Application Of Breastfeeding Intervention Based On Self-efficacy Theory In Patients With Gestational Diabetes Mellitus

Objective1.To understand the psychological feelings and needs of early postpartum breastfeeding in patients with gestational diabetes mellitus(GDM),so as to provide reference for the formulating breastfeeding intervention program in patients with GDM.2.Under the guidance of self-efficacy theory,combined with semi-structured interviews,expert discussion and other methods,the breastfeeding intervention program was constructed to explore the application effect of this program in GDM patients.Methods1.Qualitative research:Purpose sampling method was used.From May to July 2019,a total of 17 GDM patients from obstetric ward of a tertiary hospital in Qingdao were selected as the research objects.Phenomenological research methods were used to collect data on psychological feelings and needs of early postpartum breastfeeding in GDM patients through semi-structured interviews.The thematic analysis method was used to analyze the interview data.2.Quantitative research:Based on literature review and qualitative research results,combined with expert discussion and pre-experiment,the breastfeeding intervention program for GDM patients based on self-efficacy theory was determined.By the convenient sampling method,140 GDM patients at 24～28 weeks of gestation in the obstetric outpatient department of a tertiary hospital in Qingdao were selected.The research objects were recruited from August to September 2019 as the control group,and from May to June 2020 as the intervention group,with 70 cases in each group.The control group received routine breastfeeding care.The intervention group received breastfeeding intervention based on self-efficacy theory,including nursing measures to enhance breastfeeding self-efficacy during the third trimester,hospitalization and after discharge.The breastfeeding knowledge questionnaire,the initiation of lactogenesis Ⅱand feeding pattern questionnaire and feeding pattern questionnaire and breastfeeding self-efficacy short scale were used for the investigation.The 3rd day postpartum,the first month and the third month postpartum were the survey time points.The initiation of lactogenesis II,breastfeeding knowledge score,exclusive breastfeeding rate and breastfeeding self-efficacy score were compared between the two groups.Using SPSS22.0statistical tools,statistical methods such as t test,chi-square test and repeated measurement analysis of variance and other statistical methods were used to analyze the data to evaluate the effect of breastfeeding intervention program based on self-efficacy theory.Results1.The results on breastfeeding feelings and needs of GDM patients in the early postpartum periodAfter interviewing 17 GDM patients,the data was saturated.Analyzing,summarizing and refining the interview data,5 themes and 14 sub-themes were finally formed:(1)lack of knowledge and skills(weak awareness of prenatal learning,lack of breastfeeding knowledge,lack of correct breastfeeding skills);(2)negative psychological feelings(lactation condition increase lactation pressure,feeding concerns caused by sucking behavior of giant fetus,doubts and concerns about the quality of milk);(3)positive emotional experience(the sense of acquisition after overcoming difficulties,the happiness of exclusive breastfeeding);(4)obstacles of breastfeeding(strong physical fatigue,interference of family members’ traditional feeding cognition,change of feeding attitude due to neonatal diseases,different feeding guidance from medical staff);(5)The needs of social support(eager for professional guidance,hope for active participation and support from spouse).2.Application effect of breastfeeding intervention based on self-efficacy theory in GDM patientsThe both groups of GDM patients had a balanced baseline in terms of general demographic data and clinical characteristics,and there was no statistically significant difference in breastfeeding knowledge and breastfeeding self-efficacy scores before the intervention(P>0.05),and they were comparable.The intervention results showed that:(1)The proportion of lactogenesis II initiation at 24～48 hours postpartum in the intervention group was higher than that in the control group(P<0.05),and the proportion of lactogenesis II initiation >72 hours postpartum was lower than that in the control group,the difference was statistically significant(P<0.05).(2)The rates of exclusive breastfeeding at 3 days,1 month and 3 months postpartum in the intervention group were higher than that in the control group,the difference was statistically significant(P<0.05).(3)The total score of breastfeeding knowledge on the third day after delivery in the intervention group was higher than that in the control group(P<0.05).The total score of breastfeeding knowledge on the third day after delivery in the two groups was higher than that before the intervention,and the difference was statistically significant(P<0.001).(4)Repeated measurement analysis of variance showed that the time effect,group effect and interaction effect on the total score and two dimension score of breastfeeding self-efficacy between the two groups were statistically significant(P<0.05).Univarate repeated measurements of variance analysis showed that the total score and skill dimension of breastfeeding self-efficacy in the control group at 1 month and 3 months postpartum were higher than those before the intervention and 3 days postpartum(P<0.05),The score of inner dimension was higher at 3 months postpartum than before the intervention and3 days postpartum(P<0.05).The total score and skill dimension of breastfeeding self-efficacy in the intervention group was 3 months postpartum>1 month postpartum>3days postpartum> before the intervention(P<0.05),and the score of inner dimension was statistically significant at 3 days,1 month and 3 months postpartum than before the intervention(P<0.05).Multivariate analysis of variance showed that the total score and two dimensions of breastfeeding self-efficacy in the intervention group were higher than those in the control group at 3 days,1 month and 3 months postpartum,and the difference was statistically significant(P<0.05).Conclusion1.GDM patients will face various breastfeeding pressures in the early postpartum period,which mainly come from problems related to milk-secretion,their own knowledge and ability,newborn health,individual psychology,inadequate support from family members and medical staff.Medical staff should pay attention to the emotional and information needs of GDM patients,provide targeted resources and support,improve the breastfeeding support ability of family members,and promote successful breastfeeding.2.The breastfeeding intervention program based on self-efficacy theory in this study is effective and feasible.This program is conducive to increasing breastfeeding knowledge of GDM patients and improving the understanding of scientific breastfeeding;It is conducive to reducing the rate of DOL II and promoting exclusive breastfeeding;It is conducive to enhancing breastfeeding self-efficacy and establishing good social support atmosphere,improve the breastfeeding situation.