The choice to breast feed or bottle feed and influences upon that choice: a survey of 1525 mothers

A consecutive sample of 1525 mothers was interviewed after delivery in hospital in order to investigate the characteristics of breast and bottle feeders and to examine the reasons for deciding how to feed and the influences upon that decision. Breast feeding was associated with age, social class and parity. A woman's choice of feeding was strongly associated with her husband's opinion if he had a definite preference; also her choice was associated with the feeding method of her own mother if it had been consistent. The most frequent reasons for breast feeding were the belief that it was 'better for the baby' and that it was 'natural'. The most commonly reported reasons for bottle feeding were that breast feeding was inconvenient and embarrassing. Women's own previous failures at breast feeding and those of their friends were powerful influences upon many mothers.     

From initiation to cessation: Turning points and coping resources in the breastfeeding experience of first-time mothers

While most mothers initiate breastfeeding, many do not continue for recommended durations. This study aimed to understand the gap between breastfeeding initiation and duration through an in-depth exploration of first-time mothers’ breastfeeding experiences. Contextual factors that may facilitate or deter breastfeeding maintenance were explored by identifying common turning points (significant events or periods promoting a change in thoughts/behaviors or facilitating maintenance) described by mothers with varied breastfeeding durations. In semistructured interviews conducted from March to June 2015, twenty-eight first-time mothers in Iowa were asked to describe their breastfeeding experiences from initiation through cessation. Using thematic analysis, seven turning points, consistent across varied durations and experiences were identified: breastfeeding problems, the unknowns, recurring stressors, living new life with baby, reentering social roles, special occasions, and letting go. Turning points were usually associated with stressful situations, and mothers described intrapersonal (e.g., determination) and interpersonal (e.g., social support) coping resources as facilitators of breastfeeding maintenance. These findings highlight contextual factors that may trigger turning points, representing critical intervention periods, and the importance of enhancing support networks. Interventions to facilitate longer breastfeeding durations should consider key turning points and availability of coping resources to determine strategies that best fit the mother at each point.     

Exploring informed choice in the context of prenatal testing: findings from a qualitative study

Purpose This study explored whether and how a sample of women made informed choices about prenatal testing for foetal anomalies; its aim was to provide insights for future health policy and service provision. Methods We conducted semi‐structured interviews with 38 mothers in Ottawa, Ontario, all of whom had been offered prenatal tests in at least one pregnancy. Using the Multi‐dimensional Measure of Informed Choice as a general guide to analysis, we explored themes relevant to informed choice, including values and knowledge, and interactions with health professionals. Results Many, but not all, participants seemed to have made informed decisions about prenatal testing. Values and knowledge were interrelated and important components of informed choice, but the way they were discussed differed from the way they have been presented in scientific literature. In particular, ‘values’ related to expressions of women’s moral views or ideas about ‘how life should be lived’ and ‘knowledge’ related to the ways in which women prioritized and interpreted factual information, through their own and others’ experiences and in ‘thinking through’ the personal implications of testing. While some women described non‐directive discussions with health professionals, others perceived testing as routine or felt pressured to accept it. Conclusions Our findings suggest a need for maternity care providers to be vigilant in promoting active decision making about prenatal testing, particularly around the consideration of personal implications. Further development of measures of informed choice may be necessary to fully evaluate decision support tools and to determine whether prenatal testing programmes are meeting their objectives.     

Factors that influence passive smoking in infancy: a study among mothers of newborn babies in The Netherlands

BACKGROUND: The aim of this study was to assess the factors that influence smoking in the presence of the infant by mothers, partners, other family members, and friends. METHODS: An observational study using questionnaires was performed with smoking and nonsmoking parents of babies between 1 and 14 months old attending Dutch well-baby clinics between February and May 1996. The main measures were prevention of passive smoking in children by mothers and the relation with self-reported attitudes, social influence, and self-efficacy. RESULTS: A total of 1702 parents completed the questionnaire (63%). A total of 1551 questionnaires were completed by the mother. Sixty-five percent of the mothers prevented passive smoking by their child. This figure was 55% for smokers and 69% for nonsmokers. Attitude was the factor that most explained preventive behavior among both smokers and nonsmokers. Among the respondents, a lack of prevention of passive smoking was significantly related to (1) a negative attitude and 2) a negative social influence exerted by their partner, (3) lower self-efficacy in reducing passive smoking, and (4) increasing age of the child. (5) Finally, a lack of prevention is associated with the mother's self-efficacy in asking others not to smoke. This association strongly differs between smoking and nonsmoking mothers. CONCLUSION: The results suggest that health education efforts should focus on attitude and self-efficacy, assuming that these precede actual behavior, and in particular on the health consequences of the exposure of young children to tobacco smoke. The information should not be restricted to parents of newborn babies; it should also focus on parents with older children. Particular attention should be paid to smokers with a low educational level. The results also indicate that education should strengthen the ability of nonsmoking parents to deal with smokers and the ability of smoking parents to deal with their own smoking behavior.     

