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Mulcahy H, Philpott LF, O'Driscoll M, Bradley R, Leahy-Warren P. Breastfeeding skills training for health care professionals: A systematic review. Heliyon 2022; 8:e11747. [PMID: 36468118 PMCID: PMC9708688 DOI: 10.1016/j.heliyon.2022.e11747] [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: 11/18/2021] [Revised: 03/15/2022] [Accepted: 11/11/2022] [Indexed: 11/19/2022] Open
Abstract
Background Breastfeeding is a public health issue and the response to the low rates in the Global North needs to be multi-faceted. Within this context healthcare professionals have an important role to play in the overall multi-dimensional promotion and support of breastfeeding. As a learned skill, there is a fundamental need to improve breastfeeding skills amongst healthcare professionals. Aim To identify, analyse and evaluate studies on breastfeeding skills education for health care professionals. Methods The review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies from June 2006 to July 2021 that examined the provision of breastfeeding skills-based education for qualified or student healthcare professionals were included. A narrative synthesis was conducted, and risk of bias independently assessed by two reviewers. Findings Of 5,497 papers originally identified, 11 were included in the review. Nine studies were interventional, whilst two were observational. Participants included paediatric residents, midwives, nurses, care co-ordinators and other health care staff. Training took place in classrooms, practical workshops, or clinical settings. Observational or experiential teaching components in combination with theoretical knowledge were found to produce better outcomes than classroom-based interventions. However, the findings need to be interpreted with caution due to the risk of bias regarding study design-specific criteria. Discussion There is both a paucity of studies, and from those available, a lack of quality in terms of educational interventions specifically offering skills-based training to healthcare professionals. Breastfeeding education needs to incorporate practical breastfeeding skills not just theoretical training. Lack of standardisation currently exists across guiding frameworks, course content, educator qualification and assessment strategies which impedes the optimisation of breastfeeding education and subsequent support for mothers. Serious or high risk of bias was identified in all but one of the studies included in the review. Conclusion There is a need for high quality research evidence to optimise the design and delivery of skills-based breastfeeding education for healthcare professionals. This would have the potential to contribute to the broad suite of interventions necessary to improve support for breastfeeding.
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Affiliation(s)
- Helen Mulcahy
- University College Cork, Ireland
- School of Nursing and Midwifery, University College Cork, Ireland
| | - Lloyd Frank Philpott
- University College Cork, Ireland
- School of Nursing and Midwifery, University College Cork, Ireland
| | - Michelle O'Driscoll
- University College Cork, Ireland
- School of Nursing and Midwifery, University College Cork, Ireland
| | - Róisín Bradley
- University College Cork, Ireland
- School of Nursing and Midwifery, University College Cork, Ireland
| | - Patricia Leahy-Warren
- University College Cork, Ireland
- School of Nursing and Midwifery, University College Cork, Ireland
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Mäkelä H, Axelin A, Kolari T, Kuivalainen T, Niela-Vilén H. Healthcare Professionals' Breastfeeding Attitudes and Hospital Practices During Delivery and in Neonatal Intensive Care Units: Pre and Post Implementing the Baby-Friendly Hospital Initiative. J Hum Lact 2022; 38:537-547. [PMID: 34841935 PMCID: PMC9329761 DOI: 10.1177/08903344211058373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Baby-Friendly Hospital Initiative represents a global effort to support breastfeeding. Commitment to this program has been associated with the longer duration and exclusivity of breastfeeding and improvements in hospital practices. Further, healthcare professionals' breastfeeding attitudes have been associated with the ability to provide professional support for breastfeeding. RESEARCH AIMS To determine healthcare professionals' breastfeeding attitudes and hospital practices before and after the implementation of the Baby-Friendly Hospital Initiative. METHODS Using a quasi-experimental pretest-posttest study design, healthcare professionals (N = 131) from the single hospital labor and delivery, maternity care, and neonatal intensive care were recruited before and after the Baby-Friendly Hospital Initiative intervention during 2017 and 2019. Breastfeeding attitudes with the validated Breastfeeding Attitude Questionnaire, breastfeeding-related hospital practices, and background characteristics were collected. RESULTS The healthcare professionals' breastfeeding attitude scores increased significantly after the implementation of the Baby-Friendly Hospital Initiative, difference = 0.16, (95% CI [0.13, 0.19]) and became breastfeeding favorable among all professional groups in each study unit. Positive changes in breastfeeding-supportive hospital practices were achieved. The infants had significantly more frequent immediate and uninterrupted skin-to-skin contact with their mothers. The rate of early breastfeeding, as well as the number of exclusively breastfed infants, increased. CONCLUSIONS After the Baby-Friendly Hospital Initiative and Baby-Friendly Hospital Initiative for neonatal wards (Neo-BFHI) interventions were concluded, we found significant improvements in the breastfeeding attitudes of healthcare professionals and in breastfeeding-related care practices.This RCT was registered (0307-0041) with ClinicalTrials.gov on 03/03/2017.
