Lynn A. Rempel

Factors Influencing the Breastfeeding Decisions of Long-term Breastfeeders

Understanding determinants of mothers’ decisions regarding long-term breastfeeding is important for the promotion of breastfeeding for up to 12 months postpartum and beyond. In this longitudinal infant feeding study, the theory of planned behavior was used to explain the intended and actual breastfeeding duration of 80 participants who were breastfeeding 9-monthold infants. Participants perceived less approval for breastfeeding the longer they breastfed. Perceived approval did not explain prenatal intended duration but strongly explained intended duration at 9 months postpartum. The amount of control mothers perceived they had over breastfeeding, however, explained both prenatal and 9-month breastfeeding duration intentions. Reasons for weaning between 9 and 12 months reflected the effects of perceived control but not of perceived approval. These results suggest the need for (1) interventions to increase the social acceptability of long-term breastfeeding and (2) ongoing breastfeeding guidance and support for long-term breastfeeders. J Hum Lact. 20(3):306-318.

The Breastfeeding Team: The Role of Involved Fathers in the Breastfeeding Family

Fathers influence mothers’ breastfeeding decisions and experiences. Fathers’ perceptions of their roles as members of the breastfeeding family are likely important components of that influence. To explore that possibility, 21 involved fathers of breastfeeding babies volunteered to be interviewed regarding their fathering breastfed babies and their roles in the breastfeeding family. Fathers identified their unique roles as team members ensuring that their babies received the benefits of breastfeeding. A primary fathering role was that of supporting breastfeeding by becoming breastfeeding savvy, by using their knowledge to encourage and assist mothers in breastfeeding, by valuing the breastfeeding mothers, and by sharing housework and child care. Fathers’ nurturing roles involved fostering positive father-infant relationships in the face of limited opportunities to bond with their babies through feeding. The experiences of these fathers suggest the importance of assisting them to recognize their unique contributions to the nurture of their children as members of the breastfeeding team.

Partner Influence on Health Behavior Decision-Making: Increasing Breastfeeding Duration

This longitudinal study examined how male partners affect the breastfeeding decisions and behavior of first-time mothers. Based on the reasons model by Meichenbaum and Fong (1993), the breastfeeding reasons, intentions, and behavior of 317 first-time mothers were assessed prenatally and at six time points in the first year postpartum. In a prenatal assessment, men indicated their prescriptive beliefs about whether their partner should breastfeed at the same six time points. Men’s prescriptive breastfeeding beliefs predicted the strength of their partners’ breastfeeding intentions, over and above the women’s own breastfeeding reasons, and they predicted breastfeeding behavior over and above the women’s intentions. These results demonstrate the influence wielded by intimate partners and highlight the importance of focusing on partners’ beliefs when predicting and intervening in health behavior decisions.

Behavioral, normative and control beliefs underlying low-fat dietary and regular physical activity behaviors for adults diagnosed with type 2 diabetes and/or cardiovascular disease

Abstract Promoting healthy lifestyle behaviors is an important aspect of interventions designed to improve the management of chronic diseases such as Type 2 diabetes and cardiovascular disease. The present study used Ajzens (1991) theory of planned behavior as a framework to examine beliefs amongst adults diagnosed with these conditions who do and do not engage in low-fat dietary and regular physical activity behaviors. Participants (N = 192) completed a questionnaire assessing their behavioral, normative and control beliefs in relation to regular, moderate physical activity and eating foods low in saturated fats. Measures of self-reported behavior were also examined. The findings revealed that, in general, it is the underlying behavioral beliefs that are important determinants for both physical activity and low-fat food consumption with some evidence to suggest that pressure from significant others is an important consideration for low-fat food consumption. Laziness, as a barrier to engaging in physical activity, also emerged as an important factor. To encourage a healthy lifestyle amongst this population, interventions should address the perceived costs associated with behavioral performance and encourage people to maintain healthy behaviors in light of these costs.

Evaluating Physical Activity Using Accelerometry in Children at Risk of Developmental Coordination Disorder in the Presence of Attention Deficit Hyperactivity Disorder.

