Transformative elements of intercultural education for Japanese nursing students.

There has been little research exploring Japanese nursing students' experiences of having Western instructors in their nursing programs. The purpose of the present study was to describe Japanese nursing students' lived experiences of being taught by foreign faculty. A qualitative design using an interpretive phenomenology approach was used with purposeful sampling. Graduate and undergraduate nursing students (n = 13), who had the experience of being taught by a foreign faculty member for at least one semester, were recruited. Six themes emerged that suggested the participants went through an evolutionary process as they worked to understand and make meaning of these intercultural experiences: struggling with uncertainty, working to understand, discovering differences in teaching styles, opening my eyes to the world, thinking differently now, and wanting to know more. The work students must do to understand foreign teachers influences what they are able to learn, and must be taken into consideration by both faculty and students. To fully realize meaningful teaching outcomes within this intercultural context, it is essential that students have sustained exposure to foreign faculty.

Effect of a hospital policy of not accepting free infant formula on in-hospital formula supplementation rates and breast-feeding duration.

OBJECTIVE: To investigate the effect of public hospitals in Hong Kong not accepting free infant formula from manufacturers on in-hospital formula supplementation rates and breast-feeding duration. DESIGN: Prospective cohort study. SETTING: In-patient postnatal units of four public hospitals in Hong Kong. SUBJECTS: Two cohorts of breast-feeding mother-infant pairs (n 2560). Cohort 1 (n 1320) was recruited before implementation of the policy to stop accepting free infant formula and cohort 2 (n 1240) was recruited after policy implementation. Participants were followed prospectively for 12 months or until they stopped breast-feeding. RESULTS: The mean number of formula supplements given to infants in the first 24 h was 2·70 (sd 3·11) in cohort 1 and 1·17 (sd 1·94) in cohort 2 (P<0·001). The proportion of infants who were exclusively breast-fed during the hospital stay increased from 17·7 % in cohort 1 to 41·3 % in cohort 2 (P<0·001) and the risk of breast-feeding cessation was significantly lower in cohort 2 (hazard ratio=0·81; 95 % CI 0·73, 0·90). Participants who non-exclusively breast-fed during the hospital stay had a significantly higher risk of stopping any or exclusive breast-feeding. Higher levels of formula supplementation also increased the risk of breast-feeding cessation in a dose-response pattern. CONCLUSIONS: After implementation of a hospital policy to pay market price for infant formula, rates of in-hospital formula supplementation were reduced and the rates of in-hospital exclusive breast-feeding and breast-feeding duration increased.

Barriers to Physical Activity Among African American Women: An Integrative Review of the Literature.

A key aspect for researchers to consider when developing culturally appropriate physical activity (PA) interventions for African American (AA) women are the specific barriers AA women face that limit their participation in PA. Identification and critical examination of these barriers is the first step in developing comprehensive culturally relevant approaches to promote PA and help resolve PA-related health disparities in this underserved population. We conducted a systematic integrative literature review to identify barriers to PA among AA women. Five electronic databases were searched, and forty-two studies (twenty-seven qualitative, fourteen quantitative, one mixed method) published since 1990 (range 1998-2013) in English language journals met inclusion criteria for review. Barriers were classified as intrapersonal, interpersonal, or environment/community according to their respective level of influence within our social ecological framework. Intrapersonal barriers included lack of time, knowledge, and motivation; physical appearance concerns; health concerns; monetary cost of exercise facilities; and tiredness/fatigue. Interpersonal barriers included family/caregiving responsibilities; lack of social support; and lack of a PA partner. Environmental barriers included safety concerns; lack of facilities; weather concerns; lack of sidewalks; and lack of physically active AA role models. Results provide key leverage points for researchers to consider when developing culturally relevant PA interventions for AA women.

The Birth and Development of the Lactation Consultant Profession (1980-2007): An Interview With Chele Marmet (Part II).

The remarkable world-changing growth of International Board Certified Lactation Consultants (globally over 35,000 IBCLCs in 2023), as the internationally recognized lactation professional since Chele Marmet conceptualized the field in 1977, demonstrates its importance for society and breastfeeding dyads. The early 1980s was a seminal time in the development of lactation care as a allied health field with specialized knowledge, study, and certification. Chele Marmet played a significant role as an innovator and activist during all these major changes. In this interview, she details these historic events, which she is elaborating further in her upcoming memoir.Although the terms LC and lactation professional have commonly been used to refer to those working clinically with breastfeeding families, in this article both terms refer only to the International Board Certified Lactation Consultant (IBCLC). JHL has a policy not to use the term LC (Dodgson, 2016, 2020); our rationale is that this term is currently too vague and is often misused by those with less education and experience than IBCLCs. However, we have used LC in this article at times when referring to lactation professionals prior to the development of the international board examination. This article is the second part of the interview; Part I was published in the previous JHL issue (February 2014). This interview has been transcribed with minor editing for ease of reading. (CM = Chele Marmet, JD = Joan Dodgson).

