A comparison of breastfeeding women's, peer supporters' and student midwives' breastfeeding knowledge and attitudes

doi:10.1016/j.nepr.2014.02.004

Nurse Education in Practice

Volume 14, Issue 3, May 2014, Pages 319-325

https://doi.org/10.1016/j.nepr.2014.02.004 Get rights and content

Abstract

In the United Kingdom over 90% of women do not breastfeed for as long as they would like, despite widespread knowledge of the benefits of breastfeeding. Negative attitudes and low levels of knowledge in staff supporting breastfeeding may be a contributing factor. This paper reports on the breastfeeding knowledge and attitudes in two key workforce groups; student midwives (n = 19) and Breastfeeding Network peer supporters (n = 36) and compares them with breastfeeding women (n = 23). All three groups had high knowledge and attitude scores, but peer supporters had significantly higher levels than student midwives or breastfeeding women. Student midwives' knowledge of breastfeeding was higher than breastfeeding women's but they had similar breastfeeding attitude scores. The higher knowledge and attitude scores in peer supporters may be attributed to the effectiveness of their training, which includes challenging their existing breastfeeding attitudes and debriefing their personal breastfeeding experience. It is suggested that midwives' breastfeeding attitudes are affected by their community culture and their personal experience of breastfeeding. It is proposed that midwifery training should continue to embrace a biopsychosocial model, including training to improve breastfeeding attitudes, particularly for professionals from areas where breastfeeding is not the cultural norm, or who have had negative personal breastfeeding experiences.

Section snippets

Background

The benefits of breastfeeding for infants and their mothers are well established and widely published (Britton et al., 2009). Breastfed infants are at a reduced risk of respiratory, gastro-intestinal, ear and urinary tract infections, obesity and type 1diabetes and allergic diseases, such as eczema and wheezing (WHO, 2003). Mothers who have breastfed are at lower risk of ovarian and breast cancer and post menopausal hip fractures (Ip et al., 2007). Given the impact of breastfeeding on health

Design

This study used a cross sectional design to compare the breastfeeding attitudes and knowledge of breastfeeding women attending BfN community support centres, BfN peer supporters (level 1) and final year student midwives. A questionnaire (online and paper-based) was used to survey participants.

Ethics

Ethical approval for the study was provided by the Directors of the BfN and by the University whose midwifery students participated in the research. All participants were provided with participant

Results

A total of 23 breastfeeding women, 36 peer supporters and 19 student midwives agreed to participate in the study (see Table 1 for participant details). Student midwives were on average 6.3 years younger than breastfeeding women and 7.1 years younger than peer supporters. Student midwives also had the fewest mean number of children (0.6), whereas breastfeeding women had a mean number of 1.4 children, and peer supporters had a mean number of 1.6 children. Only 5 of the 19 student midwives had

Discussion

This study is the first to investigate the breastfeeding knowledge and attitudes of breastfeeding women and those who support them. The overall aim was to compare the levels of breastfeeding attitudes and knowledge of breastfeeding women, peer supporters and final-year student midwives. The authors were pleased to find that in all three groups, participants on average had very high, positive attitude scores, ranging from 84.7% for breastfeeding women to 94.7% for peer supporters. Participants

Conclusions

In conclusion, peer supporters were found to have high levels of knowledge and more positive attitudes to breastfeeding, far in excess of the women they were supporting and their midwifery colleagues. This has been attributed to the nature of their training (Kempenaar and Darwent, 2013) including their opportunity to debrief and make sense of their own experience and the family and cultural values of the community they are drawn from, which may not be supportive of breastfeeding. Midwifery

Conflict of interest statement

The authors declare that they have no conflicting interests.

Source of funding

This study was unfunded.

Authors' contributions

Both authors contributed equally to the production of this paper.

Acknowledgements

We would like to thank Jennie Stewart (School of Health and Life Sciences, Glasgow Caledonian University) for her helpful comments while writing this paper.

