momHealth: A Feasibility Study of a Multibehavioral Health Intervention for Pregnant and Parenting Adolescent Mothers.

INTRODUCTION: In 2016, 209,809 babies were born to mothers 15 - 19 years of age, for a live birth rate of 20.3 per 1,000 in this age group. Many health issues surround adolescent mothers and their infants, many of which can be addressed through behavioral change. The main purpose of this study was to examine the feasibility, acceptability, usability, and relevance of momHealth, an innovative multiple health behavior change (MHBC) education and support mHealth intervention, focused on breastfeeding, healthy eating and active living, and depression prevention among pregnant and parenting adolescents. We also evaluated the proposed online surveys and physical outcome measures for feasibility and acceptability (burden, time, ease of use). METHODS: A one-group quasi-experimental longitudinal design was used to examine the intervention components and the breastfeeding, diet/activity, and depression outcome measures. Nine iPad-delivered education modules, text messaging, and virtual individual and group support were provided for 12 weeks, beginning at 32 weeks of pregnancy, with follow-up to three months postpartum. Data on the main behaviors and outcomes were collected at three in-home visits, one telephone call soon after birth, and ten postpartum weekly and biweekly online surveys. RESULTS: Although recruitment and attrition presented challenges, six participants enrolled in the study during prenatal clinic visits; all were pregnant with their first child, single, and had a mean age of 17.7 years (SD = 1.4). Intervention participation ranged from 59% to 91% for educational module completion, text message reading, and individual virtual support meetings and three virtual peer support groups were held. Intervention acceptability, relevance, and delivery was supported by reports of clear and relevant content, reasonable time burden, iPad ease of use, and acceptable intervention length. Data collection was reported as convenient and non-burdensome, but the diet recall method and activity monitoring challenged some. CONCLUSIONS: This was the first MHBC research in adolescent pregnant women designed to improve breastfeeding outcomes, healthy eating/active living, and depression prevention. Findings demonstrated strengths and challenges of the interventions and methods, support feasibility and acceptability of momHealth, and informed the recruitment and intervention protocols of our pilot randomized trial.

Health behavior change in pregnant women: a two-phase study.

BACKGROUND: Maternal health behaviors during pregnancy/infancy can have a significant impact on maternal and child health. Many women engage in health risk behaviors during pregnancy. Multiple health behavior change (MHBC) interventions provide support to change health behaviors, but further information is needed on potential targets for such an intervention, as well as on the feasibility of technology use and e-health with this population. MATERIALS AND METHODS: Two studies were completed as part of this project. First, a survey to examine views regarding health behaviors, desires to change health behaviors, and use of technology was completed by 68 pregnant women presenting for routine care. Based on survey findings, a brief MHBC e-health educational intervention related to breastfeeding, healthy nutrition/lifestyle, and stress management, using iPad(®) (Apple, Cupertino, CA) and text-messaging media, was then developed and piloted in the home with five pregnant women. RESULTS: In the survey, the majority of participants reported interest in receiving help to improve health behaviors, including losing weight or eating a healthier diet, breastfeeding, smoking cessation, and help with depression. The majority of women reported access to a computer with Internet, a phone, and frequent use of text messaging. In the second phase, results suggest that the home-based intervention was feasible and that the technology was convenient and user-friendly. CONCLUSIONS: Pregnant women are interested in improving health behaviors and found a brief technology-based e-health intervention feasible, convenient, and user-friendly. In-home technology appears to be a feasible and convenient approach to addressing the multiple health behavior change needs of pregnant women.

A pilot study of home-based videoconferencing for breastfeeding support.

