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Lynn Z, Chuemchit M. Determinants of prenatal breastfeeding knowledge, attitudes and self-efficacy among Burmese migrant pregnant mothers in Samut Sakhon Province, Thailand: a cross-sectional study. BMJ Open 2024; 14:e084609. [PMID: 38991685 DOI: 10.1136/bmjopen-2024-084609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
OBJECTIVE The study aimed to explore the determinants of prenatal breastfeeding knowledge, attitudes and self-efficacy among Burmese migrant pregnant mothers in Samut Sakhon Province, Thailand. DESIGN The data were collected as part of a baseline survey of a randomised controlled trial. SETTING AND PARTICIPANTS A total of 198 Burmese migrant mothers between 28th and 34th weeks of gestation were recruited from the antenatal care clinic of Samut Sakhon Hospital. PRIMARY OUTCOME MEASURES Breastfeeding knowledge, attitudes and self-efficacy RESULTS: The prevalence of good breastfeeding knowledge was 65.7% (n=130), positive attitudes towards breast feeding were 55.1% (n=109) and high breastfeeding self-efficacy was 70.7% (n=140). Multivariate logistic regression models revealed that mothers aged above 25 years (adjusted OR, AOR 3.1, 95% CI 1.2 to 7.9), being Bamar (AOR 2.3, 95% CI 1.2 to 4.4), having support from husband (AOR 2.3, 95% CI 1.2 to 4.6) and having previous childbirth experience (AOR 2.5, 95% CI 1.3 to 4.8) were the main determinants of good breastfeeding knowledge. Similarly, being Bamar (AOR 2.8, 95% CI 1.5 to 5.3), having high school education (AOR 4.3, 95% CI 1.8 to 10.1) and having access to workplace breastfeeding support (AOR 5.3, 95% CI 1.4 to 20.1) were found to be significant predictors of positive attitudes towards breast feeding. Moreover, mothers aged above 25 years (AOR 2.9, 95% CI 1.1 to 7.8), being Bamar (AOR 2.4, 95% CI 1.2 to 5.1), being unemployed (AOR 7.8, 95% CI 1.9 to 31.9), having support of husband (AOR 3.2, 95% CI 1.5 to 7.0), having previous breastfeeding experience for 6 months or more (AOR 5.0, 95% CI 2.1 to 11.7) and having intention to exclusively breastfeed (AOR 2.7, 95% CI 1.3 to 5.8) had significant associations with high breastfeeding self-efficacy. CONCLUSION The prenatal breastfeeding knowledge, attitudes and self-efficacy among Burmese migrant mothers were influenced by many factors. A comprehensive understanding of these factors will enable policy-makers and healthcare providers to develop context-specific interventions for the promotion of exclusive breast feeding among Burmese migrant mothers in Thailand. TRIAL REGISTRATION NUMBER TCTR20230310004.
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Affiliation(s)
- Zayar Lynn
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Montakarn Chuemchit
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
- Excellent Center for Health and Social Sciences and Addition Research, College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
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Yadollahi P, Padashian F, Doostfatemeh M. Five-factor model personality traits, exclusive breastfeeding, and self-efficacy: a mediational analysis. BMC Pregnancy Childbirth 2024; 24:279. [PMID: 38627657 PMCID: PMC11022404 DOI: 10.1186/s12884-024-06494-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Despite the World Health Organization's (WHO) emphasis on exclusive breastfeeding, the documents show a declining trend worldwide. Studies assert that the mother's personality traits appear to have an impact on this issue. This study aimed to investigate the potential influence of personality traits on exclusive breastfeeding, which might be channeled by self-efficacy as a mediator variable. METHODS Data were analyzed from the cross-sectional study. The exclusive breastfeeding scale, the breastfeeding self-efficacy questionnaire, and the Five-Factor Model questionnaire (as follows: neuroticism, extraversion, openness experience, agreeableness, and conscientiousness) were completed by120 Iranian volunteer mothers with an infant aged 6-12 months referred to health centers in Shiraz (a major city in southern Iran) between May to December 2019. The structural equation modeling (SEM) approach was used to obtain the direct and indirect effects of personality traits and self-efficacy on exclusive breastfeeding. RESULTS The study showed the significant direct effect of some personality traits (agreeableness, extraversion, and consciousness) and self-efficacy on exclusive breastfeeding. The indirect effect of extraversion on exclusive breastfeeding through self-efficacy was also obtained from the result of SEM analysis. The model fit the data satisfactorily, according to the fit indices criteria extracted from the mediational analysis. CONCLUSIONS Self-efficacy appears to be a significant predictor of exclusive breastfeeding. Therefore, exclusive breastfeeding could be enhanced by safe education in pregnancy, reinforcing the self-efficacy of pregnant women and considering their personality traits.