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Affiliation(s)
- Heli Mäkelä
- Department of Nursing Science, University of Turku, Turku, Finland.,Satakunta Hospital District, Satasairaala, Pori, Finland
| | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Terhi Kolari
- University on Turku, Department of Biostatistics, University of Turku, Turku, Finland
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Rosen-Carole C, Halterman J, Baldwin CD, Martin H, Goldstein NP, Allen K, Fagnano M, Widanka H, Dozier A. Prenatal Provider Breastfeeding Toolkit: Results of a Pilot to Increase Women's Prenatal Breastfeeding Support, Intentions, and Outcomes. J Hum Lact 2022; 38:64-74. [PMID: 33823702 PMCID: PMC8492789 DOI: 10.1177/08903344211008797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Breastfeeding rates for United States women with lower incomes fall below the government's Healthy People 2020 Goals. Breastfeeding recommendations combined with support from providers and peer counselors help women decide to begin and sustain breastfeeding, but peer counselor uptake is low. RESEARCH AIM To evaluate changes in referrals to Women, Infants, and Children's Supplemental Nutrition Program peer counselors, reported prenatal provider education and support, and breastfeeding outcomes (intention, initiation, 1-month duration of any and exclusive breastfeeding) after a prenatal breastfeeding promotion intervention. METHOD In this pre-post intervention study (2015-2016; upstate New York), providers implemented a Toolkit to discuss infant feeding recommendations and initiate peer counselor referral. We surveyed women pre- and post-implementation (after delivery; 1 month postpartum) about prenatal breastfeeding intentions, provider support, and breastfeeding outcomes. Analyses controlled for secular trends. RESULTS Pre-intervention (n = 71) and post-intervention (n = 70) participants were 49% Black, 61% publicly insured, and 16% uninsured. More post-intervention participants had > 1 Toolkit use (76%), peer counselor program referrals (60.0% post vs. 36.6% pre, p < .01), reported any breastfeeding intention (89% vs. 72%, p = .013), and intended to breastfeed for > 1 year (31% vs. 14%, p = .014). Post-intervention breastfeeding initiation and exclusivity were higher, but not significantly different. Post-intervention participants reported better prenatal breastfeeding support. CONCLUSIONS Implementing a prenatal Breastfeeding Toolkit, including facilitating peer counselor referral, was associated with increases in provider counseling, participants' breastfeeding intentions, and uptake of peer counselors. Replicating this approach may reinforce efforts to support breastfeeding in similar practices serving women with lower incomes.