BACKGROUND: Research on using videoconferencing for breastfeeding support is limited. PURPOSE: Although European case reports have described videoconferencing for providing lactation support, this was the first study to assess the reliability and feasibility of home videoconferencing for breastfeeding assessment and support in the United States. METHOD: The study used 4 real-time, secure videoconferencing sessions to deliver lactation support to 10 mothers in the home. To assess interrater reliability, percentage agreement was calculated on LATCH assessment scores from telehealth and home-visit International Board Certified Lactation Consultants (IBCLCs) during the first 2 visits. Participants' perceptions of satisfaction and the overall experiences were documented. RESULTS: The percentage agreement on the 5 LATCH score dimensions ranged between 40% to 100% during the first visit and 80% to 100% during the second visit. To assess feasibility, participants reported their satisfaction with the technology and their perceptions of the videoconference consultation. All participants "strongly agreed" that they were comfortable talking about breastfeeding concerns using home videoconferencing. CONCLUSION: The findings suggest videoconferencing can potentially be used to support breastfeeding mothers in their homes.

A randomized controlled trial of breastfeeding support and education for adolescent mothers.

Despite substantial evidence of maternal and infant benefits of breastfeeding, adolescent mothers initiate breastfeeding less often and maintain breastfeeding for shorter durations when compared to their adult counterparts. A randomized controlled trial drawing on the theory of planned behavior and developmental theory was conducted to determine if an education and counseling intervention provided by a lactation consultant-peer counselor team increased breastfeeding initiation and duration up to 6 months postpartum among adolescent mothers. Study participants ( N = 289) enrolled from multiple prenatal clinic and school settings, were 15 to 18 years old, and predominately African American, single, and primiparous. The intervention, which started in the second trimester of pregnancy and extended through 4 weeks postpartum, positively influenced breastfeeding duration (p < .001) within the experimental group, but not breastfeeding initiation or exclusive breastfeeding rates. This education/support intervention was partially effective in enhancing breastfeeding outcomes. Implications for research and practice are described.

Psychometric evaluation of the Employer Support for Breastfeeding Questionnaire (ESBQ).

The purpose of this descriptive methodological study was to develop and evaluate the psychometric properties of the Employer's Support for Breastfeeding Questionnaire (ESBQ). The convenience sample consisted of 380 business owners, managers, or supervisors from the Midwestern United States. Data were collected using Web and paper-based questionnaires from January to March 2008. Psychometric evaluation included item analysis, scale reliability, and construct validity. The ESBQ subscales had Cronbach's alphas ranging from 0.85 to 0.92. Most inter-item and item-to-total correlations were above the recommendation of 0.30. The test-retest reliability of each subscale ranged from 0.93 to 1.0. Confirmatory factor analysis supported the construct validity of the scale. The comparative fit index (CFI) and the non-normal fit index (NNFI) were 0.90 and 0.91, respectively, and the root mean square error of approximation (RMSEA) was 0.05. Findings supported the ESBQ as reliable, valid, and theoretically consistent with the theory of planned behavior.

Breastfeeding experiences of urban adolescent mothers.

This qualitative descriptive study examined the breastfeeding experiences of urban adolescent mothers using a combination of focus groups and semi-structured interviews. Analysis of verbatim interview text, field, and debriefing notes was undertaken to discover categories, themes and an emerging conceptual framework. Twenty-three teens, between the ages of 14 and 18, enrolled from two postpartum clinics described the process of teens' breastfeeding decision-making, initiation, continuation, and termination of breastfeeding. Roughly half of the teens were currently breastfeeding and the other half had weaned their infant within the last six months. Adolescent mothers chose breastfeeding mainly for infant health reasons, closeness and bonding. Positive and negative events; barriers and facilitators to continued breastfeeding; and types of support received during breastfeeding illuminated the experience starting in the hospital and extending over time. Among those who weaned, a combination of primary and secondary obstacles or problems, such as perceptions of insufficient milk supply, nipple/breast pain, time demands of school or work, problems with pumping, and feeling overwhelmed and frustrated led to weaning. Many who weaned did not seek out available help and ultimately many reported regret about weaning earlier than intended. Those who continued breastfeeding beyond six weeks reported significant emotional, informational and instrumental support from family, friends, school, and their babies. Implications for nursing practice and research are discussed.

