Human Caring Theory-based Breastfeeding Education
Condition: Breastfeeding Education
Study type: Interventional

Summary: 
      It is a randomized controlled prospective study. The purpose of the study is to examine the
      effect of breastfeeding education and support program based on Human Caring Theory (HCT) on
      mothers' breastfeeding self-efficacy, duration and definitions, and their satisfaction with
      this process. As a result, Human Caring Theory based breastfeeding education program improved
      breastfeeding self-efficacy, duration and exclusive breastfeeding.
    

Detailed description: 
      Although breastfeeding have many benefits, breastfeeding rates are still not at the desired
      level. One of the most important factors in increasing breastfeeding rates is breastfeeding
      education. Therefore, the purpose of the study is to examine the effect of breastfeeding
      education and support program based on Human Caring Theory (HCT) on mothers' breastfeeding
      self-efficacy, duration and definitions, and their satisfaction with this process.

      It is a randomized controlled prospective study conducted between January 2019- March 2020 in
      100 Turkish women (intervention:50; control: 50). A simple randomization method was performed
      using the siterandomizer.org to ensure samples' equality in two groups. The participants were
      randomly assigned to the groupwith Human Caring Theory based education and support
      (intervention) or a standard education program (control) group. The study method was
      explained, and informed consent was obtained from all participants. The researcher applied
      the education and support, and hence, blinding could not be done.

      An intervention program was prepared by researchers who received many trainings on the
      practical use of Watson Human Caring theory. Watson Human Caring Theory based education and
      support program was conducted in groups of 6-8 pregnant woman in prenatal period and
      continues individualty web- based and by phone support in postnatal period. Two experts who
      have PhD degree in women's health nursing assessed the validity of the breastfeeding
      education program based on the HCT. The intervention group was given a breastfeeding
      education program based on the HCT for six face to face session conducted in parallel with
      asynchronous distance education sessions in prenatal period and continued with web based
      sessions and telephone support in postnatal period. The control group received solely
      standard education program for one sessions in prenatal period. Especially in postnatal
      period traditional face-to-face breastfeeding education and support may not be easy for women
      and their families. The "Breastfeeding Self-Efficacy Scale", "Baby's Feeding Definition Form"
      and "Watson Caritas Patient Score"instruments were used for data collection.

      Women's Descriptive Characteristics Question Form, The Baby's FeedingDefinition Form,
      Breastfeeding Self- Efficacy Scale-Short Form and Watson Caritas Patient Score were the
      instruments used for data collection.

      Women's Descriptive Characteristics Question Formincluded ten questions related to age,
      education level, previous breastfeeding educationand gestational age.

      In order to asses baby's feeding, The Baby Feeding Definition Form was used. This form was
      prepared by researchers in line with literatüre. The questions such as the baby's sucking
      status, the status of receiving liquid or nutrients other than breast milk, and the baby's
      appearance of peace after sucking were based on Labbok and Krasovec (1990) and WHO
      classificationts relted to baby breast milk intake level. At the same time the state of peace
      of the baby was evaluated according to the expressions of the mothers. Consequently three
      breastfeeding experts evaluated the form and found it suitable for the assessment of infants'
      feeding level. The responses obtained from the evaluation form were classified according to
      the diagnostic criteria for breastfeeding by Labbok and Krosovec (1990).

      The Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) comprised 14 items developed by
      Dennis in 2003. The BSES-SFis a 5-point Likert-type scale, with 1meaning "not at all
      confident" and 5 meaning "very confi-dent," yielding a minimum possible score of 14 points
      and a maximum score of 70 points. Regarding this scale a high score indicates high
      breast-feedingself-efficacy. The scale had a Cronbach's alpha value of 0.94. Turkish validity
      and reliability of the scale were done by Tokat, Okumuş and Dennis (2010). In the same study,
      Cronbach's alpha coefficient for internal consistency was 0.87 antenatally and 0.86
      postnatally. Prenatal items was created by using the future tense expression in the antenatal
      form of the breastfeeding self-efficacy scale.

      The Watson Caritas Patient Score (WCPS) was used to assess satisfaction of the education
      program. WCPS was developed based on caritas factors and caritas processes by Dr. Jean Watson
      et al. (2010). WCPS is a reliable and valid instrument used in hospitals and systems to
      assess perspectives of caring practices of hospital staff, of colleagues and peers.The WCPS
      items are each scored on a 7-point scale, ranging from "not at all" (1) to "very much" (7).
      The reliability was confirmed with a Cronbach's α of .90. (Brewer & Watson, 2015). The
      internal consistency of the WCPS assessed using Cronbach's alpha was .90 in Turkey
      (Durmazoglu, 2020).The highest score that can be obtained from WCPS is 35, and the lowest
      score is five. In this form there is also comments and suggestions section. In this section
      people can write their comments for more effective process.

      The data were analyzed using the Statistical Package for Social Sciences (SPSS 22.0) for
      Windows. The normal distribution of the data was evaluated using the Kolmogorov-Smirnov test.
      The descriptive statistics of the study were evaluated with frequency, mean, standard
      deviation, number and percentage. Pearson's chi-square test was used to evaluate the
      homogeneity of the data according to the groups. The t-test was used for comparisons between
      variables in two categories. Multiple and one-way analysis of variance was used for repeated
      measurements. The reliability of the scales was tested with Cronbach's alpha. The
      significance threshold was set at 0.05.
    

Intervention name(s): Human Caring Theory based Education; Standard Education
Intervention type(s): Other; Other
Intervention description(s): The intervention group was given a breastfeeding education program based on the HCT for six face to face sessionconducted in parallel with asynchronous distance education sessions in prenatal period and continued with web based sessions and telephone support in postnatal period.; The control group received solely standard education program for one sessions in prenatal period.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Supportive Care
Keywords: Theory of Human Caring; Breastfeeding; Nursing; Self-efficacy