| ObjectiveThe purpose of this study is to construct a hospital-community-family triple-linkage breastfeeding intervention program based on the nudge theory,combining with the relevant policy guidelines and qualitative research results of breastfeeding,and to explore the intervention effects of the program on evaluation indicators such as maternal breastfeeding knowledge,breastfeeding self-efficacy,and exclusive breastfeeding rate.The purpose of this study is to provide reference for obstetric medical personnel in hospitals and community maternal and child health personnel in implementing breastfeeding guidance for pregnant and lying-in women.Methods1.The construction of a triple-linkage breastfeeding intervention program based on the nudge theory:This study takes the nudge theory as the theoretical framework,systematically searches for the application of the linkage management model to the intervention research literature on breastfeeding in pregnant and lying-in women,combines relevant policy guidelines on breastfeeding,and learned the real experience of community maternal and child health workers and mothers on breast-feeding promotion actions through semi-structured interviews,so as to form the first draft of the program.After expert discussion and preliminary test modification,the final intervention plan is formed.2.Implementation of triple-linkage breastfeeding intervention program based on the nudge theory:By convenience sampling method,134 pregnant women who planned to give birth in our hospital from November to December 2021 were selected as research objects.They were divided into control group and intervention group with 67 cases in each group according to the community they lived in.Pregnant women in the control group received routine breastfeeding nursing health education.The intervention group received a hospital-community-family intervention program based on nudge theory in addition to routine breastfeeding care.Before intervention,general data such as age,prenatal feeding intention.Breastfeeding knowledge,breastfeeding self-efficacy,frequency of breast problems,maximum duration and interval of exclusive breastfeeding,and feeding methods were collected on the day of discharge and at 1,3 and 6 months after delivery,respectively.SPSS26.0 software was used for data analysis.The data analysis usedχ~2 test,independent sample t-test,Mann-Whitney U rank sum test,repeated measurement analysis of variance and other statistical methods to evaluate the implementation effect of the hospital-community-family triple-linkage breastfeeding intervention program based on the nudge theory.Results1.The construction of a triple-linkage breastfeeding intervention program based on the nudge theory:This study is based on the three-step nudge method of primary nudge,intermediate nudge and advanced nudge,forming an intervention framework of five elements:nudger,environment,intervention strategies,nudgee and expected goals.Secondly,a total of 10 domestic and foreign intervention research literature and 7 policy guidelines related to breastfeeding were consulted.Through semi structured interviews with 11 community maternal and child health personnel l and 14 pregnant women,three topics were extracted to form the first draft of the intervention plan.Finally,the final intervention program was determined through expert discussion and pilot testing.2.Implementation of triple-linkage breastfeeding intervention program based on the nudge theory:A total of 134 pregnant and lying-in women were included,including 56 in the final control group and 60 in the intervention group.(1)Before intervention:there was no statistically significant difference between the two groups in the baseline data of general demographic data,feeding intention,planned exclusive breastfeeding time,breastfeeding knowledge and self-efficacy of breastfeeding(P>0.05).(2)Feeding mode:There was no significant difference between the intervention group and the control group in the rate of exclusive breastfeeding on the day of postpartum discharge(P>0.05).The rate of exclusive breastfeeding in the intervention group was higher than that in the control group at postpartum 1,3 and 6 months,and the differences were statistically significant(P<0.05).(3)The frequency of breast problems:There was no significant difference in the incidence of breast problems between the intervention group and the control group on the day of discharge and 6 months after delivery(P>0.05).The incidence of breast problems in the intervention group was lower than that in the control group at 1 month and 3 months postpartum,and the difference was statistically significant(P<0.05).(4)The longest duration and the longest interval of exclusive breastfeeding:There was no significant difference between the intervention group and the control group in the longest duration of exclusive breastfeeding on the day of postpartum discharge and at 3 and 6months postpartum(P>0.05).The longest duration of exclusive breastfeeding in the intervention group at 1 month postpartum was higher than that in the control group,and the longest interval of exclusive breastfeeding at 1,3 and 6 months postpartum was lower than that in the control group,with statistical significance(P<0.05).(5)Breastfeeding knowledge:The results of inter-group comparison showed that the scores of breastfeeding knowledge in the intervention group were higher than those in the control group on the day of discharge and at 1,3 and 6 months after delivery,with statistical significance(P<0.01).Repeated measures analysis of variance showed that both the time effect and the intergroup effect of breastfeeding knowledge score were statistically significant(P<0.001),and there was an interaction between them(P<0.001).The results of intra-group comparison showed that the scores of maternal breastfeeding knowledge at5 time points before and after intervention were statistically significant between the two groups(P<0.001).(6)Breastfeeding self-efficacy:The results of inter-group comparison showed that the total score of breastfeeding self-efficacy and the scores of inner dimension in the intervention group were higher than those in the control group on the day of discharge,at1 month,3 months and 6 months postpartum,the difference was statistically significant(P<0.01).The scores of breastfeeding skill dimension in the intervention group were higher than those in the control group at 1 month,3 months and 6 months postpartum.The difference was statistically significant(P<0.001).Repeated measures analysis of variance showed that both the time effect and the intergroup effect of breastfeeding self-efficacy score were statistically significant(P<0.001),and there was an interaction effect between them(P<0.001).The results of intra-group comparison showed that the breastfeeding self-efficacy scores of the two groups at 5 time points before and after the intervention were statistically significant(P<0.001).Conclusion1.This study is based on the nudge theory,combined with the relevant policy guidelines and qualitative interview results of breastfeeding,and through expert discussion and pre-experiment,constructs a scientific and feasible hospital-community-family triple-linkage breastfeeding intervention program based on the nudge theory.2.The hospital-community-family triple-linkage breastfeeding intervention program based on the nudge theory can effectively improve the breastfeeding knowledge reserve and self-efficacy of pregnant women in the community,improve breast problems related to breastfeeding,reduce the feeding interruption time,and increase the pure breastfeeding rate of infants within 6 months. |
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