Assessing the Knowledge and Attitudes of Breastfeeding During the COVID-19 Pandemic.

Background It is generally accepted that breastfeeding is a practice that provides valuable health benefits to both mother and baby. However, the COVID-19 pandemic unveiled questions regarding the safety of breastfeeding, leading to potential hesitation among the public. Our study seeks to appreciate the public's understanding and attitudes toward breastfeeding during the COVID-19 pandemic. Methods An anonymous survey was distributed online through social media platforms. Demographic information was collected with questions specifically analyzing the knowledge and attitude of each participant. Calculations were performed using Spearman's rho correlations to determine significant differences. Results Thirty-nine women were recruited. The average overall knowledge score was 93% correct. 87% of participants believe breastfeeding is better than formula feeding, and 92% stated they would breastfeed their infant if they knew it could protect their child from COVID-19. Discussion The results of our study indicated that although overall knowledge of breastfeeding during the COVID-19 pandemic was well understood, higher levels of education may play a role in the depth of one's knowledge. In addition, while participants were reporting high levels of education about breastfeeding from their healthcare providers, few were receiving data specific to the pandemic. The data gathered from this study may help to target future educational initiatives.

Levels and Determinants of Antenatal Breastfeeding Attitudes among Pregnant Women: A Cross-Sectional Study.

Breastfeeding attitudes are strong predictors of breastfeeding behavior. Gaining a deeper understanding on the levels and determinants of antenatal breastfeeding attitudes is crucial. This cross-sectional study involved 124 pregnant women at a tertiary hospital in Hunan, China. A self-administered questionnaire, the Iowa Infant Feeding Attitude Scale, the Edinburgh Postnatal Depression Scale, the Pregnancy Stress Rating Scale, the Childbirth Attitude Questionnaire, the Perceived Social Support Scale, and the Breastfeeding Knowledge Questionnaire were assessed during their first-trimester, second-trimester, and third-trimester hospital visit. Multiple linear regression was conducted to identify the determinants of breastfeeding attitudes. The participants reported neutral (56.39 ± 5.69) levels of breastfeeding attitudes. The determinants of antenatal breastfeeding attitudes were other family members' support for exclusive breastfeeding: moderate (ß = 0.278, p < 0.05), depressive symptoms (ß = -0.191, p < 0.05), and breastfeeding knowledge (ß = 0.434, p < 0.001). The variables explained 33.9% (adjusted R2) of the total variation in breastfeeding attitudes scores (F = 4.507, p < 0.001). Namely, other family members' support for EBF was a negative influence on positive breastfeeding attitudes. The women whose other family members were moderate of EBF had more positive attitudes toward breastfeeding compared to those whose other family members were very supportive of EBF. The depressive symptoms were negatively associated with positive breastfeeding attitudes, and lower levels of depressive symptoms were associated with higher levels of positive breastfeeding attitudes among pregnant women. Additionally, breastfeeding knowledge was positively associated with positive breastfeeding attitudes. The more knowledgeable about breastfeeding, the more positive the attitude towards breastfeeding. Health professionals should identify these modifiable factors that may contribute to poorer breastfeeding attitudes, which is useful in targeting promotions of breastfeeding.

Associations between Perinatal Sleepiness and Breastfeeding Intentions and Attitudes and Infant Feeding Behaviors and Beliefs.

Breastfeeding rates fall short of public health goals, but barriers are poorly understood. We examined whether excessive sleepiness during pregnancy and the postpartum period was associated with breastfeeding intentions, attitudes, initiation, and continuation in a tobacco-exposed sample participating in a randomized controlled trial to reduce smoke exposure (n = 399). We used the Epworth Sleepiness Scale (ESS) to examine associations between excessive sleepiness in early (12-16 weeks gestation) and late (32 weeks gestation) pregnancy and at 6 months postpartum, with breastfeeding attitudes using the Mitra index, intentions, initiation, and continuation, as well as other infant feeding practices using the Infant Feeding Questionnaire. Logistic regression models adjusted for age, racial/ethnic identity, parity, marital status, and maternal education showed that excessive sleepiness in late pregnancy was associated with less favorable attitudes toward breastfeeding. In addition, in unadjusted models, excessive sleepiness at 6 months postpartum was associated with less of a tendency to use feeding to calm a fussy infant. Excessive sleepiness was not associated with intent, initiation, or continuation of breastfeeding. Assessing excessive sleepiness in late pregnancy may assist in identifying individuals with negative attitudes to breastfeeding and lead to novel approaches to promoting breastfeeding in populations with lower breastfeeding rates.

