A questionnaire for assessing breastfeeding intentions and practices in Nigeria: validity, reliability and translation

Perspectives of old-age and dementia researchers on communication with policymakers and public research funding decision-makers: an international cross-sectional survey

Introduction

Society commonly believes that research knowledge is complementary to public decision-making. This study aimed to understand the perspectives and implications of dementia researchers communicating with policymakers and public research decision-makers (public officials).

Methods

This study uses 24 questions from an anonymous, online survey, which was received by 392 members of nine European, Latin American, and United States medical researcher associations/networks in the fields of age-related neurological degeneration and dementia medicine. The data were analyzed via crosstab analysis, two group comparison analyses, and a logistic regression model.

Results

In total, 91 (23.2%) respondents completed the questionnaire. Eight independent variables were related to researchers' research discipline, research remuneration, experience, authorship, H-index, and research grants. The statistically significant variables determining whether the respondents had contact with public officials were "Years of research experience" (p = 0.004), "Number of articles first-authored in the last 5 years" (p = 0.007), and "Average H-index in the last 5 years" (p = 0.048) [median (IQR)]; 47% of the surveyed researchers had been in contact with public officials in the last 12 months. The most frequently communicated topics were the importance of their own research to society (61%) and their own funding (60%); 87% (n = 79) of the researchers did not believe that public officials had a very good understanding of their dementia research.

Conclusion

Less than half (47%) of dementia researchers communicate with public officials, and they communicate mostly about the importance of their own research and funding their own research. Nine of 10 researchers do not believe that public officials understand their research well.

The Importance of Personal and Familial Factors on Breastfeeding Intention and Practices, and Postpartum Distress during the Pandemic: A Longitudinal Observational Study

BACKGROUND

The COVID-19 pandemic has significantly impacted pregnant and breastfeeding women. Both low- and high-risk groups adopted preventive approaches such as mask-wearing and handwashing to slow down and prevent viral transmission during critical periods that may affect mother-child interactions.

METHODS

A longitudinal observational study was conducted with primiparous women recruited using convenience sampling from the postpartum care ward of Afzalipour Teaching Hospital in Kerman from August 1, 2020 to March 30, 2021. The research questionnaires included demographic information, preventive behaviors, breastfeeding intention and practices, postpartum distress, and Edinburgh Postpartum Depression Scale. All the questionnaires were self-reported online in three stages: before discharge from the postpartum ward, the first month after delivery, and the third month after delivery.

RESULTS

A Total of 160 primiparous women were included. The results showed significant changes in preventive behaviors and postpartum distress levels during the study. Breastfeeding intention and practices were negatively affected by postpartum distress (P = 0.034), unwanted pregnancies (P = 0.009), and cesarean delivery (P < 0.001). Postpartum distress was directly affected by the presence of depression (P < 0.001). Preventive behaviors at discharge were significantly associated with postpartum distress three months after delivery (P = 0.013). The study also found an association between women's and partner's education, unwanted pregnancy, and cesarean delivery that determined postpartum distress.

CONCLUSIONS

Pandemic restrictions did not affect breastfeeding intentions or practices, possibly due to sufficient social and family support during the pandemic. However, robust guidelines are required to increase enable women's access to specializede care to cope with future pandemics, particularly during the first few weeks after childbirth.

Co-designing psychosis simulated patient scenarios with mental health stakeholders for pharmacy curricula

BACKGROUND

Pharmacists need knowledge and confidence to support people living with mental illness. Evidence-based educational materials for pharmacy students to provide psychosis care is limited.

AIM

To co-design, content validate and pilot-test, with mental health stakeholders, simulated patient scenarios to educate and assess students in providing psychosis care.

