Medical and Nursing Students' Perceptions of and Advice for Extended Breastfeeding: An Exploratory Study.

Although the health benefits to both mother and child produced by breastfeeding have been documented, and numerous efforts have been made to promote breastfeeding rates in the United States, extended breastfeeding (breastfeeding beyond 12 months) research has been largely overlooked. Guided by the Framework of Integrative Normative Influences on Stigma, this study examined how extended breastfeeding was perceived among medical and nursing students and how perceptions of extended breastfeeding were translated into stigmatizing outcomes including attitudes, behavioral predispositions, and behavioral intention to encourage weaning. One hundred and sixteen medical and nursing students enrolled at a large mid-western University completed an online survey. Participants were asked to provide answers to questions regarding their knowledge of extended breastfeeding, attitudes toward it, perception about stigma associated with breastfeeding, and their behavioral intention to encourage future patients to wean. A lack of knowledge about extended breastfeeding was evident among the medical and nursing students; they also exhibited increasingly negative attitudes toward extended breastfeeding as the child's age increased. Medical and nursing students' behavioral intention to encourage weaning is associated with their pre-dispositional stigma of extended breastfeeding. Addressing stigma and negative attitudes toward extended breastfeeding in pre-healthcare students' curriculum may help future healthcare providers understand that while cultural norms in the United States do not tend toward extended breastfeeding, it is more common in other parts of the world, as well as help them understand health benefits to the child and to the mother.

Too Old to Be Breastfed? Examination of Pre-Healthcare Professionals' Beliefs About, and Emotional and Behavioral Responses toward Extended Breastfeeding.

While breastfeeding seems to be widely accepted in the United States, extended breastfeeding (defined as breastfeeding beyond 12 months of age) tends to be stigmatized. Healthcare professionals are assumed to play a significant role in supporting women who desire to practice extended breastfeeding; however, how healthcare professionals react to extended breastfeeding has not been well understood. This research surveyed 116 healthcare students, who majored in nursing and human medicine, and examined their perceived advantages and disadvantages, emotional responses to, and advice that they would provide to future mothers regarding extended breastfeeding. The results indicated that students responded predominantly with negative emotions and neutral responses to extended breastfeeding, with a small number of participants responding with positive emotions. Many participants believed that it would bring benefits to the child and that it would be burdensome to the mother. Participants displayed a variety of behavioral responses when asked about advice that they would provide to future mothers with whom they will interact in a clinical setting. Practical implications are discussed.

Media Presentation of Breastfeeding Beliefs in Newspapers.

Despite numerous health benefits for babies and mothers, many women do not either initiate or continue breastfeeding for the recommended duration, and increasing breastfeeding is a national priority. It is important to understand media messages on the topic, given that breastfeeding is influenced by many environmental factors and that perceived norms, social support, and perceptions of difficulties predict breastfeeding. The current study analyzes how media covers (1) breastfeeding in general, (2) public breastfeeding, and (3) extended breastfeeding (past 1 year). Guided by the theory of planned behavior, this study analyzes 318 news articles sampled from 10 of the most commonly read mainstream newspapers from 2008-2013. This sample covers a wide range of topics related to breastfeeding, including health benefits, societal reform efforts, social/human interest stories, parenting choices, and stories about pumped breast milk and formula. The results indicate approving social norms by public health officials and medical professionals about breastfeeding in general. A significantly larger number of articles discussed positive behavioral beliefs associated with breastfeeding rather than negative behavioral beliefs. However, articles more often presented barriers, rather than factors that facilitate breastfeeding. Theoretical and practical implications are discussed.

Risk Belief and Attitude Formation From Translated Scientific Messages About PFOA, an Environmental Risk Associated With Breast Cancer.

Evidence regarding possible environmental causes of breast cancer is advancing. Often, however, the public is not informed about these advances in a manner that is easily understandable. This research translates findings from biologists into messages at two literacy levels about perfluorooctanoic acid (PFOA), a possible environmental contributor to breast cancer. The Heuristic Systematic Model (HSM) was used to investigate how ability, motivation, and systematic and heuristic processing lead to risk beliefs and, ultimately, to negative attitudes for individuals receiving translated scientific messages about PFOA. Participants (N = 1,389) came from the Dr. Susan Love Research Foundation's Army of Women. Findings indicated that ability, in the form of translated messages, predicted systematic processing, operationalized as knowledge gain, which was negatively associated with formation of risk beliefs that led to negative attitudes toward PFOA. Heuristic processing cues, operationalized as perceived message quality and source credibility, were positively associated with risk beliefs, which predicted negative attitudes about PFOA. Overall, more knowledge and lower literacy messages led to lower perceived risk, while greater involvement and ratings of heuristic cues led to greater risk perceptions. This is an example of a research, translation, and dissemination team effort in which biologists created knowledge, communication scholars translated and tested messages, and advocates were participants and those who disseminated messages.