Physical activity (PA) is compromised in children and adolescents with developmental coordination disorder (DCD). Approximately half of all children with DCD suffer from attention-deficit hyperactive disorder (ADHD); a cohort often considered more physically active than typically developing youth. Accelerometry is an effective method of assessing physical activity patterns; although estimates of PA in children with DCD using this quantifiable method have not been attempted. We hypothesize that children with co-morbid DCD/ADHD will be more physically active than children with DCD and healthy peers. Therefore, the purpose of this study was to contrast physical activity (step count and activity energy expenditure using accelerometry [AEE]) between children with DCD, co-morbid DCD and ADHD (DCD/ADHD), and healthy controls. A sample of 110 children with DCD (N=32), DCD/ADHD (N=30) and controls (N=48) age 12-13 years agreed to participate. Co-morbid DCD/ADHD was present in nearly half of the children with DCD (48.4%). Analysis of covariance demonstrated a positive interaction for females step count (F[1,92]=4.92, p=0.009). A significant group difference for step count (F[1,92]=4.43, p=.04) was identified in females. Post hoc comparison tests identified significantly lower step count between males with DCD and controls (p=.004) and males with DCD/ADHD and controls (p=0.003). Conversely, females with DCD/ADHD had significantly more step counts than their controls (p=.01). Hyperactivity in females with DCD/ADHD appears to contribute to more physical activity, whereas DCD may contribute to decreased activity in males with DCD and DCD/ADHD. Hyperactivity expressed among girls with DCD/ADHD appears to override the hypoactive behavior associated with females with DCD. Conversely, the expression of hyperactivity among boys with DCD/ADHD does not translate as hypothesized. The contrasting expression of physical activity (i.e., step count and AEE) evaluated using accelerometry in boys and girls with DCD, co-morbid DCD/ADHD and healthy peers are intriguing and constitute further investigation in a larger investigation.

Why Breastfeed? A longitudinal test of the reasons model among first-time mothers

This longitudinal study tested the ability of the reasons model (Meichenbaum & Fong, 1993) to predict the breastfeeding intentions of 317 first-time mothers before and after breastfeeding experience. The reasons model proposes that three levels of reasons for (pro) and against (con) adherence to health-related advice predict intentions: evidence-based (Level I); self-consequential (Level II); and affective, schema-related (Level III) reasons. Path analyses showed that the reasons model was able to predict breastfeeding intentions. Level III reasons most strongly predicted prenatal and early postpartum intentions, whereas Level II con breastfeeding reasons predicted later postpartum intentions. Breastfeeding intentions significantly predicted behavior. This study indicates that the reasons model is valuable for understanding health behavior over time, and that all three levels of reasons should be considered when developing behavior change interventions.

Effects of the implementation of a breastfeeding best practice guideline in a Canadian public health agency

Several strategies were used to implement a breastfeeding best practice guideline (BPG) in a Canadian public health agency. Nurses surveyed before and 1 year after implementation reported increased BPG-related knowledge and stronger beliefs regarding breastfeeding duration beyond 1 year. Telephone surveys also were conducted with mothers; 90 before BPG implementation and another cohort of 141 mothers following implementation. Post-implementation mothers were more knowledgeable about sources of breastfeeding help, obtained more help from public health nurses, and reported more breastfeeding-related discussion with healthcare providers. Compared to the pre-implementation cohort, mothers in the post-implementation cohort who were still breastfeeding at 6 months intended to continue breastfeeding longer. Implementing a breastfeeding BPG can affect breastfeeding-related experiences at a population level.

Influence of father–infant relationship on infant development: A father-involvement intervention in Vietnam.

We examined the extent to which fathers can be taught and encouraged to develop positive relationships with their children, especially in infancy, and the effects of this fathering intervention on infant development. A multifaceted relationally focused intervention was used to assist fathers in Vietnam to engage in responsive direct and indirect involvement with their infants and work together with the mother as part of a parenting team. Fathers and mothers from 13 communes in a rural and semiurban district were recruited to the intervention group. Intervention fathers received group and individual counseling before and after birth, an interactive print resource, community messages about fathering, and the opportunity to participate in a Fathers Club. Couples from 12 comparable communes in a noncontiguous district were recruited to the control group. Fathers and mothers completed questionnaires at the prebirth recruitment and at 1-, 4-, and 9-months postbirth. Intervention fathers demonstrated greater increase in knowledge and attitudes regarding father–infant relationships. Both fathers and mothers reported that fathers engaged in more affection, care-taking, and play in the early months of their infants’ lives and fathers felt more attached to their infants right from birth. A developmental assessment at 9 months showed that intervention infants demonstrated higher levels of motor, language, and personal/social development. This study demonstrated that fathers can be taught to interact more sensitively, responsively, and effectively with their newborn infants. Their increased interaction and emotional attachment appears to lay the foundation for enhanced infant development.