Experiences of infant-feeding decision-making among urban economically disadvantaged pregnant adolescents.

AIM: The aim of this paper is to report a pilot study of influencing factors in disadvantaged urban pregnant adolescents' decision-making about infant-feeding choices. BACKGROUND: Research related to decision-making among adolescents indicates that attitudinal, social, perceived control, and commitment factors are influential in choosing and initiating breast- or bottle-feeding. However, there is a need for further description of decision-making processes in disadvantaged teenagers before intervention research is done. METHODS: Focus group interviews with the Theory of Planned Behavior guiding the questioning were used with 14 pregnant adolescents between 18 and 39 weeks of gestation and between the ages of 14 and 18 in two obstetric clinics in Midwestern USA urban teaching hospitals. The majority of adolescents were African-American and primiparae. FINDINGS: The experiences of infant-feeding decision-making among pregnant adolescents were captured by two major themes: benefits vs. barriers of breastfeeding and bottle-feeding, and independent choice vs. social influences. A common thread in these themes was ambivalence and uncertainty. The adolescents had both positive and negative attitudes toward methods, with many expressing their desire to combine breast- and bottle-feeding. Many reported the health benefits of breastfeeding, yet identified barriers of pain, public exposure, and the complexity of breastfeeding. They viewed bottle-feeding as automatic and simple, allowing freedom to leave the infant with others. Although adolescents were adamant that choice of feeding method was their independent decision, social and family influences were evident. CONCLUSIONS: Consistent with the Theory of Planned Behaviour and other research, attitudes, perceived social influences, and perceived control factors were influential to adolescents when choosing infant feeding methods. The findings suggest that adolescents need education on decision-making, and are being used to fine-tune the interventions of a randomized clinical trial to investigate promoting and supporting breastfeeding among adolescent mothers.

Blended roles: preparing the advanced practice nurse educator/clinician with a Web-based nurse educator certificate program.

Changing demographics, a nursing shortage, and various societal changes underscore the need for nurse educators and new nurse educator programs. This article describes a Web-based nurse educator program designed to prepare advanced practice nurses for faculty roles while simultaneously preparing them as clinicians. Guided by adult education theory and self-directed learning theory, the Web-based Nurse Educator Certificate (four Web-based nurse educator courses including a teaching practicum) has been developed and offered to clinical master's and postmaster's students. This article also describes student work with mentors, interactive Web-based teaching strategies, portfolios, graduate competencies, and initial evaluative data. In the first two years of the program, 48 students have taken at least one course in the Nurse Educator Certificate program and eight students have completed it. A Web-based nurse educator certificate program, as part of a clinical master's or postmaster's program, has the potential to help meet the faculty shortage.

Patient satisfaction with an early discharge home visit program.

In 1995, to meet the needs of mothers and newborns discharged early, a home care follow-up program using an advanced practice nurse was initiated at a Midwest academic medical center. Information about the program and elements of patient satisfaction, as measured from program inception, are presented in this article. The major correlates of satisfaction were nurse friendliness, technical skills, infant care teaching, and individualized care. Attending to these areas can facilitate existing program improvement and new program development.

Lactation mastitis: a descriptive study of the experience.

This descriptive study of 31 women diagnosed with lactation mastitis in the midwestern United States investigated mastitis symptomatology, self-care and treatment, burden of mastitis, and symptom recurrence and complications. Data collected via telephone interviews soon after diagnosis and daily through the seventh day after symptom onset documented that symptom intensity was moderate, peaked on the second day, and lasted on average 3 to 4 days. Symptoms had greater impact on activities of daily living than on breastfeeding. Sources of advice for self-care included lactation consultants, nurses, nurse practitioners, physicians, family, and friends. Continued breastfeeding was the most frequently used of several self-care practices and was rated as highly effective. Follow-up at 2 and 6 weeks established mastitis recurrence as the most common complication. Breastfeeding women need specific information about mastitis causes, symptoms, and self-care strategies to help prevent and treat the condition.