Effects Of Breastfeeding Education Based On Rain Classroom On Mothers With Preterm Infants

Background:With the progress of medical technology,the survival rate of preterm infants has been improved significantly.As the best source of nutrition,breast milk plays an important role in the growth and development of surviving preterm infants.However,the inadequate knowledge,negative attitudes and lacking confidence of breastfeeding among mothers with preterm infants remain major barriers tobreastfeeding for preterm infants.In view of the shortcomings of the existingapproaches of breastfeeding education,it is very urgent to explore how to use new online platforms to carry out more effective,convenient,and economicalbreastfeeding education for mothers with preterm infants.In recent years,the online teaching platform has been rising rapidly and improving day by day.The RainClassroom,as one of the free online teaching platforms,especially providespotentially available resources for effective,convenient,and economical online breastfeeding education for mothers with preterm infants.Objectives:To identify the effect of the breastfeeding education based on Rain Classroom on improving the knowledge,attitude,self-efficacy,practice ofbreastfeeding and psychological well-being status of mothers with preterm infants.To analyze the participation of the breastfeeding education based on Rain Classroom for mothers with preterm infants.Methods:This is a quasi-experimental study using convenient sampling.We included the first 25 mothers with preterm infants in the control group and the last 25 mothers with preterm infants in the intervention group according to preterm infants’admission order.Mothers in the control group received routine breastfeeding education,while mothers in the intervention group received both routine breastfeeding education and a3-month breastfeeding education based on Rain Classroom（online course,onlineconsultation,online peer support,and online follow-up）.Within 7 days postpartum（T₀）,we took the baseline measurements.At 1 month postpartum（T₁）and 3 months postpartum（T₂）,we respectively evaluated mothers’breastfeeding knowledge,breastfeeding attitude,breastfeeding attitude self-efficacy,postpartum depression,and anxiety levels by the breastfeeding knowledge questionnaire,the Iowa infant feeding attitude scale,the breastfeeding self-efficacy scale,the Edinburgh postnataldepression scale and the self-rating anxiety scale,and surveyed preterm infants’feeding pattern.At the end of this study,we assessed the online course participation rate of mothers in the intervention group.Results:The control group included 25 mothers with 30 preterm infants,while the intervention group included 25 mothers with 33 preterm infants.Baselinemeasurements showed that there was no statistical difference between two groups（p>0.05）.At 1 month and 3 months postpartum,the mothers’scores of thebreastfeeding knowledge questionnaire（T₁:16.00 vs.15.00;T₂:16.50 vs.15.00）,the Iowa infant feeding attitude scale（T₁:62.28 vs.61.60;T₂:64.00 vs.61.71）,and the breastfeeding self-efficacy scale（T₁:105.08 vs.101.40;T₂:116.50 vs.101.86）in the intervention group were higher than those in the control group.Especially,themothers’score of breastfeeding knowledge questionnaire in the intervention group was significantly higher than that in the control group at 3 months postpartum（p=0.044）.At 1 month and 3 months postpartum,the rates of exclusive breastfeeding（T₁:33.3%vs.30.0%;T₂:28.1%vs.22.2%）and any breastfeeding（T₁:78.8%vs.73.3%;T₂:75.0%vs.66.7%）of preterm infants in the intervention group were higher than those in the control group,but there was no statistically significant difference.In addition,there was no statistically significant difference in the positive rates ofpostpartum depression（T₁:44.0%vs.40.0%;T₂:25.0%vs.14.3%）and anxiety（T₁:4.0%vs.16.0%;T₂:10.0%vs.9.5%）between two group mothers at 1 month and 3months postpartum.However,the positive rate of postpartum depression of two group mothers decreased significantly over time（p=0.001）.The theme with the highestparticipation rate was breastfeeding methods and skills（88.0%）,while the theme with the lowest participation rate was feeding program during hospitalization（48.0%）,with an average online course participation rate of 72.57%.Conclusions:The breastfeeding education based on Rain Classroom can significantly improve the breastfeeding knowledge level of mothers with preterm infants,but there was no significant effect on improving mothers’breastfeeding attitude,self-efficacy,and practice,as well as psychological well-being status.In addition,the participation of the breastfeeding education based on Rain Classroom for mothers with preterminfants need to be improved.Rain classroom can be applied in the future research and practice of breastfeeding education for mothers with preterm infants,but thefollowing methods are suggested to use to improve it and further explore its effect:（1）It is suggested to carry out prenatal health education on preterm infants’breastfeeding based on Rain Classroom for pregnant women with high risk of preterm delivery;（2）In the use of Rain Classroom for the breastfeeding education for mothers with preterm infants,the offline breastfeeding education for mothers with preterm infants should be further strengthened at the same time;（3）The positive rate of postpartum in mothers with preterm infants is high,and it is paramount to incorporate professionalpsychological intervention into the breastfeeding education based on Rain Classroom for mothers with preterm infants;（4）The participation of the breastfeeding education based on Rain Classroom for mothers with preterm infants should be improvedthrough engagement techniques,such as gamification,push notifications,and online real-time classroom,so as to improve the effectiveness of the health education.Further multicenter randomized controlled trials with large sample size areneeded in the future.In addition,quantitative studies with more systematic evaluation indicators of participation,as well as qualitative studies on the subjective perceptions and experience of mothers with preterm infants should be carried out in the future.