Breastfeeding as health-promoting behaviour for Hispanic women: literature review

Prevalence and Predictive Factors for Exclusive Breastfeeding at Six Months among Thai Adolescent Mothers

Exclusive breastfeeding (EBF) in the first six months of life is the best and the most frequent choice for infants since it has important benefits for the infants and their mothers. However, the exclusive breastfeeding rate in Thailand remains low, especially among adolescent mothers. This predictive correlation study aimed to investigate factors predicting breastfeeding at six months among 253 Thai adolescent mothers from nine hospitals of the Bangkok Metropolitan Administration. Data were collected by using seven questionnaires: the Personal Characteristics, Pregnancy Intention and Breastfeeding Practice, Perceived Benefits of Breastfeeding, Perceived Barriers to Breastfeeding, Breastfeeding Self-Efficacy, Family Support, Maternity Care Practice, and Digital Technology Literacy Questionnaires. Data were analyzed by using descriptive statistics and logistic regression. The findings revealed that the prevalence of EBF at six months among Thai adolescent mothers was only 17.39%, and predictive factors were occupation (work/study) (p = 0.034), digital technology literacy (p < 0.001), family support (p = 0.021), pregnancy intention (p = 0.001), breastfeeding self-efficacy (p = 0.016), and perceived benefits of breastfeeding (p = 0.004). These factors could, together, predict the EBF rate at six months among Thai adolescent mothers in 42.2% (Nagelkerke R2 = 0.422) of the cases. These findings may help health professionals to develop activities and strategies for promoting exclusive breastfeeding by increasing breastfeeding self-efficacy, perceived benefits of breastfeeding, and family support, as well as improving digital technology skill among Thai adolescent mothers, especially student/employed adolescents who have unintended pregnancies.

Duration of Breastfeeding and Maternal-Related Factors in Iran, Systematic Review and Meta-Analysis

BACKGROUND

Although the benefits of breastfeeding are commonly approved, there remains a significant discrepancy between maternal practices and World Health Organization (WHO) guidelines in some countries.

OBJECTIVES

We had two aims in this study; average duration of breastfeeding, and its maternal determinants.

DATA SOURCES

A web-based citation index was used for citing documents.

STUDY ELIGIBILITY CRITERIA AND PARTICIPANTS

We included observational studies evaluating breastfeeding duration among children who were at least two years old and not older than five were included in Iran.

SYNTHESIS METHODS

The pooled mean and mean differences were considered. Heterogeneity was evaluated with the I² statistic.

RESULTS

The pooled mean of breastfeeding duration was calculated at 17.31 months. Children with younger mothers and lower birth orders had shorter durations of breastfeeding. Women with a high school and higher education level had early cessation of breastfeeding in comparison with less educated women.

LIMITATIONS

The main limitation of the current study was lack of librarian assistance.

CONCLUSIONS

The pooled mean of breastfeeding duration in Iranian children aged 2-5 was less than WHO recommendations. Accurate identification of the effect a mother's level of education has on duration of lactation requires standardized categorization.

IMPLICATIONS OF KEY FINDINGS

Raising awareness among women can be an effective strategy in increasing the duration of lactation.

Reasons for Stopping Exclusive Breastfeeding Between Three and Six Months: A Qualitative Study

PURPOSE

Scant published qualitative literature exists focusing on why exclusive breastfeeding rates decline between three and six months. This study aims to develop an understanding of why exclusive breastfeeding tails off so dramatically between three and six months after birth in New Zealand.

DESIGN AND METHODS

A generic qualitative methodology was employed in this study and social constructionism selected as the main epistemological framework underpinning the research. This study was carried out between September 2013 and July 2014, involving face-to-face interviews with 30 women who were characterised as highly motivated to complete six months exclusive breastfeeding prior to the birth of their child. In order to gain an in-depth understanding of the research material, thematic analysis of the interview transcripts was completed using manual coding techniques.

RESULTS

After thematic analysis of the data four key themes were identified: 1) The good employee/good mother dilemma. 2) Breastfeeding is lovely, but six months exclusively is demanding. 3) Exclusive breastfeeding recommendations should be individualised. 4) Introducing solids early as a cultural practice.

CONCLUSIONS

Most studies have linked barriers to six months exclusive breastfeeding to difficulties within the mother-infant dyad, as well as negative maternal socioeconomic and socio-demographic characteristics. However, this study has shown that the maintenance of six months exclusive breastfeeding is also challenging for this group of mothers who were socially advantaged, well-educated and highly motivated to breastfeed their babies exclusively for six months.

An experimental study of an educational intervention to promote maternal self-efficacy in breastfeeding

Objective:

to build, validate and assess an educational intervention using the flip chart titled "I Can Breastfeed My Child."

