Qualitative Article Article Reviews Example

Breastfeeding from birth up to two years has proven health benefits for the child. The benefits include a stronger immune system and a lower likelihood of asthma (NICHHD, 2014). However, many mothers do not breastfeed or switch to infant formula before the child is 6 months old. While quantitative studies have elucidated the factors associated with an increased likelihood of formula feeding, the findings cannot generate an in-depth understanding of the influences that shape women’s decisions not to breastfeed. Qualitative studies complement quantitative studies by eliciting, analyzing, and synthesizing women’s breastfeeding experiences thus uncovering themes and permitting the development of theories or models that explain this phenomenon.

Article Selection

The interest in the topic is fueled by the observation that most mothers breastfeed at delivery but are no longer doing so or are alternating with formula at the time of the home visit 6 weeks after giving birth. This is an important clinical issue because of the health implications for the mother and child. The two articles selected reflect this topic. They were chosen by searching the ProQuest database and the internet using the search terms breastfeeding and qualitative. Of the resulting articles, the abstracts were accessed to determine if the study sheds light on the reasons why new mothers do not breastfeed exclusively for the first 6 months of the infant’s life. The final choices included a meta-synthesis and a serial qualitative interview study.
The meta-synthesis highlights how the mother’s confidence in breastfeeding influences the decision to continue or stop breastfeeding and how confidence is, in turn, affected by the mother’s expectations, members of her social support network, breastfeeding professionals, and society’s conception of breastfeeding and women’s bodies (Larsen, Hall & Aagaard, 2008). On the other hand, the serial qualitative interview study by Hoddinott et al. (2012) underscored what women, their families, and their social support network considered when deciding whether to continue breastfeeding or not. The study, in addition, brought to light women’s experiences with health care professionals, hospitals, and the health care system. A deeper understanding of women’s decisions to stop breastfeeding is crucial to developing interventions that will assist them in overcoming barriers or challenges.

Comparison of Methods, Purpose, and Results

The study by Larsen, Hall and Aagaard (2008) is a meta-synthesis which they defined as systematically comparing the findings of qualitative studies on a similar topic for the purpose of generating a more in-depth interpretation that enhances understanding of a phenomenon. The specific meta-ethnographic framework used was by Noblit and Hare who developed the model in a previous study on breastfeeding experiences. The model consists of 7 steps: identifying the subject, delimiting the subject, reviewing studies, relating the studies, interpreting the concepts, comparing interpretations, and presenting the meta-synthesis (Larsen, Hall & Aagaard, 2008, p. 654). The delimitation of the subject involved searching 3 databases for relevant studies using search terms and applying inclusion and exclusion criteria before the researchers settled on 7 studies with an aggregate sample of 883 mothers. The studies employed qualitative interview, focus group, ground theory, and ethnographic research methods.
In contrast, Hoddinott et al. (2012) conducted a study using the serial qualitative interview method. They employed a sample of 72 individuals who were mothers, partners, sisters, maternal mothers, or health professionals rather than a pooled sample from multiple studies. As a primary study wherein data is collected firsthand, the selected research method enabled the development of trust between participant and researcher. The serial nature of data collection also permitted questions arising during data analysis following each semi-structure interview to be examined in subsequent interviews. The authors analyzed raw interview transcripts as opposed to the concepts and interpretations of authors of different studies in a meta-analysis. Hoddinott et al. (2012) identified and interpreted themes based on the transcripts and with the use of FrameWork, a software data management tool used in qualitative research.
The two studies were similar in the general purpose which is discovering the contributory circumstances to women stopping breastfeeding. The specific purpose of Larsen, Hall and Aagaard (2008), however, was to explore the factors negatively affecting women’s confidence in breastfeeding resulting in their giving it up despite knowledge of its importance. On the other hand, Hoddinott et al. (2012) investigated, through the perspectives of women and their family members, what made a difference in their decisions pertaining to breastfeeding. The studies seek to inform policy and intervention trials that would enhance breastfeeding outcomes.
The results differed between the 2 studies given the differences in specific purpose. Larsen, Hall and Aagaard (2008) found that women’s confidence in their ability to breastfeed was affected by whether or not the breastfeeding experience paralleled their own expectations and those of their families and the health care professionals. At another level, women’s confidence was reduced because of the dominant belief that breastfeeding is natural and as such it is expected that they should be successful in it. Another belief was that women were not persons but bodies functioning machines for the production of milk that health care professionals had to intervene in when they were unsuccessful (Larsen, Hall & Aagaard, 2008). A third conception of breastfeeding was the need for caution in that mothers were made ultimately responsible for the health of their infants. Based on these interpretations, 3 issues arose that must be considered in policy or interventions, namely that women should have a right to express thoughts and concerns about breastfeeding, they should be told the truth and not confusing information about breastfeeding, and that women should not be treated differentially based on their breastfeeding choices (Larsen, Hall & Aagaard, 2008).
Meanwhile, the results of Hoddinott et al.’s (2012) study demonstrated a conflict between ideal breastfeeding versus the reality. For instance, the ideal is exclusive breastfeeding brings about optimum health while the reality is that the ideal is a happy mother, infant, and family with breastfeeding decisions determined by balancing numerous factors. Even the health service ideal was found not to reflect reality. For instance, not all staff fully supported the policy of exclusive breastfeeding nor were they adequately trained to provide education and support for the mothers. Prenatal breastfeeding education was found to be unrealistic and there was little time to reassure and build the confidence of mothers towards breastfeeding. The authors recommended forming individualized and family-centered goals that mothers and their significant others could realistically achieve given their values and family situation.

