Impact of An Educational Intervention on Nurses' Breastfeeding Knowledge and Attitudes

In order to be successful in their lactation efforts, new mothers attempting to breastfeed their infant need accurate and consistent information and technical support from their health professional. Health professionals, especially nurses, are central to this support network. However, research has indicated, that maternal-newborn nurses and other health professionals vary in their lactation knowledge and ability to support these mothers’ breastfeeding efforts. The goal of this research was to test the effect of a breastfeeding educational program on the breastfeeding knowledge and attitudes of nurses with the intent to improve their ability to be supportive. The Theory of Reasoned Action (Azjen & Fishbein, 1980) guided this quasi-experimental study. Using a pre-test, post-test design, a convenience sample of thirteen hospitals agreed to participate in the study. The nine experimental sites had 297 participants and the four control sites had 64 participants. One control site was unable to complete the study, for a final count of 12 participating sites. The sample size of 240 registered nurses included 206 RNs in the experimental sites and 34 RNs in the control sites. The pretest measures of the dropouts and those who completed the study were not significant.

Participation in the experimental groups involved the completion of two questionnaires (I - breastfeeding knowledge, and II - breastfeeding attitudes and beliefs) upon study entry and then again after completion of a self-study module. The module included specific content about the benefits of breastfeeding, lactation physiology, basic techniques of breastfeeding, recognition and care of common breastfeeding problems, and care of mother/infant dyads with special breastfeeding needs. Participants in the control groups completed the self-study module after their pre-tests and post-tests were submitted. Cross-pollination was very unlikely since the experimental and control groups were located in different parts of the country. No significant differences in sample characteristics were noted between the experimental and control groups and none of the pretest measures regarding breastfeeding differed between groups.

Bivariate analysis of the post-test measures indicated a significant difference in the posttest breastfeeding knowledge (t= 10.66, p<.001), posttest attitudes toward breastfeeding (t=2.35, p=0.020), posttest beliefs about the importance of breastfeeding (t=2.51, p=0.017), and posttest intentions to support breast feeding mothers (t=2.30, p=0.022). The final step in the analysis was multiple regression, using a stepwise forward technique for posttest knowledge, attitudes, and beliefs.  The final model that explained 36.67% of the variance in posttest knowledge (mean= 37.60, range 19-49) included the intervention (R² =0.216), pretest knowledge (R² =0.354), and pretest normative beliefs (R² =0.366).  The final model that explained 44.5% of posttest attitudes toward breast feeding included pretest attitudes (R² =0.028), the intervention (R² =0.411), and pretest normative beliefs. (R² =0.445).  The final model that explained 42.4% of posttest intentions to support breastfeeding mothers (mean=19.36 out of 21) included pretest intentions (R² =0.261), the intervention (R² =0.279), and posttest normative beliefs (R² =0.424). Findings suggest that this intervention may be a valuable resource for improving lactation knowledge and attitudes of nurses working in inpatient and outpatient settings.