Breastfeeding Knowledge Questionnaire Research Articles

Determinants and Prevalence of Exclusive Breastfeeding Among Thai Muslim Mothers: A Cross-sectional Analysis

Exclusive breastfeeding is pivotal for the health and development of infants and offers numerous benefits to mothers. However, unique cultural beliefs and practices, particularly among Muslim communities, can significantly influence breastfeeding behaviors. This study sought to elucidate the factors influencing exclusive breastfeeding among Thai Muslim mothers. The sample was 168 postpartum Muslim mothers from well-baby clinics in southern Thailand, selected through multi-stage random sampling. Data were collected from June to December 2022 employing the Demographic Data Form, Infant Feeding Intentions Scale, Breastfeeding Knowledge Questionnaire, Iowa Infant Feeding Attitude Scale, Breastfeeding Self-Efficacy Scale -Short Form, Maternal Health Literacy Scale, Islamic Belief Scale, Exclusive Breastfeeding Social Support, and Breastfeeding Practices Questionnaire. Data were analyzed using descriptive statistics, Spearman rank’s correlation, and binary logistic regression analysis. The study found that the rate of exclusive breastfeeding among Thai Muslim mothers at six months postpartum was 54.8%. Notably, breastfeeding self-efficacy emerged as the sole predictor of exclusive breastfeeding, accounting for 11% of the variance in this practice. These findings underscore the critical role of breastfeeding self-efficacy in promoting exclusive breastfeeding. It is recommended that nurses and healthcare professionals develop culturally tailored support programs that enhance breastfeeding self-efficacy, aligned with Islamic beliefs, to improve breastfeeding practices among Muslim mothers.

The effectiveness of online breastfeeding education and support program on mothers of preterm infants: A quasi-experimental study

ObjectiveTo develop a WeChat-mini-program-based Online breastfeeding education and support program and explore its impacts on promoting mothers of preterm infants’ breastfeeding knowledge, attitudes, self-efficacy, and rates. Design, setting, and participantsThis was a quasi-experimentation with two-group comparisons. The eligible preterm mother-infant pairs were recruited from the NICU within seven days postpartum. The first 25 mothers admitted to the NICU during the study period were included in the control group, and the following 25 mothers were in the intervention group according to the admission order of their preterm infants. A generalized linear mixed model was used to detect the effects of the online intervention program and the interaction effects of group and time. InterventionsThe participants received a 3-month online breastfeeding intervention from a WeChat mini program for the intervention group. MeasurementsMothers of preterm infants’ breastfeeding knowledge, attitudes, self-efficacy, and breastfeeding rates of different patterns were respectively evaluated by the Breastfeeding Knowledge Questionnaire (BKQ), Iowa Infant Feeding Attitude Scale (IIFAS), and Breastfeeding Self-Efficacy Scale (BSES) at three different points of times including before intervention (T0), at one month postpartum (T1) and three months postpartum (T2). FindingsThe breastfeeding knowledge significantly differed between the two groups but without differences between different time points and in the grouping*time interaction. Within the intervention group, significant improvements were observed from T0 to T2 and T1 to T2. No significant differences in breastfeeding attitudes, self-efficacy, and breastfeeding rates were found between and within groups. Key conclusionsThe WeChat-mini-program-based online breastfeeding intervention may improve the breastfeeding knowledge level of mothers of preterm infants but has no significant impact on mothers’ breastfeeding attitudes, breastfeeding self-efficacy, and breastfeeding rates. Implications for practiceThe WeChat mini program can be used to improve the breastfeeding knowledge level of mothers of preterm infants. Future interventions need to target both mothers of preterm infants and their family members by combing online and offline approaches.

Using the theory of planned behavior model to predict factors influencing breastfeeding behavior among preterm mothers at week 6 postpartum: the mediating effect of breastfeeding intention.

