Development and Validation of a Breastfeeding Health Literacy Scale (BFHLS) for Taiwanese Pregnant Women.

BACKGROUND: Breastfeeding is the best source of nutrition for infants. Health literacy is a critical factor affecting breastfeeding rates. RESEARCH AIMS: The aim of this research was to develop and test the Breastfeeding Health Literacy Scale to determine its validity and reliability. METHODS: This study featured a cross-sectional telephone survey design. Researchers reviewed the literature and used expert opinions to develop the content-validated 30-item Breastfeeding Health Literacy Scale covering five dimensions. We examined internal consistency, exploratory factor analysis, and confirmatory factor analysis to assess reliability and construct validity. A Taiwanese government organization provided potential participants' contact information. After mailing an invitation letter, researchers phoned all participants to invite participation, obtain oral consent and complete a Breastfeeding Health Literacy Scale and collect demographic data. RESULTS: Participants (N = 300) had a mean age of 31.8 (SD = 4.66) years. The item-level content validity index was 0.67 to 1.00 and scale-content validity index was 0.94. After performing exploratory factor analysis, three factors were extracted. Examining content factor analysis for the three factors resulted in χ2/df = 2.05; p < .001; goodness of fit index = 0.90; Comparative Fit Index (CFI) = 0.96; and Root Mean Square Error of Approximation (RMSEA) = 0.06. Cronbach's alphas on the total scale and the subscales ranged from 0.87 to 0.94. Women with multigravida, breastfeeding information from physicians and nurses, and previous breastfeeding experience had better breastfeeding health literacy. CONCLUSIONS: Psychometric analysis demonstrated that the newly developed 20-item Breastfeeding Health Literacy Scale is a valid self-assessment instrument. Improving breastfeeding health literacy during pregnancy could help enable breastfeeding success.

Exploring physical activity behavior in middle-aged Taiwanese women based on the theory of planned behavior.

The study aimed to apply the theory of planned behavior (TPB) to understand middle-aged women's behavior of physical activity (PA). We recruited 185 women between 45 and 64 years (mean: 53.2 ± 5.6) for this cross-sectional study. Participants complete demographic data and an exercise behavior questionnaire including attitudes, subjective norms, perceived behavioral control (PBC), and intention. Means, frequencies, and t-tests were used. To test TPB, we used structural equation modeling. Fit indices for this model demonstrate a good fit: chi-square and degree of freedom ratio X2/df = 2.14 (p = .34), goodness of fit =.97, comparative fit index =.99, root mean square error of approximation =.019, and Akaike information criterion = 28.14. Significant positive correlations between subjective norms and intention (ß=.18, p < .05) and between PBC and intention (ß=.48, p < .01). Women believed that close family and friends promoted their intention to perform PA. Increased PBC would positively enhance their intention. Findings showed that PBC was the strongest predictor. Enhancing women's PBC over their PA can improve their intention. Future researchers are encouraged to examine the barriers to and benefits of improving PBC so that a useful and effective intervention can be designed to promote PA.

Psychometric Properties of the Short Form of the Health Practices Questionnaire-II Chinese Version.

OBJECTIVE: To examine the psychometric properties of the Health Practice Questionnaire-II Chinese version (HPQ-II CV), a self-report instrument designed to measure the health behaviors of pregnant women. DESIGN: Cross-sectional, psychometric design. SETTING: Prenatal clinics of four hospitals in southern Taiwan. PARTICIPANTS: Two convenience samples, 368 pregnant women in Phase 1 and 289 pregnant women in Phase 2. METHODS: In Phase 1, the 34-item HPQ-II was translated into Chinese. Then, we explored the factor structure of the HPQ-II CV using exploratory factor analysis, determined the factors of the HPQ-II CV, and shortened the length of the scale. In Phase 2, we used confirmatory factor analysis to cross-validate the factor structure of the 13-item HPQ-II CV. RESULTS: In Phase 1, we used item analysis to reduce the 34-item HPQ-II CV to 21 items. Using exploratory factor analysis and parallel analysis, we shortened the 21-item HPQ-II CV to 15 items grouped in four factors: Taking Safety Measures (4 items), Eating A Healthy Diet (3 items), Coping With Uncertainty (3 items), and Seeking Help From Professionals (5 items), which accounted for 45.70% of the total variance. In Phase 2, two items were removed from the 15-item HPQ-II CV after confirmatory factor analysis. Cronbach's alpha coefficient of the 13-item HPQ-II CV was .80, and the cross-sample validity supported the best-fit model for the 13-item HPQ-II CV. CONCLUSION: We found acceptable validity and reliability statistics for the 13-item HPQ-II CV when administered to pregnant, Taiwanese women.

Breastfeeding self-efficacy and related factors in postpartum Vietnamese women.

