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      Breastfeeding needs of mothers of preterm infants in China: a qualitative study informed by the behaviour change wheel

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          Abstract

          Background

          Although breastfeeding is strongly recommended, the breastfeeding rate of preterm infants in China remains significantly low. In addition to the global structural challenges to breastfeeding and the physiological immaturity of preterm infants, Chinese mothers of preterm infants face unique challenges of maternal-infant separation after birth. Moreover, little is known about Chinese mothers’ specific needs in coping with the difficulties posed by these challenges. This study utilized the Behaviour Change Wheel to investigate the breastfeeding needs of Chinese preterm mothers that may facilitate its practice in the future.

          Method

          A qualitative descriptive design was implemented in Wuhan in 2022. Based on purposeful sampling, 13 preterm mothers were recruited from a NICU in a Grade III Class A hospital in Wuhan, China. Face-to-face semi-structured interviews were conducted to collect data using the interview guide developed by the Theoretical Domains Framework. Theoretical Thematic Analysis was used to review the data in 6 steps to identify themes.

          Results

          Five major themes emerged: (1) capability: ability to interpret infants’ cues and identify problems, and need for breastfeeding knowledge and skills training; (2) physical opportunity: cleanliness and quietness in household environment, private lactation spaces and breastfeeding tools in workplaces and hospitals; (3) social opportunity: family support, peer support, and authoritative support from healthcare providers; (4) reflective motivation: information on health impacts of breastfeeding; (5) automatic motivation: maternal-infant bonding, free of aversive stimulus.

          Conclusion

          Preterm mothers’ needs to enable breastfeeding were diverse, including increasing their capability, physical and social opportunities, and reflective and automatic motivation. People, resources and environments associated with these needs should be engaged together to stablish a conducive structural environment for breastfeeding. The policy change for “zero separation” and implementation of kangaroo care should also be implemented in Chinese neonatal intensive care units. Future studies are needed to design effective interventions according to mothers’ specific needs.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s13006-023-00587-9.

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          The behaviour change wheel: A new method for characterising and designing behaviour change interventions

          Susan Michie, Maartje M. van Stralen, Robert H. West (2012)
          Background Improving the design and implementation of evidence-based practice depends on successful behaviour change interventions. This requires an appropriate method for characterising interventions and linking them to an analysis of the targeted behaviour. There exists a plethora of frameworks of behaviour change interventions, but it is not clear how well they serve this purpose. This paper evaluates these frameworks, and develops and evaluates a new framework aimed at overcoming their limitations. Methods A systematic search of electronic databases and consultation with behaviour change experts were used to identify frameworks of behaviour change interventions. These were evaluated according to three criteria: comprehensiveness, coherence, and a clear link to an overarching model of behaviour. A new framework was developed to meet these criteria. The reliability with which it could be applied was examined in two domains of behaviour change: tobacco control and obesity. Results Nineteen frameworks were identified covering nine intervention functions and seven policy categories that could enable those interventions. None of the frameworks reviewed covered the full range of intervention functions or policies, and only a minority met the criteria of coherence or linkage to a model of behaviour. At the centre of a proposed new framework is a 'behaviour system' involving three essential conditions: capability, opportunity, and motivation (what we term the 'COM-B system'). This forms the hub of a 'behaviour change wheel' (BCW) around which are positioned the nine intervention functions aimed at addressing deficits in one or more of these conditions; around this are placed seven categories of policy that could enable those interventions to occur. The BCW was used reliably to characterise interventions within the English Department of Health's 2010 tobacco control strategy and the National Institute of Health and Clinical Excellence's guidance on reducing obesity. Conclusions Interventions and policies to change behaviour can be usefully characterised by means of a BCW comprising: a 'behaviour system' at the hub, encircled by intervention functions and then by policy categories. Research is needed to establish how far the BCW can lead to more efficient design of effective interventions.
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            Why invest, and what it will take to improve breastfeeding practices?

            Nigel Rollins, Nita Bhandari, Nemat Hajeebhoy … (2016)
            Despite its established benefits, breastfeeding is no longer a norm in many communities. Multifactorial determinants of breastfeeding need supportive measures at many levels, from legal and policy directives to social attitudes and values, women's work and employment conditions, and health-care services to enable women to breastfeed. When relevant interventions are delivered adequately, breastfeeding practices are responsive and can improve rapidly. The best outcomes are achieved when interventions are implemented concurrently through several channels. The marketing of breastmilk substitutes negatively affects breastfeeding: global sales in 2014 of US$44·8 billion show the industry's large, competitive claim on infant feeding. Not breastfeeding is associated with lower intelligence and economic losses of about $302 billion annually or 0·49% of world gross national income. Breastfeeding provides short-term and long-term health and economic and environmental advantages to children, women, and society. To realise these gains, political support and financial investment are needed to protect, promote, and support breastfeeding.
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              Developing and evaluating complex interventions: the new Medical Research Council guidance.

              Peter Craig, Paul Dieppe, Sally MacIntyre … (2013)
              Article 0 comments Cited 350 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Genzhen Yu: 757352754@qq.com
                Journal
                Journal ID (nlm-ta): Int Breastfeed J
                Journal ID (iso-abbrev): Int Breastfeed J
                Title: International Breastfeeding Journal
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1746-4358
                Publication date (Electronic): 1 September 2023
                Publication date PMC-release: 1 September 2023
                Publication date Collection: 2023
                Volume: 18
                Electronic Location Identifier: 50
                Affiliations
                [1 ]GRID grid.33199.31, ISNI 0000 0004 0368 7223, Nursing Department, Tongji Hospital, Tongji Medical College, , Huazhong University of Science and Technology, ; No. 1095, Jiefang Avenue, Wuhan, China
                [2 ]GRID grid.33199.31, ISNI 0000 0004 0368 7223, School of Nursing, Tongji Medical College, , Huazhong University of Science and Technology, ; No. 13, Aviation Road, Wuhan, China
                [3 ]GRID grid.33199.31, ISNI 0000 0004 0368 7223, Nursing Department, Union Hospital, Tongji Medical College, , Huazhong University of Science and Technology, ; No. 1277, Jiefang Avenue, Wuhan, China
                Article
                Publisher ID: 587
                DOI: 10.1186/s13006-023-00587-9
                PMC ID: 10472562
                PubMed ID: 37658411
                SO-VID: e55fa405-cec1-45e1-85b3-6866019c411b
                Copyright © © BioMed Central Ltd., part of Springer Nature 2023
                License:

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 27 March 2023
                Date accepted : 25 August 2023
                Funding
                Funded by: Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology
                Award ID: 2022C09
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © BioMed Central Ltd., part of Springer Nature 2023

                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: breastfeeding,mothers,preterm infant,barriers and facilitators,behaviour change wheel,neonatal intensive care unit,separation,qualitative study
                Data availability:
                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: breastfeeding, mothers, preterm infant, barriers and facilitators, behaviour change wheel, neonatal intensive care unit, separation, qualitative study

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