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Affiliation(s)
- Casey Rosen-Carole
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry
| | - Jill Halterman
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry
| | - Constance D. Baldwin
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry
| | - Hayley Martin
- Public Health Sciences, University of Rochester School of Medicine and Dentistry
- University of Rochester School of Medicine and Dentistry
| | | | - Katherine Allen
- Department of Pediatrics, University of Minnesota at Minneapolis, MN
| | - Maria Fagnano
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry
| | - Holly Widanka
- Public Health Sciences, University of Rochester School of Medicine and Dentistry
| | - Ann Dozier
- Public Health Sciences, University of Rochester School of Medicine and Dentistry
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4
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A Vision for the Future of Nursing Leadership in the Lactation Field. J Perinat Neonatal Nurs 2021; 35:302-304. [PMID: 34726646 DOI: 10.1097/jpn.0000000000000607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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5
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Appiah F, Ahinkorah BO, Budu E, Oduro JK, Sambah F, Baatiema L, Ameyaw EK, Seidu AA. Maternal and child factors associated with timely initiation of breastfeeding in sub-Saharan Africa. Int Breastfeed J 2021; 16:55. [PMID: 34281591 PMCID: PMC8287803 DOI: 10.1186/s13006-021-00402-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 07/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background The probability of not breastfeeding within the first hour after delivery (timely initiation of breastfeeding) is particularly pronounced in sub-Saharan Africa. In this study, we examined the maternal and child factors associated with timely initiation of breastfeeding in sub-Saharan Africa. Methods We pooled data from 29 sub-Saharan African countries’ Demographic and Health Surveys conducted from 2010 to 2018. A total of 60,038 childbearing women were included. Frequencies, percentages, and binary logistic regression analyses were carried out. Binary logistic regression was used to examine the maternal and child factors associated with timely initiation of breastfeeding and the results were presented as adjusted odds ratios (aOR) at 95% confidence interval (CI). Results We found a prevalence of 55.81% of timely initiation of breastfeeding in the sub-region. The country with the highest prevalence of timely initiation of breastfeeding was Burundi (86.19%), whereas Guinea had the lowest prevalence (15.17%). The likelihood of timely initiation of breastfeeding was lower among married women, compared to never married women (aOR 0.91; 95% CI 0.85, 0.98); working women compared to non-working women (aOR 0.90; 95% CI 0.87, 0.93); women who watched television at least once a week, compared to those who never watched television (aOR 0.74; 95% CI 0.70, 0.78); women who delivered through caesarean section, compared to vaginal birth (aOR 0.30; 95% CI 0.27, 0.32); and those with multiple births, compared to those with single births (aOR 0.67; 95% CI 0.59, 0.76). Women who lived in Central Africa were less likely to initiate breastfeeding timely compared to those who lived in West Africa (aOR 0.80; 95% CI 0.75, 0.84). Conclusions The findings call for the need for a behavioural change communication programmes, targeted at timely initiation of breastfeeding, to reverse and close the timely initiation of breastfeeding gaps stratified by the maternal and child factors. Prioritising policies to enhance timely initiation of breastfeeding is needed, particularly among Cental African countries where timely initiation of breastfeeding remains a challenge. Sufficient supportive care, especially for mothers with multiple births and those who undergo caesarean section, is needed to resolve timely initiation of breastfeeding inequalities.
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Affiliation(s)
- Francis Appiah
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana.,Berekum College of Education, Berekum, Bono Region, Ghana
| | - Bright Opoku Ahinkorah
- Faculty of Health, School of Public Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Eugene Budu
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Joseph Kojo Oduro
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Francis Sambah
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Linus Baatiema
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Edward Kwabena Ameyaw
- Faculty of Health, School of Public Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana. .,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia. .,Department of Estate Management, Takoradi Technical University, Takoradi, Ghana.
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Thepha T, Marais D, Bell J, Muangpin S. The Evaluation of Training for Health-Care Professionals and Community Leaders Regarding 6-Month Exclusive Breastfeeding in Northeast Thailand. J Perinat Educ 2021; 30:71-77. [PMID: 33897231 PMCID: PMC8061724 DOI: 10.1891/j-pe-d-19-00028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To address the reduction of the 6-month exclusive breastfeeding (EBF) rate in Northeast Thailand, a 3-year 6-month EBF intervention model was developed using concept mapping. A training for health-care professionals and community leaders was prioritized as the initial intervention. The aim was to assess the feasibility of the training intervention and its potential to improve 6-month EBF knowledge. A pre- and posttest, and an open question were conducted. Data were analyzed using t tests and thematic analysis. For the 17 health-care professionals and community leaders who participated, the mean 6-month EBF knowledge scores improved significantly from 5.28 to 10.21 (p value < .01). It is recommended that this workshop could be duplicated and scaled up in other regions across Thailand to standardize care.