Method:

an experimental study using a pretest, intervention and posttest, as well as a control group. A total of 201 women, who had been hospitalized immediately, for at least 6 hours, postpartum. The mothers were allocated to the intervention (100 women) or control groups (101 women) according to the length of their hospital stay. The effectiveness of the flip chart was assessed by applying the Breastfeeding Self-Efficacy Scale - Short-Form at admission, discharge and by telephone in the second month postpartum. The intervention and control groups were similar in their socio-demographic, obstetric and gynecological variables.

Results:

the intervention was beneficial because mothers in the intervention group had higher self-efficacy scores, more mothers continued breastfeeding and mothers had a longer duration of exclusive breastfeeding, both at the time of hospital discharge and at the second month postpartum, with statistically significant associations.

Conclusions:

this experimental study assessed the educational strategy mediated via the flip chart titled "I Can Breastfeed My Child" as being effective both in increasing self-efficacy and increasing the duration of breastfeeding.

Risk factors in road crossing among elderly pedestrians and readiness to adopt safe behavior in socio-economic comparison

This research examines the Health Promotion Behavior (HPB) models regarding elderly pedestrians' behaviors and attitudes. We studied cognitive-psychological variables, such as risk estimation, self-efficacy and demographic variables and compared elderly pedestrians' attitudes and behaviors in a city with higher socio-economic level (Tel Aviv) versus a city with low socio-economic level (Beer Sheva). We expected to find more problematic behaviors among elderly pedestrians in the low socio-economic city compared to the high socio-economic city, and also less feeling of self-efficacy, and lessened awareness of the risks, that leads to lessened willingness to adopt preventive behaviors. The research was conducted in two studies. The first study was based on observations on 2591 pedestrians in six similar crosswalks in both cities. It revealed that pedestrians in the high socio-economic city demonstrated safer road crossing patterns than in the low socio-economic city and that elderly pedestrians reveal safer crossing patterns than younger pedestrians. We found an interaction of location and age due to greater gap of safe behaviors of elderly and young pedestrians in the high socio-economic city than in the low socio-economic city. In Tel Aviv elderly adhere to the crossing rules much more than the young while in Beer Sheva elderly and young people are almost similar in their crossing patterns. The second study used questionnaires that have been completed by 143 elderly in both cities. The questionnaires referred to (a) demographic variables such as gender, age, marital status, education, socio-economic level, (b) variables related to the affiliation to the main culture such as migration, date of migration, knowledge in Hebrew (local language) and connectivity to media and (c) cognitive as well as psychological variables related to the decline to adopt healthy behaviors based on Schwarzer and Fuchs (1995). This part also indicated that elderly in Tel Aviv have higher awareness of risk factors on the road and their limitations as elderly pedestrians. The HPB (Pender, 1996) emphasizes the role of risk perception as a predictor of willingness to adopt preventive strategies. Moreover, elderly pedestrians in Beer Sheva compared to those in Tel Aviv estimated their ability to cross safely the streets as higher.

Exclusive Breastfeeding Experiences among Mexican American Women

BACKGROUND

According to the Centers for Disease Control and Prevention, Hispanic breastfeeding mothers begin early formula supplementation at higher rates than other ethnic groups, which can lead to shorter breastfeeding duration and decreased exclusive breastfeeding. Acculturation, the process of adopting beliefs and behaviors of another culture, appears to influence breastfeeding practices of Hispanic women in the United States. Little is known about Mexican American mothers' formula use and exclusive breastfeeding within the context of acculturation.

OBJECTIVE

Our study identified perceived benefits and barriers to exclusive breastfeeding and levels of acculturation among Mexican American women living in a Midwestern city.

METHODS

We used a qualitative descriptive design integrating Pender's Health Promotion Model concepts. Individual interviews were conducted in English or Spanish (N = 21). The revised Acculturation Rating Scale for Mexican Americans was used to examine acculturation levels.

RESULTS

Acculturation scores indicated that the majority (66%) of the sample was "very Mexican oriented." Most women exclusively breastfed, with a few using early supplementation for "insufficient milk production." Three themes emerged: (1) It is natural that a woman give life and also provide the best food for her baby; (2) Breastfeeding is ultimately a woman's decision but is influenced by tradition, guidance, and encouragement; and (3) Breast milk is superior but life circumstances can challenge one's ability to breastfeed.

CONCLUSION

Strong familial/cultural traditions supported and normalized breastfeeding. Barriers to exclusive breastfeeding were similar to breastfeeding women in general, in the United States. Findings support the need for culturally competent and individualized lactation care.

