Jaclyn Broadbent

Psychosocial correlates of exclusive breastfeeding: A systematic review

BACKGROUND the World Health Organization recommends that all infants worldwide are exclusively breastfed for the first 6 months of life for optimal health and development. However, very few women worldwide are meeting this recommendation. Psychosocial factors have been identified as potentially modifiable factors implicated in a womans ability to successfully exclusively breastfeed, however there is very limited research examining these factors specifically for exclusive breastfeeding to 6 months duration. METHODS a search of psychological, nursing and medical databases was conducted in June 2011 for studies published from 2000 to 2011 examining psychological correlates of exclusive breastfeeding to four to 6 months duration. RESULTS nine papers from eight studies were found to be eligible for the review. Psychological factors have been reported to be highly predictive of exclusive breastfeeding outcomes. Research to date shows that psychosocial factors are not only importantly implicated in exclusive breastfeeding duration but they can also be changed through intervention and experiences. CONCLUSIONS while there is a wealth of literature on the role of psychosocial factors in breastfeeding, there is very limited research specifically examining the role of psychosocial factors of exclusive breastfeeding to 6 months duration. Interpreting the results of the available literature is difficult due to the various methodologies and definitions of exclusive breastfeeding and small sample sizes. Further research, specifically, longitudinal cohort studies are needed which examine psychological determinants of exclusive breastfeeding and infant feeding methods from pregnancy through to 6 months postpartum.

The role of psychosocial factors in exclusive breastfeeding to six months postpartum

OBJECTIVE to investigate the psychosocial variables associated with the ability to exclusively breastfeed to six months postpartum. Additionally, to evaluate a conceptual model of psychosocial correlates of exclusive breastfeeding duration. DESIGN online, retrospective questionnaire. SETTING the questionnaire was placed online and participants accessed it through social networking sites including groups relating to breastfeeding, motherhood and parenting. Participants were also able to share the link with their own networks. This online setting facilitated recruitment of a wide range of Australian and international participants. PARTICIPANTS 174 women aged 18 years and older who had given birth between six months to two years prior. Participants completed an online questionnaire, which asked them to report on three time points: pre-pregnancy, during pregnancy and during the first six months postpartum. Data were collected from June to December 2011. MEASUREMENTS psychometrically validated tools such as the breastfeeding Self-Efficacy Scale, Body Attitude Questionnaire, Depression Anxiety and Stress Scale, Fetal Health Locus of Control Scale, and the brief COPE scale were used to measure psychosocial variables. Additional scales were developed by the researchers and met scale reliability criteria. FINDINGS correlation analyses, t-tests and path analysis were used to statistically analyse the data. Results showed that women who exclusively breast fed to six months postpartum exhibited higher intention to exclusively breastfeed, breastfeeding self-efficacy, comfort breastfeeding in public, perceived physical strength and reported less perceived breastfeeding difficulties. Path analyses indicated that breastfeeding self-efficacy was a strong significant predictor of both exclusive breastfeeding intention and duration. Maternal attitude towards pregnancy (both during pregnancy and postpartum), psychological adjustment and early breastfeeding difficulties were also found to be significant predictors of exclusive breastfeeding intention and duration. KEY CONCLUSIONS psychosocial factors are likely to play a significant role in the maintenance of exclusive breastfeeding for six months post-birth. Future research should adopt a prospective study design to examine the influence of psychosocial factors systematically and rigorously. IMPLICATIONS FOR PRACTICE longitudinal, prospective studies are needed to further examine the role of psychosocial factors on exclusive breastfeeding outcomes. Interventions, which involve improving psychosocial factors such as breastfeeding self-efficacy, may improve exclusive breastfeeding outcomes.

The meaning of body image experiences during the perinatal period: A systematic review of the qualitative literature.

Literature reporting body image disturbances across the perinatal period has produced inconsistent findings, owing to the complexity of body image experiences during pregnancy and the first year postpartum. Existing qualitative data might provide potential avenues to advance understanding of pregnancy-related body image experiences and guide future quantitative research. The present systematic review synthesised the findings of 10 qualitative studies exploring the body image experiences of women through the perinatal period, albeit the majority focused only on pregnancy. Themes emerging included malleability of body image ideals across pregnancy (including the shift from aesthetic to functional concerns about ones appearance), the salience of stomach and breasts for self-rated body satisfaction, and perceived pressure to limit weight gain across pregnancy in order to return quickly to pre-pregnancy figure following birth. These qualitative findings suggest greater complexity of body image experiences during perinatal period than can be captured by typically used self-report measures.

