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Developing the Preterm Breastfeeding Attitudes Instrument: a tool for describing attitudes to breastfeeding among health care professionals in neonatal intensive car
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Perinatal, Neonatal and Pediatric Cardiology Research.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare.ORCID iD: 0000-0001-5104-1281
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Perinatal, Neonatal and Pediatric Cardiology Research.ORCID iD: 0000-0001-5955-1278
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2021 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 94, article id 102919Article in journal (Refereed) Published
Abstract [en]

Objective: The 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.

Design: The 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 participants: A 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 findings: Higher scores indicated more positive attitudes and the median total PreBAI score was 42 points (out of 48), on both the preand 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 Breastfeedingand 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 (r(s) = 0.383, p = 0.001). Those who had previously received extra breastfeeding education scored higher on the instrument.

Place, publisher, year, edition, pages
Elsevier, 2021. Vol. 94, article id 102919
Keywords [en]
attitudes, breastfeeding, healthcare professionals, instrument, preterm infant
National Category
Pediatrics
Identifiers
URN: urn:nbn:se:uu:diva-408021DOI: 10.1016/j.midw.2020.102919ISI: 000615888000001PubMedID: 33422884OAI: oai:DiVA.org:uu-408021DiVA, id: diva2:1421357
Funder
Gillbergska stiftelsenAvailable from: 2020-04-02 Created: 2020-04-02 Last updated: 2024-01-15Bibliographically approved
In thesis
1. Self-efficacy in breastfeeding mothers of term and preterm born infants
Open this publication in new window or tab >>Self-efficacy in breastfeeding mothers of term and preterm born infants
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Breast milk is beneficial for all infants, but especially for infants born preterm and optimizing breastfeeding can enhance health outcomes. Despite this, breastfeeding duration has declined in more than twenty years in Sweden and even more among preterm infants. Mothers’ self-efficacy is a modifiable factor that can affect breastfeeding duration and Breastfeeding Self-efficacy Scale-Short Form (BSES-SF) has been tested in several countries in order to identify mothers with low self-efficacy in breastfeeding, however, the scale has not been validated for a Swedish sample. Moreover, there is a need for evidence-based breastfeeding support programs adapted for the healthcare professionals (HCPs) working with mothers of preterm infants.

A first aim of the present thesis was to psychometrically test the BSES-SF among mothers to both term- and preterm infants and to examine whether self-efficacy predicts breastfeeding duration. A secondary aim was to evaluate a breastfeeding support program based on Baby-Friendly Hospital Initiative for Neonatal Intensive Care (Neo-BFHI) and to describe HCPs’ experiences of the program.

Papers I and II show potential for BSES-SF to be used in research with the aim to identify mother’s self-efficacy in breastfeeding. In Paper III findings reveal that self-efficacy predicts the mother’s adaptation to the infant. This is an important finding as the mother's adaptation to the infant is closely related to the theories of bonding and attachment. Paper IV describes and evaluates a training program for neonatal intensive HCPs based on Neo-BFHI’s ten steps to successful breastfeeding, with main results indicating that the training program was appreciated by the HCPs. In Paper V, we constructed and evaluated an instrument that measures the attitudes to breastfeeding and skin-to-skin contact among neonatal intensive care units’ HCPs. Findings suggest that the instrument could be used to evaluate future Neo-BFHI interventions to improve breastfeeding duration as well as HCPs’ support and skills.

The main conclusion of this thesis is that mothers’ low self-efficacy in the early phase can be an important predictor for shorter breastfeeding duration. The breastfeeding training program was regarded as relevant and useful according to different HCPs categories and was shown to increase the HCPs’ interest in breastfeeding and provide them with tools for improved breastfeeding support. The program is designed in a way that makes it easy to copy and spread to other neonatal intensive care units in Sweden and it can also be used for newly employed HCPs.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2020. p. 67
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1663
Keywords
adaptation, Baby-Friendly, breastfeeding, mother, preterm infant, self-efficacy, support, training
National Category
Pediatrics Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Pediatrics
Identifiers
urn:nbn:se:uu:diva-408022 (URN)978-91-513-0934-7 (ISBN)
Public defence
2020-05-27, Rudbecksalen, Rudbecklaboratoriet, Dag Hammarskjölds väg 20, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2020-05-06 Created: 2020-04-02 Last updated: 2020-06-16

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Gerhardsson, EmmaOras, PaolaMattsson, ElisabetThernström Blomqvist, YlvaFunkquist, Eva-LottaRosenblad, Andreas

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