Dataset Information

Supporting, failing to support and undermining breastfeeding self-efficacy: Analysis of helpline calls.

ABSTRACT: Although a complexity of factors explain early cessation of breastfeeding, the encounter of a problem is often a critical point in this decision. For this reason, breastfeeding self-efficacy, a mother's evaluations of her ability to successfully overcome challenges, is an effective target in interventions to sustain breastfeeding. This study examined factors affecting the success of one such intervention, reactive telephone support. Across a 4-week period, recordings of all calls to a nurse-staffed parent helpline in Queensland, Australia were made. Of these calls, 60 were from mothers encountering a breastfeeding problem. Using a standard protocol, each call was scored for trajectories of mother's breastfeeding self-efficacy from opening to close of call. Calls showing an upward trajectory were defined as supporting (53%), those with no change were defined as ineffective (25%), and those with downward trajectory as undermining (22%). Using trajectory scores, case exemplars were purposively selected for detailed analysis of interactional sequences to identify strategies that distinguished outcome. The supportive call was distinguished by information sharing, mutual trust and respectful relationships, and personalized affirmation and advice. The ineffective call focused on technical aspects of breastfeeding, whereas the undermining call made moral judgements of mother's behaviour. The findings identify interactional quality of telephone support, not simply provision, as the key success factor in reactive telephone support. The findings also present interactional quality as a potential explanation for inconsistent outcomes in evaluation of reactive telehealth interventions to support breastfeeding.

SUBMITTER: Thorpe K

PROVIDER: S-EPMC7083474 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Supporting, failing to support and undermining breastfeeding self-efficacy: Analysis of helpline calls.

Thorpe Karen K Danby Susan S Cromack Ceridwen C Gallegos Danielle D

Maternal & child nutrition 20200205 2

Although a complexity of factors explain early cessation of breastfeeding, the encounter of a problem is often a critical point in this decision. For this reason, breastfeeding self-efficacy, a mother's evaluations of her ability to successfully overcome challenges, is an effective target in interventions to sustain breastfeeding. This study examined factors affecting the success of one such intervention, reactive telephone support. Across a 4-week period, recordings of all calls to a nurse-staf ...[more]

PMID: 32026573

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Project description:Helpline services have become an increasingly popular mode of providing community access to information and expert information and advice in the health and welfare sector. This paper reports on data collected from 908 callers to UK-based breastfeeding helplines.A mixed methods design was adopted utilising a structured interview schedule to elicit callers experiences of the help and support received. In this paper we report on a series of multiple regression models undertaken to elicit the variables associated with callers' 'overall satisfaction' with the helpline service. Three models were constructed; 1) caller demographic/call characteristics; 2) attitudes and effectiveness of service characteristics and 3) impact of support on caller wellbeing.Overall, 74.6% of callers were very satisfied, and 19.8% were satisfied with the help and support received by the helpline service. The caller demographic/call characteristics found to have a significant relationship with overall satisfaction related to the ease of getting through to the helpline and whether the woman had previously breastfed. Service characteristics associated with overall satisfaction related to whether the information received was helpful and whether the support helped to resolve their issues. The extent to which the volunteer was perceived to have enough time, whether the support had encouraged them to continue breastfeeding, met the caller's expectations and/or provided the support the caller needed were also significantly associated. Caller outcomes contributing significantly to overall satisfaction concerned callers feeling less stressed, more confident, reassured and determined to continue breastfeeding following the call. Consideration of the effect sizes indicated that key factors associated with overall satisfaction related to: volunteers having sufficient time to deal with the callers' issues; the information being perceived as helpful; the volunteers providing the support the callers needed; and for callers to feel reassured following the call.Overall, these results highlight the value of the breastfeeding helpline(s) in terms of providing rapid, targeted, realistic, practical, and responsive support that provides affirmation and encouragement. The benefits include confidence building and callers feeling reassured and motivated to continue breastfeeding. Care needs to be taken to ensure that helpline support is easily accessible to ensure that callers and their families can access support when needed. This may require consideration of extension to a 24 hour service.

