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Flacking, Renée
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Publications (10 of 15) Show all publications
Joffer, J., Jerden, L., Öhman, A. & Flacking, R. (2016). Exploring self-rated health among adolescents: a think-aloud study. BMC Public Health, 16, Article ID 156.
Open this publication in new window or tab >>Exploring self-rated health among adolescents: a think-aloud study
2016 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 16, article id 156Article in journal (Refereed) Published
Abstract [en]

Background: Despite extensive use of self-rated health questions in youth studies, little is known about what such questions capture among adolescents. Hence, the aim of this study was to explore how adolescents interpret and reason when answering a question about self-rated health. Methods: A qualitative study using think-aloud interviews explored the question, "How do you feel most of the time?", using five response options ("Very good", "Rather good", "Neither good, nor bad", "Rather bad", and "Very bad"). The study involved 58 adolescents (29 boys and 29 girls) in lower secondary school (7th grade) and upper secondary school (12th grade) in Sweden. Results: Respondents' interpretations of the question about how they felt included social, mental, and physical aspects. Gender differences were found primarily in that girls emphasized stressors, while age differences were reflected mainly in the older respondents' inclusion of a wider variety of influences on their assessments. The five response options all demonstrated differences in self-rated health, and the respondents' understanding of the middle option, "Neither good, nor bad", varied widely. In the answering of potential sensitive survey questions, rationales for providing honest or biased answers were described. Conclusions: The use of a self-rated health question including the word 'feel' captured a holistic view of health among adolescents. Differences amongst response options should be acknowledged when analyzing self-rated health questions. If anonymity is not feasible when answering questions on self-rated health, a high level of privacy is recommended to increase the likelihood of reliability.

Keywords
Self-rated health, Subjective health, Health assessment, Feel, Adolescence, Qualitative, Think-aloud interview, Cognitive interviewing, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-281801 (URN)10.1186/s12889-016-2837-z (DOI)000370407800001 ()26880571 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2016-03-30 Created: 2016-03-30 Last updated: 2017-11-30Bibliographically approved
Ericson, J. & Flacking, R. (2013). Estimated Breastfeeding to Support Breastfeeding in the Neonatal Intensive Care Unit. Journal of Obstetric, Gynecologic and Neonatal Nursing, 42(1), 29-37
Open this publication in new window or tab >>Estimated Breastfeeding to Support Breastfeeding in the Neonatal Intensive Care Unit
2013 (English)In: Journal of Obstetric, Gynecologic and Neonatal Nursing, ISSN 0884-2175, E-ISSN 1552-6909, Vol. 42, no 1, p. 29-37Article in journal (Refereed) Published
Abstract [en]

Objective To evaluate the effects of estimated breastfeeding on infant outcomes in comparison to test weighing and to describe staff members experiences of estimated breastfeeding as a method for supporting the transition from tube feeding to breastfeeding. Design A mixed method evaluation. Setting Neonatal Intensive Care Unit (NICU) in Sweden. Participants The study included 365 preterm (25th36th gestational weeks) infants and 45 nurses or nurse assistants. Methods A retrospective comparative medical record study was used to assess infant outcomes during a period of test weighing (196 infants) and again after the implementation of estimated breastfeeding (169 infants). A qualitative survey was conducted to explore the staff experiences of estimated breastfeeding. Results No differences were found between groups regarding duration of tube feeding, length of hospital stay, gestational age, weight at discharge, and rate of any breastfeeding. Infants in the estimated breastfeeding group had a higher risk of not being exclusively breast milk fed than infants in the test-weighing group (OR = 2.76, CI [1.5, 5.1]). Staff perceived estimated breastfeeding as a more facilitative and less stressful method for mothers than test weighing. Some staff had difficulty following guidelines while simultaneously providing person-centered care. Conclusions Estimated breastfeeding is a nonintrusive and feasible method for assessing and supporting the transition from tube feeding to breastfeeding among preterm infants in a NICU. However, the increased risk for not being exclusively breastfed is of concern. Additional research is needed to assess whether this method is appropriate and feasible in varying contexts and cultures.

