The Effects Of Whole-Process Interventions Based On Self-Efficacy Theory On Breastfeeding Of Primiparas

Objective:The aim of this study is to explore primiparas' emotional experiences about breastfeeding and develop whole-process interventions against primiparas based on self-efficacy theory,evaluating the feasibility and acceptability of the intervention plan for improving breastfeeding status quo at the same time.Methods:This study designed as mixed methods research.Part one was a qualitative design involving in-depth semi-structured interview with cases between January 2017 and February 2017,a phenomenological research methodology was implemented.Primiparas' breastfeeding related emotional experiences were identified based on thematic analysis with Colaizzi method.Then,based on the results of qualitative research,a whole-process and multidimensional nursing intervention program guided by self-efficacy theory was constructed.The program was evaluated by a quasi-experiment study,recruiting primiparas who met the criterion and taken pregnancy test in the First Hospital of Jilin University(Jilin,Changchun)between March 2017 and June 2017,the former 188 cases for the control group,after 166 cases for the intervention group.The control group was given routine care,the intervention group received multidimensional nursing intervention,throughout the periods of late pregnancy,hospitalization and post-discharge,10 phases in total.Evaluating breastfeeding condition,breastfeeding knowledge and self-efficacy of subjects,and SPSS 22.0 was used for data analysis.The independent sample t test(Mann-Whitney U rank sum test)or chi-square test(Fisher's exact probability method)were used to compare the baseline level;Mann-Whiney U of two independent ranked data was used to compare the differences in breastfeeding condition between two groups at different time points;using the repeated measures analysis of variance to compare the breastfeeding knowledge and self-efficacy in intervention group with that in control group.Results:1.Results of qualitative research: A total of 16 subjects participated in the interview.Themes were summarized into two aspects: having negative effects and positive effects on breastfeeding.Emotional experiences that had negative effects on breastfeeding include sense of decision-making difficulties,sense of breastfeeding-related burden,unable to express demand for help;emotional experiences that had positive effects on breastfeeding include anticipation and excitement,sense of breastfeeding-related benefits,regret and remorse.2.Results of quantitative research: There were 152 cases and 148 cases in control group and intervention group with complete collected information,respectively.Two groups were baseline equilibrium in general demographic data and clinical features(P>0.05).The effectiveness of intervention was shown in following aspects:(1)Intervention programme had positive effects on breastfeeding condition.At 2 weeks,6 weeks,3 months and 6 months after delivery,there were statistically significant differences between two groups(P<0.05),breastfeeding condition in intervention group was better than that in control group.Exclusive breastfeeding rates in intervention group were higher than that in control group at all times,the difference was greatest at 3 months after delivery.(2)Results of repeated measures analysis of variance about breastfeeding knowledge showed that breastfeeding knowledge scores in two groups were all increased over time.There were interaction effects between time factor and group factor(F=94.582,P<0.001),participants in different groups had different change tendencies in breastfeeding knowledge scores based on time.The results of independent effect analysis of intervention effects shown that differences about breastfeeding knowledge scores between two groups were statistically significant at every time points after intervention(P<0.001),and intervention group scored higher than control group.(3)Results of repeated measures analysis of variance about breastfeeding self-efficacy shown that self-efficacy scores in two groups were all increased over time.There were interaction effects between time factor and group factor(F=9.698,P< 0.001),participants in different groups had different change tendencies in breastfeeding self-efficacy scores based on time.The results of independent effect analysis of intervention effects shown that differences of breastfeeding self-efficacy scores between two groups on the day of delivery and discharge had no statistical significance(P > 0.0083),after that two points,differences were statistically significant(P<0.0083).Intervention group scored higher than control group all the time.Conclusions:1.The emotional experiences of primiparas related to breastfeeding provide following enlightenment for improving the promotion program of breastfeeding:(1)providing complete,accurate and up-to-date breastfeeding informations to primiparas;(2)guiding and assisting first-time mothers to interact benignly with families and other care support systems;(3)improving the operations of breastfeeding consultation and clinic;(4)promoting breastfeeding behavior by taking use of positive emotional experiences.2.On the results of qualitative research,based on the four effective dimensions of self-efficacy theory,a multidimensional and whole-process intervention program through late pregnancy,hospitalization and post-discharge,10 stages in total,had been formed.3.Multidimensional and whole-process intervention program could improve the breastfeeding self-efficacy and breastfeeding knowledge of primiparas,improve the overall breastfeeding condition,and increase the rate of exclusive breastfeeding at discharge,2weeks postpartum,6 weeks postpartum,3 months postpartum and 6 months postpartum ultimately.