Scoping Review of Barriers and Facilitators of Breastfeeding in Women on Opioid Maintenance Therapy.

OBJECTIVE: To synthesize the literature on the barriers and facilitators of breastfeeding among women on opioid maintenance therapy (OMT) to inform nursing interventions and improve breastfeeding outcomes. DATA SOURCES: We searched 11 databases using the following key terms: breastfeeding, barriers, facilitators, promotion, and opioid. STUDY SELECTION: We included articles published in English since 2015 that addressed barriers and facilitators of breastfeeding in women on OMT. We did not limit our search to specific types of studies. Our search produced 65 records. After reviewing titles and abstracts, we assessed 21 full-text articles and excluded seven for lack of data related to our key terms. As a result, we included five qualitative studies, three reviews, three mixed-methods studies, two retrospective cohort studies, and one case report (14 articles) in our final review. DATA EXTRACTION: We extracted data from each article and sorted them in a table for analysis and synthesis. Data included study purpose, research questions, design and methodology, and findings specifically pertaining to the identification of barriers and facilitators of breastfeeding for women on OMT. DATA SYNTHESIS: We identified three themes related to facilitators of and barriers to breastfeeding: Information, Support, and Health Care System Factors. CONCLUSION: The results of our review suggest that most barriers and facilitators of breastfeeding in women on OMT are manageable with improved health care practices. Primary and acute care health professionals should modify practices to minimize barriers to breastfeeding. Nurses should provide better breastfeeding education and preparation, sensitive care in the immediate postpartum period, and extended follow-up after hospital discharge for women on OMT.

Supporting breastfeeding for women on opioid maintenance therapy: a systematic review.

OBJECTIVE: Despite evidence to support breastfeeding, rates remain low in women on opioid maintenance therapy (OMT). The goal of this review was to synthesize current knowledge regarding interventions to promote breastfeeding in women on OMT. STUDY DESIGN: A systematic search of databases including PubMed, CINAHL, PsycINFO, Embase, Scopus, Web of Science, and the Cochrane database of systematic reviews was conducted. Key words included breastfeeding, lactation, opioid use disorder, and opioid maintenance therapy. Risk of bias was assessed by two reviewers. RESULT: Four quasi-experimental studies met inclusion criteria. Improved rates of breastfeeding reached statistical significance in all four. Three studies had moderate to serious risk of bias related to confounding variables. Interventions shared common features, including an integrated approach, a well-prepared multidisciplinary team, nonseparation of mother and newborn, and patient centered care. CONCLUSIONS: Further research should explore barriers and facilitators to breastfeeding in this vulnerable population.

Psychometric Properties of the Short Form of the Health Practices Questionnaire-II Chinese Version.

OBJECTIVE: To examine the psychometric properties of the Health Practice Questionnaire-II Chinese version (HPQ-II CV), a self-report instrument designed to measure the health behaviors of pregnant women. DESIGN: Cross-sectional, psychometric design. SETTING: Prenatal clinics of four hospitals in southern Taiwan. PARTICIPANTS: Two convenience samples, 368 pregnant women in Phase 1 and 289 pregnant women in Phase 2. METHODS: In Phase 1, the 34-item HPQ-II was translated into Chinese. Then, we explored the factor structure of the HPQ-II CV using exploratory factor analysis, determined the factors of the HPQ-II CV, and shortened the length of the scale. In Phase 2, we used confirmatory factor analysis to cross-validate the factor structure of the 13-item HPQ-II CV. RESULTS: In Phase 1, we used item analysis to reduce the 34-item HPQ-II CV to 21 items. Using exploratory factor analysis and parallel analysis, we shortened the 21-item HPQ-II CV to 15 items grouped in four factors: Taking Safety Measures (4 items), Eating A Healthy Diet (3 items), Coping With Uncertainty (3 items), and Seeking Help From Professionals (5 items), which accounted for 45.70% of the total variance. In Phase 2, two items were removed from the 15-item HPQ-II CV after confirmatory factor analysis. Cronbach's alpha coefficient of the 13-item HPQ-II CV was .80, and the cross-sample validity supported the best-fit model for the 13-item HPQ-II CV. CONCLUSION: We found acceptable validity and reliability statistics for the 13-item HPQ-II CV when administered to pregnant, Taiwanese women.