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Affiliation(s)
- Parvin Yadollahi
- Maternal-fetal Medicine Research Center, Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Padashian
- Department of Midwifery, Behbahan Branch, Islamic Azad University, Behbahan, Iran
| | - Marziyeh Doostfatemeh
- Department of Biostatistics, Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Lee TA, Bishop J, Drover A, Midodzi WK, Twells LK. A cross-sectional study of breastfed infants referred for tongue tie assessment and frenotomy in one Canadian health region. Pediatr Investig 2024; 8:53-60. [PMID: 38516135 PMCID: PMC10951488 DOI: 10.1002/ped4.12416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/31/2023] [Indexed: 03/23/2024] Open
Abstract
Importance Tongue tie (TT) is a condition that can cause infant feeding difficulties due to restricted tongue movement. When TT presents as a significant barrier to breastfeeding, a frenotomy may be recommended. Universally accepted diagnostic criteria for TT are lacking and wide prevalence estimates are reported. New referral processes and a Frenotomy Assessment Tool were implemented in one Canadian health region to connect breastfeeding dyads with a provider for TT evaluation and frenotomy. Objective To determine the proportion of babies with TT as well as the frequency of frenotomy. Methods This cross-sectional study included infants who initiated breastfeeding at birth and were referred for TT evaluation over a 14-month period. Data were collected retrospectively by chart review and analyzed using SPSS. Factors associated with frenotomy were examined using logistic regression. Results Two hundred and forty-one babies were referred. Ninety-two percent (n = 222) were diagnosed with TT and 66.0% (n = 159) underwent frenotomy. In the multivariate model, nipple pain/trauma, inability to latch, inability to elevate tongue, and dimpling of tongue on extension were associated with frenotomy (P < 0.05). Most referrals in our region resulted in a diagnosis of TT; however, the number of referrals was lower than expected, and of these two-thirds underwent frenotomy. Interpretation TT is a relatively common finding among breastfed infants. Future research should examine whether a simplified assessment tool containing the four items associated with frenotomy in our multivariate model can identify breastfed infants with TT who require frenotomy.
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Affiliation(s)
- Tiffany A. Lee
- School of PharmacyMemorial University of Newfoundland (MUN)St. John'sCanada
| | - Jessica Bishop
- Faculty of MedicineMemorial University of Newfoundland (MUN)St. John'sCanada
| | - Anne Drover
- Faculty of MedicineMemorial University of Newfoundland (MUN)St. John'sCanada
| | - William K. Midodzi
- Faculty of MedicineMemorial University of Newfoundland (MUN)St. John'sCanada
| | - Laurie K. Twells
- Faculty of MedicineMemorial University of Newfoundland (MUN)St. John'sCanada
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Ferguson L, Chervonsky A, Fogel J, Jacobs AJ. Association of Maternal Preferred Language with Breastfeeding Attitudes, Intentions, and Knowledge. JOURNAL OF MOTHER AND CHILD 2023; 27:209-216. [PMID: 37991976 PMCID: PMC10664786 DOI: 10.34763/jmotherandchild.20232701.d-23-00026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 10/19/2023] [Indexed: 11/24/2023]
Abstract
INTRODUCTION Assessing intentions, attitudes, and knowledge about breastfeeding among different language groups is important because the languages reflect cultural differences. We compared attitudes, subjective norms, perceived behavioural control, intentions, and knowledge of breastfeeding among mothers with the five most common preferred languages spoken at a New York City hospital. MATERIALS AND METHODS This cross-sectional study surveyed women (n = 448) in the prenatal clinic and the post-partum unit of a New York City hospital. The survey questions were about breastfeeding attitudes, subjective norms, perceived behavioural control, and intentions, based on the Theory of Planned Behavior. We also administered the Iowa Infant Feeding and Attitude Scale and measured the knowledge of the mothers about breastfeeding. The preferred language spoken by the mother was the main predictor variable. English, Russian, Spanish, Urdu, and Uzbek were the languages studied. RESULTS Multivariate linear regression analyses showed that Russian (B = 2.24, SE = 1.09, p = 0.04), Urdu (B = 2.90, SE = 1.45, p = 0.046), and Uzbek (B = 4.21, SE = 1.35, p = 0.002) speakers all had significantly more positive attitudes toward breastfeeding than did English speakers. Spanish and English language speakers did not differ from each other in their attitudes towards breastfeeding. The language groups did not differ significantly for subjective norms, perceived behavioural control, intention to breastfeed, the Iowa Infant Feeding and Attitude Scale, nor in knowledge regarding breastfeeding. CONCLUSIONS Urdu, Uzbek, and Russian speakers had significantly more positive attitudes towards breastfeeding than did English speakers. To the extent that preferred language is a proxy for culture, clinicians can use this parameter as a basis for directing approaches toward lactation education.