The Conception and Birth of the Lactation Consultant Profession (1977-1983): An Interview With Chele Marmet (Part I).

In 2015, Miriam Labbok, MD, MPH, entrusted Chele Marmet with the task of writing a chapter on the early history of the lactation consultant profession for the public health textbook she was preparing about lactation, saying, "I invited you to author it because you conceptualized and pioneered the profession, and there is nobody else I could ask who could do it justice," (M. Labbok, personal communication, June 28, 2015). Chele Marmet envisioned the allied health field of lactation consulting, complete with international educational standards, professional organizations, and a scope of practice. She was an active contributing founder of the International Lactation Consultant Association, developed hundreds of test questions for the early International Board of Lactation Consultant Examiners (IBCLE), and co-founded the first academic (BA and MA) lactation education program, The Lactation Institute, to name only a few of her many innovations and contributions to the field of lactation we know today-a field that has grown exponentially globally since those early days in the 1970s when Chele began creating our profession. Her academic background in speech and hearing gave her the orientation to delve into infants' oral-motor function. Additional education and experience followed as her passion for helping breastfeeding families grew. This is the first part of her interview; the second part will follow in the next JHL issue. Fortunately, Chele is working on her memoir, which will detail topics we could only briefly discuss in this interview. It was my honor to interview Chele Marmet.Joan E. Dodgson.

Impact of baby-friendly hospital practices on breastfeeding in Hong Kong.

BACKGROUND: The World Health Organization (WHO) developed the Baby-Friendly Hospital Initiative to improve hospital maternity care practices that support breastfeeding. In Hong Kong, although no hospitals have yet received the Baby-Friendly status, efforts have been made to improve breastfeeding support. The aim of this study was to examine the impact of Baby-Friendly hospital practices on breastfeeding duration. METHODS: A sample of 1,242 breastfeeding mother-infant pairs was recruited from four public hospitals in Hong Kong and followed up prospectively for up to 12 months. The primary outcome variable was defined as breastfeeding for 8 weeks or less. Predictor variables included six Baby-Friendly practices: breastfeeding initiation within 1 hour of birth, exclusive breastfeeding while in hospital, rooming-in, breastfeeding on demand, no pacifiers or artificial nipples, and information on breastfeeding support groups provided on discharge. RESULTS: Only 46.6 percent of women breastfed for more than 8 weeks, and only 4.8 percent of mothers experienced all six Baby-Friendly practices. After controlling for all other Baby-Friendly practices and possible confounding variables, exclusive breastfeeding while in hospital was protective against early breastfeeding cessation (OR: 0.61; 95% CI: 0.42-0.88). Compared with mothers who experienced all six Baby-Friendly practices, those who experienced one or fewer Baby-Friendly practices were almost three times more likely to discontinue breastfeeding (OR: 3.13; 95% CI: 1.41-6.95). CONCLUSIONS: Greater exposure to Baby-Friendly practices would substantially increase new mothers' chances of breastfeeding beyond 8 weeks postpartum. To further improve maternity care practices in hospitals, institutional and administrative support are required to ensure all mothers receive adequate breastfeeding support in accordance with WHO guidelines.

An Intergenerational Exploration of Breastfeeding Journeys Through the Lens of African American Mothers and Grandmothers.

BACKGROUND: Many individuals comprise a nursing mother's social support network. Grandmothers within African American families, historically, have played a vital role in the transmission of culture. Understanding intergenerational perspectives within African American families related to infant feeding and scholarship about breastfeeding is critical, given the breastfeeding patterns among African American women. RESEARCH AIM: To describe intergenerational perspectives within African American families, where the mother has successfully breastfed. METHODS: A prospective, cross-sectional, qualitative design using semi-structured interviews was used. African American nursing mothers and maternal grandmothers (N = 14) residing in the Metro-St. Louis area, who reflected economic and educational diversity, were recruited. Inductive and iterative data analysis, framed by Black Feminist Theory allowed for emerging patterns reflecting the participants' voices. RESULTS: Three of the six (50%) grandmother participants had breastfed. The majority of the mother participants were married (n = 5; 62.5%) and had a college degree (n = 4; 50.0%) or a high school diploma (n = 1; 12.5%); and four (50.0%) had received the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Three patterns emerged: (a) intergenerational connections; (b) changes in breastfeeding experiences over time; and (c) going with the flow (referring to the choice to work within the constraints of one's circumstances). Grandmothers supported mothers' breastfeeding decisions; grandmothers who had breastfed benefited from the updated information the mothers provided; and grandmothers who did not breastfeed acquired new breastfeeding knowledge, which informed the ways they supported the mothers. CONCLUSION: The intergenerational perspectives surrounding breastfeeding within African American families participating in this study offer future research directions.

