An Evaluation of the Effectiveness of School-Based Breastfeeding Education

Perceptions of Breastfeeding Among Adolescents and Young Adults

Purpose: We aimed to understand adolescents' and young adults' perceptions and the extent of their knowledge about breastfeeding. Methods: Participants (adolescents and young adults in the United States, 14-24 years of age) were texted five open-ended questions about their perceptions of various aspects of breastfeeding including their initial reaction to breastfeeding, the impact on the infant and parent, how it compares with formula, and whether they were breastfed. The responses were analyzed for themes using an inductive content analysis approach. Responses were compared using χ2 tests to assess if knowledge and education about breastfeeding differed according to gender identity and age. Results: Among 1,283 participants, 829 responded (response rate = 64.4%). The average age was 18.8 (standard deviation [SD] = 2.9), with 53% female and 10% Black. Most adolescents and young adults understand there are health benefits of breastfeeding for the breastfeeding dyad (n = 589; 78.8%), yet also indicate an awareness of negative aspects (n = 256; 36.1%). Participants who identified as female or gender-variant and those who were older were more likely to refer to the emotional and bonding connections breastfeeding creates (p = 0.0011 and p = 0.0002). Males were more likely to have less knowledge about breastfeeding effects on the breastfeeding person but have more negative attitudes toward formula (p = 0.0298 and p = 0.0543). Younger respondents tended to indicate that formula was better than breast milk (p = 0.0534). Conclusion: We found a mix of positive and negative perceptions of breastfeeding among adolescents and young adults. Understanding how youth view breastfeeding can inform targeted education for this population that includes all genders and can begin before pregnancy.

A qualitative study exploring teachers' beliefs regarding breastfeeding education in family and consumer sciences classrooms

Background

Research shows that elementary and secondary school children have considered infant feeding choices for when they become parents and are interested in learning about breastfeeding in school. Despite recommendations to include infant feeding education in secondary school classrooms, teachers’ practices and attitudes regarding this topic have been the subject of minimal research. The purpose of this study was to explore North Carolina, USA, family and consumer sciences teachers’ infant feeding education practices and their views on incorporating breastfeeding education in the curricula of family and consumer sciences classes that cover topics related to parenting and nutrition.

Methods

The study used a purposive sample of 19 teachers who participated in semi-structured qualitative telephone interviews exploring their attitudes and practices relating to infant feeding education. We transcribed and analyzed the interviews using the constant comparative method through the lens of the Theory of Planned Behavior by examining the participants’ attitudes, subjective norms, and perceived behavioral controls.

Results

Teachers had predominantly positive attitudes towards the inclusion of breastfeeding education in high school parenting, child development, and nutrition courses, citing the need to normalize breastfeeding and support students’ ability to make informed choices when they become parents. Teachers’ subjective norms included concerns about parents’ and administrators’ views on the appropriateness of the content and apprehension about negative student responses. Perceived behavioral controls included student maturity, teachers’ own experiences and comfort with infant feeding, and the view that curriculum guidelines limit content selection.

Conclusions

The results of this study can be used in the development and implementation of secondary school education programs that increase knowledge about infant feeding and positive attitudes towards breastfeeding for all members of the community. Teachers’ concerns need to be addressed in the implementation of these programs.

Behaviour, Attitudes and Knowledge of Healthcare Workers on Breastfeeding

The aim of this paper is to determine the current state of behavior, attitudes, and knowledge of health professionals about breastfeeding in Croatia. Data were collected via a breastfeeding behavior, attitudes, and knowledge questionnaire, which has already been validated and used in Croatia. The secondary aim is to identify differences in outcomes of respondents by occupation (nurses versus others health professionals). In the study, 374 health professionals participated (37 males and 337 females). Respondents completed the questionnaire online. Respondents were rarely involved in breastfeeding education. On the behavior scale, the worst answer was given to the question of advising mothers on breastfeeding after 24 months. On the attitude scale, the worst result was achieved in terms of public breastfeeding and the support of the child's father for the breastfeeding mother. Respondents demonstrated the worst knowledge of The International Code of Marketing of Breast-milk Substitutes and the use of medications while breastfeeding. There was no statistically significant difference between the results of respondents in relation to the occupation of the respondents. In the preparation of future breastfeeding education for health professionals in Croatia, particular attention should be given to these issues.

