Six-month breastfeeding maintenance after a self-efficacy promoting programme: an exploratory trial.

BACKGROUND: Breastfeeding care plays a fundamental role in establishing breastfeeding and longer duration after discharge. Practices though vary among professionals involved and are often inconsistent with good practices recommended, being a threat to women's breastfeeding self-efficacy. Breastfeeding self-efficacy is considered a predictor for successful breastfeeding and a significant variable amenable to intervention for promoting lactation AIM: To evaluate the efficacy, feasibility and acceptability of a new breastfeeding self-efficacy promoting programme (SIALAC) on 6-month breastfeeding maintenance. METHODS: In this exploratory multi-centre controlled trial, participants were allocated into control and intervention groups sequentially. Professionals in charge of the treatment groups were trained in between, with an especial focus on reducing practice variability. Control and intervention group women received usual care, and the intervention group received in addition SIALAC, a three-stage breastfeeding self-efficacy promoting programme. Primary outcome was breastfeeding maintenance up to 6 months analysed by Kaplan-Meier and Cox proportional hazard regression analysis. Student's t-test or chi-square tests were also used for continuous and categorical variables. Data on breastfeeding status and breastfeeding self-efficacy were collected at baseline, and 4, 8 and 24 weeks after birth. RESULTS: From May 2014 through November 2015, participants were enrolled. The sample consisted of 112 women. No relevant socio-demographic or obstetric difference was found between groups. The intervention achieved a significant difference between groups in breastfeeding survival (X2  = 4.94, p = 0.026). Six-month breastfeeding maintenance was significantly higher in the intervention group (67% vs. 55%; X2  = 5.384, p = 0.020). Breastfeeding dropout in the control group was 3.3 (CI 1.1, 10.1) times higher than that of the intervention group at 6 months. Breastfeeding self-efficacy scores were higher in the intervention group although without significant statistical difference. The programme showed good acceptability. CONCLUSION: Breastfeeding self-efficacy promoting programme SIALAC was beneficial in fostering 6-month breastfeeding survival. Full-scale trial should consider feasibility-related issues identified.

Design, implementation and evaluation of an education course to promote professional self-efficacy for breastfeeding care.

The objective of this study was to determine the effect of an education short course on professional' self-efficacy in the area of breastfeeding care. The intervention had a pre-post design. A total of 43 healthcare professionals attended the course. The Kirkpatrick model for the development, implementation and evaluation of education actions was used for a 4.5-h course. The aspects evaluated included professionals' satisfaction and learning regarding confidence to support lactating mothers, perceived transfer of knowledge to the workplace and organizational changes. Data were collected using self-administered questionnaires (participants, unit managers, and education planners), before and after the intervention. Participants' satisfaction with the education action was high in all of the aspects measured (greater than 3.9 in scores of 0-5). Professionals showed a significant increase in self-efficacy levels for supporting breastfeeding (Wilcoxon test p-value = < 0.05, before intervention: median = 55, [IQR] = 11; after intervention: median = 60, [IQR] = 14). Participants, managers and organizers of the course identified changes in the way that professionals cared for breastfeeding mothers. In conclusion, this educational intervention enhanced professional self-efficacy and performance in breastfeeding care.

Student nurses at Spanish universities and their attitude toward xenotransplantation.