BACKGROUND: Breastfeeding self-efficacy refers to a mother's confidence about her ability to breastfeed, which has been found to shape her choice about whether or not to do so. It depends on social and psychological factors and has not previously been studied in postpartum Vietnamese women. PURPOSE: The purpose of this study was to explore factors related to breastfeeding self-efficacy and its predictors among postpartum Vietnamese women. METHODS: This cross-sectional study was conducted on 164 postpartum women in Tu Du hospital in Vietnam from August to September 2017. The study used the Breastfeeding Self-Efficiency Scale (BSES), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Edinburgh Postnatal Depression Scale (EPDS) to explore factors affecting breastfeeding selfefficacy. Independent t-test, ANOVA, Pearson's correlation coefficient, and hierarchical linear regression were used to determine the relationship between independent variables and the dependent variable. RESULTS: Breastfeeding self-efficacy was related to mothers' age, mother's occupation, previous breastfeeding experience, mode of delivery, skin-to-skin contact with the baby, and extent of breastfeeding in the hospital. It was also positively correlated with social support and was significantly lower in women with more postpartum depression. Independent variables predicted 36.8% of breastfeeding self-efficacy in the hierarchical linear regression. CONCLUSION: Strategies to foster breastfeeding self-efficacy should focus on decreasing the incidence of postpartum depression and promoting social support for breastfeeding. Health care providers should screen for and pay close attention to signs of postpartum depression. Moreover, health care providers should offer adequate support tailored to the mother's needs and involve her social network in breastfeeding education.

[Application of Epigenetics in Perinatal Nursing Care].

Epigenetics is a field of biomedicine that expanded tremendously during the 1980s. Epigenetics is the study of heritable changes in gene expression independent of underlying DNA (DeoxyriboNucleic Acid) sequence, which not only affect this generation but will be passed to subsequent generations. Although conception is the critical moment for making decisions regarding gene mapping and fetal health, studies have shown that perinatal nursing care practices also affect the genetic remodeling processes and the subsequent health of the mother and her offspring. To optimize maternal-infant and the offspring health, it is important to ensure that the new mother get adequate nutrition, reduce stress levels, adopt gentle birth practices, facilitate exclusive breastfeeding, and avoid contacting toxic substances.

Effect of social support and donation-related concerns on ambivalence of living liver donor candidates.

Ambivalence in the decision-making process for living liver donors has the potential to result in their experiencing a negative mental status. To promote donor candidates' well-being, it is important to study the factors related to ambivalence. Thus, the aim of this study was to explore the ambivalence of living liver donor candidates and to investigate the effect of social support and donation-related concerns on their ambivalence. A cross-sectional design was used. In total, 100 living liver donor candidates who underwent a preoperative evaluation between April and October 2009 were recruited for the study. Participants completed a self-administered questionnaire that contained items related to ambivalence, donation-related concerns, and social support. The mean score for ambivalence was 3.14 (standard deviation = 1.8), and the median was 3. Only 7% of the study sample reported no ambivalence during the assessment stage. Ambivalence was positively correlated with donation-related concerns (physical concerns, r = 0.39; psychosocial concerns, r = 0.43; financial concerns, r = 0.29) and negatively correlated with social support (r = -0.16 to -0.33). Those with psychosocial concerns had significantly worse ambivalence (ß = 0.29, P = 0.03), but social support mitigated ambivalence (ß = -0.34, P = 0.01). When intimacy and social support were included in the model, the effect of psychosocial concerns on ambivalence became nonsignificant (ß = 0.24, P = 0.08). Ambivalence is common among living liver donor candidates, but instrumental social support can mediate the negative effect of donation-related concerns. Recommendations include providing appropriate social support to minimize donation-related concerns and, thus, to reduce the ambivalence of living liver candidates.

Confirmatory factor analysis of the menopausal interpretations/perceptions questionnaire.

OBJECTIVE: This study aims to develop the Menopausal Interpretations/Perceptions Questionnaire (MIPQ) using confirmatory factor analysis. METHODS: A descriptive cross-sectional design was used to examine the MIPQ. We recruited 228 women through mail-outs and word of mouth. The women were aged between 45 and 64 years (mean [SD], 55.6 [5.2] y) and were able to read and write English. Most were non-Hispanic white (63.4%), college-educated (74.2%), and postmenopausal (76.8%). We modified the Revised Illness Perception Questionnaire to reflect menopausal perception by substituting the word "menopause" or "menopausal symptoms" for the word "illness" to develop the MIPQ. RESULTS: Using confirmatory factor analysis to test the MIPQ model, we deleted 22 items that did not reflect their respective subscales (latent variable). The fit indices indicated acceptable fit (χ209 = 425.5; P = 0.000; goodness of fit = 0.96; comparative fit index = 0.93; root mean square error of approximation = 0.07; 90% CI, 0.06-0.08; Akaike information criterion = 559.5). There were significant correlations among the MIPQ constructs. Correlations between the MIPQ subscales and the Greene Climacteric Scale were significant and in the expected direction, supporting construct validity. The intercorrelations between the MIPQ subscales supported the discriminant validity of the constructs. CONCLUSIONS: The MIPQ provides a comprehensive measure of menopausal experience to more fully understand women's interpretations/perceptions of their experiences. Future researchers should further examine the construct validity of the MIPQ.