A Multi-Center Educational Research Regarding Breastfeeding for Pediatrics Residents in Korea

Purpose: Pediatricians have a significant responsibility to educate mothers about the importance of breastfeeding. However, there have been minimal efforts in the courses of resident training in Korea. The purpose of this study is to evaluate the change in knowledge and attitude before and after a 4-week breastfeeding educational intervention among multicenter residents.Methods: Prospective interventional educational research was designed for residents at eight training hospitals in Korea. Institutional reviews were obtained in each hospital. The education curriculum consisted of 14 courses regarding breastfeeding theory and practice. These materials were used to teach pediatric residents for 4 weeks. Knowledge-based tests were administered before the course, and re-tests were administered after the course using different test items of similar levels. Test scores and survey responses were compared before and after the intervention.Results: A total of 73 residents (1st year 20, 2nd year 23, 3rd year 16, and 4th year residents 14) from eight training hospitals completed the intervention. Their average age was 30.3±2.9 years, 17 (23.3%) were male, 22 (30.1%) were married, and eight had more than one child of their own. The mean pre-test score was 61.8±13.4 and the mean post-test score was 78.3±7.5 (P<0.001). The inter-grade difference in the score was significant in the pre-test (P=0.005), but not significant in the post-test (P=0.155). There were more responses of obtaining confidence after the intervention (P<0.001).Conclusion: In our study, pediatric residents showed improvement in their knowledge and confidence level after 4 weeks of the breastfeeding curriculum. This will provide a basis for future policymaking in the training of pediatric residents regarding breastfeeding in Korea.

Breastfeeding and the origins of health: Interdisciplinary perspectives and priorities

Breastfeeding and human milk (HM) are critically important to maternal, infant and population health. This paper summarizes the proceedings of a workshop that convened a multidisciplinary panel of researchers to identify key priorities and anticipated breakthroughs in breastfeeding and HM research, discuss perceived barriers and challenges to achieving these breakthroughs and propose a constructive action plan to maximize the impact of future research in this field. Priority research areas identified were as follows: (1) addressing low breastfeeding rates and inequities using mixed methods, community partnerships and implementation science approaches; (2) improving awareness of evidence-based benefits, challenges and complexities of breastfeeding and HM among health practitioners and the public; (3) identifying differential impacts of alternative modes of HM feeding including expressed/pumped milk, donor milk and shared milk; and (4) developing a mechanistic understanding of the health effects of breastfeeding and the contributors to HM composition and variability. Key barriers and challenges included (1) overcoming methodological limitations of epidemiological breastfeeding research and mechanistic HM research; (2) counteracting 'breastfeeding denialism' arising from negative personal breastfeeding experiences; (3) distinguishing and aligning research and advocacy efforts; and (4) managing real and perceived conflicts of interest. To advance research on breastfeeding and HM and maximize the reach and impact of this research, larger investments are needed, interdisciplinary collaboration is essential, and the scientific community must engage families and other stakeholders in research planning and knowledge translation.

Exploring North Carolina Family and Consumer Sciences Teachers' Attitudes Towards Breastfeeding and Infant Feeding Education Practices

BACKGROUND

The World Health Organization (WHO) and the United Kingdom Committee for UNICEF recommend that secondary schools include infant feeding education in the curriculum. However, little attention has been given to the study of educators' views and practices regarding infant feeding education.

AIMS

The aims of this research were to (1) explore North Carolina Family and Consumer Sciences teachers' attitudes towards infant feeding education in secondary schools and (2) describe North Carolina Family and Consumer Sciences teachers' infant feeding education practices.

METHODS

Researchers conducted interviews (N = 19) and a survey (N = 137) using a sequential mixed methods design. The constant comparative method was used to analyze interview transcripts. Subsequently, a 33-item survey was developed to assess teachers' attitudes and practices, and this survey was tested for validity and reliability.

RESULTS

The majority of participants supported including infant feeding (n = 119, 86.9%) and breastfeeding (n = 116, 84.7%) education in high school. Approximately half of the participants supported including infant feeding (n = 71, 51.9%) and breastfeeding (n = 64, 46.7%) education in middle school. Participants reported that they taught infant feeding at both levels; topics taught included complementary foods, patterns of infant feeding, and the safe preparation of infant formula. Breastfeeding content was covered primarily in the high school Parenting and Child Development course.

CONCLUSIONS

North Carolina Family and Consumer Sciences teachers have positive attitudes towards teaching about breastfeeding at the secondary school level. Content about infant nutrition and breastfeeding is currently included in courses that cover child development and human nutrition.

High confidence, yet poor knowledge of infant feeding recommendations among adults in Nova Scotia, Canada

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.

