نوع مقاله : مقاله پژوهشی

نویسندگان

1 دانشجوی کارشناسی ارشد، گروه مدیریت خدمات بهداشتی و درمانی، واحد مرودشت، دانشگاه آزاد اسلامی، مرودشت، ایران

2 استادیار، گروه مدیریت خدمات بهداشتی و درمانی، واحد مرودشت، دانشگاه آزاد اسلامی، مرودشت، ایران

3 دانشیار، گروه بهداشت عمومی، دانشکده بهداشت، دانشگاه علوم پزشکی شیراز، شیراز، ایران

10.30476/smsj.2021.82100.1014

چکیده

مقدمه: تغذیه با شیر مادر برای شش ماه اول و ادامه تغذیه با شیر مادر تا 2 سال یا بیشتر یک روش مطلوب برای تغذیه نوزاد است. توانمندسازی شیردهی مادر یکی از عوامل مهم در پیشبرد تغذیه با شیر مادر محسوب می شود و شناسایی عوامل تسهیل کننده آن می تواند به توسعه سیاست ‌های موثر و مداخله کمک کند. هدف از انجام این مطالعه تعیین عوامل مرتبط با توانمند سازی مادران جهت شیردهی در بیمارستان مادر و کودک شیراز  در سال 1397 بود.
روش­ها: پژوهش حاضر یک پژوهش توصیفی - کیفی با رویکرد پدیدار شناختی بوده  و تعداد مشارکت کننده 12 نفر و از طریق مصاحبه نیمه ساختار یافته صورت گرفته است و تحلیل محتوا همزمان با جمع اوری داده ها صورت گرفت. به منظور تحلیل داده‌ها در ابتدا هر یک از مصاحبه خوانده شد و مطالب نگارش می گردید. سپس عبارات مهم در محتوای داده‌ها مشخص و (کد‌های باز) آن تعیین شد. بر اساس شباهت‌ها و تفاوت‌‌های موجود و مقایسه مستمر کد‌های باز در طبقات مشابهی قرار داده شدند و زیرطبقات را تشکیل دادند و در نهایت درون مایه‌های اصلی تعیین شد.
یافته‌ها: شرکت کنندگان در پی کسب مهارت ‌های تغذیه با شیر مادر در بیمارستان، مشاوره تغذیه با شیر مادر در مراکز بهداشتی درمانی را به عنوان عوامل مهمی در تسهیل توانمند سازی آنها در شیردهی و تداوم آن عنوان نمودند . تجزیه و تحلیل بیشتر نشان داد "تصمیم مادر برای تغذیه با شیر مادر" همراه با درک او(خودکارآمدی مادر، اعتقاد زن و اعتماد به نفس در توانایی او در تغذیه با شیر مادر) ، "نگرش مثبت فرهنگی  و مشارکت همسر و خانواده در تغذیه با شیر مادر"(آموزش و حضور همسر و عشق ورزیدن به مادر در زمان شیردهی )، " آموزش عمومی و ارایه  اطلاعات "(یک ارتباط شخصی موفق مادر  با دوستانش) و "نقش ماما و سایر کادر درمانی و بهداشتی(تشویق مادران و افزایش ترغیب مادر به شیردهی )" زمینه مناسب را برای تداوم تغذیه با شیر مادر فراهم می کند

نتیجه گیری: چهار اصل اصلی از "نقش پرسنل کادر بهداشتی درمانی "، "عوامل فرهنگی " و "عوامل فردی " و عوامل  اموزشی از توضیحات شرکت کنندگان استخراج شده است، که نشان دهنده ابعاد تسهیل کننده برای توانمندسازی زنان در شیردهی است. یافته ‌های پژوهش حاکی از آن است که خدمات شیردهی بیمارستانی نقش کلیدی در توانمندی در شیردهی دارد و وجود واحد اختصاصی آموزش و مشاوره شیردهی در بیمارستان، تأکید بر انجام تماس پوست با پوست مادر و نوزاد تأکید بر شروع زودرس شیردهی، حمایت و آموزش عملی مادر و ارجاع موارد مشکل دار به واحد مشاوره شیردهی منجر به شکل گیری توانمندی مادر در شیردهی می شود.

کلیدواژه‌ها

عنوان مقاله [English]

Effective Factors in Empowering Mothers for Breastfeeding: A Qualitative Study

نویسندگان [English]

  • sara Bazrriz 1
  • abbas yazdanpanah 2
  • Ali Khani Jeihooni 3

1 Instructor, Department of Healthcare Management, Marvdasht Branch, Islamic Azad University, Marvdasht, Iran

2 Assistant Professor, Department of Healthcare Management, Marvdasht Branch, Islamic Azad University, Marvdasht, Iran

3 Associate Professor, Department of Public Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran

چکیده [English]