An Effort to Increase Organ Donor Registration Through Intergroup Competition and Electronic Word of Mouth.

The effort to increase Web organ donation registrations in Michigan by enhancing 2 types of university campaigns with social media strategies informed by social identity theory is the focus of this research. The two campaigns focused on either ingroup or rivalry outgroup social identification, and each was enhanced with individually focused social media in the first year of the campaign and with electronic word of mouth in Year 2 of the campaign. Results indicated that individually focused social media such as Facebook ads worked well in rivalry campaigns (in which registrations increased two times over baseline) but not in ingroup identification campaigns (in which registrations decreased significantly over baseline when ads were introduced in the first year of each type of campaign). Electronic word-of-mouth strategies worked well in both ingroup identification campaigns (in which registrations increased two times over baseline) and rivalry campaigns (in which registrations rose almost eight times over baseline, when strategies were introduced in the second year of each type of campaign).

Scientific Message Translation and the Heuristic Systematic Model: Insights for Designing Educational Messages About Progesterone and Breast Cancer Risks.

Results of ongoing scientific research on environmental determinants of breast cancer are not typically presented to the public in ways they can easily understand and use to take preventive actions. In this study, results of scientific studies on progesterone exposure as a risk factor for breast cancer were translated into high and low literacy level messages. Using the heuristic systematic model, this study examined how ability, motivation, and message processing (heuristic and systematic) influenced perceptions of risk beliefs and negative attitudes about progesterone exposure among women who read the translated scientific messages. Among the 1254 participants, those given the higher literacy level message had greater perceptions of risk about progesterone. Heuristic message cues of source credibility and perceived message quality, as well as motivation, also predicted risk beliefs. Finally, risk beliefs were a strong predictor of negative attitudes about exposure to progesterone. The results can help improve health education message design in terms of practitioners having better knowledge of message features that are the most persuasive to the target audiences on this topic.

Comparison of communication and personal characteristics of living kidney donors and a matched quota sample.

Deceased organ donation does not meet the need for kidney transplants. Thus, it is important to examine topics relevant to kidney donors such as communication leading to the donation decision and donor characteristics. This study reports personal characteristics and communication leading to the decision to donate among living kidney donors and a demographically matched quota sample. Donors had higher scores for compassion, while non-donors reported more volunteerism. Donors and non-donors did not differ in conversation or conformity orientations of family communication styles. Only 4.7% of donors reported being asked to donate directly. Matched respondents reported feeling more comfortable than unsettled with the idea of being asked directly and indicated a preference to learn of the need directly or indirectly, giving them the option to volunteer. The majority of donors were giving to family members and friends, and the matched sample indicated greater willingness to donate to immediate family members, followed by friends. Practical implications of the findings are offered.

The effects of heuristic cues, motivation, and ability on systematic processing of information about breast cancer environmental factors.

The heuristic systematic model is used to investigate how ability, motivation, and heuristic message cues predict knowledge scores for individuals receiving messages written for different literacy levels about 3 environmental risk factors for breast cancer. The 3 risk factors were the roles of genetics, progesterone, and ingesting perfluorooctanoic acid in breast cancer risk. In this study, more than 4,000 women participated in an online survey. The results showed support for the hypotheses that ability (measured as education, number of science courses, and confidence in scientific ability) predict knowledge gain and that those individuals who presented with the lower literacy level message had significantly higher knowledge scores across all 3 message topics. There was little support for motivation or heuristic cues as direct predictors of knowledge gain across the 3 message topics, although they served as moderators for the perfluorooctanoic acid topic. The authors provide implications for health communication practitioners.

Help a buddy take a knee: creating persuasive messages for military service members to encourage others to seek mental health help.