Breastfeeding and weaning practices among Hong Kong mothers: a prospective study.

BACKGROUND: Breastfeeding provides optimal and complete nutrition for newborn babies. Although new mothers in Hong Kong are increasingly choosing to breastfeed their babies, rates of exclusive breastfeeding are low and duration remains short. The purpose of this study was to describe the breastfeeding and weaning practices of Hong Kong mothers over the infant's first year of life to determine the factors associated with early cessation. METHODS: A cohort of 1417 mother-infant pairs was recruited from the obstetric units of four public hospitals in Hong Kong in the immediate post-partum period and followed prospectively for 12 months or until weaned. We used descriptive statistics to describe breastfeeding and weaning practices and multiple logistic regression to investigate the relationship between maternal characteristics and breastfeeding cessation. RESULTS: At 1 month, 3 months, 6 months and 12 months only 63%, 37.3%, 26.9%, and 12.5% of the infants respectively, were still receiving any breast milk; approximately one-half of breastfeeding mothers were exclusively breastfeeding. Younger mothers, those with a longer duration of residence in Hong Kong, and those returning to work postpartum were more likely to wean before 1 month. Mothers with higher education, previous breastfeeding experience, who were breastfed themselves and those who were planning to exclusively breastfeed and whose husbands preferred breastfeeding were more likely to continue breastfeeding beyond 1 month. The introduction of infant formula before 1 month and returning to work postpartum were predictive of weaning before 3 months. CONCLUSIONS: Breastfeeding promotion programs have been successful in achieving high rates of breastfeeding initiation but the focus must now shift to helping new mothers exclusively breastfeed and sustain breastfeeding for longer.

New mothers' experiences of social disruption and isolation during the severe acute respiratory syndrome outbreak in Hong Kong.

In Hong Kong during the severe acute respiratory syndrome outbreak of 2003, sustained uncertainty caused daily stress for residents for > 3 months. Expectant women experienced unexpected social disruption and isolation within their day-to-day life that have not been described in their own voice. The purpose of this study was to describe the experiences of women who became mothers during the outbreak and the ways in which these experiences impacted their early post-partum mothering. A phenomenological research design was chosen. The participants' responses then led the interview process. As the women's experiences had many similarities, saturation was reached after eight interviews. Four themes emerged: living with uncertainty, intense vigilance, isolation, and disrupted expectations. The participants spoke of disrupted daily routines as they tried to eliminate their risk of contracting this disease, including relationship difficulties with their spouse. None of the women had the birth experience they had hoped for because of changes in hospital practices.

Reflexivity in Qualitative Research.

All qualitative research is contextual; it occurs within a specific time and place between two or more people. If a researcher clearly describes the contextual intersecting relationships between the participants and themselves (reflexivity), it not only increases the creditability of the findings but also deepens our understanding of the work. The issues surrounding the researchers' reflexivity are many and complex; however, journal space for discussing them may be very limited. Therefore the researcher has the responsibility of succinctly and clearly addressing these issues, so the reader can evaluate the research. Some of the ways that researchers can address reflexivity are discussed.

Growth and Change in the Journal of Human Lactation: A Content Analysis 1985-2018.

BACKGROUND: A professional association journal should reflect the needs of its organization, its readers, and the field it represents. Evaluating the needs that the Journal of Human Lactation has met, and those it has not, is essential if it is to remain relevant to its readers. AIMS: (1) Describe the characteristics of articles published from 1985 through 2018. (2) Describe content intended to educate lactation support providers and clinicians. (3) Explore the ways the content has illustrated the growth and development of lactation knowledge, and (4) identify the reoccurring content threads consistent throughout the 34 years. METHODS: A prospective mixed methods approach incorporating a quantitative content analysis and a qualitative thematic analysis was used. Frequency distributions were done on all the variables extracted from published articles (N = 1586). The second level of analysis identified themes using an iterative and consensus approach. RESULTS: Mirroring the growth in the lactation field, the volume of research articles published each year has increased along with the percent of research articles per issue. Research methods have become more diverse. The international scope and relevance, while always present, has been steadily increasing. Threads identified were; striving for international scope, advancing lactation education, developing a body of knowledge that informs clinical practice in lactation, and creating a centralized place for multidisciplinary research about lactation. CONCLUSION: The body of work published in the Journal of Human Lactation parallels the development of the lactation specialty. We have highlighted areas for improvement and possible further study.

