Feasibility of Ottawa Decision Support Tool to Assist HIV Positive Mothers With Infant Feeding Choice

Purpose:

HIV positive women face a difficult choice when having to decide which feeding mode to use for their new babies. Breastmilk is the ideal infant feed and cultural acceptable. However, the HIV virus can be transmitted through breast milk although the risk is minimal when the women use antiretroviral therapy and breastfeed exclusively. The risk of mother-to-child transmission can be avoided when using a breast milk substitute but there is a risk that it can not be used safely. The WHO (2010) guidelines acknowledge both methods. Decision support tools have been used to assist patients with their decision making regarding use of hormone replacement therapy and termination of pregnancy. This study explored and described the feasibility of the Ottawa Decision Support Tool (ODST) (Légaré et al., 2006) to assist HIV positive women in their choice of infant feeding mode.

Methods:

An explorative, decriptive qualitative design was used. After optaining ethics approval, permission from the relevant authorities and informed consent, midwives providing ante-natal care to HIV positive women and who received in-service training in the use of the ODST, participated in 3 focus group interviews.  Data was analysed using the framework approach according to Smith and Frirth (2011).

Results:

The following themes emerged from the data-analysis and was supported by verbatim quotations:

Theme 1: Appropriateness

1.1 Capacity building of midwives

1.2 User-friendliness

1.3 Time saving

1.4 Comprehensiveness

Theme 2: Receptiveness of professional intervention

2.1 Rapport building between midwife and client

2.2 Support and empowerment

Theme 3: Effectiveness

3.1 Values and beliefs consideration

3.2 Confidentiality maintenance

3.3 Improved adherence and responsibility

3.4 Easy decision-making

Conclusion:

The overall conclusion was that the ODST is feasible to assist HIV positive mothers’ infant feeding choice. Some of the recommendations from the study are that the ODST must be incorporated in the prevention of mother to child transmission guidelines and that it should be introduced during midwifery training.