Infants get vital nutrients from their mothers during breastfeeding. It improves infant maternal health. Additionally, breastfeeding has also been proven to improve mother-infant bonding. Women who breastfeed are highly likely not to develop gastrointestinal (GI) and respiratory disease, as well as allergies. Apart from reducing the incidence of various diseases, breastfeeding also improves visual acuity and cognitive development in infants. It is a cost-effective source of food for infants.
Infants who are breastfed are less likely to suffer or develop the following conditions: sudden infant death syndrome, childhood cancer, and insulin-dependent diabetes (Lumbiganon et al., 2016). It is also important to consider that the type of infant feeding a mother chooses since it determines the likelihood of becoming overweight or obese in early and late childhood. Exclusively breastfeeding a child for six months produces more advantages than exclusively breastfeeding a child for four or fewer months (Lumbiganon et al., 2016). Therefore, the advantages associated with breastfeeding are dependent on the duration of exclusive breastfeeding.
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Breastfeeding is also advantageous to mothers in various ways. For instance, a frequent and prolonged period of exclusive breastfeeding leads to a delay in the return of fertility after giving birth (Lumbiganon et al., 2016). In addition, prolonged period of exclusive breastfeeding lowers the risk of developing some diseases, such as cancer (Lumbiganon et al., 2016). It also reduced the chance of developing osteoporosis. Breastfeeding for more than a year also reduces the risk of getting type 2 diabetes (Schwarz et al., 2010). Apart from physical health, breastfeeding also affects psychological health in women, whereby women who breastfeed have better emotional health indicated by less anxiety. Lumbiganon et al. (2016) shed light on some of the benefits of breastfeeding to psychological health. Therefore, breastfeeding ensures that mothers have optimum mental and physical health required to raise a child. This paper describes a research proposal to determine the impact of increased prenatal breastfeeding education before, during and after pregnancy versus little to no breastfeeding education in African American women.
Background
Mizrak, Ozerdogan, & Colak (2017) describe several elements that determine the onset of breastfeeding among new mothers, the duration, and the decision to prolong it. Some of the factors outlined by Mizrak and his colleagues include the following: mother’s socioeconomic status, age, smoking, support resources, and education. Additionally, factors such as the mother’s attitude and beliefs towards breastfeeding, positive intentions, and hospital policies influence breastfeeding rates and duration among new mothers (Mizrak et al., 2017). Confidence in breastfeeding, otherwise referred to as “breastfeeding self-efficacy” is also one of the factors that influences breastfeeding. It is a modifiable factor that determines the duration and success of breastfeeding. For instance, mothers with high breastfeeding confidence experience no barriers to breastfeeding initiation and continuation than mothers with no breastfeeding confidence (Mizrak et al., 2017). Mothers with no breastfeeding confidence tend stop breastfeeding earlier than the recommended time.
Breastfeeding education can be used to increase self-efficacy. In addition, it can be used to eliminate the negative factors that discourage breastfeeding. Education and supportive measures should be initiated during the prenatal period. Antenatal/prenatal breastfeeding education is defined as the process of imparting breastfeeding information during pregnancy (Lumbiganon et al., 2016). Breastfeeding education and support are some of the interventions used to increase breastfeeding self-efficacy among new mothers. According to a research carried out by Mizrak et al. (2017), increasing self-efficacy increases breastfeeding success. More to this is that is facilitates longer duration of breastfeeding. With this in mind, it is vital educate women on this issue in order to increase their breastfeeding self-efficacy among mothers. This is because it influences the choice to breastfeed, how much effort a mother expends, and the presence of self-enhancing or self-defeating patterns.
Surveillance estimates in the United States (US) indicate that infants from the African American ethnicity are less likely to be breastfed compared to infants from other ethnicities. According to a study carried out by Beauregard et al. (2019), there is a 14.7% breastfeeding difference between African American and Caucasian infants. The differences were recorded for non-exclusive and exclusive breastfeeding between three and six months. According to Beauregard et al. (2019), some of the factors associated with the racial disparities in breastfeeding rates among black women were related to poverty levels, marital status, age, and level of education. The researchers add that black women disproportionately have incomes that are 100% below the poverty line. They were also more likely to receive the “Special Supplemental Nutrition Program for Women, Infants, and Children” benefits, have lower education levels, and lead single-parent homes. Beauregard and his colleagues stated that, in 2015, only 69.4% of infant from the African American ethnicity initiated breastfeeding in contrast to 85.9% of Caucasian infants. Rates of exclusive breastfeeding in black infants were lower than those of white infants at 36% and 53% respectively (Beauregard et al., 2019).
