Breastfeeding knowledge and attitudes of health professional students: a systematic review

Comparison of the Effect of Distance and Face-to-face Breastfeeding Education on Female Nursing Students' Knowledge: A Quasi-experimental Study

Background

Support for breastfeeding by female nursing students has a beneficial impact during the exclusive breastfeeding. This study was conducted to compare the effect of distance and face-to-face breastfeeding education on female nursing students' knowledge.

Methods

This is a quasi-experimental study conducted on 138 female nursing students in their third to eighth semesters at nursing and midwifery school in Shiraz. One hundred and thirty eight students were selected using convenient sampling and divided equally into two experimental groups (face-to-face education with 46 participants and distance education with 46 participants) and one control group (46 participants). Sampling started at the beginning of May 2023 and ended at the end of October 2023. The experimental groups (Groups A and B received face-to-face training and distance education, respectively) received the educational program in three 45-minute sessions over three weeks. Data were collected using a demographic questionnaire and a knowledge questionnaire regarding breastfeeding nutrition at three stages: before, immediately after, and one month after the intervention. The data were entered into SPSS 22 software and analyzed using descriptive and inferential statistics.

Results

There was a statistically significant difference in the two interventional groups compared to the control group regarding the mean score of breastfeeding knowledge immediately (P=0.049) and one month (P<0.001) after the intervention.

Conclusion

Distance breastfeeding education led to more increase in nursing students' knowledge one month after the intervention, compared to the face-to-face training. It could provide a suitable method for improving the knowledge of health professionals regarding breastfeeding.

Assessment of the Knowledge of Healthcare Professionals Regarding Radiological Examination in Lactating Mothers: A Cross-Sectional Survey Study in the Kingdom of Bahrain

Objectives Breastfeeding is critical for a mother's health, as well as the development and survival of her infant. Healthcare personnel are a reliable source of information for breastfeeding mothers during and after radiological procedures, assuming their understanding is appropriate. As a result, this study analyzed healthcare professionals' knowledge of breastfeeding and radiological tests on lactating mothers. Methods A cross-sectional survey was implemented using a validated questionnaire containing 25 items about breastfeeding habits and radiation imaging including male and female healthcare staff in primary and tertiary hospitals in Bahrain. The survey comprised 384 responders who were doctors, nurses, radiology technicians, and other allied health professionals. Results In general, 284 (74%) participants scored outstanding knowledge on questions about the health benefits of breastfeeding for both mothers and newborns. However, there was a clear lack of awareness concerning the use of imaging modalities and contrasts on lactating mothers, with only 117 (30.5%) participants scoring an "Excellent" knowledge score. Factors associated with basic knowledge included breastfeeding practice, source of knowledge, and years of experience. The availability of CT/MRI/nuclear scans was one factor related to radiological imaging knowledge. Participants' age, academic background, and profession had strong correlations with fundamental and radiological knowledge. Conclusion Overall, health professionals' awareness and understanding of breastfeeding was average; there is a lack of knowledge of radiological imaging on lactating mothers, which may lead to the discontinuation of breastfeeding following radiological examination. Our study advises incorporating the impacts of exposure to radiological imaging into breastfeeding education programs to increase healthcare providers' knowledge and thereby encourage breastfeeding practice.

A mixed methods evaluation of the breastfeeding memory aide CHINS

Breastfeeding rates remain persistently low in the United Kingdom (UK) despite wide-scale rollout of UNICEF Baby Friendly Initiative training and accreditation. More must be done to ensure breastfeeding practitioners can provide effective support. The memory aide CHINS (Close, Head free, In-line, Nose to Nipple and Sustainable) could help practitioners remember, recall, and apply breastfeeding theory in practice and this paper presents a UK evaluation of its impact. A concurrent, convergent mixed methods approach was adopted using Normalisation Process Theory (NPT) as an overarching framework. An online survey targeted breastfeeding practitioners and academics from the UK (n = 115). A sub-set (n = 16) of respondents took part in qualitative focus groups. Survey data was subjected to descriptive and inferential statistical analysis, and the focus group data was analysed, using NPT. CHINS is widely used in breastfeeding education and practice largely because of its simplicity and ease of integration in everyday practice, as well as its sustained inclusion in UNICEF Baby Friendly Initiative training. CHINS has introduced a standardised approach to the principles of positioning for effective breastfeeding. Doing so has helped address inconsistencies and poor practice in this area, and CHINS plays a role in assisting practitioners in building confidence in their breastfeeding practice. More needs to be done to ensure the breastfeeding workforce develop and maintain the requisite skills to promote and support breastfeeding, including the role of memory aides such as CHINS in achieving this.

The effect of on-site and on-call nurse on exclusive breastfeeding in two different hospital settings: a prospective observational cohort study

BACKGROUND

Exclusive breastfeeding during postpartum hospitalization is very important for ensuring the success of breastfeeding at home. The aim of the study is to determine if the on-site nurse in rooming in improves exclusive breastfeeding ratio.

METHODS

We conducted a prospective observational cohort study to evaluate exclusive breastfeeding during the first three months of life in two Neonatology Units in the South of Italy with different hospital settings: Ente Ecclesiastico Miulli of Acquaviva delle Fonti with on-site nurse h24 (on-site group) and Policlinico of Bari with nurse available on call h24 from Neonatology Unit (on-call group).

RESULTS

A total of 564 mother-baby dyads were admitted from 3 January to 31 March 2018 (299 in on-site group and 265 in on-call group). In the overall population, exclusive breastfeeding rate was 76.4% at 90-days, confirming the role of nurse and rooming in, independently of modality of setting. Considering the way of delivery, in infants from cesarean section there were higher rates for exclusive breastfeeding at 30 and 90 days of life in on-site group.

CONCLUSIONS

We can assume that the presence of a nurse h24 could better identify breastfeeding problems. Our study suggests the role of on-site nurse during rooming in to encourage exclusive breastfeeding until three months of life in mothers who underwent caesarean section.

LATCHES - a memory aide for the principles of attachment for effective breastfeeding: findings of a regional pilot in the Northeast of England and North Cumbria

BACKGROUND

This paper outlines a pilot of a new memory aide for breastfeeding conducted in the Northeast of England and North Cumbria between April and August 2023. The United Kingdom has some of the lowest rates of breastfeeding, particularly in the Northeast of England, and as such more needs to be done to support mothers to breastfeed for as long as they would like to. Good support from health professionals can be effective in influencing decisions to breastfeed as well as helping to ensure initiation and continuation of breastfeeding but there is evidence to suggest that professionals and students do not always feel adequately trained and it is here, where memory aides may have value.

METHODS

Key breastfeeding practitioners and educators were brought together to select one of two memory aides for principles of attachment for effective breastfeeding. The selected memory aide, LATCHS, was piloted with 57 participants with a key role in promotion and support of breastfeeding in the Northeast of England and North Cumbria.

RESULTS

Participants conveyed mixed views about the proposed memory aide with more experienced staff reporting more favourable opinions than student midwives and early years practitioners. Experienced staff felt the new memory aide would complement an early memory aide, CHINS, which focused on principles of positioning.

DISCUSSION

Findings of the pilot indicate there is a role for a mnemonic to help practitioners understand, recall, and retain theory around attachment for effective breastfeeding and that memory aides can play an important role in complementing existing approaches to education and practice. The participants felt the proposed memory aide had some limitations and suggested important ways for it to be improved, particularly in adding an E to reflect the expecting wording. This produced the final memory aide: LATCHES.

CONCLUSION

Using data from the pilot, the memory aide was refined, and the final version LATCHES agreed for wider dissemination. Future research is needed to understand the value of LATCHES on the wider breastfeeding workforce and whether any future improvements can be made to enhance its utility.

