best start northern conference october 18, 2010 research study “improving breastfeeding outcomes...
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Best Start Northern Best Start Northern Conference Conference
October 18, 2010 October 18, 2010 Research Study “Improving
Breastfeeding Outcomes Among Aboriginal Women”
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Research TeamResearch TeamCollaboration between Thunder
Bay District Health Unit and Lakehead University
Collaborative community partner is Anishnawbe-Mushkiki
Funding from Registered Nursing Association of Ontario
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RecommendationsRecommendationsBreastfeeding is recommended as
the optimal source of nutrition for newborns for the first 6 months of life and beyond with the addition of complimentary foods (WHO, HC, CPA, AAP)
Benefits well documented for infants, mothers, families and society (Kramer et al., 2001; Stanley et al, 2007).
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Clinical ProblemClinical Problem
Despite the benefits of breastfeeding many women do not meet the breastfeeding recommendations
Stats Canada, 2003: 84.5% of women initiated breastfeeding, with only 18.7% exclusively breastfeeding at 6 months and 38.7% practicing any breastfeeding at 6 months.
Rates are lower in US
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Breastfeeding duration tends to decrease quickly in the first four to six weeks (Barber et al., 1997; Sheehan et al., 2001; Sheenhan et al.,2006).
Rates are even lower in socially disadvantaged women (Dubois & Girard;
Guise et al., 2003; Li et al., 2003). Studies have also indicated that
many mothers are not meeting their desired breastfeeding goals
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41%-53% of mothers reported meeting their intended duration of breastfeeding in 3 different studies (Chezem et al., 2003; Lavender et al., 2005; Kronberg & Vaeth, 2004).
Negative perceptions of the experience
Experience feelings of self-doubt, disappointment and/or guilt about not continuing
Many discontinue due to difficulties encountered rather than choice (Dennis, 2002; Gaffy & Taylor, 2005; Mozingo & Droppleman, 2000).
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VariablesVariablesReasons for discontinuation are
multifactorial and complexSocio-demographic variablesAttitudinal and intrapersonal
characteristics (goals and intentions)
Hospital policiesIntrapartum experiencesSupportBreastfeeding difficultiesPsychosocial factors (anxiety,
depression)Confidence (self-efficacy)
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Relevance to Aboriginal Relevance to Aboriginal MothersMothers
Many studies have been conducted in larger urban centers with with different demographic characteristics than communities in Northwestern Ontario
Little research has been conducted with Aboriginal women
Health care providers should provide services that meet the unique needs of their community
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Studies with Aboriginal Studies with Aboriginal MothersMothersOntario James Bay (Moose Factory),
initiation rate of 51.9% (Black, Goodwin
& Ponka, 2008) Manitoba South First Nations
reported initiation of breastfeeding between 43%-65% (Martens et al., 2008).
Labrador study had a 54% initiation rate among Aboriginal/Inuit mothers (McKim et al., 1998).
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Proposed ResearchProposed Research
PurposeTo evaluate two potentially
modifiable variables affecting breastfeeding outcomes among Aboriginal women.
1.Breastfeeding self-efficacy also referred to as mothers’ confidence
2.Peer support
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Breastfeeding Self-Breastfeeding Self-EfficacyEfficacyA mother’s confidence in her ability to
breastfeed her infant (Dennis, 1999)Has been identified as an important,
potentially modifiable variable affecting breastfeeding initiation, duration and exclusivity in diverse settings with varying populations (Canada, UK, China, Australia, Poland, Primigravidas, WIC participants, adolescents)
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Increased breastfeeding self-efficacy has been associated with increased initiation, duration and exclusivity (Blyth et al., 2002; Dennis & Faux, 1999; Kingston et al., 2007)
Many of the above studies also identified that a mother’s breastfeeding self-efficacy in the early postpartum period is predictive of breastfeeding outcomes
Therefore, we can identify mothers at risk for early discontinuation due to low-self efficacy
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However…However…
The tool to measure breastfeeding self-efficacy has not been tested among Aboriginal women
The variable has not been identified as influencing breastfeeding outcomes among Aboriginal women
Very little is known about the goals and rates of breastfeeding initiation, duration and exclusivity among Aboriginal women
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Research QuestionsResearch Questions
1. What is the reliability and validity of the BSES-SF in-hospital and 4 weeks postpartum among Aboriginal women?
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Additional QuestionsAdditional Questions
1. What are the breastfeeding rates and levels among Aboriginal mothers in-hospital, at 4 and 8 weeks postpartum?
1. What sociodemographic and early postpartum variables predict early discontinuation of breastfeeding among Aboriginal women?