METHOD

Mental health consumers were invited to co-design three simulated patient scenarios (first-episode psychosis, carer of someone living with schizophrenia, non-adherence to antipsychotics), guided by published and psychometrically-tested materials. A panel of mental health stakeholders participated in two rounds of content validation (RAND/UCLA appropriateness model). Round 1 involved individual survey completion to calculate item content validity index (I-CVI) for relevance/clarity, content validity ratio for essentiality and overall scale content validity index (S-CVI/Ave and S-CVI/UA) scores for each scenario. Scores analyses and feedback comments informed revisions. Round 2 involved a panel meeting to discuss revisions and finalise content. The scenarios were then pilot-tested with pharmacy students.

RESULTS

Two consumers participated in co-design, nine stakeholders in content validation. All items showed excellent content validity for relevance/clarity. Eleven items were revised for essentiality, discussed, then re-rated at the panel meeting for consensus. The scenarios were pilot-tested with pharmacy students (n = 15) and reported to be realistic and relevant to future practice, contributing to students' confidence in supporting people experiencing mental health symptoms or crises.

CONCLUSION

Partnering with mental health stakeholders has enabled co-design of authentic, content valid educational materials for pharmacy students to provide psychosis care, in preparation for future provision of mental health support.

Knowledge and perceptions of food sustainability in a Spanish university population

In 2015, the United Nations adopted the 2030 Agenda for Sustainable Development, with 17 Sustainable Development Goals (SDGs) at its core. Besides tackling climate change and the fight to reduce inequality, the SDG number 12 is specifically focused to develop strategies toward food sustainability. The aim of this study, aligned with SDG number 12, was to analyze the level of knowledge and perceptions of food sustainability in a university community from Spain. A descriptive cross-sectional study, based on an online questionnaire, was carried out between July and November 2021 with convenience sampling. The survey included 28 items and was distributed among students, teachers, researchers and administrative staff from a Spanish university. A total of 1,220 participants completed the survey. 70.4% of the respondents heard about the environmental impact of food and more than 50% were aware of the existence of the SDGs. The different aspects related to diet that concerned them the most were food waste, plastic usage, and environmental impact. They reported that a sustainable diet should be mainly based on local and seasonal products and with a low environmental impact as well as no or the minimum food waste. When asked if they were following a sustainable diet, 77% answered affirmatively. Moreover, the food groups more involved in a sustainable diet should be vegetables and fruits, olive oil, legumes, and whole grains. Regarding food waste, 60% of the surveyed population claimed to generate it at home, with the use of leftovers and planning shopping and meals being some of the most important domestic actions to avoid it. Further initiatives must be implemented to increase the level of knowledge as well as to raise the awareness on the importance to translate it into individual and collective actions that allow a shift toward more sustainable practices.

Development and validation of scale assessing the knowledge about breast feeding benefits and practices among antenatal and postnatal mothers in South India

BACKGROUND

Developing a scale to address the breastfeeding benefits and practices among antenatal and postnatal mothers is important as it helps in evaluating the change in the behavior, attitude, and practice with appropriate health education.

AIM

This study was done to develop and validate a scale to assess the knowledge about the breastfeeding benefits and practices in Tamil language among antenatal and postnatal mothers belonging to rural areas of Chengalpattu, South India.

METHODS

We developed a scale to assess the knowledge about the benefits and practices of breastfeeding through literature review and expert opinion. Final version was administered among 377 antenatal and postnatal mothers in selected villages of rural Chengalpattu, South India. Construct validation was evaluated through principal component analysis (PCA). Confirmatory factor analysis was performed to check the goodness-of-fit of results. Internal consistency was evaluated through the Cronbach's alpha co-efficient.

RESULTS

A total of 11 questions were finalized in the questionnaire following face and content validity. In PCA, three factor models were obtained with the eigen values of 4.18, 1.91 and 1.48, respectively. These three factors were able to explain for about 68.9% of the variance. Goodness-of-fit indices revealed satisfactory comparative fit indices (0.81), Tucker-Lewis Index (0.73), standardized root mean square residual (0.11), and root mean square error of approximation (0.14). The reliability co-efficient for the questionnaire was 0.80.