Keywords
breastfeeding, medical record, neonatal intensive care units, preterm birth, tube feeding, qualitative research
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-195618 (URN)10.1111/j.1552-6909.2012.01423.x (DOI)000313728100009 ()
Available from: 2013-02-27 Created: 2013-02-26 Last updated: 2017-12-06Bibliographically approved
Flacking, R., Thomson, G., Ekenberg, L., Loewegren, L. & Wallin, L. (2013). Influence of NICU co-care facilities and skin-to-skin contact on maternal stress in mothers of preterm infants. Sexual & Reproductive HealthCare, 4(3), 107-112
Open this publication in new window or tab >>Influence of NICU co-care facilities and skin-to-skin contact on maternal stress in mothers of preterm infants
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2013 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 4, no 3, p. 107-112Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate the influence of co-care facilities and amount of skin-to-skin contact during Neonatal Intensive Care Unit (NICU) stay on maternal stress in mothers of preterm infants at two months corrected age. Methods: A prospective cohort study that involved 300 mothers of pre-term infants was conducted in four NICUs (two with co-care facilities and two with non co-care) in Sweden. Data on duration of skin-to-skin contact per day for all days admitted to the NICU were collected using self-reports. Maternal stress was measured by the Swedish Parental Stress Questionnaire (SPSQ) at two months of infant's corrected age. Results: Mothers whose infants were cared for in a NICU with co-care facilities reported significantly lower levels of stress in the dimension of 'incompetence' compared to mothers whose infants had been cared for in non co-care NICUs. The amount of skin-to-skin experienced during the neonatal stay was not significantly associated with levels of maternal stress at two months corrected age. Conclusion: The finding that mothers who do not experience co-care facilities experience greater levels of stress in relation to feelings of incompetence is of concern. Improvements to NICU environments are needed to ensure that mother-infant dyads are not separated.

Keywords
Skin to skin, Co-care, Mother, Neonatal intensive care unit, Parental stress, Preterm infant
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-210720 (URN)10.1016/j.srhc.2013.06.002 (DOI)000325387700005 ()
Available from: 2013-11-18 Created: 2013-11-14 Last updated: 2017-12-06Bibliographically approved
Ericson, J., Eriksson, M., Hellström-Westas, L., Hagberg, L., Hoddinott, P. & Flacking, R. (2013). The effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants: study protocol for a randomized controlled trial. BMC Pediatrics, 13, 73
Open this publication in new window or tab >>The effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants: study protocol for a randomized controlled trial
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2013 (English)In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 13, p. 73-Article in journal (Refereed) Published
Abstract [en]

Background: Although breast milk has numerous benefits for infants' development, with greater effects in those born preterm (at < 37 gestational weeks), mothers of preterm infants have shorter breastfeeding duration than mothers of term infants. One of the explanations proposed is the difficulties in the transition from a Neonatal Intensive Care Unit (NICU) to the home environment. A person-centred proactive telephone support intervention after discharge from NICU is expected to promote mothers' sense of trust in their own capacity and thereby facilitate breastfeeding. Methods/design: A multicentre randomized controlled trial has been designed to evaluate the effectiveness and cost-effectiveness of person-centred proactive telephone support on breastfeeding outcomes for mothers of preterm infants. Participating mothers will be randomized to either an intervention group or control group. In the intervention group person-centred proactive telephone support will be provided, in which the support team phones the mother daily for up to 14 days after hospital discharge. In the control group, mothers are offered a person-centred reactive support where mothers can phone the breastfeeding support team up to day 14 after hospital discharge. The intervention group will also be offered the same reactive telephone support as the control group. A stratified block randomization will be used; group allocation will be by high or low socioeconomic status and by NICU. Recruitment will be performed continuously until 1116 mothers (I: 558 C: 558) have been included. Primary outcome: proportion of mothers exclusively breastfeeding at eight weeks after discharge. Secondary outcomes: proportion of breastfeeding (exclusive, partial, none and method of feeding), mothers satisfaction with breastfeeding, attachment, stress and quality of life in mothers/partners at eight weeks after hospital discharge and at six months postnatal age. Data will be collected by researchers blind to group allocation for the primary outcome. A qualitative evaluation of experiences of receiving/providing the intervention will also be undertaken with mothers and staff. Discussion: This paper presents the rationale, study design and protocol for a RCT providing person-centred proactive telephone support to mothers of preterm infants. Furthermore, with a health economic evaluation, the cost-effectiveness of the intervention will be assessed. Trial registration: NCT01806480