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The Joanna Briggs Institute (JBI) approach to systematic reviews of qualitative studies was followed. Seven databases: CINAHL, MEDLINE, EMBASE, PsycINFO, Scopus, Maternal & Infant Care, and Web of Science were searched. Included papers were critically appraised using the JBI Critical Appraisal Checklist for Qualitative Research. JBI's meta-aggregation approach was used to synthesise findings. JBI's ConQual process was followed to assess confidence of evidence.
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Twenty-three papers presenting findings from 22 studies were included. The synthesised findings included: (1) Positive characteristics, approaches and benefits of peer support(ers); (2) Relationships between healthcare professionals and peer supporters; (3) Improving women's access to peer support services; (4) Barriers and enablers to provide peer support.
Breastfeeding peer support increased women's self-esteem and confidence in breastfeeding while reducing social isolation. Peer supporters valued the experience, which gave them a sense of purpose and confidence, and felt good about helping the women they supported. Women appreciated peer supporters who were caring, spent time with them, shared experiences, provided realistic information, practical and emotional support. Although there were tensions between some healthcare professionals and peer supporters, many valued the mutual support offered. Embedding peer supporters in healthcare systems for them to work alongside healthcare professionals, combined with good communications and building trusty relationships could be a useful strategy to reduce tensions between them.
Nursing student's knowledge about breastfeeding: Design and validation of the AprendeLact questionnaire
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Breastfeeding is the best source of food that a mother can offer her child during the first months of life because it provides numerous benefits for both mother and baby. Despite breastfeeding being an innate act, it requires qualified health professionals for advice and support.
To design and validate a questionnaire to evaluate nursing student breastfeeding knowledge.
Cross-sectional study. Construction and validation of the questionnaire (content validity, test-retest reliability and internal consistency). Descriptive and bivariate analyses of socio-demographic variables and the questionnaire results.
Optimum results were obtained in terms of internal consistency (KR-20 = 0.9) and test-retest reliability (ICC = 0.925) with a samples of 144 participants (mean age of 22.69 years). Statistical significance were observed among the questionnaire score and academic year, clinical practice, type of breastfeeding in childhood, knowing about support groups and participating in a breastfeeding workshop or course.
A questionnaire on breastfeeding knowledge was validated. Nursing students progressively acquire breastfeeding skills as they advance in their undergraduate studies.
Attitudes, Perceptions, and Knowledge of Breastfeeding Among Professional Caregivers in a Community Hospital
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The literature also shows differences in attitudes toward breastfeeding between physicians and nurses (Darwent & Kempenaar, 2014; Holmes et al., 2013; Radzyminski & Callister, 2015). Researchers have identified, for example, that breastfeeding and its nuances are not readily or fully embraced by physicians and nurses (Darwent & Kempenaar, 2014; Holmes et al., 2013; Radzyminski & Callister, 2015). Specifically, attitudes toward breastfeeding can be influenced by one’s personal or familial experiences with breastfeeding, cultural tradition, religious preference, or socioeconomic status (Brown, 2014; Marinelli et al., 2013).
To explore the knowledge, attitudes, and perceptions of exclusive breastfeeding among professional caregivers in a suburban community hospital who typically provide, or influence, the care of parturient women.
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Acute care community hospital in suburban New Jersey with 3,500 births per year.
Obstetricians, midwives, neonatologists, pediatricians, and registered nurses.
We designed a survey using two instruments—the Iowa Infant Feeding Attitudes Scale and the Breastfeeding Attitudes Scale—to explore concepts of breastfeeding knowledge, attitudes, and perceptions. Data were analyzed by using descriptive and inferential statistics with SPSS (Version 19). Independent sample t tests, Pearson’s correlation coefficient, and Pearson’s chi-square test (×2) were used to assess differences between the groups.
When the physician scores were separated out by specialty, statistically significant differences in mean scores were found (p = .002). Pediatricians had lower scores on attitude toward breastfeeding. In contrast, mean scores for perceptions and knowledge of breastfeeding were positive for physicians and nurses, regardless of area of specialization, with no statistically significant differences found.
Although pediatricians’ attitudes, perceptions, and knowledge of breastfeeding cannot be deemed the sole cause for our organization’s low rates of sustained exclusive breastfeeding in the postpartum period, this study provided an avenue for exploration that we did not immediately consider as we dissected our performance metrics related to exclusive breastfeeding. We encourage teams at other organizations to replicate and build on this work to explore influences surrounding low rates of exclusive breastfeeding.
Breastfeeding knowledge and attitudes of baccalaureate nursing students in Taiwan: A cohort study
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This study examined the effects of breastfeeding education in a baccalaureate nursing program on Taiwanese nursing students’ knowledge and attitude towards breastfeeding. This study is important because previous studies undertaken in the USA, Australia, Egypt and UK, which have explored the impact of breastfeeding education for students have only collected data at one point in time.5–8,23 Our findings revealed that nursing students’ knowledge and attitudes towards breastfeeding were significantly increased following both theoretical, and clinical, learning experiences.
Optimal nutrition during the first year of life is critical to infants’ healthy growth and development. Hence, it is vital that undergraduate health professional curricula provide good quality learning environments to enable students to acquire the necessary knowledge and skills to support breastfeeding mothers.
To examine the change in knowledge and attitude in Taiwanese nursing students following theoretical and clinical learning experiences on breastfeeding.
This study used a pre-test/post-test survey design with two cohorts of nursing students (N = 215). Knowledge and attitude were assessed before and after: (a) theoretical (didactic and skills laboratory) education in Cohort One, and (b) clinical placement in Cohort Two.
Students in both cohorts demonstrated significant improvements in knowledge and attitude post-theoretical education, and post-clinical placement. Prior to theoretical education in Cohort One, those with experience of close family members being breastfed were more than 14 times (adjusted odds ratio: 14.09, 95% confidence interval: 1.73–114.64) to be in the high knowledge group. However, following theoretical or clinical education, there were no sociodemographic group differences in breastfeeding knowledge or attitude in Cohorts One or Two.
Results revealed that the current breastfeeding education program in Taiwan, both theoretical and clinical components, increased nursing students’ knowledge and improved positive attitudes towards breastfeeding, and any sociodemographic differences in knowledge and attitude about breastfeeding were ameliorated following theoretical and clinical placement experience focused on breastfeeding.
Breastfeeding Simulation With the Standardized Patient
2019, Nursing for Women's Health
Despite an emphasis on lactation and the availability of resources to support and sustain lactation, our community hospital’s rates of exclusive breastfeeding remained less than the 50% to 70% benchmark recommended by The Joint Commission and the World Health Organization. Concluding that we had exhausted the majority of evidence-based best practices described in the literature, we sought to find a new way to provide an engaging, useful medium for nursing education and improvement of clinical nurses’ skills related to breastfeeding. Here, we describe the simulation program we developed using the standardized patient model. Although our rates of exclusive breastfeeding remained unchanged after introducing the simulation program, the experience enabled us to identify inconsistent practices and knowledge gaps.
Breastfeeding knowledge, attitudes, intentions, and perception of support from educational institutions among nursing students and students from other faculties: A descriptive cross-sectional study
2018, Nurse Education Today
Citation Excerpt :
Of note, a considerable proportion of both nursing students and students from other faculties who participated in the present study had previous breastfeeding experience. In the present study, nursing students had better breastfeeding knowledge than that reported in other studies (Ahmed and El Guindy, 2011; Darwent and Kempenaar, 2014; Payghan and Kadam, 2012), with a mean score of 10/11 points. Moreover, in the present study nursing students' knowledge was higher than that of students from other faculties.
Nursing education aims to promote positive health practices among the general population as well as among nurses themselves. Breastfeeding is one of these important health practices. However, to date there is little evidence regarding the extent to which nursing education affects nursing students' attitudes, knowledge, intentions, and their perception of institutional support regarding breastfeeding.
To compare breastfeeding attitudes and knowledge among nursing students and students from other faculties, as well as their perception of their academic institution's support for breastfeeding, and to explore the association between these factors and students' intention to breastfeed during the course of their studies.
This study was a descriptive cross-sectional study.
The study was conducted at a large university in central Israel.
One hundred female students from the faculty of nursing and 100 female students from other faculties, of childbearing age, who were either pregnant or mothers.
The students completed a questionnaire regarding their breastfeeding knowledge, intentions, attitudes, and their perception of their academic institution's support for breastfeeding.
Nursing students' level of breastfeeding knowledge was very high, and higher than that among students from other faculties. However, both groups had similar moderately positive overall scores for attitudes towards breastfeeding. In addition, both groups expressed similar moderate intentions to breastfeed during the course of their studies. Students' perception of their academic faculty as supportive of breastfeeding, their breastfeeding attitudes, and breastfeeding knowledge, were found to predict their intention to breastfeed during the course of their studies.
Nursing programs should place more emphasis on improving nursing students' attitudes towards breastfeeding. In order to promote breastfeeding among students during their studies, it is important to ensure a pro-breastfeeding environment on campus.

