The World Health Organisation promote breastfeeding as the recommended feeding method exclusively for the first six months of a baby’s life. Breastfeeding is a key public health concern around the world and there are multiple policies around that recommend breastfeeding. There are many health benefits to breastfeeding, both for the mother and the baby, and these include reduced risk of obesity, hypertension, allergies, diabetes and a reduced risk of infant death syndrome (Giles et al 2010, UNICEF 2014).
One in fifteen births in the United Kingdom are to women under the age of 20, and this age group are less likely to initiate and continue breastfeeding. With only 7 percent of teenage mothers from the UK breastfeeding until baby is 6 months old (Condon et al 2012).
Increasing breastfeeding rates among young mothers is a main concern for the government in the UK (Department of Health UK 2012). Despite the WHO promoting breastfeeding as the optimal feeding method, the initiation rates for breastfeeding remains low in these disadvantaged groups (Macgregor E and Hughes M 2010).
Excusive breastfeeding for the first six months is promoted by health visitors, in accordance with World Health Organisation recommendations, however, this may be less successful in teenage mothers (Dyson et al 2010)
*Add in here role of Specialised Community Public Health Nurse (SCPHN) in breastfeeding *
A brief review of key literature (200 words)
For the purpose of this literature review, Liverpool John Moores University discovery service programme was used, searching databases such as ‘CINAHL’ and using keywords such as ‘Breastfeeding’ + ‘Teenage mother’ and ‘Breastfeeding’ + ‘barriers’ + ‘teenage mothers’. A time frame was chosen from 2006-2015, as this would enable the researcher to enhance their knowledge on up to date literature.
Although the number of teenage mothers has reduced over the previous ten years, they are still considered one of the most disadvantaged groups in society and have increased health inequalities for themselves and their babies (Jennison L 2015).
There is evidence to suggest that teenage mothers need extra support with breastfeeding to become independent from from the cultural standard of formula feeding amongst this age group (Dyson et al 2010). Health visitors are well positioned to offer this support, although support and encouragement is vital, past experience and self-confidence affects the teenage mother (Bettison J 2014). In most cases, teenage mothers do not receive sufficient support to continue breastfeeding (Tucker et al 2011) they may lack assertiveness, and may be hesitant to ask questions (Bailey et al 2014). Consequently the health visitor’s role in encouraging mothers to breastfeed, may need a different approach when working with teenagers. (Bettison J 2014)
Barriers will vary for each individual (Regan 2009) the main barriers to breastfeeding are pain, inconsistent information from Health professionals and loss of freedom, preventing the teenage mother to return to pre-pregnancy life. (Macgregor and Hughes 2010)
Teenage mothers want to breastfeed, but there is potential for social embarrassment, and lack of support (Condon 12) Peer backing is the greatest influence and support (Hall 12, Lavender 2005).
Qualitative studies tend to be used with teenage mothers, due to the emotive nature (Condon et al 2012, Hall et al 2012, and Brown et al 2011).
NICE (add in!)
The research question
What are the barriers to teenage mothers continuing to breastfeed?
Design and methodology
The purpose of this study is to discover and gain an understanding into why teenage mothers do not continue to breastfeed. The researcher will use a mixed methods approach, which will enrich the quality of research findings and will enhance the reliability and validity of the data collection methods used and incorporates a positivist approach (Parahoo 2006 and Andrew and Halcomb 2009). The use of both approaches makes a great contribution to research, building on existing knowledge and skills (Gelling 2014). Bryman (2012) supports mixed methods studies as they can identify weaknesses in the other method and both can complement each other, although Saks and Allsop (2013) found that mixed methods research can be challenging and may complicate the proposal.
Quantitative and qualitative research styles will both be used to increase the validity of the study, Parahoo (2006) agrees with this and describes this method as triangulation, incorporating a positivist approach. De Poy and Gitlin (2011) and Bryman (2012) agree with this and express that using a mixed methods approach gives a further comprehensive knowledge of the research method and conjoining the two can complement each other. Furthermore, Larkin et al (2014) state that the intention of mixed methods research is to improve confidence in findings, increase understanding in healthcare and ensure all groups in society are listened to. Moreover, Gelling, L (2014) found that the use of both approaches makes a great contribution building on existing knowledge and skills. Conversely, Saks and Allison (2013) believe that it can be challenging and complicated mixing the two methods, and Freshwater and Bishop (2004) believe the method to be time consuming and add extra pressure into the researcher.