Prelicensure Nursing Students' Attitudes Regarding Breastfeeding Education

ABSTRACT

Breast milk feeding is vital to the health outcomes of the breastfeeding dyad. Nurses have a significant role to promote, educate, and support breastfeeding practices for breastfeeding dyads in diverse settings. Nurses should also promote breastfeeding awareness to normalize breastfeeding as the optimal food for infants. This pilot study investigated the effects of a basic breastfeeding educational module on the breastfeeding attitudes of prelicensure nursing students. There was a statistically significant change in attitudes from pretest and posttest. Developing a comprehensive breastfeeding module is a significant step to standardize education and promote breastfeeding best practices.

Working on Counseling Skills to Improve Nursing Undergraduates' Knowledge and Breastfeeding Professional Self-Efficacy

Being well prepared and feeling confident when working with women who are breastfeeding is a challenge for many health professionals who need to be prepared to manage breastfeeding or any associated problems. The purpose of this study was to explore the changes in students' breastfeeding professional self-efficacy and knowledge after a workshop on breastfeeding counseling. The counseling workshop increased their knowledge (p ≤ .001) and breastfeeding professional self-efficacy (p ≤ .001) in the provision of labor support. Counseling skills help students to integrate the knowledge and feel more confident to provide breastfeeding care.

Thai novice nurses' lived experiences and perspectives of breastfeeding and human milk in the Neonatal Intensive Care Unit (NICU)

BACKGROUND

Breastfeeding and human milk have well-documented health benefits for newborn infants, particularly those who are sick. However, breastfeeding rates and human milk feeding among infants in neonatal intensive units (NICU) in Thailand are still low; thus, breastfeeding promotion and support are required for Thai mothers of premature infants. Newly graduated nurses can play a critical role within the healthcare support system and can have a significant impact on improving breastfeeding practices in the NICU. The objective of this study was to investigate the lived experiences and perspectives of Thai novice nurses on supporting breastfeeding and human milk feeding in the NICU.

METHODS

The study was conducted between March 2021 and May 2022 at three medical centers in the central region of Thailand. This study employed a descriptive phenomenological approach to explore Thai novice nurses' experiences and perspectives on breastfeeding. Purposive sampling was used to invite Thai novice nurses who have work experience in providing breastfeeding support to NICU mothers and their infants to participate in online interviews using a video conference platform (Zoom). Semi-structured questions were used to interview study participants in their native language. Data were analyzed using Colaizzi's method of data analysis to identify emergent themes. Member checks, peer debriefing, and self-reflection were applied to ensure the validity and trustworthiness of the study results. Back-translation was also used as a quality and accuracy assurance.

RESULTS

A total of thirteen novice nurses agreed to participate in the study. All were female, and their ages ranged from 21 to 24 years old at the time of the interview. The researchers identified five major themes related to the overall study objectives and research questions. They are: positive attitude toward breastfeeding and human milk, facing breastfeeding challenges at work, self-confidence rooted in experience, professional skill needs, and requiring further support.

CONCLUSIONS

Our results suggest that breastfeeding education plays a vital role in encouraging new nurses to provide breastfeeding support to mothers of preterm infants. Establishing breastfeeding support training and innovative learning strategies can be crucial in developing appropriate breastfeeding practice guidelines and policies to support Thai breastfeeding mothers in the NICU.

Translation and validation of the Chinese version of the comprehensive breastfeeding knowledge scale (CBKS)

BACKGROUND

The level of breastfeeding knowledge of nursing students may influence their ability to support breastfeeding families. However, to date, it has not been possible to measure this accurately due to the lack of existence of a validated tool in Chinese.

OBJECTIVES

To translate the Comprehensive Breastfeeding Knowledge Scale (CBKS) into Chinese, and then evaluate its psychometric properties among Chinese undergraduate nursing students in order to inform and evaluate a nursing breastfeeding education programme.

METHODS

The Brislin translation model was followed, and a three-phase process (translation, back-translation and cultural adaptation) was used to sinicize the CBKS and evaluate its content validity. Construct validity was evaluated with exploratory factor analysis (EFA), and the reliability of internal consistency of the Chinese version of the CBKS was tested by calculating Cronbach's alpha coefficient and the half reliability coefficient.

SETTINGS

Two nursing schools in Beijing and Nanjing, China.

PARTICIPANTS

Four hundred and thirty-nine undergraduate nursing students (257 from Beijing and 182 from Nanjing).

RESULTS

Five experts rated the content validity of the Chinese version of the CBKS as excellent. EFA showed that the Chinese version of the CBKS had three subscales and 23 items. Cronbach's alpha coefficient of the Chinese version of the CBKS and the half reliability coefficient were 0.70 and 0.73, respectively. Students who had completed an obstetrics or paediatric nursing course had significantly higher total scores and mean scores for most items compared with those who had not taken a course. Most of the indictors of EFA met the standards of construct validity, and some were very close to the cut-off.

CONCLUSION

Overall, the 23-item Chinese version of the CBKS is an acceptable tool to measure the level of breastfeeding knowledge among undergraduate nursing students. This scale can be used to inform the design and evaluation of breastfeeding education materials for nursing students or other health profession students.

Barriers to optimal breastfeeding of medically complex children in the UK paediatric setting: a mixed methods survey of healthcare professionals

BACKGROUND

Breastfeeding is indisputably significant for infants and children, as well as their mothers. However, when breastfed children are admitted to the paediatric ward, they may experience breastfeeding modification due to clinical challenges, lack of staff training and institutional barriers. Although previous research has identified multiple barriers to optimal feeding within the maternity, neonatal and community settings, we know less about the barriers that exist in paediatrics. Paediatric healthcare staff attitudes, training and awareness as well as ward culture are likely to have an impact on the experiences of families but are relatively unresearched in the paediatric setting, especially with regard to the multidisciplinary nature of clinical paediatric care. The aim of this study was to explore the attitudes, awareness and perceived barriers to effective breastfeeding support provision, as well as healthcare professional perception of barriers for families.

METHODS

This was a mixed methods study utilising a questionnaire which was completed by 409 healthcare professionals who identified as working within the paediatric setting. It included responses from paediatricians of all training grades, nurses, healthcare assistants and allied health professionals. Qualitative data from professionals were analysed to develop themes around professional and perceived parent barriers to optimal breastfeeding.

RESULTS

This study explored the barriers experienced by staff, as well as professionals' perception of parent barriers. These included lack of knowledge of how to help, a default formula culture, the pressure of maintaining strict fluid balance and breastfeeding being a low priority in the face of critical illness. Of the paediatric departments represented by this sample of healthcare professionals, most had a relatively poor culture of supporting breastfeeding, with multiple institutional barriers identified. Most professionals felt that there was not enough support for breastfeeding families on an average shift, and a large proportion identified as being one of just a few breastfeeding advocates on their ward.

CONCLUSION

In this relatively motivated and experienced sample of healthcare professionals, there were many identified barriers to optimal breastfeeding which could potentially be addressed by training that is carefully nuanced for the paediatric population. Ensuring that paediatric multidisciplinary healthcare professionals have sufficient skills and knowledge would address the identified challenge of poor awareness of breastfeeding and of how to overcome clinical lactation obstacles. Further improvements at policy level need to address the systemic lack of resourcing in paediatrics, as well as the lack of embedded breastfeeding-friendly organisational structures.

Applying Legitimation Code Theory to teach breastfeeding in nurse education: A case study

AIM

To use Legitimation Code Theory as a framework to inform the design of nursing education and gain insights into student perspectives of this design.

BACKGROUND

Internationally, the World Health Organization's breastfeeding recommendations are not being met. One contributing factor is that healthcare providers including registered nurses lack the knowledge to support breastfeeding women on an ongoing basis and rely on their personal experiences to inform the care they provide. Undergraduate nursing students should receive education to assist breastfeeding women in practice.

DESIGN

The study is underpinned by case-study methodology. The Legitimation Code Theory (LCT) dimension of Semantics and the concepts of semantic gravity and semantic density were used to theoretically frame and develop an intervention module to teach undergraduate nurses about breastfeeding.