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Affiliation(s)
- Lincoln Ferguson
- Department of Obstetrics and Gynecology, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
- Department of Obstetrics and Gynecology, South Brooklyn Health, Brooklyn, New York, USA
| | - Alexandra Chervonsky
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York, USA
| | - Joshua Fogel
- Department of Obstetrics and Gynecology, South Brooklyn Health, Brooklyn, New York, USA
- Department of Business Management, Brooklyn College, Brooklyn, New York, USA
| | - Allan J. Jacobs
- Department of Obstetrics and Gynecology, South Brooklyn Health, Brooklyn, New York, USA
- Department of Obstetrics and Gynecology, Downstate Medical Center, Brooklyn, New York, USA
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Adegbayi A, Scally A, Lesk V, Stewart-Knox BJ. A Survey of Breastfeeding Attitudes and Health Locus of Control in the Nigerian Population. Matern Child Health J 2023; 27:1060-1069. [PMID: 37029895 PMCID: PMC10160144 DOI: 10.1007/s10995-023-03638-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVES Breastfeeding is important to infant health and survival in sub-Saharan Africa. To promote breastfeeding effectively, understanding of psychological factors associated with infant feeding choices is required. This study investigated breastfeeding attitudes and health locus of control (HLoC) in a Nigerian community sample. METHODS Men and women (N = 400) (71% female; mean age 34.2 years/ range 18-86 years) were recruited through community groups in Nigeria. Self-report survey by questionnaire measured breastfeeding attitudes using the Iowa Infant Feeding Attitude Scale (IIFAS) and health locus of control using the Multidimensional Health Locus of Control Scale (MHLoCs). RESULTS MEAN IIFAS scores (mean = 57.7; sd = 7.8) became less favourable with increasing age (p = 0.02). Men had higher IIFAS scores (mean = 58.6; sd = 7.6) than women (mean = 56.6; sd = 8.0) indicating more favourable attitudes toward breastfeeding (p = 0.02). Women scored higher than men on external chance HLoC (ECHLoC) (p = 0.003) and external powerful others HLoC (EPHLoC) (p = 0.02). Increasing age was associated with higher scores on ECHLoC (p < 0.01) and EPHLoC (p < 0.01). Multiple linear regression analysis was significant (p < 0.001) and explained 7.8% of variance in breastfeeding attitude. Lower IIFAS scores, reflecting more negative attitudes to breastfeeding, were associated with higher ECHLoC (p < 0.01) and EPOHLoC (p < 0.05). Higher IIFAS scores, reflecting more positive attitudes to breastfeeding, were associated with greater IHLoC (p < 0.01). Neither age nor gender were associated with IIFAS scores in the final model. CONCLUSIONS This implies a need to explore health locus of control when promoting positive attitudes to breastfeeding and supporting families in breastfeeding advocacy.
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Affiliation(s)
- Adenike Adegbayi
- Department of Psychology, University of Bradford, Richmond Road, BD71DP, Bradford, UK
| | - Andrew Scally
- School of Clinical Therapies, University College Cork, Cork, Ireland
| | - Valerie Lesk
- Department of Psychology, University of Bradford, Richmond Road, BD71DP, Bradford, UK
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Demirci JR, Glasser M, Bogen DL, Sereika SM, Ren D, Ray K, Bodnar LM, O'Sullivan TA, Himes K. Effect of antenatal milk expression education on lactation outcomes in birthing people with pre-pregnancy body mass index ≥25: protocol for a randomized, controlled trial. Int Breastfeed J 2023; 18:16. [PMID: 36927811 PMCID: PMC10019405 DOI: 10.1186/s13006-023-00552-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/19/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Birthing people with pre-pregnancy body mass indices (BMIs) ≥ 25 kg/m2, particularly those without prior breastfeeding experience, are at increased risk for suboptimal lactation outcomes. Antenatal milk expression (AME) may be one way to counteract the negative effects of early infant formula supplementation common in this population. METHODS This ongoing, randomized controlled trial in the United States evaluates the efficacy of a telelactation-delivered AME education intervention versus an attention control condition on lactation outcomes to 1 year postpartum among 280 nulliparous-to-primiparous, non-diabetic birthing people with pre-pregnancy BMI ≥ 25 kg/m2. The assigned study treatment is delivered via four weekly online video consultations between gestational weeks 37-40. Participants assigned to AME meet with study personnel and a lactation consultant to learn and practice AME. Instructions are provided for home practice of AME between study visits. Control group participants view videos on infant care/development at study visits. Participants complete emailed surveys at enrollment (340/7-366/7 gestational weeks) and 2 weeks, 6 weeks, 12 weeks, 6 months, and 12 months postpartum. Surveys assess lactation and infant feeding practices; breastfeeding self-efficacy, attitudes, and satisfaction; perception of insufficient milk; onset of lactogenesis-II; lactation support and problems; and reasons for breastfeeding cessation. Surveys also assess factors associated with lactation outcomes, including demographic characteristics, health problems, birth trauma, racial discrimination, and weight stigma. Health information and infant feeding data are abstracted from the pregnancy and birth center electronic health record. Milk samples are collected from the intervention group at each study visit and from both groups at each postpartum follow-up for future analyses. Qualitative interviews are conducted at 6 weeks postpartum to understand AME experiences. Primary outcomes of interest are breastfeeding exclusivity and breastfeeding self-efficacy scores at 2 weeks postpartum. Outcomes will be examined longitudinally with generalized linear mixed-effects modeling. DISCUSSION This is the first adequately powered trial evaluating the effectiveness of AME among U.S. birthing people and within a non-diabetic population with pre-pregnancy BMI ≥ 25 kg/m2. This study will also provide the first evidence of acceptability and effectiveness of telelactation-delivered AME. TRIAL REGISTRATION ClinicalTrials.gov: NCT04258709.