Self-Efficacy and Outcomes in Women with Diabetes: A Prospective Comparative Study.

Background: Breastfeeding is especially beneficial to women with diabetes and their infants, yet diabetic mothers frequently experience less favorable breastfeeding outcomes. Objectives: To identify facilitators and barriers to breastfeeding for women with diabetes by comparing cognitive and social factors, health and hospital-related factors, and breastfeeding outcomes between women with and without diabetes. Design/Methods: Women with any type of diabetes (n = 28) and without diabetes (n = 29) were recruited during pregnancy. Data were collected from the electronic medical record and maternal surveys at 24-37 weeks' gestation, birth hospitalization, and 4 weeks' postbirth. We compared differences in mother's regard for breastfeeding, breastfeeding intention, and birth hospital experience by diabetes status, and estimated odds ratios for exclusive breastfeeding (EBF) and unmet intention to breastfeed. Results: Women with and without diabetes had similar breastfeeding intentions, attitudes, and self-efficacy. Women with diabetes were less likely to EBF, and more likely to have unmet intentions to EBF at hospital discharge, compared to women without diabetes. At 4 weeks' postpartum, there was no difference in breastfeeding by diabetes status, although EBF at hospital discharge was strongly associated with EBF at 4 weeks. Infant neonatal intensive care unit (NICU) admission and hypoglycemia were significantly associated with diabetes status, reduced EBF rates, and unmet breastfeeding intentions. Conclusions: Despite having a strong intent to breastfeed, women with diabetes experienced less favorable early breastfeeding outcomes and were less likely to meet their own breastfeeding goals. These differences may be driven by neonatal complications, such as infant hypoglycemia and NICU admissions, rather than maternal cognitive and social factors.

Parenting styles and types: Breastfeeding attitudes in a large sample of mothers.

OBJECTIVE: The importance of breastfeeding for both maternal and infant health is well established. However, it remains the case that only a small percentage of infants are breastfed after the first six months of life. Maternal negative breastfeeding attitudes are associated with a reduced likelihood of breastfeeding an infant, but they are a malleable target for practitioner interventions. By adjusting perceptions, and therefore behaviours within the population, maternal and infant health outcomes may be improved. As such, it is important to understand whether certain types of mother might feel more negatively about breastfeeding. Here. we investigated the relationships between parenting styles, personality traits, and breastfeeding attitudes. In addition, we aimed to address the interrelated nature of parenting styles by identifying 'types' of mother who may feel more negatively about breastfeeding. DESIGN: A cross-sectional survey was used in order to measure parenting styles, personality traits, and attitudes to breastfeeding. PARTICIPANTS: A sample of 1,347 mothers (age M = 31.4 years, SD = 7.4 years) participated. Recruitment took place through online mother and baby groups based predominantly in the United Kingdom. RESULTS: More permissive and less uninvolved mothers felt positively about breastfeeding, but limited associations between personality factors and breastfeeding attitudes were found. We applied a cluster analytical approach to investigate whether there were particular 'types' of mothers in our sample, and if these showed systematic differences. Our analyses revealed two profiles, best described as 'high nurturance' (high scoring on authoritative and permissive) and 'low nurturance' (low scoring on these dimensions). These two types of mother showed significant differences along all four parenting styles, and our 'high nurturance' type was more conscientious and emotionally stable, and felt more positively about breastfeeding. CONCLUSIONS: Parenting styles were associated with breastfeeding attitudes. Through identifying an underlying nurturance dimension that best explains differences in parenting styles across mothers, we provide a potential avenue to improving breastfeeding attitudes. By focussing on 'low nurturance' mothers in particular, professionals may be able to provide interventions to improve breastfeeding attitudes and, as a result, address low rates of breastfeeding in the UK.

