Liderazgo en cuidados, autoeficacia y lactancia materna

Abstract

The benefits of breastfeeding have been widely documented. However, in spite of this, and of the different strategies carried out for their protection, promotion and support, there is still a premature abandonment of breastfeeding. The design, implementation and evaluation of a new intervention for the promotion of breastfeeding is presented in this thesis. The study used the Medical Research Council framework more specifically its first three stages, namely the theoretical phase, the conceptual modelling and the exploratory trial. The theoretical phase included the analysis of effective interventions for breastfeeding in the literature, the causes of premature abandonment of breastfeeding, and the role played by health professionals. A modifiable factor with great influence on the initiation and maintenance of lactation that is self-efficacy was the theoretical construct addressed in the intervention. Once the theoretical framework and the key elements of the program were identified, a logic model was created to guide the intervention process and design the Sialac programme (Synergy, self-efficacy, breastfeeding and care). The exploratory trial used an intervention design, corresponding to a multicentre controlled clinical trial. A total of 123 women participated in the trial, of which 63 were included in the intervention group and 60 in the control group. The Sialac programme was implemented in the intervention group in the context of usual care, following the protocol described during the prenatal period, admission after delivery and in the postnatal stage with follow-up over 6 months. The professionals caring for the mothers in the settings involved were the ones who delivered the intervention. In order to do so, a specific training in self-efficacy and breastfeeding was proposed, whose effect was measured and controlled. The analysis of the data focused on determining the effectiveness of the program and its acceptability. Effectiveness of Sialac programme was measured in terms of incidence and duration of breastfeeding and changes in mothers’ perceived Self-Efficacy with respect to breastfeeding. The effectiveness of the training programme was measured through changes in professionals’ perceived Self-Efficacy regarding Breastfeeding. The results showed a statistically significant effect on the duration of breastfeeding at 6 months being this effect bigger in the intervention group. The intervention group also had better outcome regarding self-efficacy compared to the control group. The training of professionals had very positive results in the satisfaction, learning and transfer of knowledge to practice. Regarding the feasibility of the program, there were identified some organizational barriers (related to difficulties in the follow-up of women, the continuity of care, the variability in practice and influences of their own personal experience and policies or context practices) as well as facilitators (leadership and alliances of researchers, unit managers and health professionals; the design of the program based on experiences and needs expressed by professionals and nursing mothers in the context were the intervention was to take place; the integration of the intervention in the standard care of pregnant and puerperium women; and adherence to the program of the participating women). The results allow concluding that intervening with health professionals (nurses and midwives) promoting self-efficacy, in the prenatal, hospital and postnatal periods is effective for the establishment and maintenance of breastfeeding. The methodological framework for complex interventions has made it possible to carry out efficient translational research, addressing and analysing the multiple factors that influence the results, and improving practice based on research.