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- Creators: Arizona State University
Description
Late preterm infants (LPIs), born between 34 and 37 weeks gestation, are at risk for a myriad of health conditions related to neuro-muscular and physiologic immaturity. However, relative stability allow many of these infants to avoid care in specialty nurseries and discharge home with their mothers after birth. Due to underlying immaturity, feeding difficulty is the most common issue LPIs experience, resulting in early breastfeeding cessation, increased risk for secondary diagnoses, and hospital readmission. The purpose of this study was to assess early breastfeeding behavior of LPIs, including testing inter-rater reliability of an assessment tool and the feeding patterns of infants over time. An extensive review of breastfeeding assessment tools resulted in the selection of the Premature Infant Breastfeeding Behavior Scale (PIBBS) based on its reliability and validity in the preterm infant population. A convenience sample of LPI dyads was recruited and used to conduct inter-rater reliability testing of PIBBS. A longitudinal one-group non-experimental study was used for observational follow-up. A strong statistical agreement of PIBBS scores occurred between mothers and a healthcare professional (Cohen’s kappa values of items ranged from .776 to 1.000, p = <.001). Participants continued using the PIBBS tool after hospital discharge until their infants expected due dates (40 weeks adjusted age). T-test analyses were conducted to examine changes in scores over time indicating increase in item scores (p = .003 - .193). PIBBS appears to be a valid and reliable tool to assess breastfeeding among LPI dyads. Incorporation of PIBBS into a comprehensive plan of care could better support and protect breastfeeding among the LPI population.
ContributorsLober, Angela (Author) / Komnenich, Pauline (Thesis advisor) / Kelly, Lesly (Thesis advisor) / Dodgson, Joan (Committee member) / Arizona State University (Publisher)
Created2018
Description
Scientific evidence strongly indicates that there are significant health benefits of breastfeeding. Lower breastfeeding initiation, duration, and exclusivity rates are found in vulnerable populations particularly among women of low socioeconomic status, and racial minorities such as immigrant, racial, and minority cultural groups. Breastfeeding disparities can contribute to negative health outcomes for the mothers, and their infants, and families.
Muslim Arab immigrants are a fast-growing, under-studied, and underserved minority population in the United States. Little is known about breastfeeding practices and challenges facing this vulnerable population. Immigrant Muslim Arab mothers encounter breastfeeding challenges related to religion, language, different cultural beliefs, levels of acculturation, difficulties understanding health care information, and navigating the health care system.
A cross-sectional descriptive study was used to describe infant feeding practices, and identify contributors and barriers to adequate breastfeeding using the social ecological model of health promotion. A convenience sample of 116 immigrant Muslim Arab women with at least one child, 5 years or younger was recruited from a large metropolitan area in the Southwestern United States. The results indicated that immigrant Muslim Arab mothers demonstrate high breastfeeding initiation rates (99.2%), and lengthy breastfeeding duration (M=11.86), but low rates of exclusive breastfeeding at 6 months (21.6%). Facilitators to breastfeeding within the sample were high intentions to breastfeed, positive breastfeeding knowledge and beliefs related to the benefits of breastfeeding, religious teachings promoting breastfeeding, and encouragement to breastfeed from the mothers’ social support system. Several barriers to successful breastfeeding were related to lacking the specific knowledge of the benefits of breastfeeding, and discomfort with breastfeeding in public, and in front of strangers. High income and religious teachings encouraging breastfeeding were significantly associated with exclusive breastfeeding at six months. Greater maternal age and comfort with breastfeeding in public were associated with longer breastfeeding durations.
The socio-cultural context for support of breastfeeding is an important consideration by healthcare providers caring for Muslim Arab women. An ecological perspective needs to be applied to interventions targeting breastfeeding promotion to facilitate effectiveness in this population. Culturally tailored intervention to the specific breastfeeding concerns and needs of Muslim immigrant women could promote optimal breastfeeding in this population.
Muslim Arab immigrants are a fast-growing, under-studied, and underserved minority population in the United States. Little is known about breastfeeding practices and challenges facing this vulnerable population. Immigrant Muslim Arab mothers encounter breastfeeding challenges related to religion, language, different cultural beliefs, levels of acculturation, difficulties understanding health care information, and navigating the health care system.