Understanding Black Matriarchal Role Models in the U.S. Attitudes and Beliefs About Breastfeeding.

Introduction: Despite the tremendous health benefits for both mother and infant, black women (including African Americans and those who self-identify as black) have lower rates of breastfeeding than all other racial groups. Historically, matriarchal role models have been essential within the black family structure. The purpose of this study was to explore matriarchal role models' attitudes and beliefs about breastfeeding. Methods: Thirty-eight black women between the ages of 46-82 years were surveyed regarding their perceptions of breastfeeding. Results: Our results revealed that 44.1% of the participants believed that breastfeeding is a better infant feeding method. However, 52.6% of the participants did not demonstrate confidence in their ability to breastfeed overall. Conclusions: These findings suggest that while black matriarchal role models have positive attitudes about breastfeeding behaviors, they may need to be educated along with postpartum and/or prenatal women about breastfeeding benefits and techniques to better support and improve black women's initiation and continuation of breastfeeding.

Validation of the Spanish-Mexican Version of the Australian Breastfeeding Attitude Questionnaire in Higher Education Health Students.

Positive attitudes towards breastfeeding in health professionals/students have been associated with increasing their confidence to provide support and accompaniment to mothers. In Mexico, there is no valid/reliable tool to assess attitudes towards breastfeeding in this population. The Australian Breastfeeding Attitudes (and Knowledge) Questionnaire (ABAQ) measures attitudes in the Australian population. We aimed to adapt and validate the ABAQ in Mexican health students. We included 264 health students (nursing, nutrition, and medicine) from the University of Guadalajara. Bilingual translators carried out the Spanish adaptation with a reverse translation into English. Experts evaluated the content validity. Reliability was evaluated through an internal consistency analysis (Cronbach's alpha) and construct validity through convergent-divergent validation, item-total correlation, exploratory factor analysis (by principal components), and confirmatory factor analysis. According to the exploratory factor analysis, only one component was identified. Seven items were removed (low correlation between items ≤0.2 and low factor load ≤0.3). The Cronbach's alpha was 0.78. According to the confirmatory factor analysis, the one-factor solution of the ABAQ-13Mx showed a good model fit (X2 = 98.41, G = 62, p = 0.02, CFI = 0.940, and RMSEA = 0.048). The ABAQ-13Mx is a reliable and valid instrument for evaluating attitudes towards breastfeeding in Mexican health degree students.

Reliability and Validity of the Greek Version of the Iowa Infant Feeding Attitude Scale Among Pregnant Women.

INTRODUCTION: A modifiable factor related to breastfeeding is breastfeeding attitudes. The Iowa Infant Feeding Attitude Scale (IIFAS) is used to evaluate this factor. Although the breastfeeding rates in Greece are declined there is not available any validated instrument to evaluate infant feeding attitudes. AIM: to determine the psychometric properties of the Greek adaptation of the IIFAS in a sample of pregnant women. MATERIALS AND METHODS: Pregnant women (N=203) from a University Hospital in Athens, Greece, were administered the Greek version of the IIFAS, while being in hospital, and their infant feeding mode at six months postpartum was recorded by telephone. The reliability of the scale was assessed by using corrected item-total correlations and Cronbach's alpha. Construct validity of the scale was assessed by using confirmatory factor analysis and predictive validity by using t-tests. Multiple linear regression analyses in a stepwise method (p for removal was set at 0.1 and p for entry was set at .05) was performed in order to find variables independently associated with IIFAS total score. RESULTS: The mean IIFAS score was 70.0 (SD=7.6). The corrected item-total correlation ranged from 0.22 to 0.51. Cronbach's alpha was equal to 0.71. The confirmatory factor analysis indicated an adequate fit of the one-factor model. Concerning the predictive validity of IIFAS it was significant for breastfeeding at six months. The mean IIFAS score was significantly greater (p=0.001) for women that had exclusive breastfeeding at six months (mean (SD): 68.4(6.6)) as compared with those that did not (mean (SD): 64.0(7.5)). Higher IIFAS scores were found in older women, with higher educational level and in those that had breastfed children in their social environment. CONCLUSION: The Greek version of the IIFAS demonstrated satisfying reliability and validity for measuring women's infant feeding attitudes in the Greek context. Also, the results of the present study provide further evidence of the international applicability of the IIFAS.

