Best Start Northern Best Start Northern Conference Conference

October 18, 2010 October 18, 2010 Research Study “Improving

Breastfeeding Outcomes Among Aboriginal Women”

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

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).

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

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

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).

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)

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

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).

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

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)

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

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

Research QuestionsResearch Questions

1. What is the reliability and validity of the BSES-SF in-hospital and 4 weeks postpartum among Aboriginal women?

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?

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

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

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)

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

OutcomesOutcomesInfant feeding methodLevel of breastfeedingBreastfeeding self-efficacy

Results to dateResults to dateTo be described at the

conference

Naadmaage Kwe (Women Helping Naadmaage Kwe (Women Helping Women)Women)

Breastfeeding Peer Support for Aboriginal Breastfeeding Peer Support for Aboriginal WomenWomen

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?

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.

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)

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.

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

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.

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

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

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.

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

DisseminationDisseminationFall 2011ReportConferencesPublications