CONCLUSION

We have developed an internally valid and reliable tool for evaluating the knowledge about breastfeeding benefits and practices. The scale should thus facilitate and fast-track the development of a structured breastfeeding educational program for antenatal and postnatal mothers receiving care at the primary health care level.

RELEVANCE FOR PATIENTS

This questionnaire allows for the objective monitoring of effectiveness of educational activities and also help in comparing the efficiency of various educational models targeting the antenatal and postnatal mothers.

Determinants of breastfeeding practice in Pujehun district, southern Sierra Leone: a mixed-method study

Background

It is well established that exclusive breastfeeding can play a critical role in reducing child morbidity and mortality. Limited research has been done thus far on the practice and perceptions of breastfeeding in Sierra Leone, where more than 10 % of children die before the age of five. This study aimed to gain understanding into and explore both matters in order to develop recommendations for effective strategies to promote breastfeeding practice in Pujehun District, Southern Sierra Leone.

Methods

This exploratory mixed-method study included a cross-sectional survey of 194 mothers, semi-structured interviews and focus group discussions. Logistic regression analysis was used calculated odds ratios of factors associated with primarily breastfeeding practice, defined as ‘Children under six months of age who are fed with breast milk only and children older than six months of age that were exclusively breastfed up to six months’, based on recall from birth. Exclusive breastfeeding rate was based on breastfeeding practice 24 h prior to the survey. Qualitative data was analysed through a deductive approach, using a pre-determined framework on determinants of breastfeeding.

Results

This study revealed an exclusive breastfeeding rate of 62.8% (95% CI 53.9, 71.7); dropping from 74% in the 0–1-month age group to 33% in the 4–5 months group. Triangulation of qualitative and quantitative data revealed enabling factors for primarily breastfeeding practice included mothers receiving support during their first breastfeed, pregnant women being provided with information on the benefits of the practice, counselling by nurses, support from husbands, and women’s awareness of how their friends and family members fed their own babies. The main barriers were a lack of encouragement by husbands, women’s perception that their infants’ stools were abnormal or that they were not producing enough breast milk.

Conclusions

Although the exclusive breastfeeding may have risen over recent years, a gap remains compared to World Health Organization recommendations. According to the breastfeeding determinants identified in this study, promotion of counselling by a nurse, encouragement of husbands’ support, and improve knowledge of mothers on breastfeeding are recommended to be incorporated in the design of future health programs.

Father's Knowledge, Attitude and Support to Mother's Exclusive Breastfeeding Practices in Bangladesh: A Multi-Group Structural Equations Model Analysis

Despite worldwide initiatives, the exclusive breastfeeding (EBF) rate is low. The study aims to investigate the role of fathers’ knowledge, attitude and support in formulating mothers’ practice of breastfeeding taking Bangladeshi parental cases as a sample. The study uses a standard survey instrument following the theory of planned behavior (TPB). Responses from 332 couples are accepted following a standard criteria and used for analysis. The sample is divided into sub-groups based on delivery mode—vaginal (n = 211, 64%) and cesarean section (n = 121, 36%). Based on the sub-groups, a multi-group structural equation modelling (SEM) is applied to analyze the phenomena. The study finds that a father’s knowledge in EBF can, in one way, significantly enhance mother’s knowledge by sharing and, in another way, can enhance his own attitude to offer different support to his partner/wife which induces the chances of EBF practices by mothers. The enhanced EBF knowledge of a mother raises her attitude to practice EBF, which is also positively affected by the father’s attitude. Thus, fathers’ support, coupled with mothers’ positive attitude, the mother’s intention to practice EBF as per standard guidelines.

Factors Associated With Timely Initiation of Breastfeeding and Prelacteal Feeding in North-Central Nigeria

OBJECTIVE

Delay in initiation of breastfeeding after birth is associated with the introduction of other feeds. It has been recommended that all women should initiate breastfeeding within the first hour after birth. Early initiation of breastfeeding and exclusive breastfeeding could reasonably reduce neonatal deaths. The aim of this study was to assess the initiation of breastfeeding and prelacteal feeding in Plateau State, Nigeria.