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Affiliation(s)
- Jill R Demirci
- Department of Health Promotion & Development, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.
| | - Melissa Glasser
- Department of Health Promotion & Development, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Debra L Bogen
- Allegheny County Health Department, Pittsburgh, PA, USA
| | - Susan M Sereika
- Department of Health & Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Dianxu Ren
- Department of Health & Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Kristin Ray
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,UPMC Children's Community Pediatrics, Pittsburgh, PA, USA
| | - Lisa M Bodnar
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Therese A O'Sullivan
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Katherine Himes
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,UPMC Magee-Womens Hospital, Pittsburgh, PA, USA
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Zhang Q, Li K, Wouk K, Lamichhane R, Guthrie J. Prenatal Perception of WIC Breastfeeding Recommendations Predicts Breastfeeding Exclusivity and Duration in the Infants' First Year. J Nutr 2022; 152:2931-2940. [PMID: 36149318 PMCID: PMC9839998 DOI: 10.1093/jn/nxac221] [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: 07/27/2022] [Revised: 09/01/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Pregnant participants who perceived that the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) recommends breastfeeding only were more likely to have better early breastfeeding outcomes. OBJECTIVES Our objective was to examine the association between prenatal perception of WIC's breastfeeding recommendations and breastfeeding duration through the first year of infant life. METHODS This observational study used a national longitudinal sample of 1594 pregnant participants in the WIC Infant and Toddler Feeding Practices Study-2 in 2013. Four measures of breastfeeding duration were used: 1) a discrete measure of exclusive breastfeeding through 5 mo; 2) a continuous measure of exclusive breastfeeding (in days up to 7 mo); 3) a discrete measure of any breastfeeding through 11 mo; and 4) a continuous measure of any breastfeeding (in days up to 13 mo). The primary explanatory variable was the participant's prenatal perception of whether WIC recommended breastfeeding only. The univariate analyses of time to breastfeeding cessation were performed using Kaplan-Meier curves. The Cox regression model was adopted to estimate the likelihood of breastfeeding outcomes over time. All analyses accounted for complex survey design effects. RESULTS Compared with their peers who perceived WIC to recommend formula only or both breastfeeding and formula equally, participants who perceived WIC as recommending breastfeeding only were less likely to stop exclusive breastfeeding through 5 mo (HR = 0.83; 95% CI: 0.69, 0.99) or to stop any breastfeeding through 11 mo (HR = 0.80; 95% CI: 0.69, 0.92), without controlling for prenatal infant feeding intentions. Similar patterns were observed in the 2 continuous measures, as they were also less likely to stop exclusive breastfeeding by 7 mo (HR = 0.78; 95% CI: 0.69, 0.90) or to stop any breastfeeding by 13 mo (HR = 0.82; 95% CI: 0.71, 0.95). CONCLUSIONS Prenatal perception of WIC's breastfeeding recommendation can be a useful predictor of breastfeeding duration in WIC participants.
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Affiliation(s)
- Qi Zhang
- Address correspondence to QZ (e-mail: )
| | - Kelin Li
- Department of Sociology, California State University-Dominguez Hills, Carson, CA, USA
| | - Kathryn Wouk
- Pacific Institute for Research and Evaluation, Chapel Hill, NC, USA
| | - Rajan Lamichhane
- Department of Clinical and Translational Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA
| | - Joanne Guthrie
- US Department of Agriculture/Economic Research Service, Washington, DC, USA
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Li JY, Huang YY, Huang Y, Du MC, Xu J, Li L, Redding SR, Ouyang YQ. Development of a breastfeeding duration risk nomogram for use in postpartum Chinese women. Res Nurs Health 2021; 45:94-107. [PMID: 34907548 DOI: 10.1002/nur.22203] [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: 05/05/2021] [Revised: 11/08/2021] [Accepted: 11/27/2021] [Indexed: 11/11/2022]
Abstract
Previous studies have investigated influencing factors of early discontinuation of breastfeeding, but few studies have developed an easy-to-use tool to identify risk of breastfeeding cessation at 6 months after birth. This research team aimed to develop and validate an exclusive breastfeeding duration risk nomogram in Chinese mothers. A longitudinal cohort survey was conducted. Data were collected from 394 postpartum women in three hospitals in Hubei Province, China from December 2017 to December 2018. The LASSO regression model was used to screen for optimized factors in an exclusive breastfeeding duration model. Multivariable logistic regression was applied to construct a prediction model. Discrimination and calibration were assessed using a C-index and calibration curve, and internal validity was established using bootstrapping validation. Factors integrated in the prediction risk nomogram were monthly household income (odds ratio [OR] = 1.31, 95% confidence interval [CI]: [0.95, 1.80]), experiences of breastfeeding (OR = 1.23, 95% CI: [0.92, 1.63]), attitude (OR = 1.72, 95% CI: [0.94, 3.16]), self-efficacy (OR = 2.45, 95% CI: [1.40, 4.29]), perceived insufficient milk supply (OR = 0.12, 95% CI: [0.06, 0.25]) and postpartum depression (OR = 0.06, 95% CI: [0.02, 0.17]). The model displayed good discrimination with a C-index of 0.87 (95% CI: [0.84, 0.91]) and good calibration. The C-index interval validation was confirmed to be 0.86. This study resulted in the development of a novel nomogram with good accuracy to aid healthcare professionals in assessing the probability of a mother discontinuing exclusive breastfeeding at the breast before 6 months.