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Relevance to RNAORelevance to RNAO
Recommendation #3Nurses should perform a
comprehensive breastfeeding assessment
Recommendation #3.3 Assessment tools should meet
the needs of the practice settings
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Community Support & Community Support & EthicsEthicsStudy being conducted in
collaboration with staff of Anishnawbe-Mushkiki
Involved right from the beginning with proposal development, questionnaires, use of their cite etc.
Ethics approval from TBRHSC and Lakehead University
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Study in ProgressStudy in ProgressParticipant recruited from the
postpartum unit at TBRHSCEligibility: (a) Aboriginal heritage, (b)
term infant, (c) intending to breastfeed, (d) speak and understand English, and (e) are 16 years of age or older
Ineligibility: (a) any condition that would interfere with breastfeeding such as premature, prolonged separation (NICU)
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MethodologyMethodology
Cohort StudyBaseline data collected in
hospital from eligible, consenting mothers
Telephoned by a research assistant at 4 and 8 weeks to evaluate method of infant feeding and variables affecting infant feeding
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OutcomesOutcomesInfant feeding methodLevel of breastfeedingBreastfeeding self-efficacy
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Results to dateResults to dateTo be described at the
conference
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Naadmaage Kwe (Women Helping Naadmaage Kwe (Women Helping Women)Women)
Breastfeeding Peer Support for Aboriginal Breastfeeding Peer Support for Aboriginal WomenWomen
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Research QuestionsResearch QuestionsHow does a community based
peer support program affect breastfeeding outcomes with Aboriginal women?
How do the mothers evaluate their peer support experience?
How do the peers evaluate their experience providing peer support?
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Breastfeeding Best Practice Breastfeeding Best Practice Guideline for Nurses Guideline for Nurses RNAO 2003, Revision 2007RNAO 2003, Revision 2007
Nurses support breastfeeding peer support programs and ensure that women are provided with peer support resources.
Organizations establish and support breastfeeding peer support programs.
Nurses provide informational support about breastfeeding.
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Evidence supported Evidence supported practice practice Pre and post natal peer support has been effective in
increasing initiation and exclusive breastfeeding (Bonuck et al., 2005 and Chapman et al., 2004)
Telephone based peer support has been effective in increasing duration and exclusive breastfeeding
(Dennis et al., 2002)
Antenatal education is effective in increasing breastfeeding initiation rates in low income women (Dyson et al., 2005)
Education is effective where initiation rates are low (Guise et al., 2003)
Lay support is associated with reduced cessation of
exclusive breastfeeding ( Britton et al., 2007)
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Prenatal SessionPrenatal Session
Objective: to provide informational support in an small group setting
Facilitated by nursesFace to face meeting with
breastfeeding support peersContent includes discussion of
benefits of breastfeeding; myths, attitudes, and concerns; anatomy and physiology; and latching and positioning skills.
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Breastfeeding Support Breastfeeding Support PeersPeersAre Aboriginal women with a
positive breastfeeding experienceAttend a training sessionReceive a peer support manualDocument contacts on Peer
Volunteer Activity Logs
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Telephone supportTelephone supportPeers contact new mothers
within 2-3 days following discharge from hospital.
Frequency of contact based on the new mother’s needs.
Suggested contacts are weekly for the first 4 weeks, every second week up to 3 months.
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Research ToolsResearch ToolsPrenatal demographic questionnaire and
breastfeeding intentionLabour and postpartum questionnaire at
1 weekInfant feeding questionnaire 4, 8 and 12
weeksLevel of breastfeeding (Labbok and
Krasovec)Peer support logsMaternal satisfaction questionnairePeer satisfaction questionnaire
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Outcomes Outcomes Frequency, duration and types of
support provided Infant feeding practices at birth and
monthly intervals up to three monthsMaternal satisfaction with
acceptability , benefits, barriers and recommendations.
Peers’ evaluation of benefits, barriers, and recommendations for the program
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Community PartnershipsCommunity PartnershipsConsultation for program
development and host site for peer training and prenatal sessions - Anishnawbe Mushkiki Community Health Centre.
Recruitment of peer volunteers and participants. Recruitment of prenatal aboriginal women with due date up to January 15, 2011.
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Potential ContributionsPotential ContributionsAdvance the body of knowledge
regarding the reliability and validity of the BSES-SF
Identify important variables predictive of early breastfeeding discontinuation
Contribute to our understanding of the breastfeeding support needs of Aboriginal women
Present valuable information regarding breastfeeding outcomes among Aboriginal women in NWO to inform future research
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DisseminationDisseminationFall 2011ReportConferencesPublications