Exclusive breastfeeding (EBF) in the first 6 weeks postpartum is key to continued breastfeeding. This study aimed to explore the role of EBF-related predictors (particularly breastfeeding intention) in breastfeeding behavior among preterm mothers at week 6 postpartum based on the theory of planned behavior (TPB). A total of 352 mothers of preterm infants were recruited, 340 of whom participated in this study. Prior to discharge, participants completed the Chinese versions of the modified Breastfeeding Attrition Predictive Tool, the Breastfeeding Knowledge Questionnaire (BKQ), the Infant Feeding Intention, and the Edinburgh Postnatal Depression Scale. Responses to the items of the Breastfeeding Behavioral Questionnaire (BBQ) were also collected by telephone at week 6 postpartum. The final analyses included 321 participants who completed the full two-wave data collection. The fitness indices of the modified TPB model were acceptable. Breastfeeding knowledge and EBF before discharge positively impacted breastfeeding intention, whereas depression had a negative impact. Before discharge, breastfeeding intention fully mediated the impacts of breastfeeding attitude, social and professional support, knowledge, depression, and EBF on breastfeeding behavior and partially mediated the influence of perceived breastfeeding control on breastfeeding behavior. These findings indicate that TPB accurately predicts breastfeeding behavior among preterm mothers at week 6 postpartum, and breastfeeding intention is key to the above-mentioned EBF-related factors and breastfeeding behavior. The findings underline the need for further longitudinal studies and corresponding interventions for preterm mothers with a high risk of EBF attrition.

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

AimsThis 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. BackgroundBreastfeeding 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. DesignA quasi-experimental study with a one-group pretest-posttest design. MethodsAn 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. ResultsFrom 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%). ConclusionsThis 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.

Levels and Determinants of Antenatal Breastfeeding Attitudes among Pregnant Women: A Cross-Sectional Study

Breastfeeding attitudes are strong predictors of breastfeeding behavior. Gaining a deeper understanding on the levels and determinants of antenatal breastfeeding attitudes is crucial. This cross-sectional study involved 124 pregnant women at a tertiary hospital in Hunan, China. A self-administered questionnaire, the Iowa Infant Feeding Attitude Scale, the Edinburgh Postnatal Depression Scale, the Pregnancy Stress Rating Scale, the Childbirth Attitude Questionnaire, the Perceived Social Support Scale, and the Breastfeeding Knowledge Questionnaire were assessed during their first-trimester, second-trimester, and third-trimester hospital visit. Multiple linear regression was conducted to identify the determinants of breastfeeding attitudes. The participants reported neutral (56.39 ± 5.69) levels of breastfeeding attitudes. The determinants of antenatal breastfeeding attitudes were other family members' support for exclusive breastfeeding: moderate (β = 0.278, p < 0.05), depressive symptoms (β = -0.191, p < 0.05), and breastfeeding knowledge (β = 0.434, p < 0.001). The variables explained 33.9% (adjusted R2) of the total variation in breastfeeding attitudes scores (F = 4.507, p < 0.001). Namely, other family members' support for EBF was a negative influence on positive breastfeeding attitudes. The women whose other family members were moderate of EBF had more positive attitudes toward breastfeeding compared to those whose other family members were very supportive of EBF. The depressive symptoms were negatively associated with positive breastfeeding attitudes, and lower levels of depressive symptoms were associated with higher levels of positive breastfeeding attitudes among pregnant women. Additionally, breastfeeding knowledge was positively associated with positive breastfeeding attitudes. The more knowledgeable about breastfeeding, the more positive the attitude towards breastfeeding. Health professionals should identify these modifiable factors that may contribute to poorer breastfeeding attitudes, which is useful in targeting promotions of breastfeeding.

Factors associated with post NICU discharge exclusive breastfeeding rate and duration amongst first time mothers of preterm infants in Shanghai: a longitudinal cohort study

BackgroundBreastfeeding is crucial for the preterm infants. Breast milk is not only food but also medicine. Few studies have focused on the longitudinal effects of exclusive breastfeeding outcome of preterm infants separated from their mothers after discharge, especially in Shanghai. We aimed to examine the exclusive breastfeeding rate and duration amongst first time mothers of preterm infants after discharge and its determinants.MethodsAnalyses were based on 500 preterm infants separated from their mothers in a tertiary maternity and infant-specialized hospital in Shanghai from September 2018 to September 2019.The Socio-demographic characteristics, breastfeeding knowledge questionnaire, breastfeeding self-efficacy short form scale, Edinburgh postpartum depression scale and breastfeeding family support scale were used for the investigation and the exclusive breastfeeding rate of premature infants was followed up on 1 month, 3 months and 6 months after discharge. The changing trend of breastfeeding knowledge, breastfeeding self-efficacy, postpartum depression and family support were measured by ANOVA at different stages. Using the chi-square test and multiple logistic regression, factors impacting the breastfeeding rate of preterm infants at three time intervals after discharge were investigated. The Kaplan Meier survival curve and cox regression model were used to analyze the determinants of exclusive breastfeeding duration of premature infants after discharge.ResultsExclusive breastfeeding rates were 19.0, 17.2 and 10.4% at 1 month, 3 months and 6 months after discharge of preterm infants, respectively. The average length of exclusive breastfeeding duration was(3.69 ± 1.80)months. Finally, type of delivery (adjusted odds ratio [AOR] 1.564; 95% confidence interval [CI] 0.513,3.116), gestational age(AOR 0.612, 95% CI 0.236, 3.418), maternal family support (AOR 6.125,95% CI 6.359, 98.452) were discovered to be independent predictors on the exclusive breastfeeding rate at 6 months after preterm infants were discharged. Through the cox regression model, we found that a maternal planned pregnancy (HR 0.681, 95%CI 0.531,0.873), delivering breast milk during hospitalization (HR 0.797, 95%CI 0.412,2.288), NICU feeding mode during hospitalization (HR 1.221, 95%CI 0.128,1.381) and family support (HR 0.561, 95%CI 0.004,2.428) were significantly associated with the exclusive breastfeeding duration after discharge.ConclusionsThe exclusive breastfeeding outcome of premature infants was affected by many factors, so we should focus on the three levels of individual, family, society and design targeted intervention measures to increase the exclusive breastfeeding rate and prolong exclusive breastfeeding duration.

