Breastfeeding behavior is not associated with health literacy: evidence from the German KUNO-Kids birth cohort study

Challenges and Choices in Breastfeeding Healthy, Sick and Preterm Babies: Review

Although breastfeeding is associated with many health-related benefits for both mothers and children, the WHO recommendation for exclusive breastfeeding is not achieved by the majority in any WHO region. This paper aims to present the current state of research on challenges and choices in breastfeeding healthy, sick and preterm babies. The research was organized as a systematic search in PubMed and the study was performed as a narrative review after applying the PRISMA protocol. Finally, n = 57 studies were included. Both barriers and support factors emerge as a complex interaction of individual, group and societal factors, the precise understanding of which is relevant to increasing breastfeeding rates in the future. Knowledge as well as practical skills proved to be generally helpful, whereas the lack of breastfeeding support for mothers, who are often separated from their premature babies in hospital, was identified as a key risk factor for this subgroup. Appropriate training for healthcare professionals can improve the situation as a result. After discharge, workplace-related barriers are of major concern to allow further breastfeeding when maternity leave ends. Thus, the promotion of breastfeeding must be perceived as a task for society as a whole.

Effects of eHealth literacy on maternal and neonatal outcomes

eHealth literacy plays a crucial role during pregnancy, as maternal health behavior can influence health outcomes for both mother and child. This study assessed the impact of eHealth literacy on maternal-fetal health outcomes through a cross-sectional analysis of 1,265 pregnant women admitted to a tertiary maternity hospital in Turkey between April and July 2022. Data on sociodemographic information, obstetric variables, birth outcomes, Internet usage, and eHealth Literacy Scale (eHEALS) were collected. Kolmogorov-Smirnov, Mann - Whitney U, Kruskal-Wallis, and Spearman correlation were used for data analysis. The median age of women was 28 years, and the mean gestational age was 38.6 weeks. Median eHealth literacy score was 21 (range:8-40). Pregnant women who had planned pregnancies, received spousal support, attended 9-12 antenatal care visits, received vaccinations, adhered to iron and folic acid supplementation, engaged in regular physical activity, and maintained regular sleep patterns exhibited higher eHealth scores (all p < .001). eHEALS scores were higher in women who experienced normal vaginal deliveries (p < .001), while lower eHEALS scores were noted in those with comorbidities (p = .001). The study suggested that higher eHealth literacy among pregnant women was associated with improved health-promoting behaviors, more favorable health perceptions, increased utilization of health services, and better maternal and fetal outcomes.

Effect of mothers' health literacy on early childhood allergy prevention behaviours: results from the KUNO-Kids health study

BACKGROUND

Parents can engage in several behaviours with regard to early childhood allergy prevention (ECAP). These can be related to diet of mother/child and the modification of the home environment; not all of them are justified by current evidence. Previous studies showed that parental health literacy (HL) is related to favourable health behaviours directed at the child. This study aimed to investigate the causal effect of mothers' HL on ECAP behaviours and to test different moderators of this effect.

METHODS

One thousand six hundred sixty-two mothers participating in the KUNO-Kids health study in the area of Regensburg, Germany were surveyed on HL (assessed via the health care scale of the Health Literacy Survey-EU questionnaire, HLS-EU-Q47) and ECAP behaviours implemented during pregnancy and the child's first year of life. Patterns in ECAP behaviours were identified by latent class analysis. Multinomial regression modelling was performed with HL as exposure, ECAP as outcome variable, allergy risk, parental competence and bonding, anxiety and depression as moderators as well as potentially confounding variables.

RESULTS

We identified three classes of ECAP behaviours (class 1: "breastfeeding " N = 871; class 2: "allergen-avoidance " N = 490; class 3: "mixed behaviours " N = 301). In univariable as well as fully adjusted regression models, compared to class 1, class 2 was negatively, and class 3 was not associated with HL. None of the tested moderating variables altered the association between HL and ECAP significantly.

CONCLUSIONS

We found an effect of mothers' HL on ECAP behaviours: lower HL of mothers increased allergen-avoiding behaviour directed at their child, while decreasing the chance of exclusive breastfeeding. Improving HL could contribute to the implementation of recommended ECAP behaviours in families, especially to the reduction of allergen-avoiding behaviours.

Maternal Health Literacy in Pregnant Women: A Concept Analysis

OBJECTIVES

Maternal health literacy (MHL) plays a vital role in pregnancy outcomes, healthcare researchers should further analyze, refine, and develop this concept. This study aims to clarify the definition of MHL in pregnant women through a analysis of the concept.