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Sprague J, Wisner KL, Bogen DL. Pharmacotherapy for depression and bipolar disorder during lactation: A framework to aid decision making. Semin Perinatol 2020; 44:151224. [PMID: 32199600 PMCID: PMC7214126 DOI: 10.1016/j.semperi.2020.151224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Breastmilk is recommended as the exclusive source of nutrition for infants younger than 6 months due to the numerous health benefits for both infants and mothers. Although many women are prescribed medications during pregnancy and postpartum, limited data are available to assist women in weighing the benefits compared to the risks of peripartum medication use. The goals of this paper are to discuss the importance of breastmilk for the health of both the mother and infant, evaluate the impact of medication use on women's infant feeding choice, describe the transfer of drugs to breastmilk and infants, and provide a framework for clinicians to support evidence-based counseling for women treated for mood disorders. RECOMMENDATIONS We recommend early pregnancy counseling to discuss the benefits and risks of medications during breastfeeding. The Surgeon General's Call to Action (2011) highlights the short and long-term negative health effects of not providing breastmilk. Integrating recommendations from the pediatric and obstetric teams allows patients to make decisions based on evidence and reach their infant feeding goals. Databases containing summaries of research findings and pharmacologic properties of the drug of interest are an essential resource for clinicians.
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Affiliation(s)
- Jennifer Sprague
- Perinatal and Women's Mental Health Fellow, Instructor, Department of Psychiatry, Northwestern University Feinberg School of Medicine, 676N St. Clair St. Suite 1000, Chicago, IL 60611, USA
| | - Katherine L Wisner
- Norman and Helen Asher Professor of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, Director, Asher Center for the Study and Treatment of Depressive Disorders, Northwestern University Feinberg School of Medicine, 676 North Saint Clair St. Suite 1000, Chicago, IL 60611, USA
| | - Debra L Bogen
- Professor of Pediatrics, Psychiatry and Clinical and Translational Sciences, University of Pittsburgh School of Medicine, Vice Chair of Education, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Co-director of Quality and Safety, Children's Community Pediatrics, 3414 Fifth Ave, CHOB 320, Pittsburgh, PA 15213, USA.
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8
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Rosen-Carole C, Allen K, Thompson J, Martin H, Goldstein N, Lawrence RA. Prenatal Provider Support for Breastfeeding: Changes in Attitudes, Practices and Recommendations Over 22 Years. J Hum Lact 2020; 36:109-118. [PMID: 30840540 DOI: 10.1177/0890334419830996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Prenatal care providers play a central role in breastfeeding outcomes. A survey on obstetricians' support of breastfeeding was conducted in 1993 in Monroe County, NY. Since the landscape of prenatal care and breastfeeding support has changed significantly in the past 2 decades, we repeated and extended this survey in 2015. RESEARCH AIM To determine changes in breastfeeding support by prenatal care providers over a 20 year period. METHODS We sent a 46-item on-line or paper questionnaire to all categories of prenatal care providers identified by an online search. A breastfeeding support score was created based on the prior survey, with a maximum score of 3. One point was awarded for: (1) personally discussing breastfeeding; (2) generally suggesting breastfeeding; and (3) commonly receiving questions from patients. Data were analyzed using Chi-square. RESULTS We had 164 participants (response rate 80%). More current participants, compared to 1993, reported discussing (97% vs. 86%, p < .001) and recommending (93% vs. 80%, p = .001) breastfeeding. Only 10% of 2015 participants gave infant formula samples, compared with 34% in 1993 (p < .0001). Improvement in the support score was seen, with 98% of current participants having high scores compared to 87% in 1993 (p < .001). Similar numbers reported receiving breastfeeding education, though more reported that the education was inadequate (54% vs. 19%, p < .0001). CONCLUSION Breastfeeding support improved significantly over time, even though breastfeeding education has not improved in quality or quantity. Improving education of prenatal care providers may help future providers be more prepared to support breastfeeding.
