Evaluating motivational interviewing to promote breastfeeding by rural Mexican-American mothers: the challenge of attrition.

Although most Hispanic/Latino-American mothers initiate breastfeeding, duration and exclusivity of breastfeeding remain low. We explored whether a motivational interviewing (MI) intervention could help rural Mexican-American mothers continue breastfeeding. We used a two-group (MI intervention n = 26, attention control [AC] n = 27) repeated measures experimental design. Assessments and interventions occurred at 3 days, 2 weeks, and 6 weeks postpartum (time points when mothers are particularly vulnerable to discontinuing breastfeeding), with a final phone assessment at 6 months postpartum. We collected demographic data and measured intent to breastfeed for 6 months (intent question), self-efficacy (Breastfeeding Self-Efficacy Scale-Short Form), and collected breastfeeding information (breastfeeding assessment questionnaire). Independent t-tests and Mann Whitney U non-parametric tests were used to evaluate group differences (α = 0.05). High levels of attrition by week 6 impaired our ability to evaluate the potential of our MI intervention. No significant differences were found between groups for any of the outcome variables (intent to breastfeed for 6 months, breastfeeding self-efficacy, and duration of breastfeeding). Though the mothers intended to breastfeed for 6 months and were confident in their ability to do so, most did not breastfeed for 6 months. At 6 months, mothers receiving the MI intervention had breastfed an average of 90 days compared to 82 days for those receiving the AC sessions and 22% of the mothers in each group were still breastfeeding at some level. Because of the impact of attrition during this study, we discuss factors that contributed to attrition and approaches to lessen this problem in future studies. Such efforts may require a greater investment of time and resources and should be budgeted accordingly. Culturally appropriate interventions are needed to help rural Mexican-American mothers meet their breastfeeding goals, thus providing an opportunity to reduce their children's risk of multiple diseases and obesity. Only when we address these considerations will we have an opportunity to decrease health disparities, promote healthy behaviors, and be trusted health care partners.

Testing protocols: care of biological samples in a rural setting.

The purpose of this study is to evaluate collection, transport, and storage protocols of urine and air allergen samples from infants in a rural setting. Infant urine and aeroallergen samples (n = 21) are collected in the home setting in rural areas where time and distance to the central laboratory is a consideration. Urine samples are analyzed using ELISA tests after being transported using three different techniques: (a) ambient temperature, (b) dry ice, and (c) packaged on dry ice and shipped commercially. Following initial ELISA testing for levels of cytokines, urine samples are frozen at -70 degrees Celsius for 6 months. Samples are then reanalyzed for levels of cytokines. Dust samples are analyzed for levels of aeroallergens, stored at 4 degrees for 6 months, and reanalyzed. The integrity of samples varies by biomarker, shipment temperature, and storage time, creating a high degree of variability in results.

Negotiating three worlds: academia, nursing science, and tribal communities.

PURPOSE: The purpose of this article is to use a cross-cultural model to guide the exploration of common issues and the dynamic interrelationships surrounding entrée to tribal communities as experienced by four nursing research teams. METHOD: Members of four research teams discuss the primary lessons learned about successful strategies and challenges encountered during their projects' early stages. RESULTS: Understanding the cultural values of relationship and reciprocity is critical to the success of research projects conducted in Native American communities. DISCUSSION: Conducting cross-cultural research involves complex negotiations among members of three entities: academia, nursing science, and tribal communities. The lessons learned in these four research projects may be instructive to investigators who have the opportunity to conduct research with tribal communities.

Influence of intention and self-efficacy levels on duration of breastfeeding for midwest rural mothers.

OBJECTIVES: The purpose of this study was to explore the relationship of two modifiable factors (intention to breastfeed for 6 months and breastfeeding self-efficacy) with the duration of breastfeeding in primiparous women. FINDINGS: Analyzed by logistic regression in a single prediction model, stronger intention (odds ratio = 1.89) and higher levels of self-efficacy at 2 weeks postpartum (odds ratio = 1.04) were significantly (p < .05) associated with an increased probability of breastfeeding for 6 months. CONCLUSIONS: The combined influence of higher intention and self-efficacy increased the likelihood of breastfeeding for the recommended 6 months. Interventions to reinforce both should be designed and evaluated.

Motivational interviewing to promote sustained breastfeeding.