METHODS

Walker and Avant's concept analysis approach was used to analyze the concept of MHL. A search of the literature was completed using the databases PubMed, CINAHL, Web of Science (WOS), and the Science and Technology Index (SINTA) for years 2001-2021; literature search included grey literature, publications from the government and academic institutions, and available both in English and Indonesia. A total of 12 articles were reviewed.

RESULTS

MHL is a multifaceted and comprehensive concept. This study presents a working definition of MHL during pregnancy as the skills enabling women to access, comprehend, evaluate, and apply health information related to pregnancy, which are necessary for making decisions for improving and maintaining both maternal and fetal health. Guided by Walker and Avant's method, the major attributes and outcomes are determined in this study.

CONCLUSION

Healthcare professionals can utilize this analysis to familiarize their institutions with the MHL concept, emphasize its importance, and apply it to practice. This contributes to enhancing the body of knowledge on MHL and potentially improving maternal health outcomes.

Factors Influencing Duration of Breastfeeding: Insights from a Prospective Study of Maternal Health Literacy and Obstetric Practices

Numerous factors concerning early breastfeeding abandonment have been described, including health literacy (HL). This study's objective was to analyze factors related to early breastfeeding abandonment (<6 months). This prospective multicentric study examined the duration of breastfeeding at 6 months postpartum and was conducted in four different regions of Spain from January 2021 to January 2023. A total of 275 women participated in this study, which focused on maternal HL and obstetric practices. A decrease in the breastfeeding rate was observed from hospital discharge (n = 224, 81.5%) to the sixth month postpartum (n = 117, 42.5%). A Cox regression analysis revealed that inadequate HL levels, lack of mobilization during labour, and induced labour were significantly associated with early breastfeeding cessation (p = 0.022, p = 0.019, and p = 0.010, respectively). The results highlight that women with adequate HL had a 32% lower risk of early breastfeeding abandonment. In comparison, mobilization during labour and induction of labour were linked to a 32.4% reduction and a 53.8% increase in this risk, respectively. These findings emphasize the importance of considering obstetric and HL factors when addressing the breastfeeding duration, indicating opportunities for educational and perinatal care interventions.

Health literacy and its related factors as predictors for the breastfeeding self-efficacy in a western province in Iran

BACKGROUND

One of the effective factors on BF (Breastfeeding) continuation is Breastfeeding self-efficacy (BFSE). This study was conducted to determine the relationship between Health Literacy (HL) and BFSE in lactating mothers referring to primary health care centers.

METHODS

This cross-sectional descriptive study was carried out on lactating mothers referring to primary health care centers in 2022. Multi-stage cluster sampling was done with 160 samples. The data were collected using demographic questionnaire, Persian shortened form of the BSES is a self-reported instrument for measuring a mother's Breastfeeding self-efficacy and Health Literacy for Iranian Adults (HELIA). Data were analyzed using ANOVA, independent t-test, correlation test and liner regression by SPSS version 16, with a significance level of 5%.

RESULTS

There was a significant positive correlation between the HL score and its four domains( Reading, Behaviour and decision making, Accessing, and Understanding) except for the appraisal domain with BFSE score. The variables of use of formula, HL, duration of breastfeeding, and education were considered predictors of BFSE.

CONCLUSION

In general, the results indicate a possible relationship between BFSE and mothers' HL. Therefore, improving mother's HL can have a positive effect on promoting infants' nutrition.

Development and Validation of the Breastfeeding Literacy Assessment Instrument (BLAI) for Obstetric Women

BACKGROUND

Despite international efforts to protect and promote exclusive breastfeeding (EBF) for infants up to six months of age, global rates of EBF continue to fall short of the targets proposed by the WHO for 2025. Previous studies have shown a relationship between the level of health literacy and the duration of EBF, although this relationship was not determinant, probably due to the use of a generic health literacy questionnaire. Therefore, this study aims to design and validate the first specific breastfeeding literacy instrument.

METHODS

A Breastfeeding Literacy instrument was developed. Content validation was carried out by a group of 10 experts in health literacy, breastfeeding or instrument validation, obtaining a Content Validity index in Scale (S-CVI/Ave) of 0.912. A multicentre cross-sectional study was carried out in three Spanish hospitals to determine the psychometric properties (construct validity and internal consistency). The questionnaire was administered to 204 women during the clinical puerperium.

RESULTS

The Kaiser-Meier-Oklin Test (KMO = 0.924) and Bartlett's Test of Sphericity (X² = 3119.861; p ≤ 0.001) confirmed the feasibility of the Exploratory Factor Analysis, which explained 60.54% of the variance with four factors.

CONCLUSIONS

The Breastfeeding Literacy Assessment Instrument (BLAI) consisting of 26 items was validated.