Knowledge of Antenatal Women Regarding Breastfeeding: A Descriptive Cross-sectional Study

This descriptive cross-sectional study was conducted among antenatal women in a hospital in Mangalore, India. This study aimed at exploring the knowledge of antenatal women regarding breastfeeding and finding association with selected socio-demographic factors. Fifty primigravidae who were either admitted to the antenatal ward or were attending the Outpatient Department of a tertiary care hospital were selected for the study using convenience sampling. Data were collected using a Breastfeeding Knowledge Questionnaire (BKQ) that had 20 multiple choice questions, developed by the authors. The average mean score (M=12), with an overall mean percentage of 60, indicated that the women had average overall knowledge but lacked knowledge in specific content areas of breastfeeding. It ranged from 18 percent in the area ‘nutritional requirements’ to 89 percent in the area ‘general aspects’. The area duration of breastfeeding had a mean percentage of 44.43 percent, with the least in the area of nutritional requirements (18%). Only 58 percent of the women knew that the duration of exclusive breastfeeding is six months. The knowledge of the women was independent of age, religion, education, occupation, type of family and monthly income. Determining the existing knowledge on breastfeeding will provide a basis for developing effective health education programmes.

Factors associated with the level of knowledge about breastfeeding

Abstract Background In Mexico, 95.6% of children under 2 years of age are breastfed at least once in their lifetime; however, only 28.6% are exclusively breastfed and 40.2% are predominantly breastfed up to 6 months of age. Mothers who do not breastfeed their children or abandon breastfeeding before 6 months of age give reasons that suggest lack of knowledge or lack of support. Aim to determine the factors associated with a high or higher level of knowledge about breastfeeding in women in Veracruz, Mexico. Methods A cross-sectional, prospective, observational and comparative study was carried out. Women between 18 and 35 years old, from Veracruz, Mexico were included, between July to December 2020. Virtual surveys were applied through social networks, using a non-probabilistic sampling, evaluating knowledge about breastfeeding through the application of the ‘Breastfeeding knowledge questionnaire', and its interpretation is carried out at four levels of knowledge: poor, regular, high and very high (Cronbach's alpha of 0.722). Results 1241 participants were included. The patients showed high or greater knowledge in 1057 (85.1%) cases. Having school as the main source of information for breastfeeding, reported an Odds Ratio (OR) of 1.5 (95%CI 1.05-2.2) and having intentions to exclusively breastfeed in the next pregnancy had an OR of 1.7 (95% CI 12 .-2.4), while obtaining the information through friends, family or acquaintances had an OR of 0.6 (95% CI 0.4-0.8), both with p values &amp;lt;0.05. Marital status, educational level, age, occupation, religion, having medical attention through social security, the number of children, receiving information about breastfeeding from a health institution, from social networks or looking independently had p values &amp;gt; 0.05; Conclusions The high level of knowledge is positively associated with the information received at school from while it is negatively associated with having family or friends as the main sources of information. Key messages The high level of knowledge is positively associated with the information received at school. The high level of knowledge is negatively associated with having family or friends as the main sources of information.

