking and scrutiny of pandemic information found online. Important directions for future research to develop the protective efficacy construct emerge as well as evidence of the rich applied and theoretical value of a deeper understanding of the perceived ability to perform recommended actions to protect another.
Collapse
Affiliation(s)
| | - Sejin Park
- Department of Media & Social Informatics, Hanyang University
| |
Collapse
|
40
|
Davie P, Bick D, Chilcot J. The Beliefs About Breastfeeding Questionnaire (BAB-Q): A psychometric validation study. Br J Health Psychol 2020; 26:482-504. [PMID: 33340201 PMCID: PMC8247407 DOI: 10.1111/bjhp.12498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/19/2020] [Indexed: 11/27/2022]
Abstract
Objectives Questionnaires used to assess women’s beliefs as a predictor of breastfeeding behaviour are not theoretically informed or tested for psychometric validity and reliability. This study conducted a psychometric evaluation of the Beliefs About Breastfeeding Questionnaire (BAB‐Q). Design A two‐phase evaluation in an online cross‐sectional questionnaire study (N = 278) and cohort study sample (N = 264). A ten‐item questionnaire was proposed to assess women’s beliefs about the benefits and efforts of breastfeeding. Methods Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) assessed construct validity and reliability. Multivariate regression analyses assessed validity in predicting breastfeeding behaviour and experiences. Results EFA found a shortened 8‐item, 2‐factor model had good fit (χ2 = 23.3, df = 13, p < .040; CFI = .99, TLI = .99, RMSEA = .05), with significant factor loadings. Factor 1 (benefit beliefs) and factor 2 (effort beliefs) accounted for 47 and 19.4% of the explained variance and correlated moderately (r = −.40). CFA confirmed the solution in the cohort sample (χ2 = 49.6 df = 19, p < .010; CFI = .97, TLI = .96, and RMSEA = .078). Adjusted regression analyses found beliefs did not reliably predict infant feeding practices. Women’s beliefs significantly predicted the likelihood that women experienced breastfeeding as ‘much more’ positive and negative than they expected. Conclusions The eight‐item questionnaire showed good model fit with acceptable loadings, and good reliability for all subscales. The utility of the BAB‐Q at predicting breastfeeding behaviour remains unclear and unsupported by empirical evidence. Further assessments of the predictive validity of the questionnaire in longitudinal studies with diverse beliefs and infant feeding practices are required.
Collapse
Affiliation(s)
- Philippa Davie
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Guy's Hospital, King's College London, UK
| | - Debra Bick
- Professor of Clinical Trials in Maternal Health, Warwick Medical School, Warwick Clinical Trials Unit, University of Warwick, UK.,Department of Women and Children's Health, Faculty of Life Sciences and Medicine, St Thomas' Hospital, King's College London, UK
| | - Joseph Chilcot
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Guy's Hospital, King's College London, UK
| |
Collapse
|
41
|
Li JY, Huang Y, Liu HQ, Xu J, Li L, Redding SR, Ouyang YQ. The Relationship of Previous Breastfeeding Experiences and Factors Affecting Breastfeeding Rates: A Follow-Up Study. Breastfeed Med 2020; 15:789-797. [PMID: 32945686 DOI: 10.1089/bfm.2020.0165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background/Objective: Many studies have focused on the effects of previous breastfeeding experience (PBE) on subsequent breastfeeding, but few have explored their specific relationships. To explain the relationship between PBE and subsequent breastfeeding behavior based on a follow-up study. Materials and Methods: After delivery, 394 participants who had no PBE completed a demographic questionnaire, breastfeeding knowledge questionnaire, the breastfeeding self-efficacy short-form scale (BSES-SF), and the Iowa infant feeding attitudes scale (IIFAS). Multiparas with PBE also completed the maternal breastfeeding evaluation scale (MBFES) in addition to the aforementioned four questionnaires. On the 42nd day after delivery, participants completed the breastfeeding experience scale (BES) through social networking platforms (QQ, WeChat: both are Chinese social medias). At 4 and 6 months postpartum, researchers contacted participants by phone or a social network regarding their exclusive and partial breastfeeding experiences. Results: In this study, exclusive breastfeeding rates were 58.6% and 30.5% at 4 and 6 months. PBE affected breastfeeding attitudes (p < 0.05), self-efficacy (p < 0.01), and difficulties (p < 0.05). Breastfeeding knowledge, attitude, self-efficacy, and difficulties were relevant to exclusive and partial breastfeeding at 4 and 6 months (p < 0.05). Multivariate logistic regression analysis showed that compared with women without PBE, the probability of exclusive breastfeeding of multiparas with PBE at 4 and 6 months increased by 275% and 369%, respectively. Conclusions: The rate of breastfeeding remains low among Chinese women, but PBE is associated with a higher probability of breastfeeding at 4 and 6 months postpartum. Multiparas, especially those having PBE were more likely to breastfeed for an extended period based on their knowledge, attitude, self-efficacy, and ability to manage difficulties.