An analysis of infant feeding content found within the Hong Kong print media.

Worldwide public media greatly affect women's decisions about infant feeding and may not reflect evidence-based practices. The aims of this research were to (1) describe the characteristics of printed articles having infant-feeding content, (2) describe this thematic content, and (3) compare the thematic content found in groupings based on media type and language (English and Chinese). Four Chinese-language newspapers, the English-language newspaper, and 3 bilingual parenting magazines were analyzed. A multiphase qualitative and quantitative content analysis found 5 themes (social context, mothers' information, effects on baby, the value of breast milk, and the utility of formula). Significant differences were found based on media type and language. Although breastfeeding was usually positively framed in all the media, Chinese media had more inaccurate information. Through this analysis, areas where actions could be taken to improve the quality of information about infant feeding received by the public have been identified.

A curricular approach to improve the information literacy and academic writing skills of part-time post-registration nursing students in Hong Kong.

In today's environment of rapidly changing health care and information technology, nurses require a broad range of skills. One of the key skills required of all health professionals in this environment is information literacy. For registered nurses returning to a university setting to study for their baccalaureate degree, becoming information literate is one of many challenges they face. Also key to students' ability to use and communicate information in an appropriate and effective manner is their writing skills. This article describes a curricular intervention designed to develop and strengthen post-registration nurses' information literacy and academic writing competencies. An introductory information management module was developed and provided to three successive cohorts of students (n=159). Students were predominantly female (85.4%) with a mean age of 34.2 years (SD=6.8). Prior to commencing the program, students reported low information literacy and writing skills, especially in accessing and searching electronic databases and using referencing formats. The post-test evaluation of skills showed substantial and statistically significant increases in all assessed competencies. This intervention demonstrated that with structured but flexible learning activities early in the curriculum, post-registration nursing students can quickly become information literate.

Knowledge, attitudes, exposure, and future intentions of Hong Kong university students toward infant feeding.

OBJECTIVE: To explore relationships between university students' infant feeding knowledge, attitudes, breastfeeding exposures, and future infant feeding intentions. DESIGN: Descriptive cross-sectional survey. SETTING: This study was conducted at a large publicly funded university in Hong Kong. Student enrollment in the university is approximately 15,000. PARTICIPANTS: Four hundred three male and female Chinese university students. Participants were young (94.4% less than 25 years of age), undergraduate students (92.2%), unmarried (99.2%), and without children (100%). RESULTS: Sixty-three percent of participants wanted their future child to be breastfed. Infant feeding knowledge scores ranged from 28.6% to 100%, with a mean of 71.1% (SD= 13.3), indicating overall high knowledge levels. Participants who intended to breastfeed were more likely to have positive attitudes, to have been breastfed themselves, or to know someone who had breastfed. CONCLUSIONS: The results provide information to health care providers on the planning of effective breastfeeding promotion programs. Findings from this study suggest that promoting breastfeeding solely to childbearing couples is unlikely to result in significant improvements in either breastfeeding initiation or duration. Future infant feeding campaigns should be directed at the societal level to change negative attitudes and to increase acceptance of breastfeeding as a normal and natural feeding method.

Outcomes of a breastfeeding educational intervention for baccalaureate nursing students.

Educational institutions have the responsibility to provide students with knowledge and practical experiences of best practices and international standards of care. Worldwide, international standards for appropriate and effective breastfeeding promotion and services often have not been met. The aim of this study was to determine the effectiveness of an infant feeding educational intervention on student nurses' knowledge levels about (1) evidence-based breastfeeding promotion, (2) evidence-based beliefs about outcomes of breastfeeding and formula-feeding, (3) evidence-based attitudes toward breastfeeding and formula-feeding, and (4) intention to perform evidence-based breastfeeding promotion behaviors. A quasi-experimental intervention with a non-equivalent control group was conducted at a major university in Hong Kong. The intervention group (n=111) received 10h of didactic instruction and an 8-week perinatal clinical rotation while the control group (n=162) did not. The intervention group was significantly more likely to associate breastfeeding with positive maternal and child outcomes. Attitudes toward breastfeeding and formula-feeding were not significantly affected by the educational intervention. On the 19-item knowledge survey, the control group (M=6.84; SD=2.95) scored significantly lower than the intervention group (M=10.30; SD=2.51). A public health breastfeeding promotion strategy frequently overlooked is professional-level curricular interventions. Improving evidence-based practices in nursing programs has the potential to impact many breastfeeding families in the hospital and the community.