More than communication skills: experiences of communication conflict in nursing home nurses.

CONTEXT: Communication conflicts are inevitable in nursing homes. Understanding communication conflicts experienced by practising nurses could provide insights to guide the development of sound communication education programmes. OBJECTIVES: The purpose of this study was to explore the experiences of nurses in nursing homes of communication conflict in encounters with nursing home residents and their families in Taiwan. METHODS: Data were collected from April 2010 to December 2011 through audiotaped, individual, in-depth interviews with 26 nurses at five nursing homes in Taiwan. Data were analysed according to van Manen's interpretive phenomenological method. RESULTS: Data analysis revealed that nurses' experiences of communication conflicts during encounters with nursing home residents and their families could be categorised under three themes: differences in perspectives of nursing home services; differences in views of nurturing health, and mediation between family members and others. CONCLUSIONS: The findings of this study can be considered by clinical educators and policymakers when designing communication education programmes for nurses and other clinicians. These programmes should include ways to increase nurses' independent thinking in settings in which power differences exist, as well as their cultural sensitivity as embodied in Leininger's culture care theory. These programmes should also include education in telephone communication and alternative methods of communication (e.g. videoconferencing).

Technology acceptance and quality of life of the elderly in a telecare program.

As information and communication technology applied to telecare has become a trend in elder care services, evaluation of the program is vital for further program design and development. This study evaluated the variables influencing the use of a telecare service program by the elderly. A questionnaire survey was used to explore the relationship between quality of life and technology acceptance of a telecare program in Taiwan. In addition, open-ended questions were used to elicit qualitative information regarding the experience of technology use. The results revealed that elderly persons with better social welfare status and health condition, who used the device frequently, had higher quality of life and accepted technology use. The correlation results also indicated that elderly persons who perceived telecare as useful in solving health problems, had the intention to use the program, and were willing to continue use, also had a better perception toward quality of life regarding their interpersonal relationships and living environment. Nonetheless, cost may be an issue that will impede their willingness to use the technology in care service.

Confirmatory factor analysis for assessment of the Menopausal Representation Questionnaire.

OBJECTIVE: The purpose of this study was to develop the Menopausal Representation Questionnaire (MRQ) using confirmatory factor analysis. METHODS: We examined the MRQ using a descriptive cross-sectional design. We recruited 228 women aged between 45 and 64 years (mean [SD], 55.6 [5.2] y). Most of them were non-Hispanic white (63.4%), college educated (74.2%), and postmenopausal (76.8%). RESULTS: After 22 items were deleted, the fit indices of the confirmatory factor analysis of the MRQ model indicated an acceptable fit: χ = 425.5; df = 209; P < 0.0001; goodness of fit = 0.96; comparative fit index = 0.93; root mean square error of approximation = 0.07 (90% CI, 0.06-0.08); Akaike information criterion = 559.5. There were significant correlations among MRQ constructs. Correlations between MRQ subscales and the Greene Climacteric Scale were significant in the expected direction supporting construct validity. Intercorrelation between factors supported the discriminant validity of the constructs. CONCLUSIONS: The MRQ provides a comprehensive measure of menopausal experiences to more fully understand women's interpretation of their experiences.

Self-regulation of menopause.

OBJECTIVE: The purpose of this study was to test Leventhal's common sense model reflecting women's menopausal experiences. METHODS: A descriptive cross-sectional design was used to examine the common sense model. We recruited 228 women between 45 and 64 years (mean, 55.6 ± 0.35 years). Most of them were white (63.4%), college educated (74.2%), and postmenopausal (76.8%). RESULTS: After adding three regression pathways based on the common sense model and modification indices, the fit indices of the alternative model indicated acceptable fit (χ(2) = 99.69 [P < 0.0001] with df = 46, goodness of fit = 0.95, comparative fit index = 0.95, root mean square error of approximation = 0.07 [90% CI, 0.05-0.09], and Akaike information criterion = 247.69). According to the results, menopausal representation can influence how women seek and engage in health behavior as coping strategies that impact their quality of life. The findings suggested the common sense model reflecting women's menopausal experiences. CONCLUSIONS: As expected, the common sense model can help healthcare professionals understand women's menopausal representations that can provide a context for specific and individualized intervention that will have a greater efficacy with women.