Tuthill Emily L, Butler Lisa M, Pellowski Jennifer A, McGrath Jacqueline M, Cusson Regina M, Gable Robert K, Fisher Jeffrey D
1School of Nursing,University of California,San Francisco,2 Koret Way,San Francisco,CA 94143,USA.
2Institute for the Collaboration on Health,Intervention and Policy,University of Connecticut,Storrs,CT,USA.
Public Health Nutr. 2017 Jun;20(8):1481-1490. doi: 10.1017/S1368980016003657. Epub 2017 Feb 8.
Exclusive breast-feeding (EBF) provides optimal nutrition for infants and mothers. The practice of EBF while adhering to antiretroviral medication decreases the risk of mother-to-child transmission of HIV from approximately 25 % to less than 5 %. Thus the WHO recommends EBF for the first 6 months among HIV-infected women living in resource-limited settings; however, EBF rates remain low. In the present study our aim was to design and implement a pilot intervention promoting EBF among HIV-infected women.
The Information-Motivation-Behavioural Skills (IMB) model was applied in a brief motivational interviewing counselling session that was tested in a small randomized controlled trial.
Pietermaritzburg, South Africa, at two comparable rural public health service clinics.
Sixty-eight HIV-infected women in their third trimester were enrolled and completed baseline interviews between June and August 2014. Those randomized to the intervention arm received the IMB-based pilot intervention directly following baseline interviews. Follow-up interviews occurred at 6 weeks postpartum.
While not significantly different between trial arms, high rates of intention and practice of EBF at 6-week follow-up were reported. Findings showed high levels of self-efficacy being significantly predictive of breast-feeding initiation and duration regardless of intervention arm.
Future research must account for breast-feeding self-efficacy on sustaining breast-feeding behaviour and leverage strategies to enhance self-efficacy in supportive interventions. Supporting breast-feeding behaviour through programmes that include both individual-level and multi-systems components targeting the role of health-care providers, family and community may create environments that value and support EBF behaviour.
纯母乳喂养能为婴儿和母亲提供最佳营养。在坚持抗逆转录病毒药物治疗的同时进行纯母乳喂养可将母婴传播艾滋病毒的风险从约25%降至5%以下。因此，世界卫生组织建议生活在资源有限环境中的感染艾滋病毒的妇女在头6个月进行纯母乳喂养；然而，纯母乳喂养率仍然很低。在本研究中，我们的目的是设计并实施一项促进感染艾滋病毒妇女纯母乳喂养的试点干预措施。
信息-动机-行为技能（IMB）模型应用于一次简短的动机性访谈咨询环节，并在一项小型随机对照试验中进行了测试。
南非彼得马里茨堡的两家类似的农村公共卫生服务诊所。
68名处于孕晚期的感染艾滋病毒的妇女于2014年6月至8月入组并完成了基线访谈。那些被随机分配到干预组的妇女在基线访谈后直接接受基于IMB的试点干预措施。产后6周进行随访访谈。
虽然试验组之间没有显著差异，但在6周随访时报告了较高的纯母乳喂养意愿和实践率。研究结果表明，无论干预组如何，高水平的自我效能感都能显著预测母乳喂养的开始和持续时间。
未来的研究必须考虑母乳喂养自我效能感对维持母乳喂养行为的影响，并在支持性干预措施中利用提高自我效能感的策略。通过包括针对医疗保健提供者、家庭和社区作用的个体层面和多系统组成部分的项目来支持母乳喂养行为，可能会创造重视和支持纯母乳喂养行为的环境。