Collapse
Affiliation(s)
- Jun-Yan Li
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Yi Huang
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Hao-Qi Liu
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Jing Xu
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Lu Li
- School of Health Sciences, Wuhan University, Wuhan, China
| | | | | |
Collapse
|
42
|
Shiraishi M, Matsuzaki M, Kurihara S, Iwamoto M, Shimada M. Post-breastfeeding stress response and breastfeeding self-efficacy as modifiable predictors of exclusive breastfeeding at 3 months postpartum: a prospective cohort study. BMC Pregnancy Childbirth 2020; 20:730. [PMID: 33238937 PMCID: PMC7687691 DOI: 10.1186/s12884-020-03431-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 11/16/2020] [Indexed: 11/25/2022] Open
Abstract
Background The rate of exclusive breastfeeding at 3 months postpartum is only 50% in Japan. In order to increase this rate, we aimed to examine modifiable factors related to exclusive breastfeeding at 3 months postpartum by focusing on breastfeeding-related and psychosocial variables at 1 month postpartum. Methods This prospective cohort study was conducted at a secondary medical care center in Osaka, Japan from February 2017 to October 2018. Demographic variables, infant feeding modality, breastfeeding-related variables, and psychosocial variables were obtained using questionnaires at 1 month postpartum. Daytime salivary cortisol levels before and after breastfeeding at 1 month postpartum were measured as a biological marker for stress responses associated with breastfeeding. Each infant’s feeding modality was re-assessed at 3 months postpartum. Multiple logistic regression analyses were performed to examine factors affecting exclusive breastfeeding at 3 months postpartum. Results Of the 104 participants, 61 reported exclusive breastfeeding at 3 months postpartum. The following factors were significantly associated with exclusive breastfeeding at 3 months postpartum: multiparity (adjusted odds ratio, 95% confidence interval: 11.13, 2.08–59.59), having a university degree (5.25, 1.04–26.53), no plan to return to work by 6 months postpartum (0.02, 0.00–0.46), and exclusive breastfeeding (42.84, 6.05–303.52), lower cortisol level after breastfeeding (0.00, 0.00–0.02), and higher breastfeeding self-efficacy scale score (1.07, 1.00–1.14) at 1 month postpartum. In parity-specific analyses, exclusive breastfeeding (25.33, 4.75–134.98) and lower cortisol level after breastfeeding (0.00, 0.00–0.21) at 1 month postpartum in primiparous women, and lower cortisol level after breastfeeding (0.00, 0.00–0.94), higher breastfeeding self-efficacy score (1.18, 1.05–1.32), and absence of breast complications (0.09, 0.01–0.82) at 1 month postpartum in multiparous women were associated with exclusive breastfeeding at 3 months postpartum. Conclusions Stress levels after breastfeeding, breastfeeding self-efficacy, and the presence of breast complications could be modifiable factors associated with subsequent exclusive breastfeeding. Further research is needed to examine whether approaches to reducing breastfeeding-related stress, improving breastfeeding self-efficacy, and preventing breast complications during lactation are effective to increase exclusive breastfeeding practices.