Breastfeeding knowledge and attitudes of baccalaureate nursing students in Taiwan: A cohort study.

BACKGROUND: Optimal nutrition during the first year of life is critical to infants' healthy growth and development. Hence, it is vital that undergraduate health professional curricula provide good quality learning environments to enable students to acquire the necessary knowledge and skills to support breastfeeding mothers. AIMS: To examine the change in knowledge and attitude in Taiwanese nursing students following theoretical and clinical learning experiences on breastfeeding. METHODS: This study used a pre-test/post-test survey design with two cohorts of nursing students (N=215). Knowledge and attitude were assessed before and after: (a) theoretical (didactic and skills laboratory) education in Cohort One, and (b) clinical placement in Cohort Two. FINDINGS: Students in both cohorts demonstrated significant improvements in knowledge and attitude post-theoretical education, and post-clinical placement. Prior to theoretical education in Cohort One, those with experience of close family members being breastfed were more than 14 times (adjusted odds ratio: 14.09, 95% confidence interval: 1.73-114.64) to be in the high knowledge group. However, following theoretical or clinical education, there were no sociodemographic group differences in breastfeeding knowledge or attitude in Cohorts One or Two. CONCLUSION: Results revealed that the current breastfeeding education program in Taiwan, both theoretical and clinical components, increased nursing students' knowledge and improved positive attitudes towards breastfeeding, and any sociodemographic differences in knowledge and attitude about breastfeeding were ameliorated following theoretical and clinical placement experience focused on breastfeeding.

Facebook support for breastfeeding mothers: A comparison to offline support and associations with breastfeeding outcomes.

OBJECTIVES: For breastfeeding mothers, online support groups through Facebook may be a more convenient and preferred source for accessing breastfeeding information and support, but few studies exist that examine the use of Facebook groups specifically for breastfeeding support. This study explores the sources of support among users of Facebook breastfeeding support groups and a possible mechanism by which support received on Facebook may translate to behavioral outcomes among breastfeeding mothers. METHODS: From July-September 2017 a survey was distributed online to African American mothers (N = 277) who participate in breastfeeding support groups on Facebook. The survey assessed network support from Facebook and other sources of breastfeeding support, perceived breastfeeding norms, breastfeeding self-efficacy and breastfeeding attitudes. Correlations and linear regression analysis were used to examine the relationship between covariates and outcome variables. RESULTS: The average intended breastfeeding duration among participants in this study was 19 months. Participants reported the highest amount of breastfeeding support received from their Facebook support group, in comparison to other sources of support, and Facebook support was significantly correlated with intended breastfeeding duration (p < 0.05). Self-efficacy and breastfeeding attitudes remained significant predictors of intended breastfeeding duration within the final regression model. CONCLUSIONS: Breastfeeding support received within Facebook groups may compensate for inadequate support received within mothers' networks. More research is needed to understand the mechanism through which Facebook support may contribute to prolonged breastfeeding durations.

Determining Clinically Relevant Cutoff Scores for the Iowa Infant Feeding Attitude Scales Among Prenatal Women in Canada.