METHODS

This module was part of an elective seven-week paediatric nursing course. University Human Research Ethics Committee (HREC201/203) reviewed the study. Participants (n = 9) completed semi-structured interviews and thematic analysis helped us to understand their experiences of the module. The Template for Intervention and Description and Replication (TIDeR) framework was used to report the intervention.

RESULTS

The breastfeeding module was positively received by participants who noted the module's structure differed from previous courses. Three main themes were identified in the student experience. These are: a) threads and links; b) engaging structure; and c) seedlings.

CONCLUSION

Legitimation Code Theory is an effective course development framework to harness the learners' prior informal knowledge and weave learning activities between theory and contextual practice to develop cumulative knowledge.

IMPACT

With an increased understanding of how undergraduate nursing students develop knowledge, the LCT dimension of Semantics can be ussed to structure content knowledge in instructional design. This approach builds explicit bridges between knowledge development in the nursing curriculum and learners' informal knowledge and contextual practice in clinical settings.

'She was hungry'-Croatian mothers' reasons for supplementing their healthy, term babies with formula during the birth hospitalisation

AIM

To explore why Croatian mothers request formula for their healthy, term newborn infants during the postnatal hospital stay.

METHODS

Four focus groups discussions were conducted with a total of 25 women who gave birth to healthy newborn infants, between May and June 2021 in Split, Croatia. A homogenous, non-random purposive sampling technique was used. The semi-structured interview schedule contained 15 open-ended questions. Reflexive thematic analysis was applied.

RESULTS

Three themes were generated. The first theme fear of hunger referred to the mothers' fears arising from difficulties in interpreting newborn infant behaviour and finding solace in giving formula. The second theme too little support-too late reflected participants' unrealised expectations of hospital staff. The third theme non-supportive communication addressed mother's need for empathy during the postpartum hospital stay.

CONCLUSION

Croatian mothers want to breastfeed, but often feel unsupported in doing so in the maternity hospital setting. Antenatal education of expectant mothers and training of maternity staff in breastfeeding counselling, with a strong emphasis on communication skills, as well as employment of International Board Certified Lactation Consultants and/or volunteer breastfeeding counsellors, were perceived by participants as a way to decrease mothers' requests for formula for their healthy, newborn infants.

Deficiencies in the Intentions, Attitudes, and Knowledge of Future Healthcare Professionals Regarding Breastfeeding

The aim of this study was to determine the level of knowledge, positive intentions, and attitudes regarding breastfeeding among university students. A validated questionnaire collected data from 236 students of the Faculty of Dental Medicine and Health Osijek about breastfeeding intentions, attitudes, and knowledge. Descriptive methods were used to present the students' results in terms of their intentions, attitudes, and knowledge. For each question included in the questionnaire, the maximum possible and maximum achieved numbers of points were calculated, as well as the percentage of points achieved in relation to the maximum possible number. Correlations between the results on individual scales of the questionnaire and the total results of the questionnaire are shown by Spearman's correlation coefficient. Questionnaire answers that were least in line with professional recommendations were selected and analyzed. We found that the areas that should be given special attention in the education of students are: the intention of breastfeeding for more than a year; the use of breaks for breastfeeding in the workplace; attitudes and knowledge about the quality of breast milk in relation to substitutes; attitudes about breastfeeding in public places and breastfeeding for more than two years; and the feeling of maternity and breastfeeding (compared to bottle feeding). The relationship between the results was considered in terms of intentions, attitudes, and knowledge in relation to the overall results of the questionnaire, and the authors' thoughts on the reasons behind the poorer results achieved for certain questions were presented.

Effectiveness of breastfeeding educational interventions to improve breastfeeding knowledge, attitudes, and skills among nursing, midwifery, and medical students: A systematic review and meta-analysis

BACKGROUND

Breastfeeding education programs are necessary to prepare healthcare students to address the breastfeeding needs of families. Various breastfeeding educational modules have been used in academic settings; however, the effectiveness of breastfeeding educational interventions remains unclear.

OBJECTIVES

To examine the effectiveness of educational interventions to improve the breastfeeding knowledge, attitudes, and skills of nursing, midwifery, and medical students.

METHODS

A systematic review was conducted searching academic databases from inception to December 22, 2022. Searches were carried out by two authors independently in PubMed, MEDLINE, Web of Science, Scopus, CINAHL Plus, Embase, Cochrane Library, and ERIC. Joanna Briggs Institute critical appraisal checklist was used. The data were extracted for a random-effects meta-analysis to estimate the standardized mean differences (SMDs) with 95 % confidence interval (CI). Subgroup analyses were performed to identify potential moderators.

RESULTS

Thirty-three quasi-experimental studies (12 two-group studies and 21 one-group studies), which included 1313 nursing students, 204 midwifery students, and 1066 medical students, were identified. The students who received educational interventions had significantly higher scores in breastfeeding knowledge (SMD: 0.67, 95 % CI: 0.46, 0.87 for two-group studies; SMD: 1.42, 95 % CI: 0.91, 1.94 for one-group studies), more positive attitudes toward breastfeeding (SMD: 0.43, 95 % CI: 0.22, 0.63 for two-group studies; SMD: 0.98, 95 % CI: 0.32, 1.63 for one-group studies), and higher scores for breastfeeding skills (SMD: 1.52, 95 % CI: 0.46, 2.58 for two-group studies; SMD: 1.33, 95 % CI: 0.43, 2.23 for one-group studies) than the control groups. As a teaching method, clinical practicums were a significant moderator of both breastfeeding knowledge (p = .035) and skills (p < .001). Few studies (n = 5) described the educational framework underpinning the program development.

CONCLUSIONS

Breastfeeding educational interventions effectively improve the breastfeeding knowledge, attitudes, and skills of undergraduate nursing, midwifery, and medical students. Incorporating clinical practicums in interventions is important. Future studies to examine useful teaching strategies for enhancing learning outcomes are warranted.

Effectiveness of an optional breastfeeding course for multidisciplinary undergraduate healthcare students: A quasi-experimental study

AIMS

This study aimed to examine and quantify the effectiveness of an optional breastfeeding course for multidisciplinary undergraduate healthcare students and to provide advice for education improvement based on students' characteristics and learning feedback.

BACKGROUND

Breastfeeding has received global awareness and educating undergraduate healthcare students is a prospective way to promote breastfeeding. This is the first report from mainland China to verify the education effects and formulate a proposal for improvement.

DESIGN

A quasi-experimental study with a one-group pretest-posttest design.

METHODS

An optional breastfeeding course covering eight topics based on the Health Belief Model was conducted for multidisciplinary students in a medical college. The Breastfeeding Knowledge Questionnaire, Iowa Infant Feeding Attitude Scale and Breastfeeding Promotion Intention Scale were completed for pre- and post-education comparison. The Wilcoxon signed-rank test, MannWhitney U test, KruskalWallis test and chi-square test were used for statistical analysis. The class average normalized gain and individual students' normalized gain were calculated to quantify the effectiveness from the perspective of learning gain.

RESULTS

From March to November 2021, 102 students specialized mainly in nursing, clinical medicine, medical imaging technology and midwifery took the course. Knowledge, attitudes and intention scores improved significantly (Z = 8.70, 8.72, 7.64, respectively, p < .001) and the class average normalized gains were 81.0%, 52.3% and 70.6%, respectively. Insignificant differences were found for students of different genders and categories of specialties (p > .05). Students of first year had significantly higher individual normalized gains (p < .05). In learning feedback, the top-ranked advice for course improvement was to increase practice and experience (75.5%).

CONCLUSIONS

This optional breastfeeding course produced medium to high learning gains for multidisciplinary healthcare undergraduates. Independent breastfeeding education based on behavioral theory for multidisciplinary students is recommended to be conducted in medical colleges. The addition of practice and experience may add value to such education.