OBJECTIVE: To explore the feasibility of using motivational interviewing to promote sustained breastfeeding by increasing a mother's intent to breastfeed for 6 months and increasing her breastfeeding self-efficacy. DESIGN: A longitudinal experimental two-group design with repeated measures was selected to explore the feasibility of using motivational interviewing to promote sustained breastfeeding in primiparous mothers. SETTING: Three Western rural community hospital sites. PARTICIPANTS: Convenience sample of 73 primiparous breastfeeding mothers ranging between the ages of 19 and 38, M = 25 (SD = 4.5). MAIN OUTCOME MEASURE: Mothers reported the date of their last day of breastfeeding, defined as any breastfeeding during the previous 24-hour period. Breastfeeding behavior was confirmed at each visit by infant test weights. RESULTS: The motivational interviewing group (M = 98.1 days, SD = 75.2) breastfed longer than the comparison group (M= 80.7 days, SD = 71.9); however, this difference was not significant, t(69) = 0.991, p = .325, Cohen's d = 0.24, related to the variability in the sample. CONCLUSIONS: Although not a statistically significant difference, the mean number of days that mothers in the intervention group breastfed was 98 days compared to the mean of 81 days by the comparison group; therefore, motivational interviewing may be useful as a strategy to test in a comprehensive intervention plan.

Early consumption of human milk oligosaccharides is inversely related to subsequent risk of respiratory and enteric disease in infants.

A pilot study tested the relationship between human milk oligosaccharide consumption, oligosaccharide content of feces, and subsequent disease in breastfed infants. Forty-nine (49) mother-infant pairs provided milk and fecal samples 2 weeks postpartum; infant health was assessed through 2, 6, 12, and 24 weeks. LNF-II (lacto-N-fucopentaose II), a major human milk oligosaccharide, was measured to represent levels of total oligosaccharides consumed in milk and remaining in feces. LNF-II levels in milk at 2 weeks postpartum were associated with fewer infant respiratory problems by 6 weeks (p = 0.010), as were LNF-II levels in infant feces (p = 0.003). LNF-II levels in milk at 2 weeks were also associated with fewer respiratory problems by 12 weeks (p = 0.038), and fewer enteric problems by 6 weeks (p = 0.004) and 12 weeks (p = 0.045). Thus, consumption of human milk oligosaccharides through breastfeeding, represented by LNF-II, was associated with less reported respiratory and gastrointestinal illness in infants.

Use of interdisciplinary simulation to understand perceptions of team members' roles.

The aim of this study was to examine the effectiveness of an interdisciplinary approach to learning in helping care providers understand their overlapping roles in the clinical management of asthma. In addition, the perceived usefulness of an interdisciplinary approach for students in the health-care disciplines of nursing, medicine, pharmacy, and respiratory therapy to learn about the clinical management of asthma was explored. The diffusion of innovation framework was used to guide the process of development of CD-ROMs. An interpretative approach was selected for this research because of the emphasis on how a phenomenon is perceived and how meaning is constructed in situations. This approach assumes that multiple ways of interpreting experiences are available through interaction. A convenience sample of health-care practitioners from two rural campuses was selected to participate in this study. The cohort of participants represented students from the population of a large midwestern moderate-sized university that has four geographically distinct campuses. Preliminary results indicate that the use of interdisciplinary learning helps clarify the roles of each discipline and that learning from one another is enhanced.

Students' perspective of the effectiveness of an asynchronous on-line seminar.

This study was conducted to understand students' perceptions of the usefulness of on-line discussion for a nursing seminar. The interpretative approach was selected to explore the students' perceptions of the effectiveness of the on-line discussion. The participants were recruited from maternity nursing courses on two rural campuses in Nebraska. A convenience sample of 31 participated in the study with a purposive sample of 10 representing extreme views selected for in-depth interviews. Eight patterns emerged as a plausible interpretation of the on-line experience. These patterns were exemplified by the themes of engagement theory (relate, create, and donate). The pattern that was identified as relational was learner-to-learner learning without face-to-face communication. However, isolation was found to inhibit relating. Creating, the second theme, was exemplified by multiperspective opinions, however, frustration with the technology and anxiety/information overload inhibited the creative aspects. Finally, the third theme, donate, was represented by having time for critical thinking/reflection while participating in the on-line discussions. The findings of this research support the need for more studies to explore students' perception of the usefulness of on-line discussion.

Rural elementary school teachers' intent to manage children with asthma symptoms.

A study of 212 rural elementary school teachers sought to determine the relationships among the variables of their general knowledge about asthma, attitude toward asthma, self-efficacy in helping children with asthma manage their asthma, and social support for initial management of children's asthma with the teachers' intent to manage children who present with signs and symptoms of asthma in the classroom. The situational variables of number of years teaching experience, number of children with asthma that teachers have had in their classroom during their teaching profession, and whether or not the teacher had asthma or knew of someone with asthma also were explored in relation to intent to manage asthma. Results indicate that although teachers had a favorable attitude toward asthma and were tolerant of students with asthma, their knowledge about asthma was low. Because asthma can be life-threatening, it is essential to assist those involved in monitoring and managing children with asthma to provide timely, appropriate care. In this way, the goal of having a child with asthma live as normal a life as possible, including all school activities, can be realized.