Introduction: Breastfeeding for the first six months and continued breastfeeding for 2 years or more is a good way to feed the baby. The empowering of mother’ breastfeeding is one of the important factors in promoting breastfeeding, and identifying its facilitating factors can help develop effective policies and interventions. This study was conducted to investigate the related factors in empowering mothers for breastfeeding in Shiraz Mother and Child Hospital in 2018.
Methods: The present study was descriptive qualitative research with a phenomenological approach in which 12 participants were interviewed through semi-structured interview. Content analysis was carried out to analyze the collected data.
To analyze the data, each interview was transcribed and codified. Finally, all thematic structures were analyzed, compared and contrasted and the main themes were determined.
Results: Following the acquisition of breastfeeding skills in the hospital, participants cited breastfeeding counseling in health centers as an important factor in facilitating their empowerment in breastfeeding and their breastfeeding continuation. Further analysis revealed that "the mother's decision to breastfeed" along with her perception (self-efficacy and confidence in her capability to breastfeed), "positive cultural attitudes and participation of spouse and family in breastfeeding" "Breastfeeding" (training the spouse and his presence while loving the breastfeeding wife), "Public education and sharing information" (a successful personal relationship between the mother and her friends) and "The role of the midwife and other health care staff (encouraging mothers and increasing their tendancy to breastfeed "provides a good ground for constant breastfeeding.
Conclusion: The four main principles including " health care personnel", "cultural factors" and "individual factors" and training factors have been extracted from the interviews conducted. These principles illustrate the dimensions which facailitate empowerment of women in lactation. Findings indicate that hospital breastfeeding services play a key role in mothers’ ability to breastfeed. Referring those who have problems in breastfeeding to the breastfeeding counseling unit will help mothers breastfeed.

کلیدواژه‌ها [English]

