Shahla Meedya

Factors that positively influence breastfeeding duration to 6 months: A literature review

QUESTION What modifiable factors positively influence breastfeeding duration to 6 months postpartum? AIM This question was posed in order to be able to develop a midwifery intervention aimed at prolonging breastfeeding. METHOD An online literature search was conducted in Medline, CINAHL, Maternity and Infant Care, and Cochrane Database of systematic reviews. The search strategy included the following keywords: breastfeeding, duration, initiation, cessation, factors, intervention, education, partner, intention, confidence, self-efficacy and support. Additional studies were located and extracted from online publications of New South Wales Department of Health, Australia. Bio-psycho-social factors that are positively associated with breastfeeding duration were identified. RESULTS Modifiable factors that influence womens breastfeeding decisions are: breastfeeding intention, breastfeeding self-efficacy and social support. Existing midwifery breastfeeding promotion strategies often include social support but do not adequately address attempts to modify breastfeeding intention and self-efficacy. CONCLUSION The modifiable factors that are positively associated with breastfeeding duration are the womans breastfeeding intention, her breastfeeding self-efficacy and her social support. Intervention studies to date have focussed on modifying these factors individually with variable results. No interventional studies have been conducted with the aim of positively modifying all three factors simultaneously.

Supporting women to achieve breastfeeding to six months postpartum – The theoretical foundations of a successful program

BACKGROUND Although the benefits of breastfeeding to six months are well-established, only about half of Australian women succeed. The factors associated with successful breastfeeding are rarely translated into effective interventions. A new educational and support program, called the Milky Way program has been demonstrated to be effective in supporting women to achieve prolonged breastfeeding. In the Milky Way program, breastfeeding is considered an embodied performance which requires an engaged combination of body, mind and spirit. This paper aims to explain how the two theories that informed the program were used to better enable womens long term breastfeeding success. METHOD The theory of self-efficacy is first described as a way to develop womens cognitive processes to organise and execute the course of actions to breastfeed for a longer period of time. Birth territory theory is then presented. This theory discusses women as embodied selves; an essential concept for breastfeeding success. Birth territory theory also describes the effects of the holistic environment on the woman and explores the effects of power that is used in the environment. This power can be used integratively to strengthen the womans breastfeeding confidence and success or, disintergratively which reduces her confidence and undermines her success. CONCLUSION Strategies based on self-efficacy theory are helpful, but are not sufficient to promote breastfeeding to six months. Health educators also need to foster the womans connection to, and trust in, her body and her babys body to breastfeed spontaneously. Being aware of environmental impacts on how the woman and baby breastfeed; and using ones own power integratively is crucial to women being able to achieve prolonged breastfeeding.

The health and health preparation of long-term Australian travellers

A growing number of Australians are travelling domestically for extended periods. This creates challenges in both continuity of health care and burdens on health services. This paper reports a cross-sectional survey aimed to explore the health needs and health planning of long-term travellers. In total, 316 respondents who had travelled for more than 3 months consecutively in the last year participated. Most respondents were retired (n=197; 62.3%); however, ages ranged from 26 to 89 years. Nearly half of the respondents or their travel companion had a long-term illness that affected their daily life (n=135; 42.7%). Nearly half of respondents visited a GP (n=133; 42.1%), nearly one-quarter visited an Emergency Department (n=72; 22.8%) and 19.9% (n=63) visited another health provider while travelling. The level of preparation around health while travelling varied between participants. This study highlights that long-term travellers have significant health needs and are likely to require health services during their extended travel. Additionally, it identifies that currently few strategies are used to plan for health care during travel. This raises issues for rural and remote health services in terms of both capacity and continuity of care.

Sufficient exercise for Australians living with dementia in residential aged care facilities is lacking: an exploration of policy incoherence

Australian and New Zealand Journal of Public Health 427

Effect of educational and support interventions to increase long-term breastfeeding rates in primiparous women: a systematic review protocol

REVIEW QUESTION/OBJECTIVE The objective of this review is to identify the effects of educational and supportive interventions provided by health professionals on long-term breastfeeding rates at six months and up to two years post partum among primiparous women who intend to breastfeed.

Impressions of using the Cohen-Mansfield Agitation Inventory as an outcome measure: Lessons learnt for future clinical researchers (innovative practice)

The Cohen-Mansfield Agitation Inventory was a tool originally developed for use in research to measure agitation and subsequently used in clinical settings. It was the primary outcome measure for a randomised controlled trial which evaluated the effects and feasibility of a physiotherapist-led physical exercise intervention on agitation and physical performance of individuals living with dementia in nursing homes. The study produced weak results in regards to the Cohen-Mansfield Agitation Inventory due to small sample size and perceived issues with the use of the Cohen-Mansfield Agitation Inventory. Therefore, the focus of this paper is consideration of the identified issues by the research team: learnt effect and Hawthorn effect, misunderstanding of behaviours and inaccurate recall and observation. It is important that tools originally developed for research are still valid and reliable in the clinical setting.

The Milky Way educational and support programme: Structure, content and strategies

BACKGROUND Health professionals have put much effort into supporting women to continue breastfeeding up to six months and beyond. The majority of those efforts have not been successful for primiparous women. Primiparous women who engaged in the Milky Way Programme had an improvement in breastfeeding rates of almost 50% at six months when compared to women in a control group. PURPOSE To provide details of the Milky Way Programme including the educational structure, content and strategies as well as the process of postnatal telephone support. OVERVIEW The details of the Milky Way Programme are presented including a summary of literature review that was used to design the programme. The structure and content of the programme is then presented. Finally, the strategies with some practical examples are outlined in more detail. CONCLUSION The programme is evidence-based, theoretically informed and woman-centred. This paper provides the necessary information to health professionals who are trained to educate and support breastfeeding women to implement similar programmes in their workplaces.