INTRODUCTION: Recent immunological and transgenic advances are a promising alternative using limited materials of human origin for transplantation. However, it is essential to achieve social acceptance of this therapy. OBJECTIVE: To analyze the attitude of nursing students from Spanish universities toward organ xenotransplantation (XTx) and to determine the factors affecting their attitude. MATERIALS AND METHODS: Type of study: A sociological, multicentre, and observational study. STUDY POPULATION: Nursing students enrolled in Spain (n = 28,000). SAMPLE SIZE: A sample of 10 566 students estimating a proportion of 76% (99% confidence and precision of ±1%), stratified by geographical area and year of study. Instrument of measurement: A validated questionnaire (PCID-XenoTx-RIOS) was handed out to every student in a compulsory session. This survey was self-administered and self-completed voluntarily and anonymously by each student in a period of 5-10 min. STATISTICAL ANALYSIS: descriptive analysis, Student's t test, the chi-square test, and a logistic regression analysis. RESULTS: A completion rate: 84% (n = 8913) was obtained. If the results of XTx were as good as in human donation, 74% (n = 6564) would be in favor and 22% (n = 1946) would have doubts. The following variables affected this attitude: age (P < 0.001); sex (P < 0.001); geographical location (P < 0.001); academic year of study (P < 0.001); attitude toward organ donation (P < 0.001); belief in the possibility of needing a transplant (P < 0.001); discussion of transplantation with one's family (P < 0.001) and friends (P < 0.001); and the opinion of one's partner (P < 0.001). The following variables persisted in the multivariate analysis: being a male (OR = 1.436; P < 0.001); geographical location (OR = 1.937; P < 0.001); an attitude in favor of donation (OR = 1.519; P < 0.001); belief in the possibility of needing a transplant (OR = 1.497; P = 0.036); and having spoken about the issue with family (OR = 1.351; P < 0.001) or friends (OR = 1.240; P = 0.001). CONCLUSIONS: The attitude of nursing students toward organ XTx is favorable and is associated with factors of general knowledge about organ donation and transplantation and social interaction.

Diseño y validez de un instrumento para evaluar la autoeficacia percibida por los profesionales de la salud acerca de su capacidad para procurar cuidados a las madres que amamantan / Design and validity of an instrument to evaluate health professionals' perceived self-efficacy to care for nursing mothers

La promoción y apoyo a la lactancia materna proporcionado por profesionales de la salud en diferentes entornos es una de las estrategias con evidencia de resultados exitosos. El propósito de este estudio es desarrollar una escala para conocer la autoeficacia percibida por los profesionales de salud acerca de su capacidad para procurar cuidados a las madres que amamantan. METODOLOGÍA. El diseño de la escala se hizo utilizando la versión española de la escala BreastfeedingSelf-EfficacyScale-Short Form para madres. Las pruebas de validación se realizaron creando un grupo de expertos y pilotando la herramienta con profesionales que cuidaban a madres lactantes de dos centros asistenciales. Las propiedades psicométricas de la escala se examinaron analizando su validez, fiabilidad, sensibilidad y factibilidad. RESULTADOS. La escala "Autoeficacia Profesional para los Cuidados en Lactancia" (APCLA)contiene 14 ítems conforme al dominio de interés, con opciones de respuesta de 1 a 5. Se elaboró en formato papel y electrónico. Tras la valoración del comité de expertos, se pilotó con 43 enfermeras y matronas. La escala muestra resultados prometedores con respecto a su validez, fiabilidad (Alpha de Cronbach 0,967), sensibilidad (p<0,05) y factibilidad. CONCLUSIÓN. Aunque será necesario continuar con el proceso de validación en otras poblaciones y con mayor número de participantes, el instrumento ha mostrado buenos resultados para la medición de la autoeficacia profesional. La valoración de la autoeficacia profesional para proporcionar cuidados a madres que amamantan ayudará a identificar áreas de formación para profesionales que permitan la reducción de la variabilidad de los cuidados.

The promotion and support of breastfeeding by health professionals in different settings is an interventional strategy with evidence of successful results. The purpose of this study is to develop a scale to understand the self-efficacy perceived by health professionals about their ability to care for breastfeeding mothers. METHODOLOGY. The design of the scale was made using the Spanish version of the 'Breastfeeding Self-Efficacy Scale-Short Form' scale for mothers. The validation tests were done by creating a group of experts and piloting the tool with professionals caring for nursing mothers from two centres. The psychometric properties of the scale were examined by analysing their validity, reliability, sensitivity and feasibility. RESULTS. The scale "Professional Self-Efficacy for Breastfeeding Care" (Autoeficacia Profesional para los Cuidados en Lactancia, APCLA) contains 14 items according to the domain of interest, with response options from 1 to 5. It was elaborated in paper and electronic format. After the assessment of the committee of experts, it was piloted with 43 nurses and midwives. The scale shows promising results with respect to its validity, reliability (Cronbach's Alpha 0.967) sensitivity (p <0.05) and feasibility. CONCLUSION. Although it will be necessary to continue the validation process in other populations and larger numbers of participants, the instrument has shown good results for the measurement of professionals' self-efficacy. Assessing professional perceived self-efficacy to care for breastfeeding mothers will help identify areas of training for professionals and reduce variability in care provision.