Factors associated with the breastfeeding intention

Abstract Background In Mexico, 47.7% of newborns are breastfed within the first hour of life and 28.6% are exclusively breastfed until 6 months of age, which does not meet the WHO definition of successful breastfeeding. Attitudes are expressed through beliefs, emotions and intentions wich represent a link between attitude and behavior, that is, a strong predictor of behavior. Objetive: to determine the factors associated with the intention of breastfeeding in womeńs next pregnancy. Methods A cross-sectional, prospective, observational and comparative study was carried out. Women between 18 and 35 years old, residents from Veracruz in Mexico, were between July and December 2020. Virtual surveys were applied through social networks, using a non-probabilistic sampling, evaluating knowledge about breastfeeding through the application of the ‘Breastfeeding knowledge questionnaire' (Cronbach's Alpha 0.722) and social characteristics were also recorded. Results 1241 participants were included, with a mean age of 22.1 (± 3.5) years. The prevalence of the intention to exclusively breastfeed was 41.2%; the factors that registered a positive association for the intention to grant exclusive breastfeeding were the age between 18 and 25 years (OR 2.0 95%IC 1.4-2.9), high knowledge (OR 2.0 IC95%1.3-2.9), being single (OR 3.7, CI95% 2.4-5.6), studyng high school (OR 1.3, 95%CI 1.05-1.7), being students (OR 2.2, 95%CI 1.7-2.8), have medical service through social security (OR 1.4, 95%CI 1.1-1.7), know what is a breastfeeding room (OR 1.9 95%CI 1.5-2.4), as well as know different points of the law in support of lactation had OR values higher than 1, with p values &amp;lt;0.05 in all cases. Conclusions Age, knowledge about breastfeeding, marital status, scholarship, occupation, having medical attention for social security, not having children, knowing the legal aspects about breastfeeding in Mexico and knowing the concept of breastfeeding room are associated with the intention to exclusively breastfeed. Key messages Women who receive medical care in the public health system increase their intention to exclusively breastfeed in their next pregnancy. High knowledge about breastfeeding, the laws that support it, being young, single, and knowing what abreastfeeding room is all favor the intentions of giving exclusive breastfeeding.

Knowledge, Intention, and Self-Efficacy Associated with Breastfeeding: Impact of These Factors on Breastfeeding during Postpartum Hospital Stays in Taiwanese Women.

Breastfeeding knowledge, intention, and self-efficacy affect breastfeeding rates during the postpartum period. Insufficient knowledge, lack of intention, and poor breastfeeding self-efficacy reduce the likelihood of breastfeeding postpartum. The purposes of this study were to (1) assess women’s intention to breastfeed and knowledge and self-efficacy regarding breastfeeding following childbirth, and to (2) identify the factors associated with postpartum breastfeeding during women’s hospital stays. This longitudinal study with a pretest and posttest design study recruited pregnant women from the gynecology and obstetrics outpatient departments and inpatient wards at a medical center in northern Taiwan. Demographic and obstetric characteristics were recorded, and participants were assessed using the Numeric Rating Scale, the Breastfeeding Knowledge Questionnaire, the Breastfeeding Self-Efficacy Scale—Short Form, and breastfeeding status postpartum. Of the 120 participants, 25% reported breastfeeding during the postpartum hospital stay. Postpartum breastfeeding was associated with lower levels of education and higher prenatal levels of breastfeeding intention. Establishing a breastfeeding-friendly environment in the family and workplace may effectively increase continued breastfeeding.

Program Evaluation of a Home Visiting Program: Perspectives of Home Visitors.

The purpose of this program evaluation was to determine if home visitors at the Child Development Resources (CDR) home visiting program perceived themselves to have adequate knowledge and resources to support the goals of the program. In addition, we aimed to determine what home visitors found to be facilitators and barriers to a successful program. The project was conducted with a convenience sample of 18 home visitors and included the following instruments: (a) demographics survey, (b) CDR Home Visiting Program Survey, and (c) Breastfeeding Knowledge Questionnaire. Results suggest (a) most of the home visitors believed they had adequate resources and knowledge necessary to support families and children, (b) some perceived barriers to carrying out goals of the home visiting program were financial limitations, lack of internet and mobile devices in many homes, and perception that programs were not designed for families with significant stressors such as poverty and mental health difficulties, (c) most of the home visitors believed their families benefit from their visiting programs, but many did not overwhelmingly feel new technology would greatly help families during home visits, and (d) most home visitors appeared to have adequate breastfeeding knowledge, however, some suggested that additional breastfeeding education would be beneficial. The information gathered from this project can be used to inform and improve home visiting programs seeking to enhance the quality of their programs which will ultimately contribute to better health outcomes for at-risk mothers and children.