A cross-sectional descriptive study was used to describe infant feeding practices, and identify contributors and barriers to adequate breastfeeding using the social ecological model of health promotion. A convenience sample of 116 immigrant Muslim Arab women with at least one child, 5 years or younger was recruited from a large metropolitan area in the Southwestern United States. The results indicated that immigrant Muslim Arab mothers demonstrate high breastfeeding initiation rates (99.2%), and lengthy breastfeeding duration (M=11.86), but low rates of exclusive breastfeeding at 6 months (21.6%). Facilitators to breastfeeding within the sample were high intentions to breastfeed, positive breastfeeding knowledge and beliefs related to the benefits of breastfeeding, religious teachings promoting breastfeeding, and encouragement to breastfeed from the mothers’ social support system. Several barriers to successful breastfeeding were related to lacking the specific knowledge of the benefits of breastfeeding, and discomfort with breastfeeding in public, and in front of strangers. High income and religious teachings encouraging breastfeeding were significantly associated with exclusive breastfeeding at six months. Greater maternal age and comfort with breastfeeding in public were associated with longer breastfeeding durations.
The socio-cultural context for support of breastfeeding is an important consideration by healthcare providers caring for Muslim Arab women. An ecological perspective needs to be applied to interventions targeting breastfeeding promotion to facilitate effectiveness in this population. Culturally tailored intervention to the specific breastfeeding concerns and needs of Muslim immigrant women could promote optimal breastfeeding in this population.
ContributorsKhasawneh, Wafa (Author) / Komnenich, Pauline (Thesis advisor) / Petrov, Megan (Committee member) / Reifsnider, Elizabeth G. (Committee member) / Ahmed, Azza (Committee member) / Arizona State University (Publisher)
Created2017
Description
Exclusivity and duration of breastfeeding and the provision of human milk in the United States is suboptimal. In the absence of adequate banked donor human milk for distribution to all infants in need, many families choose to engage in the practice of Private Arrangement Milk Sharing (PAMS), partially facilitated through social media, to procure human milk for their infants. Evidence regarding the participant and infant characteristics and risk abatement practices is incomplete. This dissertation describes and explores the characteristics of recipient participants and infants, family constellation, donor screening practices, and related risk abatement strategies. Data was collected via on-line survey as a sub-group of a larger data set including donor participants and international participants. Binary logistic regression modeling of factors that contribute to consistent screening and risk abatement practices and important antecedents to engaging in PAMS was conducted. Results are contextualized within a tailored socioecological framework of factors affecting infant feeding practices. Tailoring was accomplished via qualitative descriptive analysis of participant responses applied to an existing breastfeeding framework. Participants in this sample were predominantly white, married, with a mean age of 32.9 years, with at least some college education and above median income. Risk abatement and screening practices were influenced by support of a healthcare provider during decision-making, college education, infant age and health status, having lactation support, birth type and birth attendant, and the duration and sources sought for learning about milk sharing.
ContributorsBond, Angela Bowen (Author) / Reifsnider, Elizabeth G. (Thesis advisor) / Keller, Colleen (Committee member) / Todd, Michael (Committee member) / Arizona State University (Publisher)
Created2016
Description
Breastfeeding is considered the optimal source of nutrition for infants because of the protection it offers against many adverse maternal and child health consequences. The greatest health benefits are associated with exclusive breastfeeding, but employees must often return to work before establishing a full milk supply. Although federal and California law mandate space and time provisions for workplace lactation accommodation, women employed in manual labor jobs, including agricultural field work, face challenges to expressing (pumping) their breast milk. Mexican-descent women, who represent more than a quarter of the California farmworker population, are particularly at risk for supplementing their breastfed infants with formula. Using a socio-ecological model (SEMBA) to guide the research process, this qualitative case study examined the experiences of five Mexican immigrant women who expressed their milk in the California agricultural workplace. The investigator conducted semi-structured interviews to explore how each level of SEMBA influenced their decision to initiate and then continue pumping in the field. Sociodemographic questionnaires were also completed for each participant. Qualitative content analysis led to the discovery of three themes: Honoring Culture, Running the Gauntlet, and Blazing a Trail. Enabling factors for milk expression in the workplace were found at all levels of SEMBA, except for the work environment. At the individual level, self-efficacy, strengthened by social support (interpersonal), was a major contributor to continuance of milk expression. Significant challenges were found at the interpersonal (coworker) and work environment levels, represented by the theme of Running the Gauntlet. Social support at the interpersonal level was provided by family members, child care providers, and WIC breastfeeding peer counselors and buffered the hardships of the workplace. Community level enablers included cultural values, reflected by the theme of Honoring Culture. Trusting in the (lactation) law at the systems level was mentioned by all study participants as a facilitator for workplace milk expression within the theme of Blazing a Trail. Improved understanding of the factors that enable or challenge success at milk expression on the job may lead to appropriate interventions that support optimal breastfeeding, especially among employees in agriculture or other manual labor jobs.