BACKGROUND: The original 17-item Iowa Infant Feeding Attitude Scale (IIFAS) has been validated and widely used to assess attitudes toward breastfeeding. A reduced 13-item version of the IIFAS was recently validated in a Canadian setting. However, cutoff scores for categorization of infant feeding attitudes on both scales have not yet been established. Research Aim: The aim of this study was to determine optimal cut-ff scores predicting infant feeding attitudes and outcomes for the original and reduced IIFASs. METHODS: A population-based prospective cohort study was undertaken in the Canadian province of Newfoundland and Labrador. A sample of 658 pregnant women were followed up to 1 month postpartum. The receiver operating curve and Youden index were assessed to identify the sensitivity and specificity of cutoff scores. The magnitude at which these scores predicted postpartum feeding outcomes was evaluated using linear regression. RESULTS: Scores of ≤60 (sensitivity = 0.81, specificity = 0.87) and ≤45 (sensitivity = 0.84, specificity = 0.83) for the 17-item and 13-item IIFASs, respectively, were found to be optimal cutoff scores for predicting negative breastfeeding attitudes. The cutoff score for the reduced IIFAS version maintained its ability to predict women who formula-fed at 1 month postpartum (adjusted odds ratio = 6.32, 95% confidence interval = 1.84-11.61) compared with the original scale (adjusted odds ratio = 4.62, 95% confidence interval = 2.42-16.52). CONCLUSION: The proposed cutoff scores for the original and reduced IIFASs have excellent predictive ability to determine infant feeding attitudes and outcomes. The classification of scores enhances the use and applicability of the IIFAS.

Validation of the Chinese Version of the Australian Breastfeeding Attitude Questionnaire.

BACKGROUND: The Australian Breastfeeding Knowledge and Attitude Questionnaire-Short Form (ABKAQ-SF) was designed to measure breastfeeding knowledge and attitudes of health professionals. To date, a Chinese version of the attitude component of the ABKAQ-SF (ABAQ) is not yet available and has not been cross-validated with nursing students. Research aims: This study aimed to examine (a) the psychometric properties of the ABAQ and (b) group differences and responsiveness of the revised 12-item ABAQ (ABAQ12) among nursing students in Taiwan. METHODS: Using a cross-sectional two-cohort study design, nursing students in Years 2 and 3 of a 4-year bachelor of nursing program ( N = 205) completed the Chinese version of the ABAQ, translated using forward and backward translations. Content validity, internal consistency reliability, construct validity, group differences, and responsiveness of the Chinese version of the ABAQ were assessed. RESULTS: Using the principal axis factoring procedure of exploratory factor analysis to examine the dimensionality of the ABAQ, a one-component structure was identified. Six items were deleted, based on the average interitem correlation (< 0.2), low corrected item-total correlation (< 0.35), and low factor loading (< 0.3). Confirmatory factor analysis of the ABAQ12 supported a one-factor solution, with good overall model fit (goodness-of-fit index = 0.949, Tucker-Lewis index = 0.951, comparative fit index = 0.965, root mean square error of approximation = 0.042). Responsiveness of the ABAQ12 scores indicated a positive change in breastfeeding attitude between the pre- and postclinical placement period. CONCLUSION: The Chinese version of the ABAQ12 is valid, reliable, and responsive and is suitable for assessing the breastfeeding attitudes of nursing students in the Taiwanese higher education settings.

Breastfeeding knowledge and attitudes of health professional students: a systematic review.