Impact of breastfeeding self-efficacy and sociocultural factors on early breastfeeding in an urban, predominantly Dominican community

BACKGROUND

Latinas have high breastfeeding initiation rates that decrease significantly in the first postpartum months. Little is known about the effects of self-efficacy and sociocultural factors on early breastfeeding among low-income Latinas. This study quantifies early breastfeeding rates and identifies factors associated with breastfeeding at 4-6 weeks postpartum in our community.

SUBJECTS AND METHODS

Mothers were recruited from a newborn clinic (NBC) in the first postpartum week. Questionnaires in the NBC and 4-6 weeks later assessed feeding practices, breastfeeding self-efficacy, and sociocultural factors. Feeding practices in the well baby nursery (WBN) were obtained by chart review. A scale from "1" (exclusive formula feeding) to "5" (exclusive breastfeeding) characterized feeding practices. Paired-sample t tests assessed change in feeding practices, and regression analysis assessed the impact of factors on breastfeeding at 4-6 weeks.

RESULTS

We interviewed 209 women: 86.1% Latina, 47.3% foreign-born, and 94.2% Medicaid-recipients. Breastfeeding increased from WBN to NBC (2.6±1.2 to 2.9±1.4; p<0.05) and then decreased by 4-6 weeks (2.9±1.4 to 2.5±1.44; p<0.05), without significant change between WBN and 4-6 weeks. Higher levels of education [β=0.21 (0.08, 0.56)], breastfeeding a previous child for ≥6 months [β=0.35 (0.57, 1.8)], foreign birth [β=0.2 (0.06, 1.07)], and higher breastfeeding self-efficacy scores [β=0.38 (0.02, 0.05)] were associated with more breastfeeding. Higher breastfeeding self-efficacy scores were associated with exclusive breastfeeding [adjusted odds ratio=1.18 (1.05, 1.32)].

CONCLUSIONS

Breastfeeding self-efficacy was the sole, modifiable factor associated with exclusive breastfeeding. Efforts to improve breastfeeding self-efficacy may serve to support breastfeeding in this population.

Evaluation of a theory of planned behaviour-based breastfeeding intervention in Northern Irish schools using a randomized cluster design

OBJECTIVE

The aim of this research was to evaluate the effectiveness of a school-based intervention designed to enhance young people's motivations to breastfeed.

DESIGN

A cluster randomized controlled trial was conducted involving 50 post-primary schools from across Northern Ireland. However, dropout and exclusion criteria utilized for the current study resulted in an effective sample size of 42 schools.

METHODS

The intervention was delivered in two 35-min classroom sessions targeting those beliefs identified by the theory of planned behaviour (TPB) as significant in predicting motivation to breastfeed. Questionnaires incorporating the key components of the TPB were administered to all intervention and control schools at baseline, 1 and 6 months post-intervention. Multi-level modelling was used to analyse the data.

RESULTS

Findings suggest that the intervention was effective in that it increased females' intentions to breastfeed, expanded their knowledge and led to more favourable attitudes and perceptions of subjective norms. Notably, females' knowledge increased more in secondary schools than in grammar schools irrespective of whether they were control or intervention schools.

CONCLUSION

The research has provided evidence to support the use of the TPB in the design and evaluation of an intervention to increase females' intentions to breastfeed.

Clinical recommendations for promoting breastfeeding among Hispanic women

PURPOSE

To synthesize research regarding the low breastfeeding rates in Hispanic women living in the United States, particularly those who immigrate to this country and become acculturated.

DATA SOURCES

Extensive review of global literature on the subject.

CONCLUSIONS

Exclusive and continued breastfeeding rates in the United States have increased in recent years but remain low, and no state in the United States currently meets the Healthy People 2010 recommendations. Due to the increasing number of Hispanic women immigrating to the United States and having children, it is imperative to develop appropriate culturally specific guidelines in breastfeeding promotion programs. When providing care to a Hispanic mother, clinicians can best assist this population by holistically reviewing all aspects of a woman's life including her environment and relationships with others to provide positive outcomes that ultimately benefit Hispanic mothers and their newborns.

IMPLICATIONS FOR PRACTICE

Guidelines and interventions for initiating and continuing breastfeeding in Hispanic women are proposed, including providing a bilingual personal breastfeeding advocate, as well as group classes that incorporate traditional Hispanic cultural beliefs and allow the women to devise personal breastfeeding plans.

