Predictors of Breastfeeding Exclusivity in a WIC Sample - Research Paper Example

?Running head: RESEARCH CRITICAL APPRAISAL Research Critical Appraisal Research Critical Appraisal The research subject of this critical appraisal is a study by Tenfelde, S., Finnegan, L., and Hill, P. entitled, ‘Predictors of breastfeeding exclusivity in a WIC sample’ which is very much relevant to the nursing practice as it discusses possible causes for exclusive breastfeeding practices among low income women. This is a relevant topic in nursing because maternal and child care nursing is one of the main functions of nursing care and the process of ensuring improved and favorable outcomes for both mother and child is an important tool for any nurse to master. This research topic also provides an assessment of predicting elements for breastfeeding exclusivity, helping the nurse evaluate patient economic conditions and how these conditions affect infant care. Moreover, the Special Nutrition Program for Women, Infants and Children is a program which is in place in the Chicago area and evaluating its possible applicability to the greater population may be a future possibility. Before such possibility can be reached, an evaluation of its current applications must first be carried out in order to improve patient outcomes as well as maternal and child care services. In evaluating the study’s frame of reference, the authors considered the components of the Interaction Model of Client Health Behavior (IMCHB). This is a client-focused framework meant to adapt to individuals and their unique qualities; it is also meant to improve client and professional interactions in relation to health behaviors. It is meant to guide professional interventions and adjust them based on individual qualities. In this case, the authors appropriately used this framework in order to evaluate patient behavior. The indicator considered was the breastfeeding exclusivity with client’s individual qualities revolving around background and relevant variables. These variables considered demographic qualities, social influence, patient history, and current resources. The interpersonal qualities included frame of reference for infant-feeding intention (motivation); benefits of breastfeeding and its related elements (cognitive); and mood (affective) (Tenfelde, et.al., 2011, p. 179). These frames of reference served to defined the aspects to be reviewed in the course of this study. They were utilized by the authors as guidelines in framing the problem and placing it in its proper context of analysis. This same framework was utilized from the beginning to the end of the research where recommendations for future research and practice were suggested. The research purpose was clearly and unambiguously worded by the authors. The authors were able to indicate their purpose in terms of the issue to be addressed, the population to be covered, the setting upon which the study shall be carried out, and the elements which would be evaluated in the study. The aim of the study was clearly understandable upon initial reading and the authors specified the related variables which would be included in their study. These variables appropriately applied to the purpose of the study and they were meant to assist the authors in meeting the purposes of this research. Variables like demographic qualities, social influence, previous health experience, and current health and environmental resources were variables which were used to establish predicting variables for breastfeeding women belonging to the low income group (Tenfelde, et.al., 2011, p. 179). Other more personal and individual variables which revolve around motivation, cognitive appraisal, and affective responses also served as variables which were used to assist the authors in evaluating the compliance of women with the Special Supplemental Nutrition Program for Women, Infants, and Children (Tenfelde, et.al., 2011, p. 180). The authors specified how these variables would ultimately assist in meeting the research purpose. The population to be sampled was specified by the authors. Moreover, such population could reasonably be foreseen as research subjects and access to them could be gained through appropriate sampling methods. The sample size of 235 low income breastfeeding women is deemed adequate for this study. They are sufficient in achieving generalizable results. The literature review of this study smoothly flowed from the general introduction of the topic to the specific research problem. The review presented studies which had similar purposes and topics for research. The review also provided possible results which may be expected from this current research. They also established a pattern of behavior which may also be seen from the current results. In general, the review revealed that age, education, and marital status were predictors of breastfeeding exclusivity, with older women being more likely to breastfeed than their younger counterparts (Tenfelde, et.al., 2011, p. 180). Higher educational levels in respondents also predicted a higher incidence of breastfeeding exclusivity. Moreover, married women were more likely to breastfeed as compared to unmarried women. The study also established