MATERIALS AND METHOD

A cross-sectional design was adopted for the study. A total of 763 women drawn equally from the three senatorial zones of the state voluntarily completed a questionnaire. Results were analyzed using chi-squared statistics and regression analysis.

RESULTS

Findings show that 33.1% of women initiated breastfeeding in a timely manner. The relationships between the timely initiation of breastfeeding and the use of pain relief, maternal age, maternal employment, economic status, influence of family and friends, and advertisement were found to be statistically significant. Furthermore, 92% gave breast milk for the first feed, while 8% gave infant formula, glucose, herbs, or water. Inadequate breast milk production, delayed initiation of breastfeeding, and health conditions were factors identified as responsible for prelacteal feeding.

CONCLUSION

The proportion of women who initiated feeding in a timely manner was low, which underscores the need to promote and support early initiation of breastfeeding in the state. There is thus a need for a public education campaign, particularly directed at women receiving antenatal care, and focusing on the need for establishing feeding early. Women with health challenges and those with a history of poor milk production may require additional support to breastfeed as recommended.

Social and Bio-Medical Predictors of Exclusive Breastfeeding Among Nursing Mothers in Lagos and Taraba States, Nigeria

PURPOSE

Although exclusive breastfeeding (EBF) is known to have positive consequences for mothers and infants, EBF rate in Nigeria is <25%. This study investigated if social factors were stronger predictors of EBF than bio-medical factors in the metropolitan areas of Lagos and Taraba States. Social factors included mother's education, infant sex, place of birth, and nature of mother's employment, while bio-medical factors included nature of birth (whether vaginal or caesarean section), problems with breast/nipple, breast milk insufficiency, and mother's age.

DESIGN AND METHODS

The study adopted a cross-sectional survey design and mixed method of data collection. From the two states, 500 mothers with babies between 7 and 12 months of age completed a structured questionnaire. Twenty respondents from each state were interviewed using an in-depth interview guide.

RESULTS

Education (β = 1.743; p < 0.001), infant sex (β = -0.454; p < 0.05), and place of delivery (β = -1.552; p < 0.001) were significant social predictors. Breast milk insufficiency (β = -1.851; p < 0.001) and mother's age (β = 0.064; p < 0.001) were significant bio-medical predictors. When all the eight factors were considered, only two of the three social factors, namely, education and infants' sex, remained significant, while three bio-medical factors, namely, breast milk insufficiency, mother's age, and nature of delivery, were significant.

CONCLUSIONS

Social and bio-medical factors co-determine the practice of EBF and must not be considered dichotomous.

PRACTICAL IMPLICATIONS

Interventions to encourage EBF among Nigerian mothers must focus on education regarding its benefits and correction of misconceptions that breast milk alone is insufficient as an infant's diet.

Content Validation through Expert Judgement of an Instrument on the Nutritional Knowledge, Beliefs, and Habits of Pregnant Women

The aim of this study was to conduct content validation through expert judgement of an instrument which explores the nutritional knowledge, beliefs, and habits during pregnancy. This is a psychometric study in which 14 experts participated in the evaluation of each of the questionnaire items, which were divided into two blocks according to the characteristics of sufficiency, clarity, coherence, and relevance. Fleiss’ κ statistic was used to measure strength of agreement. A pre-test with 102 participants was conducted to measure the degree of understandability of the instrument. The strength of agreement obtained for each of the dimensions was almost perfect. For each pair of experts, strength of agreement ranged between substantial and almost perfect. Sufficiency was the characteristic of the questionnaire that obtained the highest values in the two blocks, and was also the most statistically significant (p < 0.001). Coherence was the most statistically significant characteristic in the first block (p = 0.030). Clarity was the most statistically significant characteristic in the second block (p = 0.037). The wording of five of the twenty original items was corrected. The new version of the instrument attained a high degree of understandability. The results suggest that the instrument is valid and may therefore be applied.