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Affiliation(s)
- Casey Rosen-Carole
- Assistant Professor of Pediatrics and Obstetrics and Gynecology, Medical Director of Lactation Services and Programs, University of Rochester School of Medicine and Dentistry
| | - Katherine Allen
- Pediatric Resident, University of Minnesota at Minneapolis, MN, USA
| | | | - Hayley Martin
- MD, University of Rochester School of Medicine and Dentistry
| | | | - Ruth A Lawrence
- MD, Professor of Pediatrics and Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Medical Director of the Ruth A. Lawrence Poison and Drug Information Center and of the Breastfeeding and Human Lactation Study Center
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9
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Infant feeding among women with a history of breast cancer. J Cancer Surviv 2020; 14:356-362. [PMID: 31933150 DOI: 10.1007/s11764-019-00852-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 12/31/2019] [Indexed: 01/07/2023]
Abstract
PURPOSE Health professional organizations recommend exclusive breastfeeding for 6 months, but there are mothers, such as those with a history of breast cancer, who are unable to exclusively provide their milk for their infants. Minimal research has been published on mothers' experience with lactation, breastfeeding, and bottle-feeding after breast cancer. This study explored mothers' perspectives of infant feeding after a history of breast cancer. METHODS Qualitative interviews were completed with 20 mothers who had experience with infant feeding after breast cancer, including exclusive breastfeeding, partial provision of human milk with formula supplementation, and exclusive formula feeding. RESULTS Mothers shared their perceptions, barriers, and experiences of infant feeding. Four themes were identified: miracle of motherhood after breast cancer, medical misinformation or no available information contributing to the exacerbation of mothers' worries, post-breast-cancer feeding challenges, and desire for infant-feeding support rather than pressure. CONCLUSIONS Mothers who have had breast cancer and have since given birth face specific challenges to infant feeding which are compounded by limited resources and knowledge among healthcare providers. Findings of the study highlight the importance of healthcare professionals becoming more educated to provide adequate support and evidence-based information on lactation and infant feeding for women with a history of breast cancer. IMPLICATIONS FOR CANCER SURVIVORS Understanding the experiences of women who have given birth after breast cancer can help women in similar situations know that they are not alone, identify resources, access peer support, and seek evidence-based infant feeding advice from healthcare providers involved in their care.
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10
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Black AD. Managing the Breastfeeding Patient in the Emergency Department. Ann Emerg Med 2020; 75:105-110. [DOI: 10.1016/j.annemergmed.2019.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Indexed: 11/29/2022]
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Abd El-Ghany SM, Korraa AAW, Ahmed EA, Salem IMW, Eslam SA, El-Taweel AA, Cadwell K. A Survey of Knowledge, Attitudes, and Practices of Providers and Staff at Al-Zahraa University Hospital Regarding the Baby-Friendly Hospital Initiative and the International Code of Marketing Breast Milk Substitutes. J Perinat Educ 2019; 28:210-217. [PMID: 31728112 DOI: 10.1891/1058-1243.28.4.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Four hundred eight providers and staff members who care for breastfeeding mothers and babies at Al-Zahraa University Hospital, Cairo, Egypt were randomly selected to assess their knowledge, attitudes, and practices regarding the Baby-Friendly Hospital Initiative. The majority of the participants scored above 50% on the knowledge and attitude questions, however, on the practice questions only 45.3% scored above 50%, similar to the result obtained 10 years prior. The results indicate that most attention should be focused on developing practice guidelines and monitoring outcomes since knowledge and attitude were found to be adequate. We would recommend self-appraisal of staff as a first step to others whose hospitals are in the process of implementing the Baby-Friendly Hospital Initiative.