Keywords
Breastfeeding, Mothers, Neonatal care, Preterm infant, Support, Telephone
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-202370 (URN)10.1186/1471-2431-13-73 (DOI)000318953500001 ()
Available from: 2013-06-24 Created: 2013-06-24 Last updated: 2017-12-06Bibliographically approved
Flacking, R., Lehtonen, L., Thomson, G., Axelin, A., Ahlqvist, S., Moran, V. H., . . . Dykes, F. (2012). Closeness and separation in neonatal intensive care. Acta Paediatrica, 101(10), 1032-1037
Open this publication in new window or tab >>Closeness and separation in neonatal intensive care
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2012 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 101, no 10, p. 1032-1037Article, review/survey (Refereed) Published
Abstract [en]

In this paper, we highlight the need for acknowledging the importance and impact of both physical and emotional closeness between the preterm infant and parent in the neonatal intensive care unit. Physical closeness refers to being spatially close and emotional closeness to parental feelings of being emotionally connected to the infant (experiencing feelings of love, warmth and affection). Through consideration of the literature in this area, we outline some of the reasons why physical closeness and emotional closeness are crucial to the physical, emotional and social well-being of both the infant and the parent. These include positive effects on infant brain development, parent psychological well-being and on the parentinfant relationship. The influence of the neonatal unit environment and culture on physical and emotional closeness is also discussed.

Conclusions: Culturally sensitive care practices, procedures and the physical environment need to be considered to facilitate parentinfant closeness, such as through early and prolonged skin-to-skin contact, family-centred care, increased visiting hours, family rooms and optimization of the space on the units. Further research is required to explore factors that facilitate both physical and emotional closeness to ensure that parentinfant closeness is a priority within neonatal care.

Keywords
Family, Infant behaviour, Intensive care, Neonatal, Parents, Preterm birth
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-182403 (URN)10.1111/j.1651-2227.2012.02787.x (DOI)000308206300015 ()
Available from: 2012-10-12 Created: 2012-10-10 Last updated: 2017-12-07Bibliographically approved
Flacking, R., Ewald, U. & Wallin, L. (2011). Positive Effect of Kangaroo Mother Care on Long-Term Breastfeeding in Very Preterm Infants. Journal of Obstetric, Gynecologic and Neonatal Nursing, 40(2), 190-197
Open this publication in new window or tab >>Positive Effect of Kangaroo Mother Care on Long-Term Breastfeeding in Very Preterm Infants
2011 (English)In: Journal of Obstetric, Gynecologic and Neonatal Nursing, ISSN 0884-2175, E-ISSN 1552-6909, Vol. 40, no 2, p. 190-197Article in journal (Refereed) Published
Abstract [en]

Objective

To investigate the use of Kangaroo Mother Care (KMC) and its association with breastfeeding at 1 to 6 months of corrected age in mothers of very preterm (VPT) and preterm (PT) infants.

Design

Prospective longitudinal study.

Setting

Neonatal Intensive Care Units in four counties in Sweden.

Participants

The study included 103 VPT (< 32 gestational weeks) and 197 PT (32-36 gestational weeks) singleton infants and their mothers.

Methods

Data on KMC, measured in duration of skin-to-skin contact/day during all days admitted to a neonatal unit, were collected using self-reports from the parents. Data on breastfeeding were obtained by telephone interviews.

Results

VPT dyads that breastfed at 1, 2, 5, and 6 months had spent more time in KMC per day than those not breastfeeding at these times. A trend toward significance was noted at 3 and 4 months. In the PT dyads no statistically significant differences were found in the amount of KMC per day between those dyads that breastfed and those that did not.