BACKGROUND: Breastfeeding support from health professionals can be effective in influencing a mother's decision to initiate and maintain breastfeeding. However, health professionals, including nursing students, do not always receive adequate breastfeeding education during their foundational education programme to effectively help mothers. In this paper, we report on a systematic review of the literature that aimed to describe nursing and other health professional students' knowledge and attitudes towards breastfeeding, and examine educational interventions designed to increase breastfeeding knowledge and attitudes amongst health professional students. METHODS: A systematic review of peer reviewed literature was performed. The search for literature was conducted utilising six electronic databases, CINAHL, MEDLINE, ProQuest, PubMed, Scopus, and Cochrane, for studies published in English from January 2000 to March 2017. Studies focused on nursing students' or other health professional students' knowledge, attitudes or experiences related to breastfeeding. Intervention studies to improve knowledge and attitudes, were also included. All papers were reviewed using the relevant Critical Appraisal Skills Programme (CASP) checklist. RESULTS: Fourteen studies were included in the review. This review indicates that in some settings, health professional students demonstrated mid-range scores on breastfeeding attitudes, and their knowledge of breastfeeding was limited, particularly in relation to breastfeeding assessment and management. All of the studies that tested a specialised breastfeeding education programme, appeared to increase nursing students' knowledge overall or aspects of their knowledge related to breastfeeding. Several factors were found to influence breastfeeding knowledge and attitudes, including timing of maternal and child health curriculum component, previous personal breastfeeding experience, gender, cultural practices and government legislation. CONCLUSIONS: Based on this review, it appears that nursing curriculum, or specialised programmes that emphasise the importance of breastfeeding initiation, can improve breastfeeding knowledge and attitudes and students' confidence in helping and guiding breastfeeding mothers.

Effect of the Knowledge and Attitudes of a Support Person on Maternal Feeding Choice.

BACKGROUND: Breastfeeding rates among urban, low-income populations are lower than the national average, and social support can affect breastfeeding initiation and duration both positively and negatively. Research aim: This study aimed to determine the effect of the presence of a support person and breastfeeding knowledge and attitudes of that person on a mother's feeding choice and perceived level of support for her choice. METHODS: Questionnaires were administered to 192 mothers receiving care for their infants in the Pediatric Practice at University Hospitals Rainbow Babies and Children's Hospital in Cleveland, Ohio, along with 74 adults accompanying these mothers. Data on demographics, feeding characteristics, and breastfeeding knowledge and attitudes were collected. RESULTS: Analysis of the entire group of mothers found that breastfeeding-supportive knowledge and attitudes were an independent predictor of exclusive breastfeeding (odds ratio [ OR] = 1.89, 95% confidence interval [CI] [1.38, 2.60]) and any breastfeeding ( OR = 2.28, 95% CI [1.62, 3.21]). The presence of an accompanying adult was not related to feeding choice. Analysis of the subgroup of mothers with surveyed accompanying adults found independent predictors of any breastfeeding include maternal intention to breastfeed ( OR = 23.68, 95% CI [1.48, 377.6]) and breastfeeding-supportive knowledge and attitudes of the mother ( OR = 2.71, 95% CI [1.36, 5.40]) and the accompanying adult ( OR = 2.78, 95% CI [1.17, 6.60]). The only independent predictor of exclusive breastfeeding was maternal intention to breastfeed ( OR = 7.64, 95% CI [2.22, 26.3]). The majority of mothers (91%) felt supported, regardless of presence or absence of an accompanying adult. CONCLUSION: These findings emphasize the importance of breastfeeding education for mothers and their support persons.

Assessing Infant Feeding Attitudes of Expectant Women in a Provincial Population in Canada: Validation of the Iowa Infant Feeding Attitude Scale.

BACKGROUND: Maternal attitudes to infant feeding are predictive of intent and initiation of breastfeeding. OBJECTIVES: The Iowa Infant Feeding Attitude Scale (IIFAS) has not been validated in the Canadian population. This study was conducted in Newfoundland and Labrador, a Canadian province with low breastfeeding rates. Objectives were to assess the reliability and validity of the IIFAS in expectant mothers; to compare attitudes to infant feeding in urban and rural areas; and to examine whether attitudes are associated with intent to breastfeed. METHODS: The IIFAS assessment tool was administered to 793 pregnant women. Differences in the total IIFAS scores were compared between urban and rural areas. Reliability and validity analysis was conducted on the IIFAS. The receiver operating characteristic (ROC) of the IIFAS was assessed against mother's intent to breastfeed. RESULTS: The mean ± SD of the total IIFAS score of the overall sample was 64.0 ± 10.4. There were no significant differences in attitudes between urban (63.9 ± 10.5) and rural (64.4 ± 9.9) populations. There were significant differences in total IIFAS scores between women who intend to breastfeed (67.3 ± 8.3) and those who do not (51.6 ± 7.7), regardless of population region. The high value of the area under the curve (AUC) of the ROC (AUC = 0.92) demonstrates excellent ability of the IIFAS to predict intent to breastfeed. The internal consistency of the IIFAS was strong, with a Cronbach's alpha greater than .80 in the overall sample. CONCLUSION: The IIFAS examined in this provincial population provides a valid and reliable assessment of maternal attitudes toward infant feeding. This tool could be used to identify mothers less likely to breastfeed and to inform health promotion programs.