Conducting Online Surveys

There is an established methodology for conducting survey research that aims to ensure rigorous research and robust outputs. With the advent of easy-to-use online survey platforms, however, the quality of survey studies has declined. This article summarizes the pros and cons of online surveys and emphasizes the key principles of survey research, for example questionnaire validation and sample selection. Numerous texts are available to guide researchers in conducting robust survey research online, however this is neither a quick nor easy undertaking. While online survey websites and software are useful for assisting in questionnaire design and delivery, they can also introduce sources of bias. Researchers considering conducting online surveys are encouraged to read carefully about how the principles of survey research can be applied to online formats in order to reduce bias and enhance rigor. In addition to alerting researchers to the pitfalls of online surveys this article also aims to equip readers of this journal with the knowledge of how to critically appraise publications based on online surveys.

Development and validation of a questionnaire for a survey on perioperative fasting practices in India

BACKGROUND AND AIMS

Perioperative fasting guidelines have been published and updated to standardise practices. Hence, Indian Society of Anaesthesiologists decided to conduct a survey to assess the fasting practices and the food habits across India, which would be subsequently used for developing preoperative fasting guidelines for the Indian population. We detail and discuss herewith the content validity of the questionnaire developed for the survey.

METHODS

Thirty-six questions related to perioperative fasting practices were framed based on the collected evidence and relevance to regional diet and concerns. Subsequently, an information sheet was prepared and sent to 10 experts to grade each question. The responses were tabulated, and item-wise content validity index (I-CVI), scale-wise content validity index (S-CVI) and modified kappa statistic were calculated in Microsoft Excel™ sheet.

RESULTS

Seven of the 10 experts completed the assessment and grading as per the instructions provided and submitted a completed proforma. S-CVI for relevance, simplicity, clarity and ambiguity was 0.72, 0.86, 0.72 and 0.72, respectively. S-CVI/average or average congruency percentagewas 0.95, 0.97, 0.95 and 0.95 for relevance, simplicity, clarity and ambiguity, respectively. Question 2 received an I-CVI of 0.71 in terms of clarity and question 23 received an I-CVI of 0.71. They were modified as persuggestions of the experts.

CONCLUSION

We conclude that our questionnaire designed to ascertain the preoperative fasting practices for a surveymet the content validity criteria both by qualitative and quantitative analyses.

Development and validation of a questionnaire for a survey on perioperative fasting practices in India

BACKGROUND AND AIMS

Perioperative fasting guidelines have been published and updated to standardise practices. Hence, Indian Society of Anaesthesiologists decided to conduct a survey to assess the fasting practices and the food habits across India, which would be subsequently used for developing preoperative fasting guidelines for the Indian population. We detail and discuss herewith the content validity of the questionnaire developed for the survey.

METHODS

Thirty-six questions related to perioperative fasting practices were framed based on the collected evidence and relevance to regional diet and concerns. Subsequently, an information sheet was prepared and sent to 10 experts to grade each question. The responses were tabulated, and item-wise content validity index (I-CVI), scale-wise content validity index (S-CVI) and modified kappa statistic were calculated in Microsoft Excel^™ sheet.

RESULTS

Seven of the 10 experts completed the assessment and grading as per the instructions provided and submitted a completed proforma. S-CVI for relevance, simplicity, clarity and ambiguity was 0.72, 0.86, 0.72 and 0.72, respectively. S-CVI/average or average congruency percentagewas 0.95, 0.97, 0.95 and 0.95 for relevance, simplicity, clarity and ambiguity, respectively. Question 2 received an I-CVI of 0.71 in terms of clarity and question 23 received an I-CVI of 0.71. They were modified as persuggestions of the experts.

CONCLUSION

We conclude that our questionnaire designed to ascertain the preoperative fasting practices for a surveymet the content validity criteria both by qualitative and quantitative analyses.

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.