Objective: The objective of this study was to determine whether primiparas who received a Breastfeeding Promotion Nursing Intervention (BPNI) would have higher scores on a composite measure of breastfeeding success, as compared to those in the control condition. This study considered that breastfeeding represents a health behavior that has the potential to positively impact both mother and infant in promoting health and wellness and preventing disease.
Design: This was a quasiexperimental, prospective study preassigning subjects by childbirth class and alternating class assignment to the experimental or control condition, extending prenatally to six weeks postpartum. One of the contributions of the current study is to operationalize the concept of breastfeeding self-efficacy based on Bandura's (1986) theoretical framework of self-efficacy. Therefore, scores on a breastfeeding self-efficacy scale were used to measure participants' levels of self-efficacy (confidence). This allowed better identification and more accurate measurement of confidence, and it provided theoretical grounding for the intervention.
Population, Sample, Setting, Years: The population targeted was healthy women who intended to breastfeed. Subjects volunteered according to eligibility criteria including: primiparous status, age 18 to 45, read and spoke English, experienced a normal prenatal course, intended to breastfeed, and had a home telephone. Of the 63 participants recruited, 50 were included in the final analysis. The setting where participants were recruited was childbirth classrooms of two rural hospitals in the northeastern United States. The dates of the study were 1994-1996.
Interventions and Outcome Variables: The intervention included a one-hour prenatal class, focusing on breastfeeding or infant care (experimental or control group, respectively) and professional follow-up and support through visitation and telephone contact. The intervention was designed to provide consistent, structured information at predictable points in time, a caring attitude, technique demonstration, and practice of the mechanics of breastfeeding. The outcome variable included the breastfeeding success score, a composite measure of postnatal breastfeeding self-efficacy, the number of days breastfed, and satisfaction with breastfeeding.
Methods: Subjects for the study were recruited at childbirth classes. The principal investigator alone recruited and carried out the prenatal class in both experimental and control groups in both institutions. Postpartally, the principal investigator and a research assistant carried out the interventions separately, one at each institution, with 25 participants each. The intervention was meant to encompass the multidimensionality of breastfeeding, and provide information to all four principal sources involved in an efficacy judgment. Women and their partners in the experimental group were given specific, consistent information on breastfeeding, including a book and hand-outs; they observed the technique as demonstrated with a doll (Lactessa) and model breast by the researcher and on video; they practiced breastfeeding with the models (doll and breast) physically and mentally rehearsed with a guided visualization exercise. The control group, in contrast, did not receive written material or specific information about breastfeeding. Instead, this group was given a class that discussed life at home with a new baby. This class met once and the total intervention took about 45 minutes, similar to the experimental condition. Both groups were supported until 6 weeks postpartum through a visit (in the hospital or at home) and telephone calls. Telephone contact was continued regardless of whether subjects continued to breastfeed or not. The interventions to enhance self-efficacy were continued with the experimental group over the telephone.
Findings: An analysis of variance demonstrated significantly higher scores (F[1,48]=4.63, p < .05) on the composite measure in experimental versus control group subjects. The research hypothesis was accepted at the P < .05 level of significance.
Conclusions: The intervention made a significant difference in the breastfeeding success of a sample of highly educated, middle class, primiparous women who had intended to breastfeed. Replication of the study with a more heterogeneous sample is recommended.
Implications: The findings advance theory by providing empirical support for the effect of an efficacy-enhancing intervention on the outcome of breastfeeding success. Some of the benefits of the intervention tested in this study were: specific problems were addressed early on; the mother received feedback on her breastfeeding and support in reading her infant's cues; and, most importantly, the mother had access to someone who was knowledgeable about breastfeeding. Finally, the self-efficacy tool is useful to target areas of decreased confidence in the prenatal and postpartum mother, having implications for nursing care.
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