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Affiliation(s)
- Jun-Yan Li
- School of Nursing, Wuhan University, Wuhan, Hubei, China
| | - Yi-Yan Huang
- School of Nursing, Wuhan University, Wuhan, Hubei, China
| | - Yi Huang
- School of Nursing, Wuhan University, Wuhan, Hubei, China
| | - Mei-Chen Du
- School of Nursing, Wuhan University, Wuhan, Hubei, China
| | - Jing Xu
- School of Nursing, Wuhan University, Wuhan, Hubei, China
| | - Lu Li
- School of Nursing, Wuhan University, Wuhan, Hubei, China
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Zhang Q, Lamichhane R, Wouk K, Guthrie J, Li K. Prenatal perception of breastfeeding recommendations predicts early breastfeeding outcomes of participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Am J Clin Nutr 2021; 114:1949-1959. [PMID: 34302329 PMCID: PMC8634569 DOI: 10.1093/ajcn/nqab268] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 07/22/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Prenatal psychosocial factors predict breastfeeding practices but are not assessed in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). OBJECTIVES This study examined how prenatal perceptions of WIC's breastfeeding recommendations were associated with early breastfeeding outcomes. METHODS This study used longitudinal data from a national sample of 2053 pregnant participants in the WIC Infant and Toddler Feeding Practices Study-2 (WIC ITFPS-2) in 2013, the only national data assessing prenatal perceptions of WIC's breastfeeding recommendations. Early breastfeeding outcomes included breastfeeding initiation, breast milk first fed after birth, breastfeeding in the first hour, breast milk first fed after leaving the hospital, and breastfeeding status at the first and third months. The primary predictor was the participant's prenatal perception of whether WIC recommended breastfeeding only or not. Log-binomial regression was used with adjustment for socio-demographics, previous breastfeeding, WIC participation, breastfeeding support, and infant feeding intentions (IFI). RESULTS Without controlling for IFI, the perception of WIC recommending breastfeeding only predicted breastfeeding outcomes positively. The risk ratio (RR) associated with prenatal perceptions varied from 1.14 (95% CI: 1.03, 1.25; P = 0.008) for breastfeeding in the first hour, to 1.27 (95% CI: 1.12, 1.43; P < 0.001) for breast milk first fed after leaving hospital, to 1.66 (95% CI: 1.35, 2.04; P < 0.001) for 3-mo breastfeeding only. After controlling for IFI, the RRs were 1.13 (95% CI: 1.02, 1.24; P = 0.017) for breastfeeding in the first hour, 1.20 (95% CI: 1.06, 1.35; P = 0.004) for breast milk first fed after leaving hospital, and 1.49 (95% CI: 1.21, 1.84; P < 0.001) for 3-mo breastfeeding only, suggesting that prenatal perception was independently associated with breastfeeding outcomes. CONCLUSIONS Prenatal perception of WIC's breastfeeding recommendations can be regarded as a new psychosocial predictor of breastfeeding and a possible target for future intervention.
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Affiliation(s)
- Qi Zhang
- Address correspondence to QZ (e-mail: )
| | - Rajan Lamichhane
- Department of Clinical and Translational Sciences, Joan C Edwards School of Medicine, Marshall University, Huntington, WV, USA
| | - Kathryn Wouk
- Carolina Global Breastfeeding Institute, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | | | - Kelin Li
- Department of Sociology, California State University-Dominguez Hills, Carson, CA, USA
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Ungváry R, Ittzés A, Bóné V, Török S. Psychometric properties of the original and short Hungarian version of the Iowa infant feeding attitude scale. Int Breastfeed J 2021; 16:54. [PMID: 34271964 PMCID: PMC8284002 DOI: 10.1186/s13006-021-00403-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 07/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Iowa Infant Feeding Attitude Scale (IIFAS) is a widely used tool to assess attitudes towards infant feeding. Attitudes towards breastfeeding are one of the main influencing factors of feeding choice and breastfeeding duration. Adaptation of the IIFAS to the Hungarian context provides an opportunity for cross-cultural comparisons and helps to target breastfeeding support interventions. The growing number of shortened scales in various fields of research, demonstrates the necessity to adapt to a changing context of data collection to avoid fatigue and dropout among respondents. However, international comparisons are difficult due to the lack of a consensual shortened form of the scale. The aim of our study was to examine the psychometric properties of the Hungarian version of the IIFAS (IIFAS-H) and propose an 8-item short version that has appropriate construct validity. METHODS The original IIFAS was translated into Hungarian and then translated back to English. A cross-sectional study based on an internet survey in 2019 was conducted among 553 mothers whose most recent child's age was between 6 and 36 months. Psychometric properties of the Hungarian IIFAS were determined and compared with international results. In order to obtain a shorter version of the Hungarian scale, we preferably kept those items that are common with other international abbreviated IIFAS versions and deleted items with a corrected item-total correlation or factor loading of less than 0.3, where factor loadings came from a principal component analysis forcing the extraction of one principal component (factor). RESULTS The 17-item IIFAS-H showed good psychometric properties with a Cronbach's alpha of0.73. Further analyses proved that the examined three shortened versions of the IIFAS consisting of 11, 9, and 8 items also showed good properties (Cronbach's alpha = 0.79, 0.79, 0.76, respectively). CONCLUSIONS The Hungarian version of the original 17-item long IIFAS proved to be a good measurement tool with good psychometric properties. Based on our analyses, we suggest the use of the 8-item short version (IIFAS-H8) of the scale.