Collapse
Affiliation(s)
- Mie Shiraishi
- Department of Children and Women's Health, Division of Health Sciences, Graduate School of Medicine, Osaka University, 1-7, Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Masayo Matsuzaki
- Department of Children and Women's Health, Division of Health Sciences, Graduate School of Medicine, Osaka University, 1-7, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Shoko Kurihara
- Department of Children and Women's Health, Division of Health Sciences, Graduate School of Medicine, Osaka University, 1-7, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Maki Iwamoto
- Department of Children and Women's Health, Division of Health Sciences, Graduate School of Medicine, Osaka University, 1-7, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Mieko Shimada
- Department of Children and Women's Health, Division of Health Sciences, Graduate School of Medicine, Osaka University, 1-7, Yamadaoka, Suita, Osaka, 565-0871, Japan.,Graduate Program of Midwifery, Dokkyo Medical University, Tochigi, Japan
| |
Collapse
|
43
|
Sustainable Value Co-Creation in the Virtual Community: How Diversified Co-Creation Experience Affects Co-Creation Intention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228497. [PMID: 33212782 PMCID: PMC7696490 DOI: 10.3390/ijerph17228497] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/06/2020] [Accepted: 11/08/2020] [Indexed: 11/17/2022]
Abstract
The popularization of digital infrastructure has enabled the rise of the online game industry. Instead of targeting entertainment-oriented technology and services, which are the focus of most relevant studies, in the present study, we review the literature from the perspective of considering players of online games as both consumers of entertainment and co-creators of value. The three major antecedents of the theory of planned behavior, namely personal attitude toward co-creation, subjective norms and perceived behavioral control, were modified to explore the relevant constructs. Specifically, the diversity of co-creation experience was used to predict co-creation intention. The proposed model was empirically evaluated through the structural equation modeling of survey data collected from 321 World of Warcraft (WoW) players. As hypothesized, the diversified co-creation experience positively affected the antecedents. The findings provide implications on how to increase players’ participation in co-creation to achieve sustainable mutual benefits.
Collapse
|
44
|
Monge-Montero C, van der Merwe LF, Papadimitropoulou K, Agostoni C, Vitaglione P. Mixed milk feeding: a systematic review and meta-analysis of its prevalence and drivers. Nutr Rev 2020; 78:914-927. [PMID: 32357372 DOI: 10.1093/nutrit/nuaa016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Carmen Monge-Montero
- Department of Agricultural Sciences, University of Naples Federico II, Portici, Italy
| | | | | | - Carlo Agostoni
- Pediatric Clinic, Fondazione IRCCS Ospedale Maggiore Policlinico, Milano, Italy; and the Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paola Vitaglione
- Department of Agricultural Sciences, University of Naples Federico II, Portici, Italy
| |
Collapse
|
45
|
Investigation of the Relationship Between Maternal Attachment and Breastfeeding Self-Efficacy and Affecting Factors in Turkish Sample. J Pediatr Nurs 2020; 54:e53-e60. [PMID: 32446666 DOI: 10.1016/j.pedn.2020.04.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/26/2020] [Accepted: 04/26/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE This research aimed to investigate the factors affecting the perception of mothers about breastfeeding self-efficacy and their maternal attachment between the fourth and eighth postnatal weeks and their relation. DESIGN AND METHODS This research, which is descriptive, was conducted on 351 postpartum women between December 2017-2018. The study used the Mother Descriptive Information Form, Maternal Attachment Inventory (MAI), and the Short Form of the Breastfeeding Self-Efficacy Scale (BSES-SF). RESULTS It was found that, mothers' mean scores on the BSES-SF and MAI were affected by their educational level, the status of regular health checkups during the last pregnancy, the number of visits for health checkups during the last pregnancy, the place where they held their babies, the status of breastfeeding previous babies, prenatal breastfeeding training, the status of finding their own breast milk sufficient, the time when they first breastfed the baby, the first food the baby received, the status of being willing to breastfeed, the status of having fatigue due to breastfeeding, the planned duration of breastfeeding, the status of using additional infant formula, and the status of having a close relative or friend also breastfeeding. It was also determined that there was a low positive relationship between breastfeeding self-efficacy and maternal attachment. CONCLUSIONS The level of breastfeeding self-efficacy and maternal attachment status of mothers should be determined in the postpartum period, and health personnel should intervene on alterable factors that adversely affect breastfeeding self-efficacy and attachment status, especially in mothers at risk.