The Relationship of Previous Breastfeeding Experiences and Factors Affecting Breastfeeding Rates: A Follow-Up Study.

Background/Objective: Many studies have focused on the effects of previous breastfeeding experience (PBE) on subsequent breastfeeding, but few have explored their specific relationships. To explain the relationship between PBE and subsequent breastfeeding behavior based on a follow-up study. Materials and Methods: After delivery, 394 participants who had no PBE completed a demographic questionnaire, breastfeeding knowledge questionnaire, the breastfeeding self-efficacy short-form scale (BSES-SF), and the Iowa infant feeding attitudes scale (IIFAS). Multiparas with PBE also completed the maternal breastfeeding evaluation scale (MBFES) in addition to the aforementioned four questionnaires. On the 42nd day after delivery, participants completed the breastfeeding experience scale (BES) through social networking platforms (QQ, WeChat: both are Chinese social medias). At 4 and 6 months postpartum, researchers contacted participants by phone or a social network regarding their exclusive and partial breastfeeding experiences. Results: In this study, exclusive breastfeeding rates were 58.6% and 30.5% at 4 and 6 months. PBE affected breastfeeding attitudes (p < 0.05), self-efficacy (p < 0.01), and difficulties (p < 0.05). Breastfeeding knowledge, attitude, self-efficacy, and difficulties were relevant to exclusive and partial breastfeeding at 4 and 6 months (p < 0.05). Multivariate logistic regression analysis showed that compared with women without PBE, the probability of exclusive breastfeeding of multiparas with PBE at 4 and 6 months increased by 275% and 369%, respectively. Conclusions: The rate of breastfeeding remains low among Chinese women, but PBE is associated with a higher probability of breastfeeding at 4 and 6 months postpartum. Multiparas, especially those having PBE were more likely to breastfeed for an extended period based on their knowledge, attitude, self-efficacy, and ability to manage difficulties.

Adaptation and validation of the Iowa infant feeding attitude scale and the breastfeeding knowledge questionnaire for use in an Ethiopian setting

BackgroundValidated instruments to assess breastfeeding knowledge and attitude are non-existent in Africa including Ethiopia. We aimed to adapt and validate the Breastfeeding Knowledge Questionnaire (BFKQ) and the Iowa Infant Feeding Attitude Scale (IIFAS) for use in Afan Oromo (AO), the most widely spoken language in Ethiopia.MethodsAfter forward-backward translation into Afan Oromo, the instruments were reviewed for content validity by a panel of a nutritionist and pediatricians, and pretested on a sample of 30 mothers. Then, a cross-sectional study involving 468 pregnant women in their second and third trimester was conducted between May and August 2017 in the Manna district, Southwest Ethiopia, using the final versions of the adapted questionnaires. We used exploratory and confirmatory factor analysis to assess the construct validity, receiver operating characteristic (ROC) curves to determine the predictive validity and Cronbach’s alpha coefficients to assess internal consistency.ResultsUsing exploratory factor analysis (EFA), nine domains containing 34 items were extracted from the BFKQ-AO. A confirmatory factor analysis of the constructs from EFA confirmed construct validity of the instrument (χ2/df = 2.11, RMSEA = 0.049, CFI = 0.845, TLI = 0.823). In factor analysis of the IIFAS, the first factor explained 19.7% of the total variance and the factor loadings and scree plot test suggested unidimensionality of the tool. Cronbach’s alpha was 0.79 for the BFKQ-AO and 0.72 for IIFAS-AO suggesting an acceptable internal consistency of both instruments. For the sensitivity and specificity in predicting intention of breastfeeding for ≥24 months, the area under the curve (AUC) was 82% for IIFAS score and 79% for BFKQ score.ConclusionsHere we present the first study that reported the use of the BFKQ and the IIFAS in Ethiopia. Our results showed that both BFKQ-AO and IIFAS-AO can be reliable and valid tools for measuring maternal breastfeeding knowledge and attitude in the study population, showing the potential for adapting these tools for application in a wider Ethiopian context.