Despite the well-documented benefits associated with breastfeeding, America experiences racial disparities when it comes to breastfeeding behavior. Black infants are the most affected by the disparities since, according to Lind et al. (2014), breastfeeding initiation and duration rates are 16% lower than among whites. Women from ethnic minorities face many difficulties when it comes to accessing supportive maternity care services. The racial disparities were proven by a study performed by the “Center for Disease Prevention and Control” (CDC). The findings of the study were that facilities located in areas with many African American population were less likely to meet five out of the ten indicators for recommended practices supportive of breastfeeding than those from areas dominated by other ethnic groups (Lind et al., 2014).
In addition to the disparities in healthcare facilities described by Lind et al. (2014), Beauregard et al. (2019) described additional disproportionate barriers to breastfeeding among women from minority groups, particularly African American women. Due to the large number of households led by single mothers, black women lack peer, family, and social support, which is a critical factor in breastfeeding behaviors. They also lack knowledge about breastfeeding and have insufficient education and support from healthcare settings. Facilities in neighborhoods with a predominantly black population also have lower rates of implementation of supportive maternity care practices. These practices include assisting women initiate breastfeeding immediately after birth and refraining from feeding infants with infant formula unless prescribed due to medical issues (Beauregard et al., 2019). These practices are associated with increasing the chances women breastfeeding their babies. Additionally, black women working in low-income jobs return to work earlier than white women. They, therefore, lower breastfeeding duration and exclusivity rates enhanced by inflexible working hours. Janelle (2019) also cited the embarrassment of breastfeeding in public as a barrier.
Research Question
The research project is undertaken to determine the impact of increased prenatal breastfeeding education throughout pregnancy and after pregnancy versus little to no breastfeeding education among African American women.
Research Question : What is the impact of increased prenatal breastfeeding education throughout pregnancy and after pregnancy versus little to no breastfeeding education among African American women?
PICOT Information
| Population/patient problem | African American women. |
| Intervention | Breastfeeding education |
| Comparison | Little to no breastfeeding education |
| Outcome | Increased rate of breastfeeding along with breastfeeding self-efficacy, duration, and success. |
| Time | 12 weeks. |
Hypothesis
It was hypothesized that increased prenatal education on breastfeeding throughout the pregnancy and after the birth of the child, would increase the rate of breastfeeding among African Americans.
Study Design
Descriptive qualitative study design will be used for the study. Before the commencement of the study, study participants are expected to sign an informed consent form. The participants must submit the consent form before they participate in the study (Appendix 4).
Data Collection and Tools
Survey instruments will be used to collect data. Some of the tools that will be used include the ANC in general practice questionnaire, a questionnaire for breastfeeding mothers, and the BSES-SF.
ANC in General Practice Questionnaire
The antenatal questionnaire form was developed to determine the sociodemographic and psychosocial characteristics of women and their spouses. The questionnaire has 23 items and is divided into two parts. Part one collects data about the mother’s attitude towards the pregnancy, her social network, and well-being while part two collects data about earlier pregnancies and issues with the children’s health (Appendix 1). This instrument is not copyrighted and can be accessed on the internet for free.
Questionnaire for Breastfeeding Mothers
The questionnaire for breastfeeding mothers was used to collect data on antenatal visits, knowledge about breastfeeding advantages and practices, and delivery experiences. The questionnaire is made up of 25 items. It is divided into two sections. The first section includes questions about the mother’s experiences during pregnancy while section two includes questions about the birth and maternity period (appendix 2). This instrument is not copyrighted and can be accessed on the internet for free.
BSES-SF
The BSES was developed to measure breastfeeding self-efficacy among postpartum mothers. The instrument was designed to collect information about a mother’s confidence that their behaviors would produce certain outcomes and their capacity to accomplish specific behavior that would produce the expected result. The instrument is composed of 14 items. Each item has a “5-point Likert-type scale.” The scale ranges from 1 to 5. A score of one indicating not at all confident (1) and a score of five indicating always confident. Higher scores indicate higher levels of breastfeeding confidence while lower scores indicated lower levels. The BSES-SF is a copyrighted scale that requires prior permission to use. Permission will be obtained by contacting the copyright owner Dr. Cindy-Lee Dennis via the email address: cindylee.dennis@utoronto.ca
Expected Results
Data collected about the psychosocial characteristics of the mothers are expected to reveal that African American mothers have high rates of unplanned pregnancies, especially among young mothers. Most of the mothers are expected to be in a single-parent home with average partner involvement. Most mothers might feel that their partners are not concerned about pregnancy. Quality contact and support from family and friends could be high. Well-being levels could be varied among mothers depending on their occupation and mental health status. It is expected that women with little or no family or partner support have lower levels of well-being.