Helping service members returning from the wars in Iraq and Afghanistan who need mental health help is an important problem for the United States military. Tanielian and Jaycox (2008) estimated that approximately 14%, or 300,000, of the service members returning from the wars have posttraumatic stress disorder (PTSD), yet just over half of those needing psychological help seek it despite the availability of effective treatments. This article reports the focus group responses of military personnel about message factors associated with persuading individuals to encourage others to seek mental health help. The results have theoretical and practical implications for future message design for promoting increased usage of mental health services among members of this population. Responses are presented in terms of the communication variables of source, message, channel, and receiver factors.

Living kidney donor decision making and communication.

There is high demand for kidney donors in the United States, and it is widely accepted that living donation is optimal for individuals who need a kidney. Much research has focused on the potential recipient, but little has been studied about the communication and decision making of living kidney donors. Interviews assessed the communication and decision-making processes of 43 kidney donor volunteers. Almost all of the participants were not asked, but instead volunteered, to donate. The majority of donors reported having conversations with the recipient and speaking about their decisions with other individuals in their social networks besides the recipient. Some participants said that they stopped talking to others because of negative feedback. Future research should further examine the communication of donors with non-recipient others and potential methods of training recipients and donors to communicate effectively about the donation process.

Made to Feel Like Less of a Woman: The Experience of Stigma for Mothers Who Do Not Breastfeed.

Background: Breastfeeding has become the recognized standard for good parenting, with social costs for not breastfeeding, but not every mother wants to or is able to breastfeed. Objectives: This study investigated social and personal costs with no breastfeeding. Materials and Methods: An in-depth survey was conducted with 250 mothers with infants who were not breastfeeding. Situated in the Framework Integrating Normative Influences on Stigma model for stigma, the study analyzed internalized stigma and perception of stigma from others, maternal feelings of warmth for the infant, and hiding formula use. Results: Mothers who chose not to breastfeed reported little personal or public stigma. In comparison, mothers who were unable to breastfeed experienced relatively more internalized stigma and perceived that other people saw them as failures. Mothers who experienced more internalized and perceived social network stigma were likely to hide use of infant formula from others and had lower feelings of warmth for their infants. Knowledge about formula use and availability of support resulted in less stigma and more warmth for the infant. Conclusions: These results suggest that public responses causing a mother to feel guilty for using infant formula result in negative feelings of self-worth and dysfunctional maternal behaviors.

Hearing loss and quality of life.

OBJECTIVE: We sought to identify multidimensional factors associated with health-related quality of life (HRQoL) for use in developing an inventory in which HRQoL is a core concept in evaluating the impact of hearing loss and the efficacy of rehabilitative interventions. METHOD: A qualitative approach was used in which we posed two major questions to a focus group consisting of eight adults with self-reported, bilateral sensorineural hearing loss of varying degrees. In essence, those questions were: (1) How do you define quality of life?, and (2) Can you describe specific incidents in your everyday life in which your hearing loss has impacted your quality of life? The discussion was embedded within a framework that utilized a modification of the Critical Incident Technique (CIT). We used well-established analytic techniques to translate the data into unitized thought units, which we coded into meaningful categories. Response frequency was used to determine the salience of responses in addressing the research questions. RESULTS: Participants defined QoL in terms of a number of primary dimensions, most of which were directly or indirectly associated with specific recalled incidents in which those dimensions have played a notable role in contributing to their QoL. CONCLUSIONS: The use of well-established methods to gather and analyze qualitative data generated by self-report techniques offers a promising direction for developing a standardized inventory for identifying the factors that impact QoL for persons with hearing loss and for evaluating the success of intervention strategies aimed at improving their HRQoL.

Doctors' and nurses' explanations for racial disparities in medical treatment.

Racial inequality in medical treatment is a problem whose sources are not fully understood. To gain better insight into how race may affect treatment, semi-structured interviews were conducted with 26 doctors and nurses. Using an open coding scheme, the explanations of racial inequality in treatment were coded by two people. Four major categories of responses emerged to explain why Black patients are less likely to receive the same levels of medical care as Whites: access to care, physician bias, Black patients' perceived shortcomings, and White patients' demands. Interviewees commonly cited access and patient factors before naming physician bias. The majority questioned the validity of studies reporting disparities. Educational campaigns should emphasize evidence that racial disparities persist even after controlling for factors such as insurance and patient characteristics. Educational programs should also address subconscious racial bias and how it may operate in a clinical setting.