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Affiliation(s)
- Renáta Ungváry
- Faculty of Health and Public Administration, Institute of Mental Health, Semmelweis University, Budapest, Hungary.
| | - András Ittzés
- Department of Applied Statistics, Institute of Mathematics and Basic Science, Hungarian University of Agriculture and Life Sciences, Budapest, Hungary.,Department of Methodology for Business Analysis, Faculty of Commerce, Hospitality and Tourism, Budapest Business School, Budapest, Hungary
| | - Veronika Bóné
- Faculty of Health and Public Administration, Institute of Mental Health, Semmelweis University, Budapest, Hungary
| | - Szabolcs Török
- Faculty of Health and Public Administration, Institute of Mental Health, Semmelweis University, Budapest, Hungary
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Jesberger C, Chertok IA, Wessells A, Schaumleffel C. Maternal Self-Confidence and Breastfeeding after Participating in a Program about Infant Prone Positioning. MCN Am J Matern Child Nurs 2021; 46:205-210. [PMID: 34166238 DOI: 10.1097/nmc.0000000000000731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Maternal self-confidence facilitates infant growth and new mother role development. Infant ability to breastfeed and maternal breastfeeding self-confidence are imperative to helping mothers meet their breastfeeding goals. Consistent opportunity for infant movement in the prone position has been shown to improve breastfeeding ability; however, families report a lack of knowledge of how to safely support this activity. Perceptions of maternal self-confidence, infant development, and breastfeeding success upon completion of an infant prone positioning program with focus on posture, movement, and connection were studied. STUDY DESIGN AND METHODS Qualitative interviews were conducted among breastfeeding mothers in three states to explore maternal perceptions of learning about infant prone positioning. RESULTS Thirty-five mothers who completed an infant prone positioning program shared their perceptions of infant interaction, prone play and positioning, and breastfeeding self-confidence. Four primary themes were identified from the analysis: maternal knowledge and self-confidence; strategies and practices learned; breastfeeding benefits of infant prone positioning; and motivation for program participation. CLINICAL IMPLICATIONS Our findings support consideration of teaching new mothers about prone positioning to enhance self-confidence in mothering, breastfeeding skills, infant development, and maternal-infant dyad bonding.
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Waterman J, Lee T, Etchegary H, Drover A, Twells L. Mothers' experiences of breastfeeding a child with tongue‐tie. MATERNAL & CHILD NUTRITION 2021; 17:e13115. [PMID: 33230939 PMCID: PMC7988863 DOI: 10.1111/mcn.13115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 10/23/2020] [Accepted: 11/04/2020] [Indexed: 11/30/2022]
Abstract
Tongue‐tie is characterized by an abnormally tight, short and thick lingual frenulum restricting the tongue's movement. This functional impairment can hinder a child's ability to maintain an effective latch and suckle and may lead to complex breastfeeding difficulties. The primary aim of this study was to explore the experiences of mothers who have breastfed a child with tongue‐tie, including their experiences with the health care system. A qualitative description study design was used. Two semistructured focus groups were conducted in February 2016 with a total of nine participants in the largest metropolitan area of Newfoundland and Labrador, Canada. Content analysis using constant comparison revealed a common incongruity between participants' breastfeeding expectations and their actual experiences of feeding a child with tongue‐tie. Three major themes are discussed: mothers' well‐being, strained interpersonal relationships and frustration with the health care system.
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Affiliation(s)
- Jillian Waterman
- Faculty of Medicine Memorial University St. John's Newfoundland and Labrador Canada
| | - Tiffany Lee
- School of Pharmacy Memorial University St. John's Newfoundland and Labrador Canada
| | - Holly Etchegary
- Faculty of Medicine Memorial University St. John's Newfoundland and Labrador Canada
| | - Anne Drover
- Faculty of Medicine Memorial University St. John's Newfoundland and Labrador Canada
| | - Laurie Twells
- Faculty of Medicine Memorial University St. John's Newfoundland and Labrador Canada
- School of Pharmacy Memorial University St. John's Newfoundland and Labrador Canada
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Taylor A, Chowdhury S, Gao Z, Van Nguyen H, Midodzi W, Gill N, Halfyard B, Newhook LAA, Twells L. Infant feeding mode predicts the costs of healthcare services in one region of Canada: a data linkage pilot study. BMC Res Notes 2020; 13:385. [PMID: 32799916 PMCID: PMC7429700 DOI: 10.1186/s13104-020-05228-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/08/2020] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The aim is to perform a pilot study evaluating the differences in healthcare service use and its associated costs by infant feeding mode in an infant's first year of life. Data from a prospective cohort study and administrative databases were linked to examine healthcare use in healthy full term infants (N = 160). Exposure was categorized as exclusively breastfed, mixed fed and exclusively formula fed. Outcomes included hospitalizations, emergency room and physician visits. Descriptive statistics and generalized linear modelling were performed. RESULTS Overall $315,235 was spent on healthcare service use for the sample of infants during their first year of life. When compared to exclusive breastfeeding, mixed feeding and exclusive formula feeding were found to be significant predictors of total healthcare service use costs (p < 0.05), driven by costs of hospital admissions. Due to the human and economic burden associated with not breastfeeding, policies and programs that support and encourage breastfeeding should be priority.