Impact of an informed choice invitation on uptake of screening for diabetes in primary care (DICISION): trial protocol

Background  

Screening invitations have traditionally been brief, providing information only about population benefits. Presenting information about the limited individual benefits and potential harms of screening to inform choice may reduce attendance, particularly in the more socially deprived. At the same time, amongst those who attend, it might increase motivation to change behavior to reduce risks. This trial assesses the impact on attendance and motivation to change behavior of an invitation that facilitates informed choices about participating in diabetes screening in general practice. Three hypotheses are tested:     

Exploring the factors that influence the goal setting process for occupational therapy intervention with an individual with spinal cord injury

This paper investigates the factors that influence the process that occurs between an individual with a spinal injury and his/her occupational therapist when setting goals for therapy intervention. A single case study design was adopted using a combination of in-depth semistructured interviews with a therapist and patient, and observation of occupational therapy treatment sessions. After analysis of the results, the following four categories emerged as influencing the goal setting process: the context for setting goals; the concept of independence; the features of goals; and the process dimensions of goal setting. The study highlights that the patient and therapist's respective views of independence, and their understanding of the features of goals may influence the success of the goal setting process. Further investigation into these areas is indicated.     

Food and nutrition policy at the local level: Key factors that influence the policy development process

Little empirical work has been undertaken examining the policy process at the local level, where the majority of public health professionals work. This has resulted in a lack of understanding of how the policy development process works at this level and of the relevance of policy theory to local policy processes and outcomes. This paper discusses the findings of four case studies undertaken during 1995-96 that examined the process of developing food and nutrition policies within Australian local governments. At two of the sites food and nutrition policies were introduced. At the other two sites the development of food and nutrition policies was funded but policies were not endorsed or implemented. Semi-structured interviews were held with key personnel and document analysis was undertaken of reports and minutes of meetings. Factors examined in the study included the roles of individuals, groups and organized interests, the influence of organizational and governmental structures and the interaction between these factors. The relevance of the policy theories of localism, agenda setting and political power and policy making to locally based health policy development is discussed. Key findings of this study are that local policy action is a function of the nature of the policy issue, it is dependent on the political and organizational environments within which it is developed and action by individuals can be very influential in the policy process.     

Tools for evaluating Veterinary Services: an external auditing model for the quality assurance process

The author describes the reasons why evaluation processes should be applied to the Veterinary Services of Member Countries, either for trade in animals and animal products and by-products between two countries, or for establishing essential measures to improve the Veterinary Service concerned. The author also describes the basic elements involved in conducting an evaluation process, including the instruments for doing so. These basic elements centre on the following:--designing a model, or desirable image, against which a comparison can be made--establishing a list of processes to be analysed and defining the qualitative and quantitative mechanisms for this analysis--establishing a multidisciplinary evaluation team and developing a process for standardising the evaluation criteria.     

Two screening instruments for collecting alcohol-related information from expectant mothers and fathers: Testing the reliability of the Parent Alcohol Screening Questionnaire and the Social Support for an Alcohol-Free Pregnancy Questionnaire

The aim is to test the reliability of two alcohol screening instruments: (1) The Parent Alcohol Screening Questionnaire (PASQ5), and (2) the Social Support for an Alcohol-free Pregnancy (SSAFP) questionnaire. This is a cohort study from the south of Sweden using repeated surveys during pregnancy. To examine if responses differed according to different data collection methods, two cohorts consisting of 289 expectant mothers and 141 fathers completed the PASQ5 both verbally (weeks 6–7) and in writing (week 12) within regular antenatal visits. One of the cohorts (n = 137/64) also completed the SSAFP in week 12 and later in week 33. The third cohort, consisting of 179 and 133 expectant mothers and fathers, respectively, completed the PASQ5 and the SSAFP twice in late pregnancy (week 31 + 33). Eight of 10 items in the PASQ5 were stable for both expectant mothers and expectant fathers when comparing verbal versus written-delivered formats. Eight of 10 questions in the PASQ5 were stable when assessing the items in a test–retest analysis in late pregnancy for expectant mothers and nine of 10 questions were stable for fathers. The SSAFP items showed high internal consistency (0.86) for expectant mothers and excellent internal consistency (0.94) for expectant fathers. Most SSAFP items (17 of 21 for expectant mothers and 18 of 22 for expectant fathers) were also stable in a test–retest scenario in late pregnancy. Both the PASQ5 and SSAFP are reliable tools and may be helpful for clinicians who aim to have a deeper dialogue about alcohol consumption during pregnancy. These tools may also be helpful for researchers aiming to better understand a person's changes in alcohol intake and/or their social support network.     