in its review that race and ethnicity were predictors of exclusivity in breastfeeding; Hispanics and African American women were less likely to breastfeed as compared to white women (Tenfelde, et.al., 2011, p. 180). The review of literature was also keen to point out that those who had low incomes, more often than not, had inadequate education, and as a result, had less support in their decision to breastfeed. Among low-income groups, fathers have been found as weak supporters of exclusive breastfeeding. Moreover, as compared to non-Hispanic fathers, the Hispanic fathers were less likely to give support for exclusive breastfeeding (Tenfelde, et.al., 2011, p. 181). Those who were already under the WIC program also did not enjoy consistent support for exclusive breastfeeding, especially from their family and friends. Low-income women with strong breastfeeding models however had more favorable breastfeeding practices. Support from family and friends among low income women also predicted better exclusive breastfeeding practices (Tenfelde, et.al., 2011, p. 181). The study was also able to establish that those who were obese were less likely to breastfeed; first time mothers were also less likely to exclusively breastfeed as compared to multiparous women (Tenfelde, et.al., 2011, p. 181). With early entry into prenatal care, mothers also had higher rates of exclusive breastfeeding. Those who delivered vaginally were also more likely to breastfeed and those who experienced problems during breastfeeding were also less likely to exclusively breastfeed. Environmental factors also predicted breastfeeding with those having larger households more likely to practice exclusive breastfeeding (Tenfelde, et.al., 2011, p. 181). Those who were also gainfully employed were more likely to wean their infant as early as possible. In reviewing dynamic variables, the intention or motivation to breastfeed also predicted favorable breastfeeding behavior. In the cognitive sense, low-income women who were able to receive significant information about breastfeeding were more likely to adopt exclusive breastfeeding practices (Tenfelde, et.al., 2011, p. 181). Finally, the review of studies also established that mothers who were depressed were less likely to exclusively breastfeed. All in all, the review of literature established that although the elements impacting on breastfeeding exclusivity have been identified, most of these studies have not highlighted women under the WIC program. The review also specified the gaps in these researches in terms of method and content, and how such gaps shall be faced and filled with the conduct of the author’s research. After identifying the relevant information established by previous studies, the authors were able to indicate the current status of knowledge and the shortcomings which their study then hoped to address. The research questions smoothly flowed from the research purpose, literature review, and on to the frame of reference. There was an effective transition from one aspect or part of the research to the next. There was a logical flow of ideas, starting with the presentation of the research question and purpose, to the presentation of the frame of reference, and then to the literature review. Each portion of the research contributed to the coherence and the rationality of the paper, ensuring that all elements assisted in answering the research question. There were no gaps seen in the research; in effect, the reader could easily understand the flow of ideas and the transition from the research question to the frame of reference and then to the literature review. The frame of reference provided sufficient basis for the rest of the study. The research hypotheses were not clearly established by the authors. No identified hypotheses could be specifically seen. Nevertheless, the authors were able to clearly establish tentative answers to the research issue by discussing the relationship of the variables to the specific population. The authors related the different variables and the specific population. These variables were able to include: background variables, demographic, and dynamic variables, among others. Variables related to the specific population were able to establish tentative answers to the question on predicting behaviors impacting on breastfeeding exclusivity. In reviewing the terms in the study and their conceptual and operational definitions, most of the definitions overlapped on the conceptual and operational plains. Some of the terms were directly related to operational terms and others were conceptual terms. Nevertheless, their usage within the research was consistent with the title, research purpose and hypothesis. They complemented each other and the terms were used accurately and appropriately throughout the study. The conceptual definitions were also within the purview of the frame of reference used in the study. The frame of reference speaks of variables impacting on exclusive breastfeeding behavior and these same variables were used consistently throughout the research without any ambiguous applications and usage. The operational definitions were also based on the conceptual definitions. There was a similarity between the terms