Breastfeeding self-efficacy as a dominant factor affecting maternal breastfeeding satisfaction

BackgroundOne of the psychological benefits of breastfeeding for mothers and infants is to get the satisfaction of breastfeeding. Maternal breastfeeding satisfaction derives from the interaction and cooperation between mothers and their babies. This research aims to identify the maternal breastfeeding satisfaction and its influential factors.MethodsThis study applied a cross-sectional design. Two hundred four breastfeeding mothers after four until 8 months postpartum were recruited using cluster sampling methods. Respondents completed the questionnaire of Maternal Breastfeeding Evaluation Scale (MBES) to identify maternal breastfeeding satisfaction. Factors affecting maternal breastfeeding satisfaction were identified using the following instruments: Breastfeeding Knowledge Questionnaire was used to identify knowledge on lactation, Infant Feeding Attitude Scale (IIFAS) to identify attitude toward lactation, and the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) to identify breastfeeding self-efficacy.ResultWe identified that 53.4% of the breastfeeding mothers had a high level of satisfaction. The results indicate that the household income, type of delivery, and breastfeeding self-efficacy was associated with breastfeeding satisfaction (p < 0.05). Breastfeeding self-efficacy is the most influential factors in maternal breastfeeding satisfaction (OR=16.64; CI 95% 7.65–35.94).ConclusionBreastfeeding satisfaction is the satisfying feeling obtained during breastfeeding resulting from cooperation between the mother and the infant to fullfil desires or needs. Education and promotion of breast milk and breastfeeding provided by professional healthcare providers encouraged the successful of breastfeeding programs. Assistance by a health care provider or breastfeeding counselor during the seven contacts breastfeeding initiated during pregnancy until after delivery should be applied so that the mother is informed about breastfeeding. Breastfeeding satisfaction can keep the mother from continuing to breastfeed her baby for up to 2 years or more.

Application and evaluation of mobile device-based continuous breastfeeding intervention program

Objective To investigate the effects of a mobile application-based continuous breastfeeding intervention program for gravidas. Methods Pregnant women who received prenatal care and delivered at First Maternity and Infant Hospital Affiliated to Tongji University were enrolled in this quasi-experiment from April 1 to May 31, 2017. Those women who met the inclusion criteria in the Eastern and Southern campuses of the hospital were recruited as intervention group (n=100) and control (n=100) group, respectively. In addition to the routine breastfeeding support which the control group was offered only, the intervention group also received mobile application-based continuous breastfeeding intervention, namely a questionnaire was sent through WeChat official account where the pregnant women had free access to continuous breastfeeding support based on their survey results, such as understanding the benefits of breastfeeding at the first trimester, relationships between breastfeeding and immunity at the second trimester, breast care at the third trimester, treatment of milk spillage/spit during labor, and iron and vitamin supplementation at puerperium. Basic information about the participants, results of Breastfeeding Knowledge Questionnaires administered at the first, second and third trimesters and during labor and the puerperium, responses to Self-efficacy of Breastfeeding Questionnaires during labor and the puerperium, and exclusive breastfeeding rates at discharge and 42 d postpartum were compared between the two groups using two independent sample t-test and Chi-square test. Results There were 83 and 80 pregnant women in the intervention group and control group finally analyzed, respectively. No statistical difference in the scores of the Breastfeeding Knowledge Questionnaire at the first trimester was observed between the intervention group and control group (13.4±1.9 vs 13.3±1.9, t=0.133, P=0.895). However, the scores at the second and third trimesters and during labor and the puerperium in the intervention group were higher than those in the control group (14.1±1.3 vs 13.5±2.0, 14.7±1.1 vs 14.2±1.3, 15.3±1.7 vs 14.4±1.2 and 15.7±1.5 vs 14.9±1.0; t=2.160, 2.435, 4.104 and 3.946; all P<0.05), respectively. The scores of Self-efficacy of Breastfeeding Questionnaires during labor and the puerperium were also higher in the intervention group (123.5±4.7 vs 118.5±5.7 and 128.4±4.2 vs 119.0±6.5, t=6.170 and 10.959, both P<0.01). Compared to the control group, the intervention group had higher exclusive breastfeeding rate at discharge and on 42 d after delivery [78.3% (65/83) vs 61.2% (49/80), χ2=5.641; 57.8% (48/83) vs 38.8% (31/80), χ2=5.938; both P<0.05]. Conclusions The mobile application-based continuous breastfeeding intervention program may effectively improve breastfeeding outcomes. Key words: Breast feeding; Telemedicine; Clinical protocols; Validation studies

Breast feeding knowledge and self-efficacy and its influencing factors among multiparae