Habit versus choice: the process of decision-making in health-related behaviour

Social differences in the role of habits in health-related behaviour are explored within both sociology and economics, where we define habits as non-reflective, repetitive behaviour. The corresponding theoretical perspectives are the habitus theory, the theory of individualization, and habits as rational decision rules. Sixteen thematically structured interviews are analysed using qualitative methodology. Three aspects of habits emerged from the narrative: the association between habits and preferences, habits as a source of utility, and the relationship between habits and norms. We find that people in lower social positions are more inclined to rely on their habits and are accordingly less likely to change their behaviour. These differences are reinforced as not only the disposition to maintain habits but also the tendency to conceive of the habitual as something good seems to be strengthened in lower social positions. We also note that the intensified individualization that characterizes current society erodes the basis for habit-governed behaviour, which may also contribute to social differences in well-being. Finally, we find that the scientific dialogue has enriched both scientific paradigms, and suggest as a tentative hypothesis that the traditional economic rational-actor model may be relatively less applicable to those with limited resources.     

Feeding the planet: an unprecedented confluence of pressures anticipated

The report from the UK government's Foresight team, The Future of Food and Farming: Challenges and Choices for Global sustainability, published in January 2011, explores the pressures on the global food system between now and 2050, and identifies the decisions that policy makers need to take today and in the years ahead in order to ensure that the future global population can be fed sustainably, and underlines the need for the public health and food supply sustainability agendas to be harnessed together. The global population is now 6.8 billion and is estimated to reach over 9 billion by 2050. Not only is the world's population expanding but it is also undergoing rapid development, and with this comes increasing demand for protein rich foods, especially meat and dairy products. As economies strengthen, the so‐called diseases of affluence are often found alongside chronic malnutrition, in India for example, making the public health challenges particularly complex. The Foresight report concludes that, without change, food production will continue to degrade the environment and compromise the world's capacity to produce sufficient food in a sustainable way, as well as contributing to climate change and destruction of biodiversity. The report also emphasises that the use of new technologies as a partial solution, such as genetic modification and livestock cloning, should not be excluded a priori on ethical and moral grounds. But the question remains ‘what should be done in terms of dietary advice?’ This paper considers some of the issues.     

Interim guidelines for the evaluation of infants born to mothers infected with West Nile virus during pregnancy

West Nile virus (WNV) is a single-stranded RNA flavivirus with antigenic similarities to Japanese encephalitis and St. Louis encephalitis viruses. It is transmitted to humans primarily through the bites of infected mosquitoes. Flavivirus infection during pregnancy has been associated rarely with both spontaneous abortion and neonatal illness but has not been known to cause birth defects in humans. During 2002, a total of 4,156 cases of WNV illness in humans, including 2,946 cases of neuroinvasive disease, were reported to CDC by state health departments. In 2002, a woman who had WNV encephalitis during the 27th week of her pregnancy delivered a full-term infant with chorioretinitis, cystic destruction of cerebral tissue, and laboratory evidence of congenitally acquired WNV infection. Although this case demonstrated intrauterine WNV infection in an infant with congenital abnormalities, it did not prove a causal relation between WNV infection and these abnormalities. During 2002, CDC investigated three other instances of maternal WNV infection. In all three cases, the infants were born at full term with normal appearance and negative laboratory tests for WNV infection; cranial imaging studies and ophthalmologic examinations were not performed. During 2003, CDC received reports of approximately 9,100 cases of WNV illness, including approximately 2,600 cases of neuroinvasive disease. CDC is gathering data on pregnancy outcomes for approximately 70 women with WNV illness during pregnancy.     

Supporting mothers to breastfeed: the development and process evaluation of a father inclusive perinatal education support program in Perth, Western Australia

Entry into fatherhood is a challenging period with new responsibilities and changes in family dynamics. Hegemonic imagery of men portray them as capable, confident and able which can disadvantage expectant fathers who often struggle to make sense of the changes occurring around and within their own parenting journey. Although fathers historically have not been included in breastfeeding classes, antenatal education programs can be an opportunity to inform and support them in their new role. Forty-five antenatal sessions for fathers (n = 342) of 1h duration were conducted by five male educators between May 2008 and June 2009 in Perth, Western Australia. A theoretical framework from health promotion literature was used as a guide in the program's development. Fathers in the intervention group gained information about their role, the importance of communication and the benefits of breastfeeding to both mother and baby. An evaluation was obtained from fathers immediately after the session and again at 6 week post-birth, whilst mothers reported on the perception of their partners' support for breastfeeding in the 6 week survey. The aim of this paper is to describe the development and process evaluation of a perinatal education and support program for fathers to assist their partners to breastfeed.