Conclusions

This study shows the importance of KMC during hospital stay for breastfeeding duration in VPT dyads. Hence, KMC has empowering effects on the process of breastfeeding, especially in those dyads with the smallest and most vulnerable infants.

Keywords
breastfeeding, infant, Kangaroo Mother Care, neonatal care, neonatal intensive care unit, preterm, skin-to-skin
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-152791 (URN)10.1111/j.1552-6909.2011.01226.x (DOI)000288500200011 ()21410756 (PubMedID)
Available from: 2011-05-02 Created: 2011-05-02 Last updated: 2017-12-11Bibliographically approved
Östlund, Å., Nordström, M., Dykes, F. & Flacking, R. (2010). Breastfeeding in Preterm and Term Twins-Maternal Factors Associated With Early Cessation: A Population-Based Study. Journal of Human Lactation, 26(3), 235-241
Open this publication in new window or tab >>Breastfeeding in Preterm and Term Twins-Maternal Factors Associated With Early Cessation: A Population-Based Study
2010 (English)In: Journal of Human Lactation, ISSN 0890-3344, E-ISSN 1552-5732, Vol. 26, no 3, p. 235-241Article in journal (Refereed) Published
Abstract [en]

To investigate the duration of breastfeeding and the impact of maternal factors for cessation of breastfeeding in twin infants, the authors undertook a population-based cohort study. Breastfeeding data obtained from Child Health Centres were matched with data on infant and maternal demographics from Swedish national registers. A total of 1.657 twins were included, of whom 695 were born preterm. Breastfeeding frequencies in preterm twins were 79% at 2 months, 58% at 4 months, 39% at 6 months, 14% at 9 months, and 6% at 12 months. In term twins, the corresponding frequencies were 84%, 63%, 45%, 18%, and 6%, respectively. In both preterm and term mothers, mothers who had a lower educational level or smoked at first antenatal care visit were subject to earlier cessation of breastfeeding by 6 months of age. In addition, in mothers of term infants, mothers who were < 23 years old or primiparous had a higher risk for cessation of breastfeeding before 6 months. Thus, mothers of twins have a good potential to breastfeed, but additional support is needed for those more susceptible to early cessation of breastfeeding.

Keywords
multiple births, breastfeeding duration, premature infants, breastfeeding cessation, Sweden, long-term breastfeeding
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-134971 (URN)10.1177/0890334409359627 (DOI)000280644200003 ()
Available from: 2010-12-07 Created: 2010-12-03 Last updated: 2017-12-11Bibliographically approved
Dykes, F. & Flacking, R. (2010). Encouraging breastfeeding: A relational perspective. Early Human Development, 86(11), 733-736
Open this publication in new window or tab >>Encouraging breastfeeding: A relational perspective
2010 (English)In: Early Human Development, ISSN 0378-3782, E-ISSN 1872-6232, Vol. 86, no 11, p. 733-736Article in journal (Refereed) Published
Abstract [en]

Despite the WHO recommendations that babies should be breastfed exclusively for six months and thereafter for up to two years and beyond this pattern of feeding is far from the global norm. Although breastfeeding is triggered through biological mechanisms which have not changed with time, the perception of breastfeeding as a phenomenon is variable, as it not only reflects cultural values of motherhood but is also negotiable from the perspective of the individual. This paper argues that relationships are central to encouraging breastfeeding at an organisational, family and staff-parent level. This shifts our conceptualisations away from the primary focus of breastfeeding as nutrition which, in turn, removes the notion of breastfeeding as a productive process, prone to problems and failure.

