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Process-oriented training in breastfeeding alters attitudes to breastfeeding in health professionals
University of Skövde, School of Life Sciences.ORCID iD: 0000-0002-2261-0112
Department of Woman and Child Health, Division of Reproductive and Perinatal Health Care, Karolinska Institutet, Stockholm, Sweden.
University of Skövde, School of Life Sciences.
2005 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 33, no 6, 424-431 p.Article in journal (Refereed) Published
Abstract [en]

Aim: The purpose of the study was to measure the attitudes of antenatal midwives and postnatal nurses to breastfeeding before and after common, process-oriented breastfeeding training. Method: Antenatal centres and child-health centres in 10 municipalities were randomized to either an intervention or a control group. The antenatal midwives and postnatal nurses in the intervention group were together given process-oriented breastfeeding training and were, in addition, asked to develop a common breastfeeding policy. A previously developed instrument was used to measure the effects of a training programme on breastfeeding attitudes among midwives and postnatal nurses. It consisted of four scales measuring a person's attitudes toward breastfeeding in four dimensions: regulating, facilitating, disempowering, and breastfeeding-antipathy attitudes. A mean score was calculated for each individual on these four dimensional scales. The higher the score, the stronger the attitude. Results: After one year, the intervention group reduced their scores on the regulating scale when compared with the control group (p<0.001). The intervention group decreased their scores on the regulating scale and increased their scores on the facilitating scale over the first year after training. The control group also significantly increased their scores on the facilitating scale. When the results were analysed profession-wise, the postnatal nurses in the intervention group decreased their scores on the regulating and disempowering scales and increased their scores on the facilitating scale. In contrast, the midwives in the intervention group decreased their scores only on the breastfeeding antipathy scale. The control group midwives decreased their scores on the disempowering scale. No differences were found among the postnatal nurses in the control group. Conclusion: Process-oriented breastfeeding training made both antenatal midwives and postnatal nurses better disposed to breastfeeding; postnatal nurses in particular improved their attitudes. Attitudes to breastfeeding tended to be stable over time, but process-oriented training lowered the scores a little on the regulating scale, suggesting that after this kind of training counsellors would find it less necessary to schedule and control the mothers' breastfeeding behaviour.

Place, publisher, year, edition, pages
Sage Publications, 2005. Vol. 33, no 6, 424-431 p.
National Category
Medical and Health Sciences
Research subject
Medical sciences
Identifiers
URN: urn:nbn:se:his:diva-1615DOI: 10.1080/14034940510005923ISI: 000233856100003PubMedID: 16332607Scopus ID: 2-s2.0-30944452598OAI: oai:DiVA.org:his-1615DiVA: diva2:31891
Available from: 2007-08-01 Created: 2007-08-01 Last updated: 2013-10-22Bibliographically approved
In thesis
1. Amning och vårdkvalitet
Open this publication in new window or tab >>Amning och vårdkvalitet
2005 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[en]
Breastfeeding and quality of care
Abstract [en]

The over all objectives of this thesis was to map factors of importance for breastfeeding such as maternal background factors, maternal perception of breastfeeding support, confidence, caring routines, breastfeeding attitudes of health care professionals, and to investigate whether a training intervention within the care team of

the antenatal (ANC) and child health centres (CHC) would improve maternal perception of support and strengthen maternal feelings for the baby.

Material and method: A questionnaire was sent to mothers when their babies were 9-12 months old (n=540). The questionnaire embraced questions regarding maternal background, caring routines, perception of support and duration of breastfeeding (I-II). Thereafter an attitudinal instrument was developed to measure breastfeeding attitudes in health care professionals (n=168). Four attitude dimensions were identified by factor analysis (III). Ten municipalities in a county of south west Sweden was paired and randomized to intervention or control (IV). Thus, all midwives and postnatal nurses working at the ANC or CHC in a randomised municipality were asked to participate in the study (n=81). Health professionals in the intervention group had a process-oriented training in breastfeeding counselling including planned continuity in family education and development of a common breastfeeding policy within the caring team. Changes in attitude were measured by the instrument developed in study III. For study V, mothers were recruited from the maternity and were allocated to intervention- or control group according to the randomization of municipalities in study IV (n=565). Questionnaires were sent out at three days, 3 and 9 months post partum to investigate how the care and counselling skills acquired by the health care professionals would be reflected in maternal perception of breastfeeding support and maternal feelings for and relation to the baby.

Results: Early initiation of suckling, late discharge from hospital (more than 72 hours) and perceived good support contributed positively to the duration of exclusive breastfeeding. Supplementation the first days after birth for other than medical reasons shortened the duration of breastfeeding. For primiparas, the partner’s presence after childbirth contributed positively to the duration of exclusive breastfeeding. Multiparas who were aware of their mothers breastfeeding history had a longer breastfeeding period than those who did not know of their mother’s breastfeeding history. Mothers were more satisfied with the breastfeeding information they had received at maternity than the breastfeeding information they got from the ANC and CHC (I-II). This induced the idea to develop an attitude instrument and start a training intervention for the care team at ANC and CHC. The attitudinal dimensions identified by the factor analysis were: The regulating factor comprising statements scheduling breastfeeding; the facilitating factor comprising statements showing confidence in the ability of the mother-infant dyad to breastfeed on their own; the disempowering factor comprising statements that objectified the woman and ascribed her no ability to breastfeed without guidance of the health care professional and the breastfeeding antipathy factor comprising statements that showed unwillingness and failing knowledge about breastfeeding (III). After training the health care professionals became less regulating and more facilitating (IV). Family classes provided the intervention mothers with better breastfeeding information, more knowledge about their social rights, the needs of the baby and a stronger social network than the control mothers (V). The postnatal nurse gave a better over all support, was a better listener, showed more understanding and provided the mother with better information about breastfeeding and the needs of the baby. Mothers in the intervention group reported that they interacted more with their baby. They had also more positive views on their baby and felt more confident and close with the baby than mothers in the control groups (V).

Conclusion: This study showed that it is important to adopt caring routines, which will facilitate breastfeeding. The health care professional needs to find out the background of the mother to be able to provide her with adequate breastfeeding counselling. Caring routines should include early suckling. Supplementation of the baby the first week after birth should only be given on medical grounds. This study showed that a processoriented training in breastfeeding counselling alters attitudes of health care professionals in a positive way. The trained health care professionals organized continuity of family classes and developed a common breastfeeding policy and were more supportive in their encounters with the mothers. These behaviors strengthen the mother’s feelings for her baby and brought about a richer interaction with her baby. A model to provide continuity of family classes, conducted by trained antenatal midwives and postnatal nurses should thus be practiced within the caring team around first time parents.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet, 2005. 44 p.
National Category
Nursing
Research subject
Medical sciences
Identifiers
urn:nbn:se:his:diva-1569 (URN)91-7140-240-3 (ISBN)
Public defence
(English)
Supervisors
Available from: 2007-07-20 Created: 2007-07-20 Last updated: 2013-10-22

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