Postpartum dönemde annelere verilen emzirme destek programının sadece anne sütü ile beslenme süresi üzerindeki etkisinin değerlendirilmesi
Küçük Resim Yok
Tarih
2016
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Araştırma kapsamında yeni doğum yapmış annelerde ilk altı ayda sadece anne sütü ile besleme oranını arttırmayı hedefleyen; doğum sonrası hastanede bir oturumluk eğitimi, taburculuk sonrası ikinci hafta hastanede izlemi ve ikinci, dördüncü, altıncı aylarda telefon izlem ve danışmanlığını kapsayan Emzirme Destek Programı (EDP) geliştirilmiştir. Bu araştırma ile EDP'nın etkinliğinin, müdahale grubunda yer alan annelerin bilgi düzeyi, emzirme özyeterlilikleri ve sadece anne sütü (SAS) ile besleme davranışları açısından kontrol grubu ile karşılaştırılarak değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Bu araştırma eğitim etkinliğinin değerlendirilmesine yönelik kontrollü bir müdahale araştırmasıdır. Araştırma grubu, Ege Üniversitesi Tıp Fakültesi Hastanesi Kadın Sağlığı ve Doğum kliniğinde 04.11.2013-25.04.2014 tarihleri arasında doğum yapan; okuryazar olan, 18 yaş ve üzeri, İzmir şehir merkezinde yaşayan, tekil ve miadında doğum yapan annelerden oluşmuştur. Örnek büyüklüğünün hesaplanması amacıyla daha önce yapılmış çalışmalarda bildirilmiş olan müdahale ve kontrol grupları arasındaki girişime yönelik etki farkı değerlendirilmiş, EDP ile altıncı ayda SAS' ne devam etme yüzdesinin % 55'e ulaşması hedeflenmiştir. NCSS-PASS 2005 programından yararlanarak ?=0.05 ve % 80'lik bir güçle hesaplanan örnek büyüklüğü müdahale grubunda 105, kontrol grubunda 105 olmak üzere toplam 210 anne olarak belirlenmiştir. İzlem kayıpları olabileceği dikkate alınarak 230 anne çalışmaya dahil edilmiştir. Araştırma süresince müdahale grubunda dört, kontrol grubunda altı annenin izlemleri tamamlanamamıştır. Müdahale grubunda yer alan annelere hastanede eğitim uygulanmadan önce; sosyodemografik, doğurganlık ve emzirme açısından özellikleri ile emzirme konusunda bilgi düzeyleri, özyeterlik algıları ve emzirme davranışlarına ilişkin verileri toplanmıştır. Veriler toplandıktan sonra müdahale grubundaki anneler EDP' na dahil edilerek, araştırmacı tarafından birebir görüşme ile emzirme eğitimi verilmiştir. Taburculuk sonrası ikinci hafta hastanede izlem, ikinci, dördüncü ve altıncı aylarda telefon izlemi ile birlikte emzirme danışmanlığı uygulanmıştır. Kontrol grubuna ise hastanedeki görüşme ile birlikte ikinci, dördüncü ve altıncı aylarda telefon izlemi yapılmış, ikinci hafta hastane izlemi yapılmamıştır. Bu gruba araştırmacı tarafından eğitim uygulanmamış, rutin hizmetlere yönlendirilmişlerdir. Altıncı ay sonunda tüm annelere Bilgi Değerlendirme Formu (son test) uygulanarak emzirme konusunda bilgi düzeyleri değerlendirilmiştir. Elde edilen verilerin istatistik analizinde tanımlayıcı özellikler ki-kare analizi ile karşılaştırılmıştır. Eğitim öncesi ve eğitim sonrası bilgi formu, Özyeterlilik ölçeği ve LATCH tanılama aracından aldıkları puanlar t testi ile değerlendirilmiştir. Anne sütü ile besleme açısından grupların kendi içindeki aylara göre değişimi Cochrane Q testiyle, emzirmenin belirleyicileri ise lojistik regresyon analizi ile incelenmiştir. Bulgular: EDP sonrası altıncı ayda uygulanan son testte annelerin bilgi puan ortalaması müdahale grubunda, kontrol grubuna göre daha yüksek bulunmuştur (t=10.737; p=0.000). Annelerin özyeterlilik düzeyleri ise ikinci ayda her iki grupta da artış göstermiş, müdahale grubundaki artışın kontrol grubuna göre anlamlı düzeyde yüksek olduğu saptanmıştır (t=7.90; p=0.000). Hastanede eğitim öncesi ve sonrası annelerin emzirme davranışlarını değerlendirmede kullanılan LATCH ölçeği puanları da müdahale grubunda, kontrol grubuna göre daha yüksek elde edilmiştir (t=7.250; p=0.000). Müdahale grubunda bebeğini sadece anne sütüyle besleme yüzdesi, hastaneden taburcu edilmeden önceki izlemden son izleme kadar kontrol grubundan anlamlı düzeyde yüksektir (p<0.05). Müdahale grubunda SAS düzeyi, hastaneden taburcu olmadan önce % 88.3, ikinci ayda % 83.8, dördüncü ayda % 71.2 ve altıncı ayda % 58.6 iken kontrol grubunda sırasıyla % 70.6, % 46.8, % 31.2 ve % 19.3'tür. Müdahale grubunda olma kontrol grubuna göre sadece anne sütüyle besleme olasılığını; taburculukta 3.02 kat, ikinci ayda 8.94 kat, dördüncü ayda 7.46 kat ve altıncı ayda 7.51 kat artırmaktadır. Sadece anne sütüyle beslemede etkili olan diğer değişkenlerin ise çekirdek ailede yaşama, normal doğum yapma, multipar olma ve biberon kullanmama olduğu belirlenmiştir. Çekirdek ailede yaşayan annelerde SAS ile bebeğini besleme olasılığı, geniş ailede yaşayanlara göre taburculukta 3.18 kat, ikinci ayda 4.84 kat ve altıncı ayda 4.45 kat artmaktadır. Normal doğum yapanlarda ise hastanede SAS ile besleme olasılığı sezaryen doğum yapanlara kıyasla 2.65 kat yüksektir. Multipar