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Affiliation(s)
- Alicia Taylor
- Faculty of Medicine, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada
| | - Sharmeen Chowdhury
- Faculty of Medicine, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada
| | - Zhiwei Gao
- Faculty of Medicine, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada
| | - Hai Van Nguyen
- School of Pharmacy, Memorial University, St. John's, NL, Canada
| | - William Midodzi
- Faculty of Medicine, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada
| | - Nicole Gill
- Newfoundland and Labrador Centre for Health Information, St. John's, NL, Canada
| | - Beth Halfyard
- Newfoundland and Labrador Centre for Health Information, St. John's, NL, Canada
| | | | - Laurie Twells
- Faculty of Medicine, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada.
- School of Pharmacy, Memorial University, St. John's, NL, Canada.
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Abdulahi M, Fretheim A, Argaw A, Magnus JH. Adaptation and validation of the Iowa infant feeding attitude scale and the breastfeeding knowledge questionnaire for use in an Ethiopian setting. Int Breastfeed J 2020; 15:24. [PMID: 32272963 PMCID: PMC7144343 DOI: 10.1186/s13006-020-00269-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 03/31/2020] [Indexed: 11/30/2022] Open
Abstract
Background Validated instruments to assess breastfeeding knowledge and attitude are non-existent in Africa including Ethiopia. We aimed to adapt and validate the Breastfeeding Knowledge Questionnaire (BFKQ) and the Iowa Infant Feeding Attitude Scale (IIFAS) for use in Afan Oromo (AO), the most widely spoken language in Ethiopia. Methods After forward-backward translation into Afan Oromo, the instruments were reviewed for content validity by a panel of a nutritionist and pediatricians, and pretested on a sample of 30 mothers. Then, a cross-sectional study involving 468 pregnant women in their second and third trimester was conducted between May and August 2017 in the Manna district, Southwest Ethiopia, using the final versions of the adapted questionnaires. We used exploratory and confirmatory factor analysis to assess the construct validity, receiver operating characteristic (ROC) curves to determine the predictive validity and Cronbach’s alpha coefficients to assess internal consistency. Results Using exploratory factor analysis (EFA), nine domains containing 34 items were extracted from the BFKQ-AO. A confirmatory factor analysis of the constructs from EFA confirmed construct validity of the instrument (χ2/df = 2.11, RMSEA = 0.049, CFI = 0.845, TLI = 0.823). In factor analysis of the IIFAS, the first factor explained 19.7% of the total variance and the factor loadings and scree plot test suggested unidimensionality of the tool. Cronbach’s alpha was 0.79 for the BFKQ-AO and 0.72 for IIFAS-AO suggesting an acceptable internal consistency of both instruments. For the sensitivity and specificity in predicting intention of breastfeeding for ≥24 months, the area under the curve (AUC) was 82% for IIFAS score and 79% for BFKQ score. Conclusions Here we present the first study that reported the use of the BFKQ and the IIFAS in Ethiopia. Our results showed that both BFKQ-AO and IIFAS-AO can be reliable and valid tools for measuring maternal breastfeeding knowledge and attitude in the study population, showing the potential for adapting these tools for application in a wider Ethiopian context.
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Affiliation(s)
- Misra Abdulahi
- Department of Population and Family Health, Jimma University, Jimma, Ethiopia. .,Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway.
| | - Atle Fretheim
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway.,Norwegian Institute of Public Health, Oslo, Norway
| | - Alemayehu Argaw
- Department of Population and Family Health, Jimma University, Jimma, Ethiopia.,Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Jeanette H Magnus
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Global Community Health and Behavioral Sciences, Tulane School of Public Health and Tropical Medicine, New Orleans, USA
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McKinley EM, Knol LL, Turner LW, Burnham JJ, Graettinger KR, Hernandez-Reif M, Leeper JD. The Prenatal Rating of Efficacy in Preparation to Breastfeed Scale: A New Measurement Instrument for Prenatal Breastfeeding Self-efficacy. J Hum Lact 2019; 35:21-31. [PMID: 30253112 DOI: 10.1177/0890334418799047] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: Breastfeeding self-efficacy and breastfeeding intention are two modifiable factors that influence rates of breastfeeding initiation. RESEARCH AIMS: (1) To develop a scale to measure prenatal breastfeeding self-efficacy, and (2) test its psychometric properties by determining the internal consistency and reliability, and (3) assess the relationships between prenatal breastfeeding self-efficacy and breastfeeding intention. METHODS: Cross-sectional prospective one-group survey design was used. A convenience sample of pregnant patients attending an obstetrics and gynecology clinic ( N=124) completed a survey at the recruitment site that assessed demographics, breastfeeding intention, and breastfeeding self-efficacy theory constructs. Retest surveys ( n=14) were taken home and returned to the researcher by mail after completion. RESULTS: Cronbach's alpha for the 39-item scale was .98 (test) and .97 (retest) with an item-to-total correlation range of .54 to .78. A four-factor solution for the scale was retained. Test-retest indicated each factor was significant and highly correlated: Individual Processes (.88, p < .001), Interpersonal Processes (.893, p < .001), Professional Advice (.919, p < .001), and Social Support (.880, p < .001). Overall prenatal breastfeeding self-efficacy score was highly correlated (.610, p <.001) with breastfeeding intention scores. CONCLUSIONS: The Prenatal Rating of Efficacy in Preparation to Breastfeed Scale is a valid and reliable measure of a prenatal women's self-efficacy in preparation to breastfeed. Measuring the level of self-efficacy could alert prenatal women and health professionals to individual skill sets.