Project description:BACKGROUND:Increasing the prevalence of optimal breastfeeding practices, including exclusive breastfeeding for 6?months, could prevent an estimated 823,000 child deaths annually. Self-efficacy is an important determinant of breastfeeding behaviors. However, existing measures do not specifically assess exclusive breastfeeding self-efficacy, but rather self-efficacy for any breastfeeding. Hence, we sought to adapt and validate an instrument to measure exclusive breastfeeding self-efficacy. METHODS:We modified and added items from Dennis' Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). It was then implemented in an observational cohort in Gulu, Uganda at 1 (n?=?239) and 3 (n?=?238) months postpartum ( clinicaltrials.gov NCT02925429). We performed inter-item and adjusted item-test correlations, as well as exploratory factor analysis and parallel analysis at 1?month postpartum to remove redundant items and determine their latent factor structure. We further applied confirmatory factor analysis to test dimensionality of the scale at 3?months postpartum. We then assessed the reliability of the scale and conducted tests of predictive and discriminant validity. Known group comparisons were made by primiparous status and correct breastfeeding knowledge. RESULTS:The modification of the original BSES-SF to target exclusive breastfeeding produced 19 items, which were reduced to 9 based on item correlations and factor loadings. Two dimensions of the adapted scale, the Breastfeeding Self-Efficacy Scale to Measure Exclusive Breastfeeding BSES-EBF emerged: Cognitive and Functional subscales, with alpha coefficients of 0.85 and 0.79 at 3?months postpartum. Predictive and discriminant validity and known group comparisons assessments supported its validity. CONCLUSIONS:This version of the Breastfeeding Self-Efficacy scale, the BSES-EBF Scale, is valid and reliable for measuring exclusive breastfeeding self-efficacy in northern Uganda, and ready for adaptation and validation for clinical and programmatic use elsewhere.

Project description:Mechanical unloading by ventricular assist devices (VAD) leads to significant gene-expression changes often summarized as reverse remodeling. However, little is known on individual transcriptome changes during VAD-support and its relationship to non-failing hearts (NF). In addition no data are available for the transcriptome regulation during non-pulsatile VAD-support. Therefore we analysed the gene-expression patterns of 30 paired samples from VAD-supported (including 8 non-pulsatile VADs) and 8 non-failing control hearts (NF) using the first total human genome-array available. Transmural myocardial samples were collected for RNA-isolation. RNA was isolated by commercial methods and processed according to chip-manufacturer recommendations. cRNA were hybridized on Affymetrix HG-U133 Plus 2.0 arrays, providing coverage of the whole human genome Array. Data was analyzed using Microarray Analysis Suite 5.0 (Affymetrix) and clustered by Expressionist software (Genedata). 352 transcripts were differentially regulated between samples from VAD-implantation and NF, whereas 510 were significantly regulated between VAD-transplantation and NF (paired t-test p<0.001, fold change >=1.6). Remarkably, only a minor fraction of 111 transcripts was regulated in heart failure (HF) and during VAD-support. Unsupervised hierarchical clustering of paired VAD- and NF-samples revealed separation of HF- and NF- samples, however individual differentiation of VAD-implantation and VAD-transplantation was not accomplished. Clustering of pulsatile and non-pulsatile VAD did not lead to robust separation of gene expression patterns. During VAD-support myocardial gene expression changes do not indicate reversal of the HF-phenotype, but reveal a distinct HF-related pattern. Transcriptome analysis of pulsatile and non-pulsatile VAD-supported hearts did not provide evidence for a pump-mode specific transcriptome pattern. Microarrays were used to elucidate the differences between non-failing control hearts and those, suffering from end-stage heart failure pre and post mechanical unloading.

Project description:OBJECTIVES:To identify sociodemographic and health-related characteristics of callers' making repeated calls within 48?hours to a medical helpline, compared with those who only call once. SETTING:In the Capital Region of Denmark people with acute, non-life-threatening illnesses or injuries are triaged through a single-tier medical helpline for acute, healthcare services. PARTICIPANTS:People who called the medical helpline between 18 January and 9 February 2017 were invited to participate in the survey. During the period, 38?787 calls were handled and 12?902 agreed to participate. Calls were excluded because of the temporary civil registration number (n=78), the call was not made by the patient or a close relative (n=699), or survey responses were incomplete (n=19). Hence, the analysis included 12?106 calls, representing 11.131 callers' making single calls and 464 callers' making two or more calls within 48?hours. Callers' data (age, sex and caller identification) were collected from the medical helpline's electronic records. Data were enriched using the callers' self-rated health, self-evaluated degree of worry, and registry data on income, ethnicity and comorbidities. The OR for making repeated calls was calculated in a crude, sex-adjusted and age-adjusted analysis and in a mutually adjusted analysis. RESULTS:The crude logistic regression analysis showed that age, self-rated health, self-evaluated degree of worry, income, ethnicity and comorbidities were significantly associated with making repeated calls. In the mutually adjusted analysis associations decreased, however, odds ratios remained significantly decreased for callers with a household income in the middle (OR=0.71;95% CI 0.54?to 0.92) or highest (OR=0.68;95% CI 0.48?to 0.96) quartiles, whereas immigrants had borderline significantly increased OR (OR=1.34;95% CI 0.96?to 1.86) for making repeated calls. CONCLUSIONS:Findings suggest that income and ethnicity are potential determinants of callers' need to make additional calls within 48?hours to a medical helpline with triage function.

Dataset Information

Supporting, failing to support and undermining breastfeeding self-efficacy: Analysis of helpline calls.

Publications

Supporting, failing to support and undermining breastfeeding self-efficacy: Analysis of helpline calls.

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