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12
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Thepha T, Marais D, Bell J, Muangpin S. Concept mapping to reach consensus on a 6-month exclusive breastfeeding strategy model to improve the rate in Northeast Thailand. MATERNAL AND CHILD NUTRITION 2019; 15:e12823. [PMID: 30958626 PMCID: PMC6851995 DOI: 10.1111/mcn.12823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 11/26/2022]
Abstract
Background In implementation research, it is essential to involve all stakeholders in the development of complex interventions to ensure that the proposed intervention strategy is relevant and acceptable to the target area and group. The aim of this study was to involve stakeholders in conceptualising, developing, and prioritising a feasible intervention strategy to improve the 6‐month exclusive breastfeeding rate in North‐east Thailand. Concept mapping was used in a purposive sample including health care volunteers, health care professionals, and community leaders. During the first meeting, stakeholders (n = 22) expressed the generation of feasible interventions. During the second meeting, participants (n = 21) were asked to individually rate the feasibility of each intervention and to group them into relevant categories to enable multidimensional scaling and hierarchical cluster analysis. The outputs of analysis included the intervention list, cluster list, point map, point rating map, cluster map, and cluster rating map. All of these were shared with stakeholders (n = 17) during the third meeting to reach consensus on an intervention model. The final proposed intervention strategy included 15 feasible interventions in five clusters: health care services, community services, and education packages for parents, family members, and communities. These interventions were prioritised for implementation over a 3‐year period. Once the feasibility of each intervention is established, the proposed model could be implemented and incorporated into local health policy. After assessing intervention effectiveness, each intervention could be scaled up to other middle‐income countries to help improve overall maternal and child survival.
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Affiliation(s)
- Thiwawan Thepha
- Department of Advanced Midwifery, Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand
| | - Debbie Marais
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jacqueline Bell
- College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK
| | - Somjit Muangpin
- Department of Advanced Midwifery, Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand
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13
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Harillo-Acevedo D, Ramos-Morcillo AJ, Ruzafa-Martinez M. Factors associated with breastfeeding support from health care professionals by implementing a Clinical Practice Guideline. Birth 2019; 46:146-156. [PMID: 30051575 DOI: 10.1111/birt.12382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 06/28/2018] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The prevalence and duration of breastfeeding are at low levels and may be improved by the support of health care professionals. Our objective was to determine the effect of implementing a breastfeeding clinical practice guideline on factors associated with breastfeeding support by health care professionals, adopting a Theory of Planned Behavior approach. METHODS We conducted an observational, cross-sectional study during 2016 in a health area with implemented clinical practice guideline on breastfeeding, comparing the results with data from a previous cross-sectional study (2011) in the same area, in a standard-care area, and in a Baby-Friendly Hospital Initiative (BFHI)-accredited area. A validated questionnaire (four scales: attitudes, beliefs, subjective norms, and behavioral intention) was completed by professionals in each area. Descriptive analysis was followed by comparisons among the different settings using the chi-square test. RESULTS In the area with the implemented clinical practice guideline, the professionals scored significantly higher in subjective norms and beliefs than had been recorded in 2011 (preimplementation), and their scores for all four scales were significantly higher than in the standard-care area. Professionals obtained significantly higher scores for subjective norms in the BFHI-accredited area than in the other settings. CONCLUSIONS Clinical practice guideline implementation improved the responses of professionals on breastfeeding support in subjective norms and beliefs scales. There is a need for activities to assist breastfeeding in a practical manner and for more effective measures to ensure compliance with the International Code of Marketing of Breast-milk Substitutes.
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14
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Meek JY. Educational Objectives and Skills for the Physician with Respect to Breastfeeding, Revised 2018. Breastfeed Med 2019; 14:5-13. [PMID: 30614733 DOI: 10.1089/bfm.2018.29113.jym] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The Academy of Breastfeeding Medicine is a worldwide organization of physicians dedicated to the promotion, protection and support of breastfeeding and human lactation. Our mission is to unite into one association members of the various medical specialties with this common purpose.