Level of Evidence and Grade of Recommendation

In regards to the study recommendations, the meta-synthesis by Larsen, Hall and Aagaard (2008) is considered Level III evidence according to the National Guidelines Clearinghouse practice guidelines. The hierarchy considers quantitative evidence especially that generated by a randomized controlled trial (RCT), as well as systematic reviews and meta-analyses of RCTs as the strongest evidence in the hierarchy. Meta-synthesis best fits into Level III evidence as the criteria includes descriptive studies which are non-experimental. For this reason, the serial qualitative interview by Hoddinott et al. (2012) is also categorized as Level III.
In terms of grade of recommendation, the studies both qualify as Grade C because they are based on Level III evidence directly. Larsen, Hall and Aagaard (2008) reviewed qualitative studies while Hoddinott et al. (2012) conducted a primary qualitative study. Evidence from the two articles must be considered in light of all other evidence, qualitative or quantitative. The two articles can be used to impact practice by generating a better understanding of what women think, feel, and need during their breastfeeding experiences. This understanding helps determine the appropriateness and acceptability of current policies and interventions leading to improvement.

Applicability of Findings

The recommendations of the 2 articles are applicable in my practice because I provide care to mothers, infants, and families. Many mothers stop breastfeeding soon after they are discharged, and this puts into question the level of support these mothers received from the staff in the areas of knowledge, skills, and confidence building as pointed out by Larsen, Hall and Aagaard (2008). Giving conflicting advice and non-consideration of mothers’ concerns and questions further undermine mothers’ confidence. The low compliance rate with the policy of exclusive breastfeeding for the first 6 months also calls into question how realistic this goal is from the mothers’ point of view in light of competing personal and family needs (Hoddinott et al., 2012). Changing the current policy to reflect the mothers’ needs and concerns will improve the duration of exclusive breastfeeding that ultimately benefit both mother and child consistent with the ethical principle of beneficence.

Impact of Findings on Policy

Policy change should ensure that nurses receive up-to-date education on breastfeeding and develop the skill of teaching about breastfeeding in a realistic way, i.e. that breastfeeding may not be easy and there are challenges women are likely to encounter and that experiences differ among women instead of presenting one ideal experience that creates unrealistic expectations. One challenge that must be discussed is how to reconcile personal needs, the needs of other children and family members, and breastfeeding. Therefore, the policy must also ensure that breastfeeding goals and decisions are made within the context of the family. In addition, a culture supportive of the individual needs of women must be instituted so that interventions conform to real conditions instead of the ideal. This culture must respect women as individuals and not just bodies that produce breast milk as well as encourage women to express their concerns and needs. Doing so improves women’s confidence and determination to breastfeed their infants.
New policies can be promoted through information technology. Up-to-date guidelines and evidence from the literature can be integrated as a clinical support tool readily accessible to the staff. Principles of family-centered breastfeeding education and support can also be available for review in electronic form. The use of diagrams, pictures, and slogans in the tools also serve to remind the staff of what new mothers need and the nurses’ role in fulfilling them. There must also be assessment and documentation forms to ensure an individualized and family-centered approach to care is adopted.

Conclusion

Compliance to exclusive breastfeeding confers health benefits to the infant and mother. However, compliance is low and qualitative studies such as meta-synthesis and serial qualitative interviews deepen current understanding about this phenomenon. Lack of confidence is one contributory factor brought on by shattered expectations when the ideal situation described during patient education does not materialize. Mothers’ confidence is also negatively affected by current and conflicting messages about breastfeeding and women’s bodies and the lack of respect of women’s decisions especially when such decisions are made in consideration of multiple factors including personal and family needs. Policies must create a culture favorable to building women’s confidence, conveying respect, supportiveness, and family-centered care. Staff education is crucial to building this culture.

References

Hoddinott, P., Craig, L.C.A., Britten, J., & McInnes, R.M. (2012). A serial quantitative interview study or infant feeding experiences: Idealism meets realism. BMJ Open, 2, 1-14. doi:10.1136/bmjopen-2011-000504
Larsen, J.S., Hall, E.O.C., & Aagaard, H. (2008). Shattered expectations: When mothers’ confidence in breastfeeding is undermined – a metasynthesis. Scandinavian Journal of Caring Sciences, 22, 653-661. doi: 10.1111/j.1471-6712.2007.00572.x.
National Institute of Child Health and Human Development (2014). What are the benefits of breastfeeding? Retrieved from http://www.nichd.nih.gov/health/topics/breastfeeding/conditioninfo/Pages/benefits.as px