Abstract
ObjectiveThe aim of this study was to develop an instrument that measures health care professionals' (HCPs) attitudes to breastfeeding and skin-to-skin contact in relation to the Baby-Friendly Hospital Initiative for neonatal intensive care. DesignThe study was part of a larger project aiming to revive the Ten Steps to Successful Breastfeeding for both full-term and preterm infants. The study had a pre-test/post-test design using online questionnaires distributed by email before and after a training programme. Setting and participantsA total of 70 specialist registered nurses, registered nurses, assistant nurses and physicians working at a Swedish neonatal intensive care unit answered 55 breastfeeding attitudes questions online before the training. The Preterm Breastfeeding Attitudes Instrument (PreBAI) consists of twelve of these 55 items/questions, selected using exploratory factor analysis. Measurements and findingsHigher scores indicated more positive attitudes and the median total PreBAI score was 42 points (out of 48), on both the pre- and the post-test questionnaires, showing no significant difference. In the pre-test questionnaire, the majority of HCPs (84%) stated that they needed further breastfeeding training. They also stated that they perceived breastfeeding as very important, scoring a median of 10 (range 5-10) points on a 10-point scale. Three separate underlying dimensions were identified in the questionnaire, indicating different attitudes: Facilitating (five items), Regulating (four items), and Breastfeeding- and skin-to-skin contact-friendly (three items). A positive correlation was found between how many years the HCPs had worked in neonatal care, and their PreBAI score (rs = 0.383, p = 0.001). Those who had previously received extra breastfeeding education scored higher on the instrument. Key conclusions and implications for practiceNeonatal intensive care units need to increase their efforts to support breastfeeding. An important factor for mothers when establishing breastfeeding is support from well-trained professionals with a positive attitude to breastfeeding. The PreBAI could be a useful tool for identifying attitudes among HCPs before and after attending a breastfeeding training programme.
Highlights
It is well documented that breast milk is especially important for infants born preterm (< 37+0 weeks of gestation) (American Academy of Pediatrics, 2012; Mosca and Gianni, 2017) and that preterm infants are breastfed less than full-term infants (Ericson et al, 2016)
This study showed a positive correlation between how the health care professionals (HCPs) valued their own breastfeeding experience and how important they thought breastfeeding is
Ekstrom et al describe the need for HCPs to process their own breastfeeding experiences in relation to the support they provide to new mothers (Ekstrom et al, 2005b)
Summary
It is well documented that breast milk is especially important for infants born preterm (< 37+0 weeks of gestation) (American Academy of Pediatrics, 2012; Mosca and Gianni, 2017) and that preterm infants are breastfed less than full-term infants (Ericson et al, 2016). One of the main factors for establishing breastfeeding is support from well-trained health care professionals (HCPs) with a positive attitude to breastfeeding (Shattnawi, 2017) and with the ability to create good relationships with the mothers (Gianni et al, 2018). Health care professionals need to be able to strengthen mothers’ self-efficacy in breastfeeding (Gerhardsson et al, 2018) and help them to adapt to their infants (Gerhardsson et al, 2020a). HCPs often agree that breastfeeding is beneficial for preterm infants, but implementation of a breastfeeding policy is often problematic and there is a risk that HCPs at a neonatal intensive care unit (NICU) spend most of their time in technical and medical care routines and, further,. Have a written breastfeeding policy that is routinely communicated to all health care staff
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