Newborn Feeding Knowledge and Attitudes among Medical Students

This study sought to assess newborn feeding knowledge and attitudes among medical students. A sample of 649 Portuguese medical students completed an online survey containing a sociodemographic questionnaire, the Newborn Feeding Ability Questionnaire (NFA), and the Iowa Infant Feeding Attitudes Scale (IIFAS). The overall sample showed moderate scores for all variables. Gender analysis identified significant differences only for the dimension related to the benefits of skin-to-skin contact between mother and newborn where women scored higher. Analysis by year of training found that students with more years of training scored higher on all variables of newborn feeding knowledge that were positively correlated and were positive predictors of newborn feeding attitudes. Students with fewer years of training scored higher on work practices interfering with newborn feeding ability, which were negatively correlated and were negative predictors of newborn feeding attitudes. These results demonstrate that medical students with more years of training are the most prepared, however, the moderate results of the sample raise concerns. Our results point to the importance of providing medical students with adequate knowledge in order to influence their attitudes toward newborn feeding and contribute to better working practices for future health professionals.

The political economy of infant and young child feeding: confronting corporate power, overcoming structural barriers, and accelerating progress

Despite increasing evidence about the value and importance of breastfeeding, less than half of the world's infants and young children (aged 0-36 months) are breastfed as recommended. This Series paper examines the social, political, and economic reasons for this problem. First, this paper highlights the power of the commercial milk formula (CMF) industry to commodify the feeding of infants and young children; influence policy at both national and international levels in ways that grow and sustain CMF markets; and externalise the social, environmental, and economic costs of CMF. Second, this paper examines how breastfeeding is undermined by economic policies and systems that ignore the value of care work by women, including breastfeeding, and by the inadequacy of maternity rights protection across the world, especially for poorer women. Third, this paper presents three reasons why health systems often do not provide adequate breastfeeding protection, promotion, and support. These reasons are the gendered and biomedical power systems that deny women-centred and culturally appropriate care; the economic and ideological factors that accept, and even encourage, commercial influence and conflicts of interest; and the fiscal and economic policies that leave governments with insufficient funds to adequately protect, promote, and support breastfeeding. We outline six sets of wide-ranging social, political, and economic reforms required to overcome these deeply embedded commercial and structural barriers to breastfeeding.

Becoming breastfeeding friendly in Wales: Recommendations for scaling up breastfeeding support

Breastfeeding and the provision of human milk is established as protecting infant and maternal health. However, breastfeeding rates in many countries, including Wales, are low. Given the significant health, economic and environmental impacts of this, the need to strengthen breastfeeding promotion, protection and support is paramount. As part of this, the becoming breastfeeding friendly: a guide to global scale-up (BBF) initiative sets out a methodology to enable countries to assess their readiness to scale up breastfeeding protection, promotion and support by gathering data and scoring progress under eight areas, termed 'gears', shown to be essential for large-scale change. Recently, Wales took part in the BBF initiative. A cross-sector committee, including stakeholders from Universities, Welsh Government, Public Health Wales and Health Boards alongside critical friends scored Wales' support for breastfeeding across the eight gears. The overall score for Wales was 1.1 out of a possible 0-3, representing a moderate scaling up the environment for breastfeeding. Six gears were rated in the moderate gear strength category and two ('Promotion' and 'Advocacy') in the weak gear strength category. Gaps in breastfeeding support were identified and 31 recommendations covering six themes for change were put forward. These included a strategic action plan, consistent and long-term funding, a nuanced, cocreated engagement and promotion framework, strengthened education and training, robust monitoring and evaluation mechanisms and ensuring maternity rights and the International Code of Marketing of Breastmilk Substitute are upheld. Taken together, the analysis and recommendations present a clear vision for protecting and not merely promoting breastfeeding in Wales.

Determinants of breastfeeding attitudes of mothers in Jordan: A cross-sectional study

Breastfeeding provides the optimal nutrition for an infant. However, breastfeeding practice is on decline globally. Attitude toward breastfeeding may determine the practice. This study aimed to examine postnatal mothers' attitude to breastfeeding and its determinants. A cross-sectional study was conducted, and data on attitude were collected using the Iowa Infant Feeding Attitude Scale (IIFAS). A convenience sample of 301 postnatal women were recruited from a major referral hospital in Jordan. Data on sociodemographic characteristics, pregnancy and delivery outcomes were collected. SPSS was used to analyze the data and identify the determinants of attitudes to breastfeeding. The mean total attitude score for participants was 65.0 ±7.15, which is close to the upper limit of the neutral attitude range. Factors associated with attitude that is positive to breastfeeding were high income (p = 0.048), pregnancy complications (p = 0.049), delivery complications (p = 0.008), prematurity (p = 0.042), intention to breastfeed (p = 0.002) and willingness to breastfeed (p = 0.005). With binary logistic regression modelling, determinants of attitude positive to breastfeeding were highest income level and willingness to breastfeed exclusively (OR = 14.77, 95%CI = 2.25-99.64 and OR = 3.41, 95%CI = 1.35-8.63 respectively). We conclude that mothers in Jordan have neutral attitude to breastfeeding. Breastfeeding promotion programs and initiatives should target low-income mothers and the general population. Policymakers and health care professionals can use the results of this study to encourage breastfeeding and improve breastfeeding rate in Jordan.

The Current Status of Breastfeeding Knowledge and Its Influencing Factors in Nursing Undergraduates: A Cross-Sectional Study in China

The aim of this study was to explore the breastfeeding knowledge of nursing undergraduates and the influencing factors. Human milk (HM) is one of the most effective nutritional supplies to improve early development and physical health, but the current status of breastfeeding in China is still not optimal. The breastfeeding knowledge of perinatal women influences their feeding beliefs and behavior. Nursing undergraduates, as core professionals who will care for perinatal women and provide feeding guidance in the future, can significantly affect feeding behavior of mothers and their babies, so their knowledge of breastfeeding may have a potential impact on breastfeeding in China. However, studies on breastfeeding knowledge among nursing undergraduates in China are limited. A convenience sampling method was conducted in four medical universities in China, and eligible nursing undergraduates were selected. An online survey was collected from 5 July 2022 to 5 August 2022. Categorical data were reported as number and percentage, while continuous data were reported as mean ± SD. Multivariate linear regression was used to evaluate the association between influencing factors and breastfeeding knowledge. The overall mean score of the 460 returned questionnaires was 43.991 out of 100. The pass rate of the questionnaire was only 23.04%. Nursing undergraduates had a relatively better grasp of the benefits of breastfeeding and related advice (correct rates: 67.83%). Birthplace, only child or not, the course in obstetrics and gynecological nursing, the course in pediatrics nursing, and placements in maternity or neonatology units were relevant factors for breastfeeding knowledge (p < 0.05). Nursing undergraduates showed unsatisfactory breastfeeding knowledge. It is urgent to raise the knowledge level of breastfeeding among nursing undergraduates. Medical colleges should optimally structure a curriculum of breastfeeding knowledge. Furthermore, it is also necessary to improve the public’s understanding of breastfeeding and the whole society’s attention to breastfeeding in China.

Knowledge, Attitudes, Practices, Barriers and Facilitators to Skin-To-Skin Contact Among Arabian Mothers and Health Care Providers in Arab Countries: A Systematic Scoping Review

BACKGROUND

Skin-to-skin contact (SSC) occurs when a naked full-term neonate is placed on their mother’s bare abdomen or chest within 10 minutes of birth or soon after. Due to its multiple benefits for both the mother and the neonate, SSC is highly recommended by the World Health Organization. However, implementation of SSC in the Arab world is limited.

AIM

To undertake a systematic review to identify the knowledge, attitudes, practice, barriers and facilitators to SSC implementation among Arabian mothers and the health care providers in Arab countries.

METHODS

A systematic scoping review using the JBI three-step search strategy was used to systematically review quantitative and qualitative evidence.