which implied the consistent application of the different terms. There were no vague analogies used by the authors. Moreover, the definitions were consistently used by the authors based on previous usages in related research. The limitations were clearly identified in the text. These limitations mostly referred to the inability of the research to use psychometrically tested instruments. Elements like substance abuse and smoking status were relevant factors in the study, but these were not adequately recorded in the analysis. Measuring the respondent’s ethnicity was also inadequate as the race/ethnicity of the respondents was not specified in the questionnaires (Tenfelde, et.al., 2011, p. 182). No differentiation on Hispanic ethnicity was made. Biases in social desirability and recall issues were also seen in some of the questions posed to the respondents. Outside elements were also not assessed, including hospital policies. Issues on convenience sampling also limited the generalizability of the research results. Moreover, only women aged 18 years and older and mothers with health infants were included, thereby preventing the applicability of these results to adolescent participants and mothers with sick children (Tenfelde, et.al., 2011, p. 182). These are elements which, on further analysis, may be predictors to exclusive breastfeeding (Jannson, 2009, p. 225). Adolescents younger than 18 may actually have a lower rate of exclusive breastfeeding and mothers with sick children may not be allowed or may choose not to breastfeed their infants (Di Meglio, et.al., 2010, p. 41). The limitations of the study were adequately identified by the authors and they also provided significant basis for future similar studies. In relation to the sample size, the sample size was appropriate for the study (235) and was sufficient to gain generalizability within the area covered and within an even larger population. The manner of sample extraction was appropriate. In addressing the external validity of the research, the sampling method had limited external validity because the samples were not randomly drawn, nevertheless, the samples were still carefully and appropriately drawn (Hayes and Krippendorff, 2007, p. 77). Furthermore, the process of gaining the sample for this study is adequate for the establishment of a sufficient number of respondents. The authors adequately explained how each sample would be drawn based on their relevance to the variables and to the current research purpose (Littman, 2011, p. 19). The exclusive criteria was also adequately explained to exclude: mothers of infants who were fewer than 37 weeks of age, weighed fewer than 2500 kg, had health complications affecting feeding, had surgery during the first 28 days of life, and were placed in adoption (Tenfelde, et.al., 2011, p. 183). The setting also maximized the internal and external validity of the sample. There was adequate control applied in the data gathering in terms of the variables and the changes in such variables. This helped support the internal validity of the study. The research design was appropriate and consistent with the frame of reference for the study. The frame of reference sought to expound on the predictive elements for breastfeeding exclusivity and the fact that there are a host of elements which can impact on breastfeeding practice. This frame of reference can be adequately studied using a quantitative approach with multiple respondents considered and with as much data gathered and reviewed for adequacy. The research design is consistent with the literature review, the research purpose, and the hypothesis. The quantitative research included multiple variables relevant in fulfilling the research purpose. In effect, elements of the quantitative research technique were able to provide the necessary tools in fulfilling the purposes of the research. Control measures were also consistent with the type of research design. Validity and reliability of data collection methods were not sufficiently addressed in the research. For one, the validity of the research sampling was reduced due to the purposive sampling method chosen. The reliability of the study was secured with the consistency of the research process, as well as the repeatability of the data collection process (Golafshani, 2003, p. 597). Issues which related to language barriers were also adequately addressed by the study, ensuring clarity of questions raised (Porter, 2007, p. 80). Psychometric properties evident were mostly related to validity – with the consistency of the data collection process applied to each respondent. In relation to the data analysis, the study appropriately utilized statistical tests for data analysis which were consistent with the research purpose, hypothesis, and method of data collection (McCoughlan, Cronin, and Ryan, 2007, p. 659). It was also appropriate based on the qualities of the sample as far as size, distribution, and level of measurement was concerned. The survey method helped establish simple frequencies from the respondents in terms of breastfeeding habits and practices. Anthropometric measures were also evaluated in order to yield relevant details from the respondents. The measures of central tendency