ContributorsVaughan, Janet Copeland (Author) / Reifsnider, Elizabeth (Thesis advisor) / Evans, Bronwynne C (Committee member) / Williams, Deborah L (Committee member) / Arizona State University (Publisher)
Created2023
Description
Immigrants and their U.S.-born children account for 26% of the American population as of 2020. Despite this large proportion, 14% of immigrants live below the federal poverty line compared to 12% of U.S.-born citizens. The immigrant population is vulnerable to food and housing insecurity and limited access to social services and medical care, on top of navigating the increasingly convoluted immigration system. Migrant women and children are especially at risk for systemic, poverty-related adversities. Periods of pregnancy and postpartum are particularly financially straining due to employment disruptions and additional expenses. Migrant mothers experience adverse health outcomes due to chronic stress, unstable living situations, integration barriers, and an unfavorable occupational environment during pregnancy. In addition to the postpartum needs of a new mother and her baby, these challenges may be barriers to maintaining breastfeeding. The unanticipated COVID-19 pandemic exasperated many existing systemic inequities and brought additional hardship. This study aims to investigate breastfeeding rates among immigrant mothers compared to U.S.-born mothers and other social disparities that affect health. While this study did not find a statistical difference between breastfeeding adherence and immigrant status during the COVID-19 pandemic, other risk factors relating to maternal-child health were identified. Immigrant families were more likely to experience job or income loss and a higher frequency of food insecurity compared to families with U.S.-born parents. The risks of being impoverished greatly reduce the incidence of breastfeeding, which can offer tremendous health benefits both to mother and baby. Most immigrants migrating to the U.S. are ethnic minorities who face additional societal disparities in culture, employment, economic stability, safety, and healthcare. The burden of social determinants of health that impact this population is not unique to adults. The moment a child is born into an immigrant family, particularly if they are also an ethnic minority, they inherit risk factors that can impact their entire lifespan. Ultimately, the risks associated with pregnancy and infant feeding are issues of social justice and health equity.
ContributorsFahmy, Gabriella (Author) / Whisner, Corrie (Thesis advisor) / Schuster, Roseanne (Thesis advisor) / Mayol-Kreiser, Sandra (Committee member) / Arizona State University (Publisher)
Created2023
Description
Despite the widely recognized health benefits of breastfeeding and its endorsement by leading health organizations, as a preventative public health intervention, inadequate breastfeeding knowledge and lactation management skills among healthcare providers continues to be a major barrier for women who choose to initiate breastfeeding. Breastfeeding competencies are not standardized in healthcare education for any of the health professions. To address this gap, a few continuing education and professional development programs have been implemented, but paucity in research regarding the efficacy of these programs exists. The purpose of this study was to explore the changes in healthcare providers’ learning outcomes related to breastfeeding support and promotion.
A non-experimental pre-posttest self-report survey design was used to assess the feasibility and preliminary efficacy of an online breastfeeding educational intervention for healthcare providers. The Theory of Planned Behavior (TPB) provided the framework for exploring the participants’ psychological and behavioral outcomes. The research questions were: (1) What is the feasibility of an online breastfeeding course for healthcare providers? (2) What are healthcare providers’ psychological and behavioral changes occurring after completion of an online course? (3) How do the post-intervention psychological and behavioral outcomes of the online format compare with those of the previous format (hybrid) of this breastfeeding course?
Although participants’ favorably assessed the feasibility (i.e., acceptability) of the 45-hour course, several factors contributed to participants’ satisfaction level: Previous online learning experience, connectedness with others, and the degree of structural support. Significant positive changes occurring in participants were increases in their knowledge and beliefs about breastfeeding; attitudes toward formula feeding; perceived behavioral control; perceptions about being able to perform breastfeeding supportive behaviors; and intentions to perform actions that are consistent with evidence-based breastfeeding supportive behaviors. Significant changes in the beliefs about formula feeding were not in the expected direction raising conceptual and pedagogical issues. Participants had negative perceptions about being able to implement what they learned in their workplaces or to affect policy. Findings support the use of online breastfeeding education programs for healthcare providers; changes at both individual and institutional levels are necessary to change provider practices.
A non-experimental pre-posttest self-report survey design was used to assess the feasibility and preliminary efficacy of an online breastfeeding educational intervention for healthcare providers. The Theory of Planned Behavior (TPB) provided the framework for exploring the participants’ psychological and behavioral outcomes. The research questions were: (1) What is the feasibility of an online breastfeeding course for healthcare providers? (2) What are healthcare providers’ psychological and behavioral changes occurring after completion of an online course? (3) How do the post-intervention psychological and behavioral outcomes of the online format compare with those of the previous format (hybrid) of this breastfeeding course?