Collapse
|
46
|
Antoñanzas-Baztán E, Belintxon M, Marín-Fernández B, Redín-Areta MD, Mujika A, Pumar-Méndez MJ, Lopez-Dicastillo O. Six-month breastfeeding maintenance after a self-efficacy promoting programme: an exploratory trial. Scand J Caring Sci 2020; 35:548-558. [PMID: 32400032 DOI: 10.1111/scs.12870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/25/2020] [Accepted: 04/20/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Breastfeeding care plays a fundamental role in establishing breastfeeding and longer duration after discharge. Practices though vary among professionals involved and are often inconsistent with good practices recommended, being a threat to women's breastfeeding self-efficacy. Breastfeeding self-efficacy is considered a predictor for successful breastfeeding and a significant variable amenable to intervention for promoting lactation AIM: To evaluate the efficacy, feasibility and acceptability of a new breastfeeding self-efficacy promoting programme (SIALAC) on 6-month breastfeeding maintenance. METHODS In this exploratory multi-centre controlled trial, participants were allocated into control and intervention groups sequentially. Professionals in charge of the treatment groups were trained in between, with an especial focus on reducing practice variability. Control and intervention group women received usual care, and the intervention group received in addition SIALAC, a three-stage breastfeeding self-efficacy promoting programme. Primary outcome was breastfeeding maintenance up to 6 months analysed by Kaplan-Meier and Cox proportional hazard regression analysis. Student's t-test or chi-square tests were also used for continuous and categorical variables. Data on breastfeeding status and breastfeeding self-efficacy were collected at baseline, and 4, 8 and 24 weeks after birth. RESULTS From May 2014 through November 2015, participants were enrolled. The sample consisted of 112 women. No relevant socio-demographic or obstetric difference was found between groups. The intervention achieved a significant difference between groups in breastfeeding survival (X2 = 4.94, p = 0.026). Six-month breastfeeding maintenance was significantly higher in the intervention group (67% vs. 55%; X2 = 5.384, p = 0.020). Breastfeeding dropout in the control group was 3.3 (CI 1.1, 10.1) times higher than that of the intervention group at 6 months. Breastfeeding self-efficacy scores were higher in the intervention group although without significant statistical difference. The programme showed good acceptability. CONCLUSION Breastfeeding self-efficacy promoting programme SIALAC was beneficial in fostering 6-month breastfeeding survival. Full-scale trial should consider feasibility-related issues identified.
Collapse
Affiliation(s)
- Elena Antoñanzas-Baztán
- Complejo Hospitalario de Navarra, Pamplona, Spain.,Department of Health Sciences, Faculty of Health Sciences, Public University of Navarra, Pamplona, Spain.,ImPuLS Research Group, University of Navarra, Pamplona, Spain
| | - Maider Belintxon
- ImPuLS Research Group, University of Navarra, Pamplona, Spain.,Department of Community, Maternity and Pediatric Nursing, School of Nursing, University of Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Blanca Marín-Fernández
- Department of Health Sciences, Faculty of Health Sciences, Public University of Navarra, Pamplona, Spain
| | - Maria D Redín-Areta
- Department of Health Sciences, Faculty of Health Sciences, Public University of Navarra, Pamplona, Spain
| | - Agurtzane Mujika
- ImPuLS Research Group, University of Navarra, Pamplona, Spain.,Department of Community, Maternity and Pediatric Nursing, School of Nursing, University of Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Maria J Pumar-Méndez
- ImPuLS Research Group, University of Navarra, Pamplona, Spain.,Department of Community, Maternity and Pediatric Nursing, School of Nursing, University of Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Olga Lopez-Dicastillo
- ImPuLS Research Group, University of Navarra, Pamplona, Spain.,Department of Community, Maternity and Pediatric Nursing, School of Nursing, University of Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| |
Collapse
|
47
|
Zhuang J, Hitt R, Goldbort J, Gonzalez M, Rodriguez A. Too Old to Be Breastfed? Examination of Pre-Healthcare Professionals' Beliefs About, and Emotional and Behavioral Responses toward Extended Breastfeeding. HEALTH COMMUNICATION 2020; 35:707-715. [PMID: 30822154 DOI: 10.1080/10410236.2019.1584739] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
While breastfeeding seems to be widely accepted in the United States, extended breastfeeding (defined as breastfeeding beyond 12 months of age) tends to be stigmatized. Healthcare professionals are assumed to play a significant role in supporting women who desire to practice extended breastfeeding; however, how healthcare professionals react to extended breastfeeding has not been well understood. This research surveyed 116 healthcare students, who majored in nursing and human medicine, and examined their perceived advantages and disadvantages, emotional responses to, and advice that they would provide to future mothers regarding extended breastfeeding. The results indicated that students responded predominantly with negative emotions and neutral responses to extended breastfeeding, with a small number of participants responding with positive emotions. Many participants believed that it would bring benefits to the child and that it would be burdensome to the mother. Participants displayed a variety of behavioral responses when asked about advice that they would provide to future mothers with whom they will interact in a clinical setting. Practical implications are discussed.