anneler, primiparlara göre bebeklerini, ikinci ayda 5.20 kat, dördüncü ayda 2.95 kat ve altıncı ayda 4.08 kat daha fazla anne sütüyle beslemektedir. Biberon kullanmayan kişilerde ise hastanede SAS ile besleme düzeyinin biberon kullananlara göre 3.60 kat arttığı bulunmuştur. Aylık izlemlerin değerlendirilmesi sonucunda annelerin en fazla aile sağlığı merkezlerinden hizmet aldığı, bu süreçte üçte birinin emzirme açısından değerlendirilmediği, ek besine başlamada en yüksek oranda sağlık çalışanının etkili olduğu ve çalışan annelerde işe başladıktan sonra emzirme sorunlarının arttığı saptanan diğer bulgulardır. Sonuç: Bilgi, özyeterlilik ve davranış bileşenleri çerçevesinde oluşturulan EDP' nın annelerin bilgi düzeylerinin geliştirilmesine önemli katkı sağladığı, emzirme özyeterliliklerini güçlendirdiği ve sadece anne sütüyle besleme düzeyini artırarak annenin emzirme davranışını olumlu yönde etkilediği belirlenmiştir. Anahtar Kelimeler: Sadece anne sütü; Emzirme Eğitimi; Özyeterlilik; Emzirme Desteği
Objective: In the scope of the research, Breastfeeding Support Program (BSP), which aims to increase the proportion of only breastfeeding through the first six months in maternals who just gave birth, and includes one postnatal training session in hospital, the second week hospital follow-up after discharging and follow-up calls through the second, fourth and sixth months, and consultancy, has been developed. With this research, it has been aimed to evaluate the efficiency of the BSP by comparing the control group with regards to knowledge of maternals taking part into the intervention group, their self-efficacy of breastfeeding and feeding behaviours consisting of exclusive breastfeeding (EBF). Method and material: This is a controlled intervention research towards the assessment of training effectiveness. The research group consists of the maternals who gave birth between the dates of 04.11.2013 and 25.04.2014 at the gynecology and obstetrics clinic of Ege University Medical Faculty Hospital, are 18 years old and over, reside in the city center of İzmir, are single and gave birth in full-term. Influence difference towards the interference between the intervention and control group that has been reported in the previous studies that has been conducted to calculate the sample size has been evaluated, and with BSP it has been aimed that the percentage of continuance to EBF in the sixth month will reach 55%. By benefiting from NCSS-PASS 2005 program, the sample size that has been calculated with a ?=0.05 and 80% power has been designated as 105 in the intervention group and as 105 in the control group and in total as 210 maternals. By taking loss of follow-ups into consideration 230 maternals have been included into the study. During the research, the follow-ups of four maternals in the intervention group and of six maternals in the control group has not been able to be completed. Before applying the training in the hospital to the maternals taking part into the intervention group, their data related to the features in terms of sociodemographic, fertility and breastfeeding, and their data related to the knowledge about breastfeeding, self-efficacy perception and breastfeeding behaviours have been gathered. After gathering the data the maternals in the intervention group have been given breastfeeding training with one on one interview by the researhcer by including them in BSP. After discharge; in the second week the follow-up in the hospital, follow-up calls in the seond, fourth and sixth months, and cobreastfeeding consultancy has been applied. Conjuction with the interview in the hospital, the follow-up calls have been applied to the control group during the second, fourth and sixth months, yet hospital follow-up has not been applied in the second week. By the researcher training hasn`t been applied to this group but the group has been directed to routine services. By the end of the week sixth all the maternal have been applied Information Assessment Form (post test) and level of knowledge in terms of breastfeeding has been assessed. Defining features in the statistical analysis of the data obtained have been compared to chi-squared analyze. Information form before and after the training with self-efficacy scale and the scores they have received from LATCH diagnosis device has been assessed with t test. While the change of the group according to the month they have in terms of breastfeeding has been examined by Cochrane Q test the determiners of breastfeeding has been studied with logistics regression analyze. Findings: In the last test applied on the sixth month after BSP average information score of maternal has been found higher (t=10.737; p=0.000) for intervention group compare to control group. The self-efficacy level of maternal has shown an increase