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Affiliation(s)
- Joan Younger Meek
- Department of Clinical Sciences, Florida State University College of Medicine, Orlando, Florida
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15
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Anstey EH, Coulter M, Jevitt CM, Perrin KM, Dabrow S, Klasko-Foster LB, Daley EM. Lactation Consultants' Perceived Barriers to Providing Professional Breastfeeding Support. J Hum Lact 2018; 34:51-67. [PMID: 28820951 DOI: 10.1177/0890334417726305] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Addressing suboptimal breastfeeding initiation and duration rates is a priority in the United States. To address challenges to improving these rates, the voices of the providers who work with breastfeeding mothers should be heard. Research aim: The purpose of this study was to explore lactation consultants' perceived barriers to managing early breastfeeding problems. METHODS This qualitative study was conducted with a grounded theory methodological approach. In-depth interviews were conducted with 30 International Board Certified Lactation Consultants across Florida. Lactation consultants were from a range of practice settings, including hospitals, Special Supplemental Nutrition Program for Women, Infants, and Children clinics, private practice, and pediatric offices. Data were digitally recorded, transcribed, and analyzed in Atlas.ti. RESULTS A range of barriers was identified and grouped into the following categories/themes: indirect barriers (social norms, knowledge, attitudes); direct occupational barriers (institutional constraints, lack of coordination, poor service delivery); and direct individual barriers (social support, mother's self-efficacy). A model was developed illustrating the factors that influence the role enactment of lactation consultants in managing breastfeeding problems. CONCLUSION Inadequate support for addressing early breastfeeding challenges is compounded by a lack of collaboration among various healthcare providers and the family. Findings provide insight into the professional management issues of early breastfeeding problems faced by lactation consultants. Team-based, interprofessional approaches to breastfeeding support for mothers and their families are needed; improving interdisciplinary collaboration could lead to better integration of lactation consultants who are educated and experienced in providing lactation support and management of breastfeeding problems.
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Affiliation(s)
- Erica H Anstey
- 1 Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Martha Coulter
- 1 Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | | | - Kay M Perrin
- 1 Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Sharon Dabrow
- 3 Department of Pediatrics, College of Medicine, University of South Florida, Tampa, FL, USA
| | - Lynne B Klasko-Foster
- 1 Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Ellen M Daley
- 1 Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA
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[Tensions and contradictions in government interventions for the promotion of breastfeeding]. Salud Colect 2018; 13:677-692. [PMID: 29340446 DOI: 10.18294/sc.2017.1357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 08/03/2017] [Indexed: 11/24/2022] Open
Abstract
With the purpose of shedding light on the decrease in the practice of breastfeeding in rural areas of Mexico, this article looks at the current biomedical model and the policies and actions to promote breastfeeding derived from the model's theoretical approach. The article also discusses operational strategies of the governmental social welfare program Oportunidades. For this purpose, the study utilizes the testimonies of 39 young breastfeeding mothers, 11 mothers and grandmothers and 12 members of the health staff in the Nahuatl population of Cuentepec, Morelos, Mexico, which were collected during a previous study in 2008 and 2009. It was found that the biomedical model, which permeates all actions to promote breastfeeding, reifies people, limits communication, devaluates women's traditional knowledge and imposes a discourse that gradually discourages the practice of breastfeeding. The article's proposal is to adopt an epistemic change in biomedical thought that shifts from a paradigm of simplicity to one of complexity, with the purpose of achieving a greater understanding of the bio-psycho-socio-cultural processes of human beings.
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Abstract
All health professional organizations recommend exclusive breastfeeding for at least 6 months, with continued breastfeeding for 1 year or more after birth. Women cite lack of support from health professionals as a barrier to breastfeeding. Meanwhile, breastfeeding education is not considered essential to basic nursing education and students are not adequately prepared to support breastfeeding women. Therefore, a toolkit of comprehensive evidence-based breastfeeding educational materials was developed to provide essential breastfeeding knowledge. A study was performed to determine the effectiveness of the breastfeeding toolkit education in an associate degree nursing program. A pretest/posttest survey design with intervention and comparison groups was used. One hundred fourteen students completed pre- and posttests. Student knowledge was measured using a 12-item survey derived with minor modifications from Marzalik's 2004 instrument measuring breastfeeding knowledge. When pre- and posttests scores were compared within groups, both groups' knowledge scores increased. A change score was calculated with a significantly higher mean score for the intervention group. When regression analysis was used to control for the pretest score, belonging to the intervention group increased student scores but not significantly. The toolkit was developed to provide a curriculum that demonstrates enhanced learning to prepare nursing students for practice. The toolkit could be used in other settings, such as to educate staff nurses working with childbearing families.
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Application of the EBP Process: Maximizing Lactation Support with Minimal Education. J Pediatr Nurs 2017; 33:97-100. [PMID: 28132750 DOI: 10.1016/j.pedn.2017.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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