African American women are expected to have limited knowledge about breastfeeding practice due to disparities in supportive care in maternity services. They are also expected to report having a poor birth and maternity period where they are not encouraged to walk and move about during labor. Additionally, breastfeeding initiation rates are expected to be low after birth due to racial disparities in physician and nurse support. The levels of breastfeeding self-efficacy are expected to be low among women from African American ethnicity. Breastfeeding education is expected to increase breastfeeding self-efficacy. This will, in turn, increase the following: breastfeeding exclusivity, duration, and success.
Budget
| Expenses | Units | Cost per Unit ($) | Total Cost ($) |
| Travel | |||
| Car Rental Monthly |
2 |
30 |
60 |
| Fuel Costs |
25 |
1 |
25 |
|
0 |
|||
| Research Equipment |
0 |
||
| Cell Phones |
1 |
20 |
20 |
| Mobile Internet Modem |
1 |
10 |
10 |
| Portable Harddrive |
1 |
10 |
10 |
| Laptop |
1 |
50 |
50 |
| Digital Recorders |
1 |
15 |
15 |
| Printing Services |
1 |
20 |
20 |
| Research Materials | |||
| Cell Phone charges |
2 |
25 |
50 |
| Mobile Internet Services Charges |
2 |
50 |
100 |
| Particapant Incentives |
2 |
150 |
300 |
| Meeting and Interview Room Rental |
2 |
300 |
600 |
| Photocopies |
1000 |
2 |
2000 |
| Stationary |
1 |
100 |
100 |
| Publication and Dissemination | |||
| Journal Application Fees |
1 |
300 |
300 |
| Total Expenses |
3660 |
||
The funding opportunity identified for this study is provided by the National Institute of Health Resource of Grants and Funding. The application process requires registration to the site, writing the application, finding the required forms, developing an accurate budget, formatting the required attachments, and uploading reference letters.
Limitations of the Research
One of the limitations of the research is the limited research budget which determines the number of study participants involved in the study. The data collected is not representative of the population, thus affecting the generalizability of the study. African American women included in the study are selected based on their zip code areas to determine race disparities in maternal healthcare services, further affecting the generalizability of the study results. Another limitation is associated with the qualitative study design whereby generalizable cause-effect relations cannot be developed. For new mothers, data collected about their experiences could be speculative since they have not experienced childbirth, therefore, they lack experiences to compare. The study results are also likely to be biased based on the mother’s attitude about breastfeeding. Additionally, there are also time constraints in the performance of the study, which might affect the data collection procedure and volume of data collected. Time constraints might also affect the quality of data collected.
Further Research Recommendations
Treadwell (2017) reports that 81.1% of mothers want to breastfeed. For these mothers, various barriers might reduce breastfeeding duration and exclusivity rates. The study performed focused on African American women. More studies should be performed to determine the barriers to breastfeeding among various races and ethnicities. More studies should also focus on the cultural factors that might influence breastfeeding success, duration, and exclusivity. According to Johnson, Kirk, Rosenblum & Muzik (2015), institutional breastfeeding interventions focused on enhancing breastfeeding behavior should be considered for use in mothers’ workplaces.
Most of the factors considered in the study and the literature reviewed focus on how breastfeeding self-efficacy, duration, and success rates can be increased among women through education. The effects of mental health are not considered. Therefore, more research should be dedicated to assessing the impact of mental health during and after pregnancy on breastfeeding initiation and behavior. Additionally, racial, ethnic, and socioeconomic disparities in maternal mental health should be determined.
Dissemination of Information
The research team will be composed of nursing students in various areas of specialization including maternal health services, mental health, and emergency nurses. Nursing students involved in the research project will be culturally diverse to ensure the elimination of bias in data collection and analysis procedures. The completed project will be peer-reviewed by fellow nursing students. It will be uploaded on the university website. It will also be printed and bounded to be distributed to the necessary faculty members. Additionally, the project will also be submitted to the funding organization to fulfill funding requirements.
References
Beauregard, J. L., Hamner, H. C., Chen, J., Avila-Rodriguez, W., Elam-Evans, L. D., & Perrine, C. G. (2019). Racial Disparities in breastfeeding initiation and duration among US infants born in 2015. Morbidity and Mortality Weekly Report , 68 (34), 745. Retrieved July 27, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6715261/
Janelle, S. (2019). Pregnant African American Women Breastfeeding Intentions, Beliefs, Attitudes and Perspectives.