Validation of Autism Spectrum Quotient Adult Version in an Australian Sample

The Autism Spectrum Quotient is used to assess autistic spectrum traits in intellectually competent adults in both the general population and the autism spectrum community. While the autism spectrum Quotient has been validated in several different cultures, to date no study has assessed the psychometrics of the Autism Spectrum Quotient on an Australian population. The purpose of this study was to assess the psychometrics of the autism spectrum Quotient in an Australian sample of both typically developing individuals (n = 128) and individuals with autism spectrum disorder (n = 104). The results revealed that the internal consistency and the test-retest reliability were satisfactory; individuals with autism spectrum disorder scored higher on total Autism Spectrum Quotient score and its subscales than typically developing individuals; however, gender differences were not apparent on total score. Possible cultural differences may explain some of the psychometric variations found. The results of this analysis revealed that the Autism Spectrum Quotient was a reliable instrument for investigating variation in autistic symptomology in both typically developing and Autism Spectrum Disorders populations within an Australian population.

Do pain-related beliefs influence adherence to multidisciplinary rehabilitation? A systematic review

Objectives:To understand how pain-related cognitions predict and influence treatment retention and adherence during and after a multidisciplinary rehabilitation program. Methods:Electronic databases including Medline, CINAHL, PsycINFO, Academic Search Complete, and Scopus were used to search 3 combinations of key words: chronic pain, beliefs, and treatment adherence. Results:The search strategy yielded 591 results, with an additional 12 studies identified through reference screening. Eighty-one full-text papers were assessed for eligibility and 10 papers met the inclusion and exclusion criteria for this review. The pain-related beliefs that have been measured in relation to treatment adherence include: pain-specific self-efficacy, perceived disability, catastrophizing, control beliefs, fear-avoidance beliefs, perceived benefits and barriers, and other less commonly measured beliefs. The most common pain-related belief investigated in relation to treatment adherence was pain-related self-efficacy. Findings for the pain-related beliefs investigated among the studies were mixed. Collectively, all of the aforementioned pain-related beliefs, excluding control beliefs, were found to influence treatment adherence behaviors. Discussion:The findings suggest that treatment adherence is determined by a combination of pain-related beliefs either supporting or inhibiting chronic pain patients’ ability to adhere to treatment recommendations over time. In the studies reviewed, self-efficacy appears to be the most commonly researched predictor of treatment adherence, its effects also influencing other pain-related beliefs. More refined and standardized methodologies, consistent descriptions of pain-related beliefs, and methods of measurement will improve our understanding of adherence behaviors.

A longitudinal study of the effect of psychosocial factors on exclusive breastfeeding duration

OBJECTIVE to examine the effect of psychosocial factors on exclusive breastfeeding duration to six months postpartum DESIGN longitudinal, prospective questionnaire based study. SETTING participants were recruited from a publically funded antenatal clinic located in the western metropolitan region of Melbourne, Victoria, Australia and asked to complete questionnaires at three time points; 32 weeks pregnancy, two months postpartum and six months postpartum. PARTICIPANTS the participants were 125 pregnant women aged 22-44 years. MEASUREMENTS AND FINDINGS psychosocial variables such as breastfeeding self-efficacy, body attitude, psychological adjustment, attitude towards pregnancy, intention, confidence and motivation to exclusively breastfeed and importance of exclusive breastfeeding were assessed using a range of psychometrically validated tools. Exclusive breastfeeding behaviour up to six months postpartum was also measured. At 32 weeks gestation a womans confidence to achieve exclusive breastfeeding was a direct predictor of exclusive breastfeeding duration to six months postpartum. At two months postpartum, psychological adjustment and breastfeeding self-efficacy were predictive of exclusive breastfeeding duration. Finally, at six months postpartum, psychological adjustment, breastfeeding self-efficacy, confidence to maintain and feeling fat were directly predictive of exclusive breastfeeding duration. KEY CONCLUSIONS psychosocial factors are significantly predictive of exclusive breastfeeding duration. Self-efficacy, psychological adjustment, body image, motivation and confidence are all important psychosocial factors implicated in a womans ability to maintain exclusive breastfeeding over time. IMPLICATIONS FOR PRACTICE Individualised antenatal breastfeeding education and support may be strengthened by strategies that build a womans confidence to exclusive breastfeeding. Implementing psychosocial supports and methods providing positive feedback that increase a womans self-efficacy to exclusively breastfeed to six months are also important two months postpartum.