Exploring the latitude of attitude: Intentions to breastfeed among adolescents in Lebanese schools

School-based breastfeeding education (SBBE) may help improve breastfeeding rates in the long-term by targeting children and adolescents' knowledge, attitudes, skills, and intentions. Breastfeeding rates in Lebanon are suboptimal. Psychosocial drivers of breastfeeding intention among the youth are unknown. We administered a survey to 658 high school students (448 females; 210 males) at two large Lebanese schools to understand intentions, intention drivers, and views on SBBE as means to guide SBBE programme design on the basis of the theory of planned behaviour. We collected information on demographics, intention to breastfeed/support wife to breastfeed future. Intention was predicted by attitude related to breastfeeding health outcomes and family normative beliefs-χ2 (25) = 115, P < .001 for males, and χ2 (39.3) = 186, P < .001 for females. Among females, intention was also positively associated with being breastfed, higher socio-economic status, and being more accepting of public breastfeeding. Seventy-eight per cent of students felt they were not learning enough about breastfeeding in school but were interested in SBBE through didactic teaching methods and interactive experiences. Findings indicate that breastfeeding intention among adolescent students is not merely influenced by the extent of knowledge but by more complicated psychosocial drivers that may differ by gender. Our findings also suggest a misalignment exists between what schools are providing with what students feel they need, thereby opening up a potential space for intervention.

Exploring Breastfeeding Knowledge and Attitudes among Noncaregivers: A Narrative Review

Exclusive breastfeeding to 6 months with continued breastfeeding up to 2 years and beyond are well-established infant feeding recommendations based on evidence that breastfeeding has unparalleled maternal and infant health benefits as well as environmental and economic benefits. As with many high-income countries, breastfeeding rates remain suboptimal with only a quarter of Canadian and European infants receiving breast milk exclusively for the first 6 months. Breastfeeding promotion efforts have largely targeted caregivers in the prenatal and postnatal period; however, breastfeeding outcomes have been shown to be associated with broader sociocultural factors. Noncaregivers play an influential role in infant feeding at both an individual level (e.g., cues and input from health care practitioners and caregivers' social networks; as future parents) as well as a broader population level (sociocultural norms and policy decisions). This paper outlines recent research on breastfeeding knowledge and attitudes of noncaregivers by population subgroup. Positive correlations have been identified between breastfeeding attitudes, infant feeding knowledge, breastfeeding exposure, and breastfeeding intention among different subgroups; however, key knowledge gaps, lack of exposure to breastfeeding, and negative public perceptions of breastfeeding persist. Dietitians can advocate for breastfeeding promotion strategies that consider the role of noncaregivers to address sociocultural norms around breastfeeding.

Getting schooled: teachers' views on school-based breastfeeding education in Lebanon

Background

School-based breastfeeding education (SBBE) may help improve breastfeeding rates in the long term by instilling in young people a base of evidence-informed knowledge, skills, and attitudes that primes them to make informed decisions about infant feeding and to become positive change agents. Breastfeeding rates in Lebanon remain suboptimal, and breastfeeding misconceptions along with social pressures to use infant formula are known contributing barriers. We conducted this study with pre-K-12 teachers to understand the SBBE landscape as well as the supports and constraints for SBBE at two large Lebanese schools.

Methods

We conducted a survey with 193 teachers during the 2017-2018 academic school year to collect information about demographics, breastfeeding history, breastfeeding teaching practices, attitudes towards SBBE such as attitude towards educating both boys and girls about breastfeeding, and views on potential constraints to successful SBBE implementation. Descriptive statistics and thematic analysis were used. Binary multiple logistic regression was used to ascertain the effects of teacher characteristics on likelihood to support SBBE.

Results

While limited SBBE is currently taking place with only eight (4%) teachers reporting teaching about breastfeeding, 133 (69%) reported students should learn about breastfeeding in school. A multiple regression model [χ2(4) = 19.71, p = 0.001] showed teachers were more likely to support SBBE if they/their partners had ever breastfed, if they taught biology, or if they believed that schools should educate both boys and girls about breastfeeding in a society where discussing breastfeeding in public is a taboo. One hundred and ten (60%) teachers reported several concerns to SBBE implementation which included limited uptake by students who might not find SBBE valuable to them and resistance from parents due to cultural barriers. In order to effectively expand SBBE in these schools, 71 SBBE supporters (59.2% of respondents; 13 with missing data) suggested supporting local teachers to deliver SBBE, and 48 (40%) suggested mandating SBBE.

Conclusions

Teachers held generally positive views on SBBE, which provides a fertile ground for growing SBBE in their schools. Future steps need to include engaging parents, students, and school principals to further understand the social constrains to SBBE before program design.