Johnson, A., Kirk, R., Rosenblum, K. L., & Muzik, M. (2015). Enhancing breastfeeding rates among African American women: A systematic review of current psychosocial interventions. Breastfeeding Medicine , 10 (1), 45-62. https://doi.org/10.1089/bfm.2014.0023
Lind, J. N., Perrine, C. G., Li, R., Scanlon, K. S., & Grummer-Strawn, L. M. (2014). Racial disparities in access to maternity care practices that support breastfeeding—United States, 2011. MMWR. Morbidity and Mortality Weekly Report , 63 (33), 725. Retrieved July 27, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5779438/
Lumbiganon, P., Martis, R., Laopaiboon, M., Festin, M. R., Ho, J. J., & Hakimi, M. (2016). Antenatal breastfeeding education for increasing breastfeeding duration. Cochrane Database of Systematic Reviews , (12). 10.1002/14651858.CD006425
Mizrak, B., Ozerdogan, N., & Colak, E. (2017). The effect of antenatal education on breastfeeding self-efficacy: Primiparous women in Turkey. International Journal of Caring Sciences , 10 (1), 503. Retrieved July 27, 2020, from https://www.internationaljournalofcaringsciences.org/docs/54_mizrak_original_10_1.pdf
Schwarz, E. B., Brown, J. S., Creasman, J. M., Stuebe, A., McClure, C. K., Van Den Eeden, S. K., & Thom, D. (2010). Lactation and maternal risk of type 2 diabetes: a population-based study. The American journal of medicine , 123 (9), 863-e1.
Treadwell, T. (2017). African American Mothers' Narratives of Breastfeeding Support from Healthcare Providers.
Tokat, M. A., Okumuş, H., & Dennis, C. L. (2010). Translation and psychometric assessment of the Breast-feeding Self-Efficacy Scale—Short Form among pregnant and postnatal women in Turkey. Midwifery , 26 (1), 101-108. https://doi.org/10.1016/j.midw.2008.04.002
Appendix
Appendix 1: Antenatal Care in General Practice (Psychosocial)
Appendix 2: Questionnaire for Breastfeeding Mothers
Appendix 3: BSES-SF
Validity=0.86 (Tokat, Okumus, & Dennis, 2010).
Appendix 4: Funding Opportunity
Appendix 4: Consent Form
CONSENT FORM
The following consent form requires you to provide consent to take part in a research study titled “The Impact of Breastfeeding Education in African American Women”. The researchers will provide detailed information about this research study as well as answer your queries. The study will be led by Shamika Belin. Dr. Deborah Hopla is the faculty advisory of this study.
Objective
The aim of the study is to determine the impact of increased breastfeeding education throughout pregnancy and after the birth of the child versus little to no breastfeeding education in African American women.
Participant Expectations
We will ask you to respond to three surveys. It is approximated that the three surveys will take half an hour. We will also ask you to undertake a breastfeeding education program designed by the project team. The study duration will last 12 weeks.
Risks and Discomforts
We may require confidential information which creates a risk for the loss of confidentiality. Emotional risks associated with the study include feeing of sadness or anxiety. No physical risks are present in the study.
Benefits
Indirect benefits enjoyed by study participants include closer bonding with infants and improved mental health. Direct benefits include increased breastfeeding self-efficacy and success. Information from this study will also help in the elimination of racial disparities in the provision of maternal healthcare services.
Compensation for Taking Part in the Study
The subjects of the study will be c in compensated and the compensation will be in the form of free meals during study activities.
Privacy and Confidentiality
To ensure that the identities of the participants are safe and secure, de-identification of participant data will be performed. Only faculty members will have access to the participants’ data. It is important to note that email communication is not private and secure. We will take the necessary measures to guard your privacy. However, it is important to note that the de-identified data collected in this study may be shared with third parties such as the funding organization. We will code any personal information. However, we cannot guarantee the anonymity of your data.
Voluntary Participation
Taking part in this research study is purely voluntary. A participant can decline to take part in this study or withdraw at any time. You are also allowed to decline to answer any questions you deem uncomfortable.
Queries
You can address any queries to Shamika Belin, the principal investigator.
Statement of Consent
I have read the information detailed above and received a satisfactory response to any queries I had. I consent to participate in the study.
Participant Signature Date
Name
Signature of Lead Investigator
Name of Lead Investigator
This consent form will be valid for three years beyond the end of the study.