FINDINGS

A total of eight studies were included. Around 82% of mothers would like to have more education about SSC. The majority of mothers (n= 254, 79%) expressed a positive attitude towards SSC, however more than three quarters did not correctly practice SSC. Among the healthcare providers, the mean knowledge score about SSC was 14.42 (95% CI = −0.21 to 29.06,I2= 96%). This review found evidence for barriers to SSC implementation including lack of education, lack of guidelines and cultural beliefs.

CONCLUSIONS

Arabian mothers had positive attitudes towards SSC, but the practice was poor due to lack of education and the lack of protocols and guidelines. The knowledge and practice of Kangaroo Mother Care (KMC) were poor among health care providers (HCPs) despite holding a positive attitude. Assessment of knowledge, attitude, and practice among Arab mothers and HCPs is needed to develop a robust educational programme to raise awareness with regards to SSC.

"We All Believe in Breastfeeding": Australian Midwives' Experience of Implementing the Baby Friendly Hospital Initiative

BACKGROUND

The education and support of new mothers during the in-hospital stay for childbirth is a critical time to establish breastfeeding. The Baby-Friendly Hospital Initiative was launched in 1991 to encourage maternity services to support and educate mothers to breastfeed by implementing Ten Steps to Successful Breastfeeding.

RESEARCH AIM

To explore midwives' experiences of implementing the Baby-Friendly Hospital Initiative in a Baby-Friendly accredited public hospital in Australia.

METHODS

In this prospective, cross-sectional qualitative study we used focus groups to explore midwives' experiences. Midwives (N = 26) participated in two focus groups conducted between October and November 2019. Data were analyzed using thematic analysis.

RESULTS

Time as a critical resource, and continuity of care, were crosscutting themes that framed midwives' experiences in supporting mothers to breastfeed their babies. Time constraints were experienced both through the health system structure and the BFHI accreditation process. Despite the challenges, the overarching theme-that we all believe in breastfeeding-fueled midwives' motivation.

CONCLUSION

Health services policy and practice need to consider ways to enable continuity of midwifery care and adequate time for midwives to support women to breastfeed their babies.

Behaviour, Attitudes and Knowledge of Healthcare Workers on Breastfeeding

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

Healthcare Professionals' Breastfeeding Attitudes and Hospital Practices During Delivery and in Neonatal Intensive Care Units: Pre and Post Implementing the Baby-Friendly Hospital Initiative

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.

Who Gets to Breastfeed? A Narrative Ecological Analysis of Women's Infant Feeding Experiences in the UK

The early post-natal period is a critical period in women's infant feeding journeys, often marked by high levels of unintended breastfeeding cessation. Previous research has argued that infant feeding should be perceived within a complex system whereby factors operating at different ecological levels (i.e., individual, social/community networks, cultural/institutional) interact to affect individual behaviors. However, currently, more work needs to be done to implement an ecological approach in breastfeeding programs. We adopted a complex-systems lens approach to explore how multi-level factors-individual, mother-infant dyad, health service, family and social networks, and wider community infrastructure-interacted with women's motivations and experiences of breastfeeding. We undertook a secondary analysis of 24 women's interviews; all the women had a strong antenatal intention to breastfeed and were expecting their first baby. The interviews were collected during the UK-based Assets-based feeding help Before and After birth (ABA) feasibility trial when their infant was aged between 4 and 21 weeks. Categorical content analysis was used to explore the interrelationships between key factors and to identify different infant feeding typologies. Two different typologies emerged: "disappointed" (n = 7) and "by hook or by crook" (n = 17). "Disappointed" women had stopped breastfeeding early; women classified as "by hook or by crook" continued breastfeeding despite facing challenges. Sociodemographic, social, and service level differences between the typologies were noted. "Disappointed" women were more likely to be younger, White-British, to have considered mixed-feeding antenatally and experienced negative breastfeeding support from healthcare professionals and personal networks. Infants of "disappointed" women were more likely to have received unexpected "top-ups" and to be perceived as having infant feeding difficulties. Women classified as "by hook or by crook" were just as likely as "disappointed" women to experience birth-related complications, but demonstrated more proactive help-seeking behaviors, had positive experiences of personal/professional support and accessed wider support. While further research is needed to consolidate and/or refute the typologies, the ecological approach shifts the focus away from mothers' decisions to consider the multi-level factors that need to be in place to enable women to breastfeed successfully. Further work to encourage help-seeking behaviors and toward improving facilities, support, and services is needed.

An Exploratory Study of the Associations Between the Hospital Work Environment and Implementation of Baby-Friendly Hospital Policy

A descriptive, cross-sectional study design was used to explore the relationships between the hospital work environment and implementation of the Baby-Friendly USA Ten Steps Policy in an urban hospital. Nurses reported the degree to which the Ten Steps policy was implemented, perceptions of the unit work environment using the Practice Environment Scale of the Nursing Work Index (PES-NWI), and self-efficacy related to the implementation of the policy. Results suggest that the work environment and the implementation of breastfeeding policy have separate and independent effects on nurse self-efficacy. Robust nursing leadership focused on education and skill development for clinicians, and focused on post-hospital care for patients and families are important contributory factors to successful breastfeeding policy implementation.

Evaluating the Implementation of the Online HUG Your Baby Course "Roadmap to Breastfeeding Success" for Nevada WIC Professionals

Lack of knowledge on the impact of infant development and behavior on breastfeeding affects both professionals and the clients they serve. Continuing education for Nevada WIC professionals with the online HUG Your Baby course Roadmap to Breastfeeding Success was implemented. This two-hour online course teaches about baby's development from birth to one year in relation to the breastfeeding journey. Tests and self-report surveys were used to evaluate these objectives pre- and post-intervention. Results showed significant improvement in knowledge about infant behavior and development, confidence in identifying and responding to infant behavior, and the positive integration of HUG resources into the professionals' work.

Breastfeeding and Human Lactation Curriculum Survey of Midwifery Programs in the United States

INTRODUCTION

The health attributes and advantages of breastfeeding are well documented in the literature. Current research identifies the importance of comprehensive lactation knowledge among health care professionals to improve breastfeeding outcomes. Educational curricula to incorporate lactation content is necessary for student preparedness to provide competent care. Midwives are in a unique position to support, promote, and manage breastfeeding. The purpose of this study was to survey Accreditation Commission for Midwifery Education (ACME)-accredited midwifery education programs in the United States for their breastfeeding curricular content including opportunities for clinical experiences in managing and counseling breastfeeding parents.

METHODS

A descriptive survey was deployed online to midwifery programs listed by the American College of Nurse-Midwives, with a response completion rate of 44.7%. Data collection included program descriptors, hours of lactation content, educational topics, faculty preparation, use of simulation, and clinical breastfeeding experiences.

RESULTS

Descriptive analyses revealed differences among the midwifery education programs surveyed regarding the amount of lactation content and clinical opportunities. Two programs offer a course specific to breastfeeding, with the remaining programs providing lactation content threaded throughout their curricula; 29.4% of programs offer 3 to 4 hours of lactation content, 35.3% report 5 to 8 hours of content, and 11.8% provide at least 10 hours of content. One program reports 18+ hours of content provided in both didactic and clinical settings. All programs report providing breastfeeding clinical opportunities for students; 18% of programs offer simulation experiences. No programs report using standardized lactation clinical competencies.

DISCUSSION

Midwives play a pivotal role in breastfeeding promotion, counseling, and clinical support. Standardization of didactic lactation education will assist programs in future curriculum mapping. Given the variability of clinical settings and patient access, creating clinical competencies and providing lactation simulation experiences may offer midwifery students a broader opportunity to gain critical skills in lactation management to best support breastfeeding families.

Educational Resources and Curriculum on Lactation for Health Undergraduate Students: A Scoping Review

BACKGROUND

Breastfeeding is a fundamental component of health care, and health professionals need to be adequately prepared. As part of the system, health care professionals have the ability to influence the establishment and maintenance of breastfeeding. The global literature regarding the curricular approach or established best practices for health professional education in lactation is inconclusive and lacking in rigor.