Sampling and strategy
The researcher will commence by using a quantitative method to collect data from questionnaires at an antenatal visit between 28-32 weeks gestation, as this will provide the parents opportunity to discuss intentional feeding methods. Questionnaires permit the researcher to stretch to a larger amount of participants (Ellis 2011). Questionnaires are a form of quantitative research and this is acknowledged as a positivist paradigm, researchers from this paradigm are typically concerned with quantifying in order to prove or disprove a hypothesis (Meadow 2003, Morgan 2007).
A letter will then be sent out to participants selected to take part in the research, with a two week scale given for participants to accept or decline the offer.
The next part of the research study will include a focus group, which can be a way of collecting data for phenomenological study, the aim of this type of research is to gain an insight into the feelings and emotions of the participant. (Franz 2011, Parahoo 2006). Conversely, Ellis (2011) highlights that a disadvantage of this may be a group consensus. A focus group can gain an insight into feelings and emotions of the participants (Franz 2011). To enhance validity and reliability, an in-depth interview will also follow.
Qualitative research is an interpretivist approach and aims to reveal findings based on people’s views and experiences (Parahoo 2006). It is a holistic and person centred approach and explores a narrative process and understanding perspective (Ellis 2011) Qualitative researchers analyse their data throughout the study, whereas quantitative researchers wait until the end of their study to analyse data.
For the purpose of this study, the researcher will use a mixed methods approach, and this kind of study relies on a mixture of probability and non-probability. However, as the target group is pregnant teenagers, convenience sampling will be used to recruit clients at antenatal visits. The advantages of using this method includes saving time and cost (Andrew and Halcombe 2009) However, convenience sampling may result in over representation of a specific group (Burns and Grove 2007)
In this study, the sample size will be between 8-10 teenagers, as this will be sufficient for the purpose of the study. The rationale for the small sample can provide rich and deep data, reflecting the intended purpose of the qualitative methodology (Ellis 2011, Richie et al 2014)
For the interview stage, the sample size needs to be large enough to produce significant evidence, but a large sample size will not be viable in the data analysis stage of the process due to data transcription being extremely time consuming. The researcher has chosen semi structured interviews, due to them being consistent, valid and reliable. They are also cost effective, flexible and produce thorough data (Speziale and Carpenter 2006).They also enable the researcher to aid the participant to further understand a question, or ask them to elaborate further (Harris and Brown 2010, Parahoo 2006). The interviews will last approximately 5-10 minutes, and data will be digitally recorded for transcription later on. Face to face interviews allow elaboration on information and the researcher is able to further explore views and experiences (Cormack, Gerrish and Lacey 2006).
Data collection technique
Data analysis is anticipated to be time consuming in qualitative research due to the focus group and interviews. Once the questionnaires are analysed via a computer system software to give us statistical answers. Parahoo (2006) state that for something to be measured, numbers must be involved. Quantitative
For the focus groups and interviews, the data will be transcribed during a structured and organised period. Peterson and Barron (2007) suggest that this will be the key to its success. Feedback will then be typed up by the researcher (Doody et al 201) and this information will be ‘fed back’ at the interviews to guarantee credibility and reliability.
The researcher would also make use of a ‘gant chart’ to assist them in the planning and management of the study. (Appendix 1)
Ethical Issues
Before the research studies commences, it is important for the researcher to gain consent from the trust involved in the study. This is to ensure the rights, wellbeing and safety of the participant (RCN 2004). Consent is fundamental to be given by the participant, it would not be ethical without consent when dealing with vulnerable members of the community involving emotive issues (Vivar 2007).
Additionally, ethical approval is required from the research ethics committee (DOH 2011b) Consent must be given by the trust involved, this will ensure an independent review to ensure rights, wellbeing and safety of participant. (RCN 2009)
The researcher will protect confidentiality by keeping interview transcripts and audio tapes in a locked cabinet. The records will be stored for 2 years following completion, following guidelines of the data protection act 1998.
How could the study contribute or develop knowledge in this field?
This study explores the barriers to teenage mothers continuing breastfeeding, and this would enable the SCPHN to recognise risk factors and empower them to promote breastfeeding in the future, and to prevent he barriers in the future. Using the mixed methods approach will improve knowledge and enhance the client/Health visitor relationship. For future studies, a recommendation would be made to increase the sample size to include other areas as the sample size, this may be a limitation.
Utilising the information research the role of SCPHN should be to ensure that the teenage mothers have breastfeeding information and support antenatally to empower them, and also maximise support in place at the most crucial time following birth.