and dispersion helped to collate the data and establish mean population for the frequencies measured among the variables (Moylan, 2005, p. 2). Measures of central tendency are considered essential for any academic study because they help provide the best approximation for collated data (Moylan, 2005, p. 2). Logistic regression was also used in order to gain reliable results in paired and set variables. In analyzing the findings of this research, these can be linked to the problem statement, hypothesis, and the frame of reference chosen. The research problem considered predictors of breastfeeding exclusivity, and the hypothesis went on to consider these predictors by establishing which variables impacted on breastfeeding practices. The frame of reference was used as guide in order to eventually establish clear concepts from which the variables could be based on. Based on the conclusion, limitations, implications and recommendations for future research, the authors were able to draw these out from the research results and variables discussed in the literature review (Morse, et.al., 2002, p. 4). The conclusion was logically drawn from the research results and from such results, implications which related to breastfeeding exclusivity and related predictors were established. The authors specified the limitations of their study which mostly related to gaps in their research process. The authors, considered these gaps in their recommendations for future studies, with the possibility of using these as guidelines in future research and future clinical practice. The conclusions, limitations, and implications, as well as recommendations for future research were reviewed in the context of the research purpose, frame of reference and findings of the study. These were all linked with each other and coordinated in relation to the overall question raised by this research (Morse, et.al., 2002, p. 4). The results of this study are significant the clinical practice because they establishes factors which impact on breastfeeding practices among mothers. For the nurse, it is important to know these factors and to consider how these can be remedied. These results can also serve as basis for recommendations made to government authorities and policy makers. Knowing the causes of low breastfeeding exclusivity rates would assist nurses in carrying out their functions and in making the adjustments in their practice. Breastfeeding is still the best means of feeding infants, especially within the first six months of their life (Ryan and Wenjun, 2002, p. 1103). Hence, it must be promoted to postpartum mothers as much as possible. This study provides cues on the part of nurses from which they can base their actions and interventions. These cues relate to recommendations for the practice, mostly on proper breastfeeding education in order to teach the mothers about the benefits of breastfeeding (Ryan and Wenjun, 2002, p. 1103). With more knowledge about breastfeeding, the possibility of mothers adopting this practice into their lives can be increased. The strengths of this study are in its focused research process, from the beginning up to its end, or in other words from the statement of the purpose to its conclusion. There is a consistency in the research process conducted, ensuring the logical and rational applications of each step of the research. The variables are especially detailed enough in order to provide a clear basis for the study; moreover, these variables are categorized adequately, helping ease the interpretation process. This research also provides a strong basis for interventions in order to promote breastfeeding among low income women infants and children. Weaknesses mostly relate to the non-inclusion of relevant variables like smoking and substance abuse in the study; moreover, details like age (adolescence) and sick infants could have also been considered as variables in this study. All in all, this study provides relevant results which seek to improve patient outcomes, especially in maternal and child nursing care. Reference Di Meglio, G., McDermott, M., & Klein, J. (2010). A Randomized Controlled Trial of Telephone Peer Support's Influence on Breastfeeding Duration in Adolescent Mothers. Breastfeeding Medicine, 5(1): 41-47. Dunn, K. & Mulvenon, S. (2009). A Critical Review of Research on Formative Assessment: The Limited Scientific Evidence of the Impact of Formative Assessment in Education. Practical Assessment, Research & Evaluation, 14(7), pp. 1-11. Golafshani, N. (2003). 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International Journal, 1(2), 1-19 Moylan, G. (2005). Working with Data. Information Services and Technology. Retrieved 24 November 2011 from http://web.njit.edu/~gam5/pdf/604_Moylan_Data.pdf. Porter, S. (2007). Validity, trustworthiness and rigour: reasserting realism in qualitative research. Journal of Advanced Nursing, 60(1), 79–86. Ryan, A., Wenjun, A., & Acosta, A. (2002). Breastfeeding Continues to Increase Into the New Millennium. Pediatrics, vol. 110(6), pp. 1103 -1109. Tenfelde, S., Finnegan, L., & Hill, P. (2011). Predictors of breastfeeding exclusivity in a WIC sample. Journal of Obstetrics, Gynecology, and Neonatal Nursing, 40, 179- 189. Read More