Keywords
Breastfeeding, Relationship, Maternity, Preterm, Baby, Mother
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-139410 (URN)10.1016/j.earlhumdev.2010.08.004 (DOI)000284569500010 ()20826072 (PubMedID)
Available from: 2010-12-23 Created: 2010-12-23 Last updated: 2017-12-11Bibliographically approved
Flacking, R., Dykes, F. & Ewald, U. (2010). The influence of fathers' socioeconomic status and paternity leave on breastfeeding duration: a population-based cohort study. Scandinavian Journal of Public Health, 38(4), 337-343
Open this publication in new window or tab >>The influence of fathers' socioeconomic status and paternity leave on breastfeeding duration: a population-based cohort study
2010 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 38, no 4, p. 337-343Article in journal (Refereed) Published
Abstract [en]

AIM:

The propensity to breastfeed is a matter of public concern because of the favourable effects for infants. However, very few studies have described the influence of paternal variables upon duration of breastfeeding. The aim of this study was to describe the effects of fathers' socioeconomic status and their use of paternity leave on breastfeeding duration for infants up to 1 year of age.

METHODS:

A prospective population-based cohort study was undertaken. Data on breastfeeding, registered in databases in two Swedish counties for 1993-2001, were matched with data on socioeconomic status and paternity leave obtained from Statistics Sweden. Fathers of 51,671 infants were identified and included.

RESULTS:

Infants whose fathers had a lower level of education, were receiving unemployment benefit and/or had a lower equivalent disposable household income were significantly less likely to be breastfed at 2, 4, 6, 9, and 12 months of age. Infants whose fathers did not take paternity leave during the infant's first year were significantly less likely to be breastfed at 2 (p < 0.001), 4 (p < 0.001), and 6 months (p < 0.001).

CONCLUSIONS:

This paper shows that an enabling of an increased involvement from fathers during the infants' first year of life, such as by paid paternity leave, may have beneficial effects on breastfeeding up to 6 months of age. A more systematic approach to supporting fathers' involvement may be particularly valuable to those infants whose fathers have a lower socioeconomic status.

Keywords
Breastfeeding, father, infant, parental leave, socioeconomic status
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-126210 (URN)10.1177/1403494810362002 (DOI)000278152300001 ()20147577 (PubMedID)
Available from: 2010-06-07 Created: 2010-06-07 Last updated: 2017-12-12Bibliographically approved
Flacking, R., Hedberg Nyqvist, K. & Ewald, U. (2007). Effects of socioeconomic status on breastfeeding duration in mothers of preterm and term infants. European Journal of Public Health, 17(6), 579-584
Open this publication in new window or tab >>Effects of socioeconomic status on breastfeeding duration in mothers of preterm and term infants
2007 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 17, no 6, p. 579-584Article in journal (Refereed) Published
Abstract [en]

Background:

The propensity to breastfeed is not only of importance with regard to the beneficial effects on the individual, but is also of concern as an indicator of health behaviour related to social conditions. Thus, our aim was to investigate the impact of socioeconomic status (SES) on breastfeeding duration in mothers of preterm and term infants.

Methods:

Prospective population based cohort study. Data for infants registered in breastfeeding databases of two Swedish counties 19932001 were matched with data from two national registriesthe Medical Birth Registry and Statistics Sweden. A total of 37 343 mothers of 2093 preterm and 35 250 term infants participated.

Results:

All socioeconomic factors; maternal educational level, maternal unemployment benefit, social welfare and equivalent disposable income, were strongly associated with breastfeeding when examined individually in mothers of preterm and term infants. Some of the associations attenuated when investigated simultaneously. Independently of SES and confounders, mothers of preterm infants were at higher risk of weaning before the infant was 2 months (adjusted odds ratio (OR) 1.70; 95 confidence interval ((Cl) 1.46-1.99)), 4 months (OR 1.79; Cl 1.602.01), 6 months (OR 1.48; Cl 1.331.64), and 9 months old (OR 1.19; Cl 1.061.34), compared with mothers of term infants.

Conclusions:

In Sweden, despite its social welfare support system and a positive breastfeeding tradition, SES clearly has an impact on the breastfeeding duration. Mothers of preterm infants breastfeed for a shorter time compared with mothers of term infants, even when adjustments are made for SES and confounders.

Keywords
breastfeeding, infants, register, socioeconomic status, Sweden
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-95918 (URN)10.1093/eurpub/ckm019 (DOI)000251680800012 ()17392294 (PubMedID)
Available from: 2007-05-14 Created: 2007-05-14 Last updated: 2017-12-14Bibliographically approved
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