ABSTRACT
Factors affecting exclusive breastfeeding rates are complex. Evaluations for early-onset sepsis can negatively impact breastfeeding success. We sought to determine whether implementing an algorithm utilizing the sepsis risk score (SRS) in chorioamnionitis-exposed newborns would increase exclusive breastfeeding rates. We collaborated with healthcare systems experts to analyze and understand our outcomes. METHODS: We describe a retrospective cohort study of chorioamnionitis-exposed newborns 35 weeks and older gestation in the Mother-Baby Unit at our institution following a quality improvement project that implemented an SRS algorithm. We compared exclusive breastfeeding rates over 2 time periods, 33 months before and 15 months after SRS algorithm implementation. We completed bivariate comparisons using chi-square and Mann-Whitney U tests to understand the factors contributing to exclusive breastfeeding rates. In a secondary analysis, breastfeeding rates and demographic patterns were examined using p-charts. RESULTS: Following algorithm implementation, exclusive breastfeeding rates increased from 49% to 58% (P = 0.10) in chorioamnionitis-exposed newborns. Factors associated with increased exclusive breastfeeding included Caucasian race, English as the primary language, private insurance, vaginal delivery, and positive group B Streptococcus status. In the secondary analysis, the proportion of non-Hispanic mothers increased from 63% to 80% during the study. CONCLUSIONS: Despite SRS implementation, exclusive breastfeeding rates increased but not significantly, and certain sociodemographic factors remain associated with exclusive breastfeeding. Secondary analysis revealed an overall demographic shift affecting the dataset, highlighting the importance of thorough data analysis when evaluating a quality improvement project.
ABSTRACT
The aims of this study were to design the Hookah Smoking Initiation for Women Questionnaire (HIWQ) and determine its psychometric properties. This was a sequential exploratory mixed-methods design consisting of qualitative and quantitative phases. This study was conducted from August 2012 to July 2013 in Tehran. In the qualitative phase, semi-structured interviews were held with 36 Iranian women for developing a preliminary item pool. Consequently, during the quantitative phase, the psychometric properties of the questionnaire were determined with the collaboration of 323 women living in various geographical locations in Tehran, Iran. Content validity of the questionnaire was examined by a panel of experts. The questionnaire's construct validity was assessed using exploratory factor analysis and confirmatory factor analyses. The Cronbach's alpha coefficient was calculated to check the questionnaire's internal consistency reliability. Moreover, its stability was tested using the test-retest method. Exploratory factor analysis indicated that the HIQW could best be explained by a six-factor solution: 'drawing the attention of other people', the need to having fun and being relaxed, 'hookah smoking in the family', 'availability of hookah', 'curiosity' and 'having a positive attitude toward hookah'. It also was found that the construct and content validity, and the reliability of the questionnaire were satisfactory (α = 0.83, ICC = 0.94). The HIQW was valid and reliable. Therefore, healthcare professionals can use it for evaluating the hookah smoking initiation in women. Future studies are required to refine this questionnaire and assess its applicability in different cultures and contexts.
