An estimation of the effect of finding nurses helpful on early breastfeeding exclusivity mediated via breastfeeding self-efficacy, using a counterfactual approach and G-computation
Notice bibliographique
Résumé
BACKGROUND: Exclusive breastfeeding is recommended for at least the first six months of life, however in South Africa only 32% of mothers are exclusively breastfeeding to six months and discontinuation happens early. Nurses are a key resource for promoting breastfeeding self-efficacy and thus exclusivity, yet mothers often report nurses to have poor attitudes, which deter health seeking behaviour. This study aimed to infer whether perceived support from nurses immediately postpartum was causally related to breastfeeding exclusivity, and specifically whether this effect was mediated via breastfeeding self-efficacy. METHODS: This cross-sectional study recruited mothers from two community clinics in Soweto and collected data on breastfeeding practices, breastfeeding self-efficacy, and mothers' perceived support received from nurses within the first few days following delivery. To estimate the causal effect, G-computation for mediation analysis with Monte Carlo simulation was used. In all cases, 1000 bootstrapped samples were created to tighten the estimates, and bias corrected 95% confidence intervals were presented. RESULTS: Data from 169 participants were included in the analysis. Most participants (55%) scored 70/70 on the breastfeeding self-efficacy scale, and only 14% scored below 56/70 (lowest quartile). Less than half of the women found the nurses helpful 'always'. Most data were collected within 4 days of birth (IQR: 3-7 days), with only 10% being collected after 12 days. While nearly 90% of women were breastfeeding at this time, only 78% were exclusively breastfeeding. The results from the mediation analysis show that there was a total causal effect of finding nurses helpful on breastfeeding exclusivity, whereby finding nurses 'always' helpful resulted in a 14% greater likelihood of exclusively breastfeeding (SE = 0.06, p = 0.03, BC 95% = 0.00 to 0.24). However, this effect was not mediated via breastfeeding self-efficacy (proportion mediated = 7%; NIE = 0.01, BC 95%: -0.00 to 0.05). CONCLUSIONS: There is evidently a need for proper training for healthcare workers in supporting mothers and providing antenatal education and anticipatory guidance around breastfeeding given the impactful role they have on breastfeeding decision making. We recommend that interventions to promote breastfeeding exclusivity need to happen prior to delivery, or immediately upon delivery. Furthermore, all clinics need to enforce the BFHI immediately to provide mothers with a chance at exclusivity.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,147 | 0,282 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,002 |
| Méta-épidémiologie (sens large) | 0,003 | 0,013 |
| Bibliométrie | 0,003 | 0,003 |
| Études des sciences et des technologies | 0,001 | 0,005 |
| Communication savante | 0,003 | 0,003 |
| Science ouverte | 0,005 | 0,004 |
| Intégrité de la recherche | 0,004 | 0,004 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,012 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».