Collapse
Affiliation(s)
- Jie Zhuang
- Department of Communication Studies, Texas Christian University
| | - Rose Hitt
- Department of Humanities and Communication, Albany College of Pharmacy and Health Sciences
| | | | | | | |
Collapse
|
48
|
Chan K, Whitfield KC. High confidence, yet poor knowledge of infant feeding recommendations among adults in Nova Scotia, Canada. MATERNAL & CHILD NUTRITION 2020; 16:e12903. [PMID: 31777186 PMCID: PMC7083488 DOI: 10.1111/mcn.12903] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/27/2019] [Accepted: 09/30/2019] [Indexed: 01/12/2023]
Abstract
In Canada, adherence to the national 'Nutrition for Healthy Term Infants' recommendations of infant and young child feeding (IYCF; 0-24 months) is suboptimal. While maternal knowledge of IYCF is commonly assessed, that of the general public has rarely been explored. Our objective was to assess the knowledge of, and confidence in answers to, Canadian IYCF recommendations among a diverse sample of adults in Nova Scotia, Canada. Between March and May 2018, a self-administered questionnaire examining IYCF knowledge, self-rated confidence, and sociodemographic information was conducted among Nova Scotians (≥19 years) in public locations. We surveyed 229 adults; 60% (n=134) were women. Mean (95% CI) age was 44 (41,46) years, 73% self-identified as white, 77% were born in Canada, and 69% were parents. Knowledge deficits were: age to terminate breastfeeding (18.3 (16.7,19.9) months; recommendation: ≥24 months), age to introduce solids (9.2 (8.2,10.2) months; recommendation: 6 months), vitamin D supplementation (10% correct), and optimal complementary foods (only 37% indicated iron-rich foods). Correct IYCF knowledge was lower among men, non-parents, young adults (19-29 years) and low-income adults (<$50,000/year). Mean self-rated confidence (out of 10) was high (7.2 (6.9,7.5)), and not different (p>0.05) between correct and incorrect responses for: best food for a newborn, age to terminate any breastfeeding, and age to start family meal foods. We found low knowledge of IYCF guidelines, yet high confidence in responses regardless of accuracy, among adults in Nova Scotia. General public knowledge deficits may contribute to an unsupportive culture around IYCF practices and low adherence to current recommendations.
Collapse
Affiliation(s)
- Kathleen Chan
- Department of Applied Human NutritionMount Saint Vincent UniversityHalifaxNova ScotiaCanada
| | - Kyly C. Whitfield
- Department of Applied Human NutritionMount Saint Vincent UniversityHalifaxNova ScotiaCanada
| |
Collapse
|
49
|
Intergenerational Transmissible Meanings in Breastfeeding in Spain: A Phenomenological Study. J Pediatr Nurs 2020; 51:e108-e114. [PMID: 31926645 DOI: 10.1016/j.pedn.2019.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/30/2019] [Accepted: 12/30/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND The process of breastfeeding is linked to intergenerational influences based on attitudes and messages of grandmothers about their own experience, and this can reinforce or interfere with the experiences of future mothers in breastfeeding. The aim of this study was to explore the meanings transmissible to the next generation of nursing mothers, based on the experiences of grandmothers. METHODS We report the findings of an interpretive phenomenological qualitative research based on the philosophy of Martin Heidegger. In-depth interviews were conducted in Madrid with 17 participants who breastfed before the age of 35 and more than 8 years ago (to ensure the settlement of transmissible meanings in remote memory). Data were analyzed by interpretive phenomenological analysis (IPA). FINDINGS Two thematic categories were identified: "Breastfeeding: life experiences" and "Breastfeeding: body and mind process", which show that mothers want to convey the need for a balance that allows maintaining the role of women outside of stereotypes but that is also compatible with the rhythm of life, giving new meanings to attachment, weaning, and modesty. CONCLUSIONS Meanings that future grandmothers wish to transmit to the next generation of nursing mothers are related to the search for a satisfactory experience for the mother, who must make an adjustment in her life, freeing herself of inflexible messages about attachment and the maternal role. PRACTICAL IMPLICATIONS Strategies to promote breastfeeding and care for nursing mothers can improve the impact of trying to understand the meanings that are transmitted by the grandmothers in the family environment.
Collapse
|
50
|
De Roza JG, Fong MK, Ang BL, Sadon RB, Koh EYL, Teo SSH. Exclusive breastfeeding, breastfeeding self-efficacy and perception of milk supply among mothers in Singapore: A longitudinal study. Midwifery 2019; 79:102532. [DOI: 10.1016/j.midw.2019.102532] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/20/2019] [Accepted: 08/28/2019] [Indexed: 11/27/2022]
|