  • Lactation
  • Capability
  • hospital
  • Mother
  1. Shahri P, Balooty T, Saadati N, Haghighi ZM. Breast feeding pattern and its relationship with mothers' weight. Payesh 2012; 11(6):893-99.
  2. Varaei SH, Mehrdad N, Bahrani N. The relationship between self-efficacy and breastfeeding, Tehran, Iran. J Hayat 2009; 15(3):31-8.
  3. Aniebue PN, Aniebue UU, Adimora GN. Knowledge and beliefs about exclusive breastfeeding among rural Nigerian men in Enugu, Southeast Nigeria. Breastfeed Med 2010; 5(4):169-71.
  4. Ministry of Health. National program to promote breastfeeding. Tehran: Health Ministry; 2009. P: 10.
  5. Britton C, McCormick FM, Renfrew MJ, Wade A, King SE. Support for breastfeeding mothers. Cochrane Database Syst Rev 2007; 1:CD001141.
  6. Kalantari N, Roudsari AH. Breastfeeding promotion in Iran: opportunities and challenges. J Comprehensive Pediatr 2013; 4(4):165-6.
  7. Avery AB, Magnus JH. Expectant fathers’ and mothers’ perceptions of breastfeeding and formula feeding: a focus group study in three US cities. J Hum Lact 2011; 27(2):147-54.
  8. Tol A, Majlesi F, Shojaeizadeh D, Esmaelee Shahmirzadi S, Mahmoudi Majdabadi M, Moradian M. Effect of the educational intervention based on the health belief model on the continuation of breastfeeding behavior. J Nurs Educ 2013; 2(2):39-47.
  9. Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016; 387(10017):475-90.
  10. Foroud A. The effect of postpartum home visit programs on continuation of breast feeding and infant weight gain in Kerman. J Rafsanjan Univ Med Sci Health Ser 2002; 1(4):267-74.
  11. Coutinho SB, Lira PI, Lima MC, Frias PG, Eickmann SH, Ashworth A. Promotion of exclusive breast-feeding at scale within routine health services: impact of breast-feeding counselling training for community health workers in Recife, Brazil. Public Health Nutr 2014; 17(4):948-55.
  12. Fu CY. A randomized controlled trial of a professional breastfeeding support intervention to increase the exclusivity and duration of breastfeeding. [Master Thesis]. Pokfulam, Hong Kong: The University of Hong Kong; 2013.
  13. Yenal K, Okumus H. A study analyzing the reliability of the LATCH Charting System. Turk J Res Develop Nurs. 2003;5 (1):45-52.
  14. Pincombe J, Baghurst P, Antoniou G, Peat B, Henderson A, Reddin E. Baby Friendly Hospital Initiative practices and breast feeding duration in a cohort of first-time mothers in Adelaide, Australia. Midwifery. 2008;24 (1):55-61.
  15. Blyth RJ, Creedy DK, Dennis CL, Moyle W, Pratt J, De Vries SM, et al. Breastfeeding duration in an Australian population: the influence of modifiable antenatal factors. J Hum Lact. 2004;20(1):30-8.
  16. Pandey S, Singh M. Women empowerment and personal values as predictors of reproductive health. J Indian Acad Appl Psychol. 2008;34 (2):309-16.
  17. Lee-Rife SM. Women's empowerment and reproductive experiences over the life course. Social Science & Medicine. 2010;71 (3):634-42.
  18. Davis C, Sloan M, Tang C. Role occupancy, quality, and psychological distress among Caucasian and African American women. Affilia. 2011; 26 (1):72-82.
  19. Casey SE. Evaluations of reproductive health programs in humanitarian settings: a systematic review. Conflict and Health. 2015;9 (1):S1.
  20. Heidari Z, Keshvari M, Kohan S. Clinical Trial to Comparison the Effect of Family-centered Educational-supportive Program on Mothers' Empowerment in Breast-feeding. Int J Pediatr. 2016; 4 (3):1445-51.
  21. Kang JS, Choi SY, Ryu EJ. Effects of a breastfeeding empowerment program on Korean breastfeeding mothers: a quasi- experimental study. International Journal of Nursing Studies. 2008; 45 (1):14-23.
  22. Heidari Z, Keshvari M, Kohan Sh. Exploring the Facilitateing and Preventing Factors in Breastfeeding: A Qualitative Study. Hakim Health Sys Res 2016; 19 (3): 170-178
  23. Brown A E, Raynor P, Lee M.D. Comparison of health professionals’ and mothers’ perceptions of factors that influence the decision to breast or bottle feed. Journal of Advanced Nursing 2011; 67 (9): 1993–2003.
  24. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qualitative Health Research. 2005; 15 (9):1277-88.
  25. Ong SF, Chan WC, Shorey S, Chong YS, Klainin-Yobas P, He HG. Postnatal experiences and support need of first-time mothers in Singapore: a descriptive qualitative study. Midwifery. 2014; 30 (6):772-8.
  26. Coutinho SB, Lira PI, Lima MC, Frias PG, Eickmann SH, Ashworth A. Promotion of exclusive breast-feeding at scale within routine health services: impact of breast-feeding counselling training for community health workers in Recife, Brazil. Public Health Nutr 2014; 17 (4): 948-55.
  27. Nilsson IM, Strandberg‐Larsen K, Knight CH, Hansen AV, Kronborg H. Focused breastfeeding counselling improves short‐and long‐term success in an early‐discharge setting: A cluster‐randomized study. Matern Child Nutr 2017; 10: 12432
  28. Bich TH, Hoa DTP, Mهlqvist M. Fathers as supporters for improved exclusive breastfeeding in Viet Nam. Matern Child Health J 2014; 16(6):1444-53.
  29. Henshaw EJ, Fried R, Siskind E, Newhouse L, Cooper M. Breastfeeding Self-Efficacy, Mood, and Breastfeeding Outcomes among PrimiparousWomen. Journal of human lactation: official journal of International Lactation Consultant Association. 2015; 31 (3):511-8. 43.
  30. MacKean, G. The Challenges of Breastfeeding in a Complex World: A critical review of the qualitative literature on women and their partners'/ supporters' perceptions about breastfeeding. Alberta, Canada, 2012. Retrieved April 2018, from https://www.albertahealthservices.
  31. Sharifirad G, Golshiri P, Shahnazi H, Barati M, Hassanzadeh A. The impact of educational program based on BASNEF model on breastfeeding behavior of pregnant mothers in Arak. Arak Med Univ J 2010; 13(1):63-70.
  32. Kamali Z, Rasouli B, Roodpeyma S, Haji Mirsadeghi Z, Eivani M. Assessment of breastfeeding and related factors in three hospitals of Tehran, 2008 . Iranian Journal of Nutrition Sciences & Food Technology. 2013; 7 (5): 125-134.
  33. Smith J, Cattaneo A, Iellamo A, Javanparast S, Atchan M, Gribble K, et al. Review of effective strategies to promote breastfeeding: An Evidence Check rapid review brokered by the Sax Institute for the Department of Health. Sydney: Sax Institute; 2018.
  34. Abdeyazdan Z,  Elahi T, Golshiri P. Comparison of an empowering breastfeeding program before and after childbirth on exclusive breastfeeding time-span. Modern Care, Scientific Quarterly of Birjand Nursing and Midwifery Faculty. 2015; 11(4): 330-338.
  35. Olang B, Heidarzadeh A, Strandvik B, Yngve A. Reasons given by mothers for discontinuing breastfeeding in Iran. International Breastfeeding Journal. 2012; 7(1):7
  36. Simbar M, Nahidi F, Tehrani FR, Ramezankhani A. Fathers’ educational needs for perinatal care in urban Iran: a qualitative approach. J Biosoc Sci 2010; 42(5):633-41.
  37. Henshaw EJ, Fried R, Siskind E, Newhouse L, Cooper M. Breastfeeding Self-Efficacy, Mood, and Breastfeeding Outcomes among Primiparous Women. Journal of human lactation: official journal of International Lactation Consultant Association. 2015; 31(3):511-8. 43
  38. Casey SE. Evaluations of reproductive health programs in humanitarian settings: a systematic review. Conflict and Health. 2015; 9(1):S1
  39. Barona-Vilar C, Escriba-Aguir V, Ferrero-Gandia R. A qualitative approach to social support and breast-feeding decisions. Midwifery. 2009; 25(2):187-94.
  40. Labarere J, Gelbert-Baudino N, Ayral AS, Duc C, Berchotteau M, Bouchon N, et al. Efficacy of breastfeeding support provided by trained clinicians during an early, routine, preventive visit: a prospective, randomized, open trial of 226 mother-infant pairs. Pediatrics. 2005; 115(2):e139-46.