RESEARCH AIM

To explore the literature for the educational resources, methods, and curriculum used in the education of undergraduate health students related to lactation.

METHODS

A scoping review examining the curricular programs of health professional students in lactation was undertaken exploring and summarizing evidence from peer reviewed and grey literature. A scoping review with a five-stage review process was followed. The database search between 1982-2018 generated 625 results, 79 full-text articles were reviewed, and 29 articles published in English met the inclusion criteria.

RESULTS

In general, educational resources, methods, curricular approaches, and foundational topics were based on best practice standards. Some authors incorporated a variety of learning methods and provided experiential learning, with evidence of translation of knowledge into clinical practice. In the studies examined, researchers reported that students had improved their: knowledge and attitudes (59%); breastfeeding support skills (45%); and confidence (10%). However, even in programs that focused on developing students' breastfeeding support skills, authors reported a lack of change in students' confidence.

CONCLUSIONS

Although only English articles met the inclusion criteria, this review was unique in its search of multidisciplinary, multilingual, and international studies. Consistency in teaching across disciplines is key and not evident in the studies reviewed.

Are they ready? Awareness and preparedness of the emerging workforce for Dental Check by One

Background Dental Check by One (DCby1) is a British Society of Paediatric Dentistry campaign, which aims to increase dental attendance of young children. As the future workforce, dental students have a key role in ensuring its long-term success.Aims To establish final-year dental students' awareness of DCby1. To evaluate their preparedness for providing dental care for young children and to identify perceived barriers to doing so at the time of graduation as they prepare to enter the workforce.Materials and methods An anonymous, online survey was administered to graduating final-year dental students in 2018, 2019 and 2020. Quantitative data were gathered using mixed item formats and Likert scales. Qualitative data were also gathered using free-text questions, allowing evaluation of the opinions of responders.Results The response rate was 83% (n = 63) in 2018, 91% (n = 62) in 2019 and 73% (n = 57) in 2020. Eight percent (n = 5) of responders were aware of DCby1 in 2018, improving to 67% (n = 38) in 2020. Each year, 98% to 100% of responders felt prepared to provide preventive care for young children. Fewer than 60% felt prepared to provide breastfeeding and weaning advice to parents. Responders felt unprepared to examine the dentition of a preschool child. Undergraduate curricula and social media were identified as preferable sources of public health campaign information for students.Conclusion Awareness and preparedness for DCby1 appears to be improving. Ninety-five percent of all responders across three years of study felt prepared to examine a child aged under one year and this is encouraging for the long-term success of DCby1. Targeted curriculum reform including both didactic teaching and online learning platforms appears to have been pivotal to improving undergraduate awareness and preparedness. Social media may offer opportunities for engaging with undergraduate learners.

Breastfeeding Knowledge and Attitudes among Midwifery Diploma Students in Jordan: A Descriptive Study

Background

Healthcare providers widely support breastfeeding as the optimal form of nutrition for infants. Midwives play a vital role in assisting the mothers to initiate and continue breastfeeding. Therefore, they must acquire proper knowledge accompanied by positive attitudes toward breastfeeding during college education. The main aim of the present study was to assess the knowledge and attitudes of diploma midwifery students toward breastfeeding.

Methods

This is a descriptive cross-sectional study. A short version of the Australian Breastfeeding Knowledge and Attitude Questionnaire (ABKAQ-SF) was distributed among 72 diploma midwifery students from one community college in July 2018, using convenience sampling. Data were analyzed using SPSS software, and the statistical significance was set at P<0.05 level.

Results

Results revealed neutral attitudes (a mean score of 3.02±0.36 out of 5), coupled with a lack of breastfeeding knowledge (mean score was 10.07±2.38 out of 22), particularly knowledge regarding breastfeeding problem management. Midwifery students' knowledge and attitudes scores were significantly correlated with one another (r=0.68, P=0.001). Demographic variables such as age, year of study, residency place, or personal breastfeeding experiences affected neither the students' breastfeeding knowledge nor their attitudes.

Conclusion

The findings of this study highlight the need for reforming the curricula of midwifery colleges. Midwifery curricula should provide in-depth knowledge of human lactation physiology and management and give students the basic skills they need to assist breastfeeding women. At the same time, it should focus on the development of supportive and positive attitudes toward breastfeeding.

Exploring the Impact of Offering an Undergraduate Lactation Elective Course as a Strategy for Normalizing Breastfeeding

Background

More breastfeeding interventions targeting female and male undergraduates before they become parents are needed to foster accurate breastfeeding knowledge, positive attitudes toward breastfeeding, and a greater intent to breastfeed. This study aimed to assess the impact of completing a lactation elective course on undergraduates' breastfeeding knowledge, attitudes, and intention.

Methods

Pre- and postcourse surveys were administered to 96 undergraduates from various majors enrolled in a lactation elective.

Results

From pre- to postcourse, this study found significant increases in undergraduates' breastfeeding knowledge, attitudes, and intent.

Conclusions

Because most undergraduates in the United States become parents only after graduation, universities have an opportunity to foster the knowledge and attitudes needed to breastfeed successfully. As breastfeeding knowledge and attitudes in men and women are strong predictors of breastfeeding intent, initiation, and duration, offering undergraduate lactation elective courses is a promising strategy to improve future parents' breastfeeding knowledge, attitudes, and intention, helping to normalize breastfeeding and improve breastfeeding rates.

Breastfeeding knowledge in university nursing students. A multicentre study in Spain

BACKGROUND

Exclusive breastfeeding is one of the main health and infant survival elements. To start and maintain breastfeeding, health professionals must receive culturally sensitive evidence-based breastfeeding training to offer future mothers the required information and support. While studying the nursing degree, acquiring the necessary knowledge and skills to successfully perform this work is essential.

OBJECTIVE

Study the level of nursing students' breastfeeding knowledge at three Spanish public universities; explore which variables are related to acquire this knowledge.

DESIGN

An observational, descriptive, cross-sectional multicentre study.

METHODS

Participants were the students registered for the 4 nursing degree years at the three participating universities (N = 1540). They were asked about their breastfeeding knowledge with the self-administered AprendeLact Questionnaire; breastfeeding-related socio-demographic variables were included.

RESULTS

The overall mean score of the 684 returned questionnaires was 4.659 (±2.377) out of 10. The year-4 students from the Castellón university obtained significantly higher mean scores and had been on practicals in maternity or neonatology units, belonged to breastfeeding associations and were artificially fed as infants. University belonged to, current academic year and placements in maternity or neonatology units were relevant factors for acquiring breastfeeding knowledge.

CONCLUSIONS

Syllabi based on progressive transversal learning, and participating in real maternity-related health settings, could be facilitating strategies to acquire a suitable level of breastfeeding knowledge.

The Evaluation of Training for Health-Care Professionals and Community Leaders Regarding 6-Month Exclusive Breastfeeding in Northeast Thailand

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.

Integrative Review of the Experiences of Registered Nurses Who Support Breastfeeding Women

OBJECTIVE

To describe the experiences of registered nurses (RNs) who support breastfeeding women and to understand the factors that they believe affect practices that support breastfeeding.

DATA SOURCES

We conducted an online search using five databases: Scopus, MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), the Cochrane Database of Systematic Reviews, and Joanna Briggs Institute of Systematic Reviews.

STUDY SELECTION

We included original research articles on the experiences of RNs who support breastfeeding women that were published in 2009 or after and were available in English. After title and abstract review of 785 articles, we included 22 articles for full text review. Nine articles met the eligibility criteria and were included in the review.

DATA EXTRACTION

We used Whittemore and Knafl's five-step framework and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines to guide this integrative review. Three authors reviewed and appraised the articles independently.