BREASTFEEDING INTENTION AND KNOWLEDGE IN SECONDARY-SCHOOL STUDENTS

SUMMARY – Breast milk makes the world healthier and better. Deaths and suffering of thousands of children and mothers each year could be prevented through universal breastfeeding, along with enormous economic savings. The aim of this study was to examine the knowledge of breastfeeding and intention to breastfeed in third-year secondary school students from various high schools and to make a conclusion on the unique and structured education program on breastfeeding in secondary schools. A total of 252 third-year secondary school students from 4 high schools in Bjelovar, Kutina and Pakrac completed an online questionnaire on the knowledge and intention to breastfeed. The results were presented by descriptive statistics methods. Kruskal-Wallis test was conducted for intention scale and χ²-test for questions about knowledge. Logistic regression was used to predict probabilities of a response. The results showed the responses of students from individual schools to be statistically significantly different in some questions of knowledge and some items of intention of breastfeeding. Insufficient breastfeeding information in schools does not provide a basis to third-year secondary school students to make an informed decision about breastfeeding in adulthood. We propose development and use of a unique structured educational program on breastfeeding for secondary school students.

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

Objective:

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

Method:

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

Results:

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

Conclusion:

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

Educational intervention about breastfeeding among secondary school students

Purpose

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

Design/methodology/approach

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

Findings

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

Research limitations/implications

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

Practical implications

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

Originality/value

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

Development and Validation of a Questionnaire on Breastfeeding Intentions, Attitudes and Knowledge of a Sample of Croatian Secondary-School Students

Background: Validating a questionnaire/instrument before proceeding to the field for data collection is important. Methods: An 18-item breastfeeding intention, 39-item attitude and 44-item knowledge questionnaire was validated in a Croatian sample of secondary-school students (N = 277). Results: For the intentions, principal component analysis (PCA) yielded a four-factor solution with 8 items explaining 68.3% of the total variance. Cronbach’s alpha (0.71) indicated satisfactory internal consistency. For the attitudes, PCA showed a seven-factor structure with 33 items explaining 58.41% of total variance. Cronbach’s alpha (0.87) indicated good internal consistency. There were 13 knowledge questions that were retained after item analysis, showing good internal consistency (KR20 = 0.83). In terms of criterion validity, the questionnaire differentiated between students who received breastfeeding education compared to students who were not educated in breastfeeding. Correlations between intentions and attitudes (r = 0.49), intentions and knowledge (r = 0.29), and attitudes and knowledge (r = 0.38) confirmed concurrent validity. Conclusions: The final instrument is reliable and valid for data collection on breastfeeding. Therefore, the instrument is recommended for evaluation of breastfeeding education programs aimed at upper-grade elementary and secondary school students.

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

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

Using a Music Video Parody to Promote Breastfeeding and Increase Comfort Levels Among Young Adults

BACKGROUND

North Americans are not meeting the World Health Organization's breastfeeding recommendations. Young adults understand that breastfeeding is healthy but are uncomfortable seeing breastfeeding. Research aim: The aim of the current project was to determine if a music video parody promoting breastfeeding is perceived by young adults to be an effective means of promotion and if exposure to such a video could increase comfort levels.

METHODS

Young adults rated how comfortable they felt looking at breastfeeding and bottle-feeding images (pretest). Two months later, a subset of participants watched the music video parody "Breastfeeding My Baby." In Phase 1, participants completed the picture-rating task again (posttest) after a 2-month delay, plus a survey to assess memory and perception of the video. In Phase 2, participants were reminded of the video before completing the comfort ratings, and in the final phase, posttest measures were administered only 1 week after exposure to the video.

RESULTS

Across all phases, the video was perceived to be effective and was memorable. Breastfeeding comfort ratings were comparable at pretest across participant groups; comfort ratings improved at posttest for participants who saw the video but only if they were reminded of seeing it before providing their ratings. At shorter intervals between seeing the video and completing the posttests, comfort ratings for breastfeeding images increased for all participants, highlighting the general importance of exposure to breastfeeding.

CONCLUSION

Young adults are receptive to using a music video parody to promote breastfeeding, which can help to increase comfort levels with breastfeeding.

Adolescents' Knowledge of Breastfeeding and Their Intention to Breastfeed in the Future

The aim of this paper is to analyze third-year secondary school students’ knowledge of breastfeeding and intention to breastfeed their children, based on the results of a questionnaire. The respondents were 154 students (101 female/43 male) of two secondary schools in Bjelovar. The students completed a questionnaire which consisted of 23 questions regarding knowledge and intention to breastfeed. The answers were analyzed statistically and different results were compared by nonparametric tests. About half of the respondents think that both partners should decide on breastfeeding and recognize the role that fathers have in initiating and maintaining breastfeeding. Only 13.64% of the respondents know that breastfeeding is to be done only on demand. Exclusive breastfeeding for 6 months, as recommended by the medical profession, is recognized by 70.13% of the students. The question on how justified is the initiation of formula together with the mother’s milk was answered correctly by 29.22% of the students. Secondary school students’ knowledge of breastfeeding is insufficient, and schools, families, social communities and other sources of information should share the responsibility for improving this. We consider it necessary to pay more attention to improving students’ knowledge of breastfeeding through school curricula.