Objective To investigate the breast feeding knowledge and self-efficacy among hospitalized multiparae and to explore the influencing factors of breast feeding self-efficacy. Methods From January to August 2018, we selected hospitalized multiparae at Yuyao People's Hospital and Zhejiang Provincial People's Hospital as subjects by simple random sampling. All of the multiparae were investigated with the general information questionnaire, breast feeding knowledge questionnaire and breastfeeding self-efficacy scale. A total of 400 questionnaire were sent out and 372 valid questionnaire were collected with 93.0% for the valid recovery rate. Results Among 372 hospitalized multiparae, the total score of breast feeding knowledge questionnaire was (5.53±1.02) ; the total score of breastfeeding self-efficacy was (80.36±16.72) . Single factor analysis showed that there were statistical differences in the scores of breast feeding self-efficacy among hospitalized multiparae with different ages, education levels, working state, living styles, income levels, delivery modes, number of complications, training for breast feeding, mastery of breast feeding knowledge, breast feeding for the first time (P<0.01) . Correlation analysis showed that breast feeding knowledge had a statistically positive correlation with the self-efficacy among hospitalized multiparae (r=0.117, P=0.026) . Multiple linear regression analysis proved that the main influencing factors of breast feeding self-efficacy among multiparae included working state, number of complications, training for breast feeding and breast feeding knowledge with a statistical difference. Conclusions The breast feeding knowledge and self-efficacy of hospitalized multiparae are not good enough. Communities and hospitals need to work hard together to improve styles and strategies of breast feeding education so as to increase the rate of breast feeding. Key words: Breast feeding; Knowledge; Multiparae; Influencing factors; Self-efficacy

Effects of follow-up management based on structural family therapy in discharged puerpera

Objective To explore the effects of follow-up management based on structural family therapy on self efficacy and quality of life in discharged puerpera. Methods A total of 124 hospitalized puerpera with childbirth of the Affiliated Hospital of Medical School of Ningbo University were selected from October 2015 to October 2016. All of them were divided into observation group and control group, 62 cases in each group. Puerpera of control group were treated with conventional nursing. On the basis of the conventional nursing, puerpera of observation group adopted follow-up management based on structural family therapy. We compared the scores of breast feeding knowledge questionnaire, the rate of exclusive breastfeeding and the quality of life with the Exercise of Self-Care Agency Scale (ESCA) and the quality of life index scale of puerpera in two groups. Results The mean score of breast feeding knowledge questionnaire of puerpera in the observation group was higher than that in the control group with a significant difference (P<0.05) . The rate of exclusive breastfeeding of puerpera in the observation group was 93.54% higher than that in the control group (74.19%) with a significant difference (P<0.05) . There was a statistically significant difference in the total score of self efficacy of puerpera between the observation group and the control group [ (143.4±14.0) vs. (109.6±11.6) ] (P<0.05) . The total score of quality of life of puerpera in the observation group was significantly higher than that in the control group [ (8.8±1.3) vs. (5.6±1.1) ] (P<0.05) . Conclusions The follow-up management based on structural family therapy is favourable to improve the self efficacy on nursing and quality of life of puerpera so as to increase the rate of breast feeding. Key words: Breast feeding; Discharged puerpera; Follow-up management; Structural family therapy

Measuring the Effectiveness of a Midwife-led Education Programme in Terms of Breastfeeding Knowledge and Self-efficacy, Attitudes Towards Breastfeeding, and Perceived Barriers of Breastfeeding Among Pregnant Women.

Introduction:Exclusive breastfeeding is the optimal mode of feeding for the first six months of a child’s life. Modifiable factors associated with increased breastfeeding, may be addressed through antenatal breastfeeding education. In Greece, the rates of exclusive breastfeeding remain rather low.Aim:The aim of the current study was to evaluate the effectiveness of a structured in-hospital midwife-led antenatal breastfeeding educational programme on breastfeeding knowledge and self-efficacy, attitudes towards breastfeeding and perceived-barriers of breastfeeding.Patients and Methods:This was a quasi-experimental study with two study groups: an intervention group (following a four-hour midwife-led antenatal breastfeeding programme) and a control group. All nulliparous women attending antenatal care at the tertiary hospital in Athens, Greece during May 2016–January 2017 were invited to participate, of which 203 nulliparous pregnant women took part. Demographic data forms, the Breastfeeding Self-efficacy Scale, the Iowa Infant Feeding Attitude Scale, the Breast Feeding Knowledge Questionnaire and the Perceived Breast Feeding Barriers Questionnaire were used for data collection.Results:Post-intervention, women in the intervention group had a more positive attitude towards breastfeeding (73.5% versus 66.1%, p<0.001), greater knowledge (14.6% versus 13.1%, p<0.001) and more breastfeeding self-efficacy (51.4% versus 45.6%, p<0.001) compared to the control group. Furthermore, they had significantly less perceived barriers regarding breastfeeding (27.4% versus 31.0%, p<0.001).Conclusion:The four-hour antenatal breastfeeding education intervention which occurred and was evaluated for the first time in the Greek female population was effective in increasing breastfeeding knowledge, self-efficacy and a positive attitude towards breastfeeding. The intervention was furthermore effective in lowering perceived breastfeeding barriers. This midwife-led antenatal breastfeeding education programme could be suitable for integration to routine antenatal care in health care services in Greece.