UK Views toward Breastfeeding in Public: An Analysis of the Public's Response to the Claridge's Incident.

BACKGROUND: The embarrassment that UK mothers experience when breastfeeding in public has often been cited as a key factor in the decision of the mother to discontinue breastfeeding. There is convincing evidence that many UK residents are not comfortable with women breastfeeding in public; however, little is known about the underlying reasons for this discomfort. OBJECTIVE: This study aimed to assess views on breastfeeding in public in the United Kingdom and to understand why some UK residents object to this practice. METHODS: The comments sections of news media websites and parenting forums were systematically identified and reviewed for statements made in response to an incident widely reported in the British press: a woman was asked to cover up while breastfeeding in public at Claridge's, a London luxury hotel. Of these, 805 comments (73 108 words) met the inclusion criteria and were thematically analyzed. RESULTS: The majority of commenters were supportive of "discreet" breastfeeding in public, but a significant portion felt that breastfeeding in public is always inappropriate. Sexualization of the breast was mainly evoked as something others may experience while viewing a breastfeeding mother, rather than to reflect the commenters' own views. Common justifications cited against breastfeeding in public were onlookers' embarrassment (not knowing where to look) and disgust (at bodily fluids and/or functions). CONCLUSION: Campaigns portraying breastfeeding in public as normal and desirable with a focus on human milk as food rather than a bodily fluid may improve societal acceptance of breastfeeding in public.

The Ability of Posters to Enhance the Comfort Level with Breastfeeding in a Public Venue in Rural Newfoundland and Labrador.

BACKGROUND: The acceptance and support of breastfeeding in public venues can influence breastfeeding practices and, ultimately, the health of the population. OBJECTIVE: The primary aim of this study was to investigate whether posters targeted at the general public could improve acceptability of breastfeeding in public places. METHODS: A convenience sample of 255 participants was surveyed at shopping centers in 2 rural communities of Newfoundland and Labrador. Experimentally, questions were posed to 117 participants pre- and post-exposure to 2 specific posters designed to promote public acceptance of breastfeeding in public. RESULTS: Initially, we surveyed that only 51.9% of participants indicated that they were comfortable with a woman breastfeeding anywhere in public. However, context played a role, whereby a doctor's office (84.5%) or park (81.4%) were the most acceptable public places for breastfeeding, but least acceptable was a business office environment (66.7%). Of participants, 35.4% indicated previously viewing specific posters. We used a visual analog scale to test poster viewing on the acceptability of public breastfeeding in the context of a doctor's office and a restaurant. Results of pre- versus post-viewing of the promotional posters indicated significant improvements in both scenarios: in a doctor's office (P = .035) and in a restaurant (P = .021). CONCLUSION: Nearly 50% of the surveyed population indicated discomfort with a mother breastfeeding in public. Both cross-sectional and interventional evidence showed that posters significantly improved the reported level of comfort toward seeing breastfeeding in public.

Validation of the Arabic Version of the Iowa Infant Feeding Attitude Scale among Lebanese Women.