DATA SYNTHESIS

We categorized the findings into three themes: Workplace Issues, Personal Experiences, and Breastfeeding Knowledge and Education. Workplace Issues included the subthemes Lack of Time and Workload and Infant Health Stability. Personal Experiences included the subthemes Attitudes, Individual Experiences With Breastfeeding, and The Experiences of Family and Friends. Breastfeeding Knowledge and Education included the subthemes Prelicensure Education and Workplace Education and Training. Most researchers identified deficits in knowledge and education among RNs. The concept of confidence was influenced by all the other themes. Participants in the included studies reported that they developed confidence after learning from lactation consultants and having role models who supported the development of their knowledge and skills.

CONCLUSION

Despite the heterogeneity among the studies, findings highlighted the need for an increased focus on the preparation of RNs to support women to effectively breastfeed within health care organizations. Multitargeted efforts, such as orientation programs and in-depth breastfeeding education using role modeling, mentorship, and role playing with practical scenarios, may improve RNs' abilities and confidence to support breastfeeding women.

ABM Clinical Protocol #14: Breastfeeding-Friendly Physician's Office-Optimizing Care for Infants and Children

A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.

Structural Racism and Barriers to Breastfeeding on Chicagoland's South Side

For African American (AA) families on Chicagoland's South Side who choose to breastfeed, finding and receiving services needed to reach their goals are difficult. The disparities in breastfeeding support across Chicagoland are symptomatic of inequitable health care access shaped by persisting structural racism. A number of community hospitals that once served AA families by providing easy access to care no longer exist. Recently, South Side obstetric unit and hospital closures have increased. Simultaneously, funding is increasingly competitive for community health organizations and federally qualified health centers. Institutions and agencies that do receive funding or adequately allocate funding to include lactation services cannot address breastfeeding barriers within socioeconomically marginalized communities. The unmet funding needs not only affect breastfeeding families but also impede the growth of a multilevel lactation care workforce. Finally, inconsistencies persist between breastfeeding information provided by lactation providers and delivery team care received in the hospital. Despite these barriers, we believe pathways exist to improve breastfeeding rates among South Side AA communities, such as perinatal home visiting services. Stakeholders must recognize the longstanding effects of structural racism and address the inequitable distribution of perinatal care across Chicagoland. Stakeholders must also place value in and be supportive of lactation care providers and the families they serve through both funding and policies. These changes, in addition to community-level collaboration, can improve breastfeeding rates for AA families on Chicagoland's South Side.

Using Simulation to Teach Breastfeeding Management Skills and Improve Breastfeeding Self-Efficacy

Breastfeeding rates in the United States continue to be variable and are not meeting benchmarks established by Healthy People 2020. The literature indicates that although breastfeeding knowledge of providers is paramount in the success of breastfeeding mothers, most receive minimal education regarding breastfeeding management. Recognizing a lack of opportunities for nursing students to practice breastfeeding management during clinical rotations, a breastfeeding simulation program was implemented for students prior to beginning Maternal Child Health clinicals. Students reported increased confidence in caring for breastfeeding dyads and enhanced comfort when providing care to a breastfeeding mother (breastfeeding self-efficacy). This hands-on educational approach can be utilized for any provider working with breastfeeding dyads.

Knowledge and attitude of health staff towards breastfeeding in NICU setting: are we there yet? An Italian survey

The benefits of human milk in preterm infants, a population at high risk for developing adverse outcomes for which breast milk is a protective factor, are widely acknowledged. However, preterms' admission in a neonatal intensive care unit (NICU) and newborn's clinical conditions have been described as significant barriers, leading to lower rates of breastfeeding initiation and duration. Healthcare workers play a crucial role in encouraging breastfeeding. We conducted a cross-sectional survey among nurses working in six Italian NICUs, exploring their knowledge and attitude towards breastfeeding. Although the majority of nurses had a specific breastfeeding education, our results show still some variations among answers regarding aspects of breastfeeding support in this setting. Specifically, family-centered care, transition feeding to the breast, and skin-to-skin practice, despite being extensively addressed by the Neo Baby-Friendly Hospital Initiative, are the items that highlighted a range of answers that could result in conflicting information to mothers.Conclusion: By underlining the gaps of knowledge and attitude towards breastfeeding of nurses working in NICUs, this study provides an insight into what needs to be improved, with the aim of promoting higher rates of breastfeeding in the preterm population. What is Known: • Breastfeeding is particularly challenging in the preterm population, despite its universally recognized health benefits. • Improving healthcare professionals' knowledge and attitude towards breastfeeding has been shown to be crucial for promoting breastfeeding in NICUs. What is New: • Our results provide useful insight into nurses' knowledge and attitude towards breastfeeding in NICU settings. • By acknowledging strengths and weaknesses highlighted by this study, tailored strategies could be developed to improve health staff breastfeeding education and support to parents in NICU settings.

Assessing Application-Based Breastfeeding Education for Physicians and Nurses: A Scoping Review

BACKGROUND

Physicians and nurses are expected to support breastfeeding mothers. However, there is a lack of standardized lactation education throughout training programs and hospitals. As a result, providers lack the necessary confidence and skills to guide mothers throughout the breastfeeding experience. The hands-on nature of breastfeeding management demands the implementation of application-based learning tools to improve skills retention and patient breastfeeding outcomes.

RESEARCH AIM

In this scoping review, we aimed to critically assess the types of application-based breastfeeding management learning tools reported within medical and nursing professions and the evaluation methods of learner and patient outcomes.

METHODS

The authors searched the literature to identify peer-reviewed articles published between 2000 and 2018 with medical or nursing students, residents, or professionals as the target learner group in an application-based educational intervention. Both authors independently assessed the content in the resulting articles, with specific focus on teaching methods, curricular development, and the learning outcomes reported within each study.

RESULTS

Ten articles matched the inclusion criteria and were included in the final review, including five studies from the medical field and five from the field of nursing. Use of real patients was a common method for application-based skills training, followed by role playing and use of standardized patients. Teaching and evaluation methods varied widely across the studies.

CONCLUSION

The results align with existing literature in finding a dearth of high-quality studies assessing breastfeeding education among physicians and nurses. The variability in teaching and evaluation methods indicates a lack of standardization in breastfeeding education between institutions.

Nursing student's knowledge about breastfeeding: Design and validation of the AprendeLact questionnaire

BACKGROUND

Breastfeeding is the best source of food that a mother can offer her child during the first months of life because it provides numerous benefits for both mother and baby. Despite breastfeeding being an innate act, it requires qualified health professionals for advice and support.

OBJECTIVES AND PARTICIPANTS

To design and validate a questionnaire to evaluate nursing student breastfeeding knowledge.

METHODS AND DESIGN

Cross-sectional study. Construction and validation of the questionnaire (content validity, test-retest reliability and internal consistency). Descriptive and bivariate analyses of socio-demographic variables and the questionnaire results.

RESULTS

Optimum results were obtained in terms of internal consistency (KR-20 = 0.9) and test-retest reliability (ICC = 0.925) with a samples of 144 participants (mean age of 22.69 years). Statistical significance were observed among the questionnaire score and academic year, clinical practice, type of breastfeeding in childhood, knowing about support groups and participating in a breastfeeding workshop or course.

CONCLUSION

A questionnaire on breastfeeding knowledge was validated. Nursing students progressively acquire breastfeeding skills as they advance in their undergraduate studies.

Knowledge, attitude, and practice of exclusive breastfeeding among mothers in East Africa: a systematic review

Background

Exclusive breastfeeding (EBF) is recommended for the first six months of age by the World Health Organization. Mothers’ good knowledge and positive attitude play key roles in the process of exclusive breastfeeding practices. In this study, we report on a systematic review of the literature that aimed to examine the status of mothers’ knowledge, attitude, and practices related to exclusive breastfeeding in East Africa, so as to provide clues on what can be done to improve exclusive breastfeeding.