for both groups on the second month and it has been found that the increase in intervention group is significantly higher than control group (t=7.90; p=0.000). LATCH scale scores used to assess the breastfeeding behaviors of maternal inside the hospital before and after training also have been obtained higher in intervention group compare to control group (t=7.250; p=0.000). The percentage of breastfeeding baby within the intervention group is significantly higher than control group (p<0.05) between the first monitoring and last one before being discharged of the hospital. Before being discharged from the hospital EBF level in intervention group is 88.3%, on the second month 83.8%, on the fourth month 71.2% and on the sixth month 58.6% and in control group it is respectively 70.6%, 46.8%, 31.2% and 19.3%. According to the control group being within the intervention group is increasing the possibility of only breastfeeding on discharge around 3.02 times, on the second month as 8.94, on the fourth month as 7.46 times and on the sixth month as 7.51 times. Other variants effective on only breastfeeding have been determined to be living in nuclear family, vaginal delivery, being multiparous and not using feeding bottle. During discharge the possibility of EBF for Maternal living in nuclear family is increasing around 3.18 times, on the second month 4.84 times, and on the sixth month 4.45 times compare to those living in big families. For those having vaginal delivery EBF possibility in hospital is 2.65 times higher than those having c-section delivery. Compare to prim parous maternal multiparous maternal feed their babies around 5.20 times on the second month, on the fourth month 2.95 and on the sixth month 4.08 times. As for those not using feeding bottle, it has been found that the level of EBF in the hospitals has increased around 3.60 times compare to those not using it. As a result of the evaluation of the monthly monitoring other findings are maternal have service more from family health centers, one out of three has not been assessed in terms of breastfeeding during that process, it is mainly the health professionals having influence on starting supplementary food and breastfeeding problems have increased for working maternal after they start working. Result: It has been determined that the BSP that has been formed with knowledge, efficiency and behavior components and is contributing significantly to the information level of maternal, strengthening the breastfeeding self-efficacy and increasing exclusive breastfeeding level and influencing the breastfeeding behavior of maternal and stated that it has influenced maternal positively . Key Words: Exclusive breastfeeding; Breastfeeding Training; Self efficacy; Breastfeeding support
Objective: In the scope of the research, Breastfeeding Support Program (BSP), which aims to increase the proportion of only breastfeeding through the first six months in maternals who just gave birth, and includes one postnatal training session in hospital, the second week hospital follow-up after discharging and follow-up calls through the second, fourth and sixth months, and consultancy, has been developed. With this research, it has been aimed to evaluate the efficiency of the BSP by comparing the control group with regards to knowledge of maternals taking part into the intervention group, their self-efficacy of breastfeeding and feeding behaviours consisting of exclusive breastfeeding (EBF). Method and material: This is a controlled intervention research towards the assessment of training effectiveness. The research group consists of the maternals who gave birth between the dates of 04.11.2013 and 25.04.2014 at the gynecology and obstetrics clinic of Ege University Medical Faculty Hospital, are 18 years old and over, reside in the city center of İzmir, are single and gave birth in full-term. Influence difference towards the interference between the intervention and control group that has been reported in the previous studies that has been conducted to calculate the sample size has been evaluated, and with BSP it has been aimed that the percentage of continuance to EBF in the sixth month will reach 55%. By benefiting from NCSS-PASS 2005 program, the sample size that has been calculated with a ?