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Affiliation(s)
- Erin M McKinley
- 1 School of Nutrition and Food Sciences, Louisiana State University and LSU AgCenter
| | - Linda L Knol
- 2 Department of Human Nutrition and Hospitality Management, The University of Alabama, Tuscaloosa, AL, USA
| | - Lori W Turner
- 3 Department of Health Science, The University of Alabama, Tuscaloosa, AL, USA
| | - Joy J Burnham
- 4 Department of Educational Studies in Psychology, Research Methodology & Counseling, The University of Alabama, Tuscaloosa, AL, USA
| | - Kristine R Graettinger
- 5 College of Community Health Sciences, The University of Alabama Medical Center, Tuscaloosa, AL, USA
| | - Maria Hernandez-Reif
- 6 Department of Human Development and Family Studies, The University of Alabama, Tuscaloosa, AL, USA
| | - James D Leeper
- 7 Department of Community Medicine and Population Health, The University of Alabama, Tuscaloosa, AL, USA
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Affiliation(s)
- Karen Wambach
- 1 School of Nursing, University of Kansas, Kansas City, KS, USA
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AlKusayer NM, Midodzi WK, Newhook LA, Gill N, Halfyard B, Twells LK. Determining Clinically Relevant Cutoff Scores for the Iowa Infant Feeding Attitude Scales Among Prenatal Women in Canada. J Hum Lact 2018; 34:691-698. [PMID: 29742357 DOI: 10.1177/0890334418772273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The original 17-item Iowa Infant Feeding Attitude Scale (IIFAS) has been validated and widely used to assess attitudes toward breastfeeding. A reduced 13-item version of the IIFAS was recently validated in a Canadian setting. However, cutoff scores for categorization of infant feeding attitudes on both scales have not yet been established. Research Aim: The aim of this study was to determine optimal cut-ff scores predicting infant feeding attitudes and outcomes for the original and reduced IIFASs. METHODS A population-based prospective cohort study was undertaken in the Canadian province of Newfoundland and Labrador. A sample of 658 pregnant women were followed up to 1 month postpartum. The receiver operating curve and Youden index were assessed to identify the sensitivity and specificity of cutoff scores. The magnitude at which these scores predicted postpartum feeding outcomes was evaluated using linear regression. RESULTS Scores of ≤60 (sensitivity = 0.81, specificity = 0.87) and ≤45 (sensitivity = 0.84, specificity = 0.83) for the 17-item and 13-item IIFASs, respectively, were found to be optimal cutoff scores for predicting negative breastfeeding attitudes. The cutoff score for the reduced IIFAS version maintained its ability to predict women who formula-fed at 1 month postpartum (adjusted odds ratio = 6.32, 95% confidence interval = 1.84-11.61) compared with the original scale (adjusted odds ratio = 4.62, 95% confidence interval = 2.42-16.52). CONCLUSION The proposed cutoff scores for the original and reduced IIFASs have excellent predictive ability to determine infant feeding attitudes and outcomes. The classification of scores enhances the use and applicability of the IIFAS.
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Affiliation(s)
- Nouf M AlKusayer
- 1 Faculty of Medicine, Memorial University of Newfoundland, Health Sciences Centre, St. John's, NL, Canada
| | - William K Midodzi
- 1 Faculty of Medicine, Memorial University of Newfoundland, Health Sciences Centre, St. John's, NL, Canada
| | - Leigh Anne Newhook
- 2 Janeway Pediatric Research Unit, Discipline of Pediatrics, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Nicole Gill
- 4 School of Pharmacy, Memorial University of Newfoundland, Health Sciences Centre, St. John's, NL, Canada
| | - Beth Halfyard
- 3 Health Analytics and Evaluation Services, Newfoundland and Labrador Centre for Health Information, St. John's, NL, Canada
| | - Laurie K Twells
- 1 Faculty of Medicine, Memorial University of Newfoundland, Health Sciences Centre, St. John's, NL, Canada.,4 School of Pharmacy, Memorial University of Newfoundland, Health Sciences Centre, St. John's, NL, Canada
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