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Physicians and breastfeeding : beliefs, knowledge, self-efficacy and counselling practice

University of British Columbia

Reversing the problems of breastfeeding failure and bottlefeeding choice depends on physicians who are skilled in breastfeeding support and management. The following study aimed to assist an urban British Columbian hospital intending to develop breastfeeding education for its physicians. The study sought specifically to determine which predisposing factors to target in order to improve physicians' willingness, motivation and ability in counselling about and managing breastfeeding. The aims of the investigation were: 1) to provide baseline data on the physicians' attitudes, beliefs, knowledge and self-efficacy concerning breastfeeding counselling; and 2) to identify which measures including cognitive factors, gender, specialty, years in practice and personal or spousal breastfeeding experience might be independently predictive of physicians' self-reported counselling behaviours. A pilot-tested survey was mailed to the offices of all 325 obstetricians, pediatricians, family practitioners and general practitioners with privileges at the hospital. Response rate was 67.3 percent. The female physicians were much more likely to respond than male physicians; response rates of 86 and 57 percent respectively. Ninety percent of the respondents reported always or usually discussing breastfeeding with their patients prenatally (65% always do) and 88% reported always or usually attempting to convince mothers to breastfeed if they intend to bottlefeed (41% always do). Correlational data showed weak to moderate associations between the reported cognitive factors and counselling behaviours. The strongest of these associations suggest that physicians counsel more if they feel confident and if they believe strongly in the immune properties of breastmilk. Female physicians expressed greater self-efficacy in counselling the mom about breastfeeding problems and in positioning the baby at the breast (p < .001). Self-efficacy scores were higher for both male and female physicians whose children were breastfed (females, p <.001; males, p< .01). The measures of self-confidence, knowledge and beliefs were added to a regression model containing measures of gender, specialty, years in practice and personal or spousal breastfeeding experience to determine whether additional variance in the counselling behaviour could be accounted for. Physicians attempted to convince women to breastfeed if they believed in the immune properties of breastmilk (Beta =.63, p=.08) and were confident in their own breastfeeding counselling (Beta =.21, p=.004). Likewise, encouraging women to continue breastfeeding in the face of breastfeeding problems was related to belief in the immune properties of breastmilk (Beta =1.04, p=.021) and confidence in breastfeeding counselling (Beta =.20, p=.038). Knowledge of how to position the infant at the breast was associated with whether physicians reported discussing breastfeeding with the patients (p<05). However, when asked to identify which of the two pictures of the infant at the breast is in fact correct, 12% of physicians chose the wrong picture. Physicians also felt that supplementation was indicated for twins, infants with a difficult latch (suckling technique), and in cases requiring an emergency C-section. These are not, however, medical indications for supplementation. Despite more than a decade of research suggesting the need for breastfeeding education to physicians, little if any education has been provided. Revision of medical school curricula and development of continuing education are necessary to improve physicians' interest in breastfeeding and to provide specific skills that will increase physicians' competence and self-efficacy in counselling patients about breastfeeding.

Thesis/Dissertation

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2009-01-14

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http://hdl.handle.net/2429/3632

Health Care and Epidemiology

University of British Columbia

UBCV

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