The Development and piloting of an eHealth breastfeeding resource targeting fathers and partners as co-parents

ObjectiveTraditionally breastfeeding education programs target mothers solely. The objective of this study was to design and pilot test an interactive eHealth breastfeeding co-parenting resource developed to target both mothers and fathers. eHealth resources provide an accessible and engaging format on which to educate parents and assist them in meeting their breastfeeding goals. Best practices to design such resources are not currently known. DesignA three phase pilot study was conducted. The three phases included conducting a needs assessment, creating the resource and pilot testing the resource with mother, father and health care professionals to determine their perspectives regarding the usability and design of the prototype resource. The interactive prototype resource was designed to provide information to parents on breastfeeding and co-parenting, which included suggestions on how fathers can be involved and support breastfeeding and how the couples can work as a team to meet their breastfeeding goals. Setting: Recruitment took place in a health region in Southern Ontario, Canada between June 2014 and March 2015. Online questionnaires were completed by participants in all phases of the study.Participants: Participants (n=149) were pregnant or new mothers and their partners in the health region who read and speak English and had access to the internet and health care professionals who work with breastfeeding families in Ontario, Canada. InterventionA prototype eHealth breastfeeding co-parenting resource was developed based on maternal and paternal feedback from Phase I and utilized an interactive interface which included games and multimodal information delivery. The prototype eHealth resource was provided to the parents in Phase II and health care professionals in Phase III. The final resource was created based on feedback from these participants. Measurements and FindingsThe resource was pilot tested with new and expectant parents using pre- and post-test questionnaires which included measures for breastfeeding self-efficacy (Breastfeeding Self-Efficacy Short Form), infant feeding attitude (Iowa Infant Feeding Attitude Scale), breastfeeding knowledge (Breastfeeding Knowledge Questionnaire) and co-parenting relationship (Co-parenting Relationship Scale). Maternal and paternal breastfeeding self-efficacy and knowledge and infant feeding attitude scores all increased from pre-test to post-test. However, there was no difference in the co-parenting relationship scores from pretest to post-test. Key ConclusionsThis study has used feedback from parents and health professionals to develop a prototype resource which appears to be effective in increasing parents’ breastfeeding knowledge, attitude and self-efficacy. The prototype resource was rated positively by parents and health care providers. Implications for PracticeAn eHealth breastfeeding co-parenting resource designed with input from the target population is an effective way of providing information to mothers and fathers. Further research with a randomized controlled design and more diverse populations is needed to determine effectiveness of the resource on breastfeeding duration and exclusivity.

Effect of WeChat platform intervention on primipara's breastfeeding during puerperium

Objective To explore the effect of WeChat platform intervention on primipara's breastfeeding during puerperium. Methods A total of 200 primiparas delivering in two maternity wards in a maternity & child care center in Dalian from August 2015 to August 2016 were selected as the research objects. A total of 100 cases in Maternity Ward I were enrolled in the observation group, while 100 cases in Maternity Ward II were set as controls. Conventional guidelines on breastfeeding were given to the control group during hospital stay, and telephone follow-up was maintained for six weeks. Based on these measures, the observer regularly pushed knowledge related to breastfeeding to the research objects after discharge via WeChat platform for six weeks in total. General data questionnaire, breastfeeding knowledge questionnaire and feeding pattern questionnaire were used before and after intervention. Results Before intervention, these two groups showed no statistically significant difference in breastfeeding knowledge questionnaire score (P>0.05) ; after intervention, the breastfeeding knowledge questionnaire score of the observation group was improved than before, and there was a statistically significant difference between two groups (t=7.69, P<0.01). The number of cases with exclusive breast feeding in the observation group after intervention was higher than those in the control group, and these two groups showed a statistically significant difference in breast feeding pattern (χ2=23.79, P<0.01) . Conclusions WeChat platform intervention can help improve breastfeeding knowledge and feeding pattern among primiparas during puerperium. Key words: Breastfeeding; Primipara; Puerperium; WeChat