=0.05 and 80% power has been designated as 105 in the intervention group and as 105 in the control group and in total as 210 maternals. By taking loss of follow-ups into consideration 230 maternals have been included into the study. During the research, the follow-ups of four maternals in the intervention group and of six maternals in the control group has not been able to be completed. Before applying the training in the hospital to the maternals taking part into the intervention group, their data related to the features in terms of sociodemographic, fertility and breastfeeding, and their data related to the knowledge about breastfeeding, self-efficacy perception and breastfeeding behaviours have been gathered. After gathering the data the maternals in the intervention group have been given breastfeeding training with one on one interview by the researhcer by including them in BSP. After discharge; in the second week the follow-up in the hospital, follow-up calls in the seond, fourth and sixth months, and cobreastfeeding consultancy has been applied. Conjuction with the interview in the hospital, the follow-up calls have been applied to the control group during the second, fourth and sixth months, yet hospital follow-up has not been applied in the second week. By the researcher training hasn`t been applied to this group but the group has been directed to routine services. By the end of the week sixth all the maternal have been applied Information Assessment Form (post test) and level of knowledge in terms of breastfeeding has been assessed. Defining features in the statistical analysis of the data obtained have been compared to chi-squared analyze. Information form before and after the training with self-efficacy scale and the scores they have received from LATCH diagnosis device has been assessed with t test. While the change of the group according to the month they have in terms of breastfeeding has been examined by Cochrane Q test the determiners of breastfeeding has been studied with logistics regression analyze. Findings: In the last test applied on the sixth month after BSP average information score of maternal has been found higher (t=10.737; p=0.000) for intervention group compare to control group. The self-efficacy level of maternal has shown an increase for both groups on the second month and it has been found that the increase in intervention group is significantly higher than control group (t=7.90; p=0.000). LATCH scale scores used to assess the breastfeeding behaviors of maternal inside the hospital before and after training also have been obtained higher in intervention group compare to control group (t=7.250; p=0.000). The percentage of breastfeeding baby within the intervention group is significantly higher than control group (p<0.05) between the first monitoring and last one before being discharged of the hospital. Before being discharged from the hospital EBF level in intervention group is 88.3%, on the second month 83.8%, on the fourth month 71.2% and on the sixth month 58.6% and in control group it is respectively 70.6%, 46.8%, 31.2% and 19.3%. According to the control group being within the intervention group is increasing the possibility of only breastfeeding on discharge around 3.02 times, on the second month as 8.94, on the fourth month as 7.46 times and on the sixth month as 7.51 times. Other variants effective on only breastfeeding have been determined to be living in nuclear family, vaginal delivery, being multiparous and not using feeding bottle. During discharge the possibility of EBF for Maternal living in nuclear family is increasing around 3.18 times, on the second month 4.84 times, and on the sixth month 4.45 times compare to those living in big families. For those having vaginal delivery EBF possibility in hospital is 2.65 times higher than those having c-section delivery. Compare to prim parous maternal multiparous maternal feed their babies around 5.20 times on the second month, on the fourth month 2.95 and on the sixth month 4.08 times. As for those not using feeding bottle, it has been found that the level of EBF in the hospitals has increased around 3.60 times compare to those not using it. As a result of the evaluation of the monthly monitoring other findings are maternal have service more from family health centers, one out of three has not been assessed in terms of breastfeeding during that process, it is mainly the health professionals having influence on starting supplementary food and breastfeeding problems have increased for working maternal after they start working. Result: It has been determined that the BSP that has been formed with knowledge, efficiency and behavior components and is contributing significantly to the information level of maternal, strengthening the breastfeeding self-efficacy and increasing exclusive breastfeeding level and influencing the breastfeeding behavior of maternal and stated that it has influenced maternal positively . Key Words: Exclusive breastfeeding; Breastfeeding Training; Self efficacy; Breastfeeding support
Açıklama
Anahtar Kelimeler
Halk Sağlığı, Public Health, Anne sütü, Milk-human, Anneler, Mothers, Bebek bakımı, Infant care, Bebek beslenmesi, Infant nutrition, Bebekler, Infant, Emzirme, Breast feeding, Hasta eğitimi, Patient education, Postpartum dönem, Postpartum period