Although participants’ favorably assessed the feasibility (i.e., acceptability) of the 45-hour course, several factors contributed to participants’ satisfaction level: Previous online learning experience, connectedness with others, and the degree of structural support. Significant positive changes occurring in participants were increases in their knowledge and beliefs about breastfeeding; attitudes toward formula feeding; perceived behavioral control; perceptions about being able to perform breastfeeding supportive behaviors; and intentions to perform actions that are consistent with evidence-based breastfeeding supportive behaviors. Significant changes in the beliefs about formula feeding were not in the expected direction raising conceptual and pedagogical issues. Participants had negative perceptions about being able to implement what they learned in their workplaces or to affect policy. Findings support the use of online breastfeeding education programs for healthcare providers; changes at both individual and institutional levels are necessary to change provider practices.
ContributorsWatkins, Amanda L (Author) / Dodgson, Joan E (Thesis advisor) / Reifsnider, Elizabeth G. (Committee member) / McClain, Darya (Committee member) / Arizona State University (Publisher)
Created2015
Associations Between Rapid Infant Weight Gain, Infant Feeding Practice and the Infant Gut Microbiome
Description
Background: Rapid infant weight gain (RWG) by six months of age has been identified as one of the earliest indicators of childhood obesity. Previous research suggests that exclusive breastfeeding over formula feeding may serve a protective effect from RWG. In addition, the makeup of the infant gut microbiome may influence RWG as differences in feeding practices have been shown to alter the bacterial makeup of the gut, potentially impacting energy metabolism. However, little research has been conducted investigating the potential relationships between RWG, infant feeding practices, and the infant gut microbiome.Methods: This study was a pilot study, which included 31 mother-infant dyads who were primarily recruited from Women, Infant, and Children’s Supplemental Nutrition Program (WIC) clinics and by word of mouth in the Southwestern United States. Participants were followed over six months, with study staff conducting home study visits four times (pregnancy, two days postpartum, three weeks and six months). Mothers who participated in this study were majority White (n=40.6%), non-Hispanic or Latino (67.7%), and obtained a graduate degree (n=22.6%). Participants were included in this analysis (n=22) if they provided at least two infant fecal samples, and the study staff were able to collect infant anthropometric data at the three-week and six-month study visits. Microbial DNA from fecal samples was sequenced using the Illumina MiSeq instrument after polymerase chain reaction (PCR) amplification was performed on the V4 region of the 16S rRNA gene sequence. Statistical analysis was performed using the QIIME2 longitudinal plug-in.
Results: Results of this study suggested a significant difference in weighted UniFrac between infants who were exclusively breastfed and formula-fed from birth to three weeks of age. Additionally, an exploratory statistical method identified family Prevotellaceae as a potentially volatile microbe; however, this model failed to reach significance for either RWG or mode of feeding. Overall, no additional alpha or beta diversity metrics or differential abundance of microbes by either RWG or feeding practice group was found in this study.
Conclusion: Future research is warranted to further explore potential connections between RWG, infant feeding practices, and the infant gut microbiome in a longitudinal study with a larger sample size.
ContributorsToffoli, Samantha (Author) / Whisner, Corrie (Thesis advisor) / Bruening, Meg (Committee member) / Sears, Dorothy (Committee member) / Arizona State University (Publisher)
Created2021
Description
The health benefits of breastfeeding are well documented and exclusive breastfeeding for at least the first six months of life is the target of national and global health care organizations. Although initial breastfeeding is on the rise, the percentage of infants still breastfeeding at six months drops significantly. In the population of newly delivered mothers of an obstetric practice, there is no readily accessible breastfeeding support offered following hospital discharge. A review of relevant literature revealed that lack of support is often cited as a key factor in the discontinuation of breastfeeding, whereas the evidence shows that participation in peer support has a positive effect on breastfeeding self-efficacy, which can have a positive effect on breastfeeding duration.
To address this problem, the initiation of a breastfeeding closed social network Facebook group for this practice setting population was developed and implemented to provide readily accessible peer support and have a positive effect on the outcome of breastfeeding self-efficacy. Three months after initiation of the Facebook group, an anonymous voluntary survey was offered to group members, and 25 members participated in the survey. Responses demonstrated that peer support is helpful with breastfeeding confidence and that, following participation in the group, the respondents wanted to continue breastfeeding.
ContributorsStorto, Pamela (Author) / Mangold, Kara (Thesis advisor)
Created2018-05-03