BACKGROUND: There is need in the Arab world for validated instruments that can reliably assess infant feeding attitudes among women. The 17-item Iowa Infant Feeding Attitude Scale (IIFAS) has consistently shown good reliability and validity in different cultures and the ability to predict breastfeeding intention and exclusivity. OBJECTIVE: This study assessed the psychometric properties of the Arabic version of the IIFAS (IIFAS-A). METHODS: After translating to classical Arabic and back-translating to English, the IIFAS-A was pilot tested among 20 women for comprehension, clarity, length, and cultural appropriateness. The IIFAS-A was then validated among 170 women enrolled in a breastfeeding promotion and support clinical trial in Lebanon. RESULTS: The IIFAS-A showed acceptable internal consistency reliability (Cronbach's α = 0.640), with principal components analysis revealing that it is unidimensional. The 17 items had good interitem reliabilities ranging between 0.599 and 0.665. The number of breastfed children was the only predictor of the overall IIFAS-A score in a multivariate stepwise regression model (ß = 1.531, P < .0001). CONCLUSION: The 17-item IIFAS-A is a reliable and valid instrument for measuring women's infant feeding attitudes in the Arab context.

Reliability and Validity of the Reduced Spanish Version of the Iowa Infant Feeding Attitude Scale.

OBJECTIVE: To translate the Iowa Infant Feeding Scale (IIFAS) into Spanish, to test its psychometric properties, and to explore item reduction for the Spanish version. DESIGN: Instrumental study. SETTING: Six hospitals in eastern Spain. PARTICIPANTS: A convenience sample of 1,354 pregnant women was recruited. METHODS: The IIFAS was translated using forward and back translation. Dimensional structure, internal consistency, and construct validity of the Spanish IIFAS version were assessed. Criteria to improve the reliability of the scale and the predictive power of the items were used to reduce the scale. RESULTS: Statistics on the psychometric properties suggested the need for item reduction. Cronbach's alpha coefficient of the nine-item final version of the Spanish IIFAS (IIFAS-S) was 0.792. The confirmatory factor analysis showed a unidimensional structure. Demographic response patterns and correlations with the IIFAS-S scale provided further evidence of construct validity. Pregnancy IIFAS-S scores significantly predicted breastfeeding rates and exclusivity. CONCLUSION: The results of this study indicated that the Spanish translation of the IIFAS is a valid and reliable measure of women's attitudes toward breastfeeding.

Maternal Beliefs Surrounding Infant Feeding, but Not Maternal BMI or Hospital Experience, Predict Breastfeeding Exclusivity and Behavior.

BACKGROUND: Overweight/Obese (OW/Ob) women are at risk for breastfeeding failure. How maternal BMI affects lactation support received in-hospital, or maternal attitudes and beliefs surrounding infant feeding remains poorly understood. We investigated 1) the impact of in-hospital lactation support and maternal attitudes and behaviors regarding infant feeding on breastfeeding exclusivity, and 2) whether these potentially modifiable attitudes and behaviors differed between normal weights (NW) versus OW/Ob women. METHODS: NW (n=18) and OW/Ob (n=20) women and their infants were followed from birth to 4-months postpartum. In-hospital experiences, problems and help received regarding breastfeeding were documented. Six maternal attitudes and behaviors surrounding infant feeding were assessed at 2-weeks and 4-months. These factors were compared between NW and OW/OB women, and in relation to breastfeeding exclusivity. RESULTS: In-hospital experiences, assistance received regarding breastfeeding difficulties, and infant breastfeeding exposure did not differ between NW and OW/Ob women. At 4-months OW/Ob women were more likely to feed their infant on a schedule (p<0.03); this was the only difference in attitudes/behaviors between BMI-groups. Feeding the infant on a schedule was predictive of lower total breastfeeding exposure (p<0.05). Maternal concern about infant under-eating/becoming underweight was associated with several negative feeding behaviors, including reduced breastfeeding exposure (p<0.02), pressuring feeding style (p<0.01), and feeding to calm fussiness (p<0.01). CONCLUSION: This hospital setting provided equitable breastfeeding support to OW/Ob and NW women. Maternal concern over infant under-eating/under-gaining and encouragement to feed on-demand are prime interventional targets to improve breastfeeding outcomes; the latter may be especially relevant to OW/Ob mothers.