Assignment to a hospital-based breastfeeding clinic and exclusive breastfeeding among immigrant Hispanic mothers: a randomized, controlled trial

A randomized controlled trial is used to determine whether assigning mixed feeders to a breastfeeding clinic within 1 week postpartum will increase exclusive breastfeeding at 1 month among Hispanic immigrants. Subjects are eligible for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and 85% are monolingual Hispanic. Mothers (n = 522) of infants at low risk for hyperbilirubinemia are approached at bedside 20 to 48 hours after delivery and randomly assigned to treatment or control groups. Intent-to-treat analysis of feeding behavior at 4 weeks postpartum indicates that the intervention group is more likely to be exclusively breastfeeding (16.4% vs 10% in the control group, P = .03; adjusted odds ratio 1.87; 95% confidence interval, 1.07-3.26); that the incidence of formula supplementation does not differ between groups; and that the intervention group is less likely to supplement with water and tea (P < .002).

Does exclusive breastfeeding increase after hospital discharge? A Greek study

To monitor the rate of exclusive breastfeeding in Greek maternity wards and to investigate possible changes in infant-feeding practices during the first month after hospital discharge, the authors questioned 4310 Greek mothers from 7 hospitals on the fourth day postpartum. Odds ratios were calculated to estimate the effects of health system, demographic, psychosocial, and environmental factors. Any breastfeeding and full breastfeeding initiation rates were 85% and 23%, respectively. One month postpartum, the corresponding rates of any and exclusive breastfeeding were 79% and 61%, respectively. Mothers of infants who lacked continuous rooming-in while in the maternity ward (OR, 2.08; 95% CI, 1.27-3.40) and with previous experience of breastfeeding (OR, 1.46; 95% CI, 1.19-1.79) were more likely to reestablish exclusive breastfeeding at home despite the use of supplementation in the maternity ward. It seems women are capable of overcoming supplementation in hospital and can revert to exclusive breastfeeding at home.

Working mothers breastfeed babies more than housewives

AIM

To examine the prevalence and determinants of breastfeeding and to identify perinatal, sociodemographic, psychosocial and environmental factors associated with maternal infant feeding intention.

METHODS

A sample of 3734 Greek mothers that delivered their infants in 2000 was recruited in a longitudinal cohort study. Data on duration of breastfeeding was based on a questionnaire answered by 76.6% of the participants at 8-12 months postpartum.

RESULTS

The rates of any breastfeeding at 3 and 6 months were 52% and 24%, respectively. The corresponding rates of exclusive breastfeeding were 37% and 17%. From Cox regression analysis mother's intention to breastfeed for a short time and upbringing in the area of Athens were significantly associated with early termination of any breastfeeding and exclusive breastfeeding. A positive intention to breastfeed was influenced by maternal entitlement more than 6 months, delivery in autumn or winter, mother's upbringing abroad and previous breastfeeding experience.

CONCLUSIONS

The rates of any breastfeeding and exclusive breastfeeding during the first year of life were fairly satisfactory. Programs to support breastfeeding are necessary and should encourage women to feel positive to breastfeed, focusing particularly on non-working mothers, mothers with a maternity entitlement less than 6 months and mothers who lack previous breastfeeding experience.

Health Promotion in the Practice Setting: Findings from a Review of Clinical Issues

BACKGROUND

Many agencies over the last few decades have called for the explicit inclusion and application of health promotion in all aspects of nursing practice. This article reviews the body of empirical (research-based) and theoretical (conceptual) literature addressing health promotion in nursing clinical practice, to uncover its nature, intention, and impact.

APPROACH

The aim of this review was to identify from the nursing literature what is reported on in relation to health promotion activity, both theoretical and clinical in the practice setting. An extensive review identified that literature pertaining to these issues clustered around the categories of: theorising and conceptualising the meaning and purpose of health promotion in nursing practice, the development and testing of tools and models for practice, and the exploration of attitudes, behaviours, roles and functions of nurses and health professionals in practice.

FINDINGS

Against more recent trends in health promotion, the literature shows that broader and wide-ranging health promotion reform has yet to have universal impact, whereas conventional health education activities remain the mainstay for the majority of "health promotion" activities in nursing practice. Where nurses purport to be conducting "health promotion" they are often conducting behavioural, lifestyle, and risk-orientated health education. The findings of this review therefore support the notion that much of nursing-related health practice is firmly located in reactive ill health and disease risk-specific preventive locations, instead of incorporating and instilling broader societal, economic, ecological, and political dimensions of health promotion. Recommendations for wider reform, developed from personal opinion and supported by the literature, are presented.

CONCLUSIONS

It is argued that nursing bodies, as well as individual nurses themselves, should seek current health promotion locations in nursing practice, and find effective ways to implement health promotion strategies and, subsequently, equip practitioners with the necessary resources and skills to engage with other health promotion agencies. Future research should be aimed at implementing and evaluating broad health promotion processes.