Tests of an extension of the dual pathway model of bulimic symptoms to the state-based level.

The dual pathway model proposes that trait body dissatisfaction leads to bulimic symptoms via two distinct pathways: dieting and trait negative affect. As many of these modelled variables have state-based equivalents, the present study evaluated the generalisability of this model to predict associations between state body dissatisfaction and instances of disordered eating. 124 women aged 18 to 40 years completed an online survey (accessed via a mobile phone device with web access) over a 7-day period. The mobile phone device prompted participants at random intervals seven times daily to self-report their state body dissatisfaction, current mood experiences, dieting attempts, and disordered eating practices. Multi-level mediation modelling revealed that both negative mood states and dieting significantly mediated the state body dissatisfaction-disordered eating relationships, although the strength of these associations depended on the aspect of disordered eating measured and individual differences in trait body dissatisfaction, internalization of appearance standards, tendency towards dieting, and BMI. Collectively, these results not only support adapting the dual pathway model to the state-level, but also suggest that several of the model implied pathways may be more relevant for individuals with more pathological eating- and body-related concerns and behaviours.

A qualitative exploration of body image experiences of women progressing through pregnancy

BACKGROUND Pregnancy provides an interesting challenge to body image theories in that the natural physiological changes push women further from the socioculturally prescribed thin ideal which these theories hinge upon. The impact that these significant physiological changes have on the womans body image during pregnancy may depend on the extent to which they retain or revise the ideal. However, little is known about body image experiences during pregnancy. AIM To provide a comprehensive exploration of the body image experiences of pregnant women. METHODS Individual structured interviews were conducted with 19 currently pregnant women. Transcriptions were analysed using a thematic content analysis approach. FINDINGS Themes extracted from the qualitative data included: (1) womens body image experiences during pregnancy were complex and changing, and shaped by the salience of specific body parts, the womens expectations for future changes to their body within the perinatal period, the functionality of the body, and their experience of maternity clothing, (2) women were able to negotiate the changes to their bodies as they recognised the functionality of the pregnant body, (3) women were surprised by the public nature of the pregnant body, (4) partner support and positive feedback about the pregnant body was highly valued, and (5) the importance of open communication around weight and body image in antenatal healthcare. DISCUSSION Our findings highlight the need for the adaptation and expansion of existing body image theories to be used as a framework for womens experiences of pregnancy.

Improving prediction of binge episodes by modelling chronicity of dietary restriction.

This study evaluates the influences of chronicity of, and time lag between, dietary restriction and binge outcome for predicting binge episode onset. Sixty-two women aged 18 to 40 years old completed an online survey at random intervals seven times daily for a 7-day period. Participants self-reported engagement in dietary restriction and/or binging, and temptation to binge. Consecutive instances of reported dietary restriction better predicted subsequent binges than single instances. As the time lag between the first report of dietary restriction and binge onset increased, a clear linear trend emerged, such that the value of restriction for predicting binges increased with the number of consecutive assessments in which they reported dietary restriction. A similar pattern was found when predicting temptation to binge. Present findings suggest that duration of restriction is a crucial determinant of binge onset. These findings have implications for clinical practice by highlighting the time course from dietary restriction to binging.

Implementing summative assessment with a formative flavour: a case study in a large class

Abstract Teaching a large class can present real challenges in design, management and standardisation of assessment practices. One of the main dilemmas for university teachers is how to implement effective formative assessment practices with accompanying high-quality feedback consistently over time with large classroom groups. This article reports on how elements of formative practices can be implemented as part of summative assessment in very large undergraduate cohorts (n = 1500 in one semester), studying in different modes (on- and off-campus), with multiple markers, and under common cost and time constraints. Design features implemented include the use of exemplars, rubrics and audio feedback. The article draws on the reflections of the leading teacher, and argues that, for summative assessment to benefit learners, it should contain formative assessment elements. The teaching practices utilised in the case study provide some means to resolve the tensions between formative assessment and summative assessment that may be more generally applicable.