Influence of grandmothers on breastfeeding practices in a rural community in Papua New Guinea: A critical discourse analysis of first-time mothers' perspectives.

BACKGROUND: Almost all babies are breastfed in Papua New Guinea (PNG); yet appropriate breastfeeding practices are not always followed. AIM: To explore the perspectives of first-time mothers in rural PNG on how the language and discourse of grandmothers about infant feeding influence their breastfeeding practices. METHODS: A critical discourse analysis (CDA) approach was used to theoretically frame the analysis of twenty first-time mothers' narratives. FINDINGS: Analysis revealed three themes: (i) prescribed knowledge repository, (ii) social control and dominance, and (iii) disapproval and role conflict, which provides an understanding of grandmothers' differing views and positions on infant feeding practices and their influence on breastfeeding. CONCLUSION: This study shows that grandmothers remain influential in infant feeding practices in rural PNG. There appears to be a societal expectation that empowers grandmothers in the maternal decision-making processes regarding breastfeeding practice. Grandmothers' influence includes the early introduction of complementary foods to infants less than six months old. Interventions aimed at promoting, protecting, and supporting breastfeeding need to include grandmothers.

A qualitative descriptive inquiry into factors influencing early weaning and breastfeeding duration among first-time mothers in Papua New Guinea's rural eastern highlands.

BACKGROUND: Exclusive breastfeeding confers multiple maternal and child health benefits. Although breastfeeding initiation following birth is common in Papua New Guinea, many first-time mothers may not achieve optimal breastfeeding duration. AIM: This study aims to explore and describe factors influencing early weaning and breastfeeding duration among first-time mothers in Papua New Guinea's rural eastern highlands. METHODS: A qualitative descriptive approach was adopted in this study. Data were collected through semi-structured in-depth interviews with 20 first-time mothers. The interviews transcripts were then thematically analysed. RESULTS: Three key themes identified were: source of breastfeeding information and support; social networks and breastfeeding communication; and balancing perceived gender and maternal roles. The study further identified a lack of fathers' involvement in supporting breastfeeding. CONCLUSION: Social and relational networks, and maternal factors need to be considered to better understand breastfeeding practices. Efforts to achieve optimal breastfeeding outcomes entail targeted and culturally appropriate programs, including fathers' involvement as they play important roles in breastfeeding and infant feeding practices.

The food choice at work study: effectiveness of complex workplace dietary interventions on dietary behaviours and diet-related disease risk - study protocol for a clustered controlled trial.

BACKGROUND: Dietary behaviour interventions have the potential to reduce diet-related disease. Ample opportunity exists to implement these interventions in the workplace. The overall aim is to assess the effectiveness and cost-effectiveness of complex dietary interventions focused on environmental dietary modification alone or in combination with nutrition education in large manufacturing workplace settings. METHODS/DESIGN: A clustered controlled trial involving four large multinational manufacturing workplaces in Cork will be conducted. The complex intervention design has been developed using the Medical Research Council's framework and the National Institute for Health and Clinical Excellence (NICE) guidelines and will be reported using the TREND statement for the transparent reporting of evaluations with non-randomized designs. It will draw on a soft paternalistic 'nudge' theoretical perspective. It will draw on a soft paternalistic "nudge" theoretical perspective. Nutrition education will include three elements: group presentations, individual nutrition consultations and detailed nutrition information. Environmental dietary modification will consist of five elements: (a) restriction of fat, saturated fat, sugar and salt, (b) increase in fibre, fruit and vegetables, (c) price discounts for whole fresh fruit, (d) strategic positioning of healthier alternatives and (e) portion size control. No intervention will be offered in workplace A (control). Workplace B will receive nutrition education. Workplace C will receive nutrition education and environmental dietary modification. Workplace D will receive environmental dietary modification alone. A total of 448 participants aged 18 to 64 years will be selected randomly. All permanent, full-time employees, purchasing at least one main meal in the workplace daily, will be eligible. Changes in dietary behaviours, nutrition knowledge, health status with measurements obtained at baseline and at intervals of 3 to 4 months, 7 to 9 months and 13 to 16 months will be recorded. A process evaluation and cost-effectiveness economic evaluation will be undertaken. DISCUSSION: A 'Food Choice at Work' toolbox (concise teaching kit to replicate the intervention) will be developed to inform and guide future researchers, workplace stakeholders, policy makers and the food industry. TRIAL REGISTRATION: Current Controlled Trials, ISRCTN35108237.

Setting priorities for non-regulatory animal health in Ireland: results from an expert Policy Delphi study and a farmer priority identification survey.

Agriculture is a very important contributor to the Irish economy. In Ireland, national animal health services have been a government, rather than an industry, responsibility. In 2009, Animal Health Ireland (AHI) was established to provide a partnership approach to national leadership of non-regulatory animal health issues (those not subject to national and/or EU regulation). The objectives of this study were to elicit opinion from experts and farmers about non-regulatory animal health issues facing Irish livestock industries, including prioritisation of animal health issues and identification of opportunities to maximise the effective use of AHI resources. The study was conducted with experts using Policy Delphi methodology over three rounds, and with farmers using a priority identification survey. Non-regulatory bovine diseases/conditions were prioritised by both experts and farmers based on impact and international competitiveness. For each high-priority disease/condition, experts were asked to provide an assessment based on cost, impact, international perception, impediment to international market access and current resource usage effectiveness. Further information was also sought from experts about resource allocation preferences, methods to improve education and coordination, and innovative measures to improve prevention and management. There was close agreement between responses from experts and dairy farmers: each gave highest priority to 3 diseases with a biosecurity risk (subsequently termed 'biosecure diseases') (bovine viral diarrhoea [BVD], infectious bovine rhinotracheitis [IBR], paratuberculosis) and 4 diseases/conditions generally without a biosecurity risk ('non-biosecure diseases/conditions') (fertility, udder health/milk quality, lameness, calf health). Beef farmers also prioritised parasitic conditions and weanling pneumonia. The adverse impact of biosecure diseases is currently considered relatively minor by experts, but would increase substantially in time. There are already substantial costs to farms and agribusiness from non-biosecure diseases/conditions. Experts preferred an equal allocation of resources between these biosecure and non-biosecure diseases/conditions, with emphasis on adopting/adapting international models, education and awareness-raising. The results from this study provide robust insights about non-regulatory animal health priorities in Ireland, as perceived by experts and farmers, using methodologies that are both transparent and inclusive. They have already been extremely influential in shaping national policy, as a foundation for interdisciplinary (and multi-agency) cooperation, as a contribution to efforts to encourage stakeholder responsibility-taking, and to ongoing development of postgraduate and undergraduate veterinary education in Ireland.