Methods

A systematic review of peer-reviewed literature was performed. The search for literature was conducted utilizing six electronic databases, Pub med, Web of Science, Google Scholar, Embase, Science Direct, and Cochrane library, for studies published in English from January 2000 to June 2019 and conducted in East Africa. Studies focused on mothers’ knowledge, attitudes, or practices related to exclusive breastfeeding. All papers were reviewed using a predesigned data extraction form.

Results

Sixteen studies were included in the review. This review indicates that almost 96.2% of mothers had ever heard about EBF, 84.4% were aware of EBF, and 49.2% knew that the duration of EBF was the first six months only. In addition, 42.1% of mothers disagreed and 24.0% strongly disagreed that giving breast milk for a newborn immediately and within an hour is important, and 47.9% disagreed that discarding the colostrum is important. However, 42.0% of mothers preferred to feed their babies for the first six months breast milk alone. In contrast, 55.9% of them had practiced exclusive breastfeeding for at least six months.

Conclusions

Exclusively breastfeeding among our sample is suboptimal, compared to the current WHO recommendations. Thus, it is important to provide antenatal and early postpartum education and periodical breastfeeding counseling, to improve maternal attitudes and knowledge toward breastfeeding practices.

Exploring the Feasibility of Utilizing Undergraduate Lactation Education Courses as a Vehicle to Prepare the Future Healthcare Workforce to Educate and Support Breastfeeding Families in the Community

Background

Minimal lactation knowledge among healthcare professionals has been linked to low breastfeeding rates. To address this problem, one university integrated into its curriculum a lactation education course which aims to provide students from a variety of healthcare related bachelor programs, with the knowledge and skills needed to educate and support breastfeeding families in the community. The aim of this study was to evaluate the feasibility of utilizing undergraduate lactation education courses as a vehicle to better prepare the future healthcare work force to educate and support breastfeeding families in the community.

Methods

A 62-question survey was administered pre and post course completion to students enrolled in four sections of a lactation course over the 2018/2019 academic year (n = 96).

Results

Findings suggest that pre to post course completion students had significant increases in their: lactation knowledge, confidence delivering lactation education, confidence in working with clients in a professional setting and positive attitude towards breastfeeding.

Conclusions

Given the lack of knowledge among healthcare professionals is a significant barrier to optimal breastfeeding rates, this evaluation study provides evidence that integrating lactation education courses into university curriculum may be an effective strategy for improving breastfeeding rates.

"They Just Need to Come Down a Little Bit to your Level": A Qualitative Study of Parents' Views and Experiences of Early Life Interventions to Promote Healthy Growth and Associated Behaviours

The first 1000 days is a critical window of opportunity to promote healthy growth and associated behaviours. Health professionals can play an important role, in part due to the large number of routine contacts they have with parents. There is an absence of research on the views of parents towards obesity prevention and the range of associated behaviours during this time period. This study aimed to elicit parents’ views on early life interventions to promote healthy growth/prevent childhood obesity, particularly those delivered by health professionals. Semi-structured interviews were conducted with 29 parents (24 mothers, 5 fathers) who were resident in Ireland and had at least one child aged under 30 months. Data were analysed using reflexive thematic analysis. Two central themes were generated: (1) navigating the uncertainty, stress, worries, and challenges of parenting whilst under scrutiny and (2) accessing support in the broader system. Parents would welcome support during this critical time period; particularly around feeding. Such support, however, needs to be practical, realistic, evidence-based, timely, accessible, multi-level, non-judgemental, and from trusted sources, including both health professionals and peers. Interventions to promote healthy growth and related behaviours need to be developed and implemented in a way that supports parents and their views and circumstances.

Are the doctors of the future ready to support breastfeeding? A cross-sectional study in the UK

Background

Currently there is no published data on the inclusion of breastfeeding education within the UK medical school curriculum. This study aims to address this knowledge gap and explore students’ perceptions of their readiness to support breastfeeding.

Methods

An online survey was used to collect data from 32 UK undergraduate medical schools and their students. All students in their final two years of study at the 30 universities offering a 5- or 6-year medicine course, were eligible.

Results

Curriculum data was obtained from 26 (81%) institutions. Compulsory breastfeeding education was provided by 85% (N = 22) institutions with 81% (n = 21) providing lecture-based teaching and 19% (n = 5) offering formal clinical education. Overall, 411 students from 22 institutions participated. A moderate ability to identify the benefits of breastfeeding was observed; however, self-rated confidence in practical skills was poor. Assisting with latching was the least confident skill, with confidence in only 3% (14/411) students. Most students (93%) viewed doctors as playing an important role in breastfeeding, with those interested in either women’s health, paediatrics or general practice perceiving the role of doctors as more important. Overall, 93% (381/411) students requested further breastfeeding education.

Conclusions

This study suggests UK medical schools are not adequately preparing students to support breastfeeding patients. Further studies should explore the competency of doctors to meet the needs of lactating women, and design optimal training for UK medical students.

Self-efficacy in breastfeeding support: a research on Italian midwifery students

BACKGROUND AND AIM OF THE STUDY

Maternal breastmilk represents the best nourishment for the newborn baby during its first six months, as it offers several benefits for the health and well-being of babies and mothers. In order to promote, protect and support effectively mother and child during breastfeeding, it is essential for midwives to be properly educated and to acquire highly professionalizing skills. This study aimed to evaluate the level of self-efficacy of the students attending the Degree Course of Midwifery, regarding the support of mother and child in breastfeeding.

METHOD

A questionnaire of 37 items (Blackmanet al, 2015) validated in Italian by Mazzeo Melchionda (2019), was sent on-line to students of ten different Midwifery Degree Courses to assess their level of self-efficacy regarding the management of breastfeeding. Statistical analysis was carried out using statistic software R3.4.3 (The Foundation for Statistical Computing).

RESULTS

158 questionnaires were collected from ten Italian Midwifery Degree Courses. The areas in which students showed a high level of self-efficacy in managing breastfeeding include: the benefits of breastfeeding; the child's tendency to take the breast within an hour from childbirth and the relevance of skin to skin contact and rooming-in. Low levels of self-efficacy concerned the comfortably breastfeeding in public places and avoiding giving formula to the baby in its first six weeks of life.

CONCLUSIONS

Generally the students attending Midwifery Degree Courses show a high level of self-efficacy in assisting mothers during breastfeeding and they prove to have a good knowledge of the benefits of breastfeeding to improve the health of mothers and their children. (www.actabiomedica.it).

Self-efficacy in breastfeeding support: a research on Italian midwifery students

BACKGROUND AND AIM OF THE STUDY

Maternal breastmilk represents the best nourishment for the newborn baby during its first six months, as it offers several benefits for the health and well-being of babies and mothers. In order to promote, protect and support effectively mother and child during breastfeeding, it is essential for midwives to be properly educated and to acquire highly professionalizing skills. This study aimed to evaluate the level of self-efficacy of the students attending the Degree Course of Midwifery, regarding the support of mother and child in breastfeeding.

METHOD

A questionnaire of 37 items (Blackmanet al, 2015) validated in Italian by Mazzeo Melchionda (2019), was sent on-line to students of ten different Midwifery Degree Courses to assess their level of self-efficacy regarding the management of breastfeeding. Statistical analysis was carried out using statistic software R3.4.3 (The Foundation for Statistical Computing).

RESULTS

158 questionnaires were collected from ten Italian Midwifery Degree Courses. The areas in which students showed a high level of self-efficacy in managing breastfeeding include: the benefits of breastfeeding; the child's tendency to take the breast within an hour from childbirth and the relevance of skin to skin contact and rooming-in. Low levels of self-efficacy concerned the comfortably breastfeeding in public places and avoiding giving formula to the baby in its first six weeks of life.

CONCLUSIONS

Generally the students attending Midwifery Degree Courses show a high level of self-efficacy in assisting mothers during breastfeeding and they prove to have a good knowledge of the benefits of breastfeeding to improve the health of mothers and their children. (www.actabiomedica.it).

Exploring Breastfeeding Knowledge and Attitudes among Noncaregivers: A Narrative Review

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