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Midwifery education in practiceA comparison of breastfeeding women's, peer supporters' and student midwives' breastfeeding knowledge and attitudes

Abstract

Section snippets

Background

Design

Ethics

Results

Discussion

Conclusions

Conflict of interest statement

Source of funding

Authors' contributions

Acknowledgements

J. Prof. Nurs. Off. J. Am. Assoc. Coll. Nurs. AACN

J. Midwifery Women's Health

Soc. Sci. Med.

Infant Feeding Survey 2005

Support for breastfeeding mothers

Cochrane Database Syst. Rev.

The relationship between personal breastfeeding experience and the breastfeeding attitudes, knowledge, confidence and effectiveness of Australian GP registrars

Matern. Child Nutr.

The baby friendly breastfeeding management course

Br. J. Midwifery

Infant feeding attitudes and knowledge among socioeconomically disadvantaged women in Glasgow

Matern. Child Health J.

The education of health practitioners supporting breastfeeding mothers: time for critical reflection

Matern. Child Nutr.

Knowledge about breastfeeding in accordance with the national policy among doctors, paramedics and mothers in baby-friendly hospitals

J. Pak. Med. Assoc.

Infant Feeding Survey 2010

Breastfeeding Statistics 2011/12

Multiprofessional training for breastfeeding management in primary care in the UK 2006

Int. Breastfeed J.

Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries

Knowledge and attitudes of breastfeeding

The impact of peer support training on mothers' attitudes towards and knowledge of breastfeeding

Matern. Child Nutr.

Improving breastfeeding knowledge, attitudes and practices of WIC clinic staff

Public Health Rep.

Midwifery education in practice
A comparison of breastfeeding women's, peer supporters' and student midwives' breastfeeding knowledge and attitudes