Breast feeding is a practice widely encouraged by the World Health Organization (WHO) because of its benefits in providing ideal food and promoting healthy growth and development in infants. WHO recommends exclusive breastfeeding for the first six months followed by addition of complementary food till the age of two years or beyond. However, despite WHO’s recommendation, only 35% of infants are breastfed globally (Akinyinka, Olatona & Oluwole, 2016). In case of Australia, 90% children initiated breastfeeding, however only 15.4% were exclusively breastfed till 5 months (The Department of Health, 2018). To resolve the issue and promote breastfeeding practice among mothers, it is essential to identify the factors that act as barriers in breastfeeding and find the reason behind reduction in breastfeeding rates. Hence, the report will critically evaluate research papers that have investigated about breastfeeding experience of Australian mothers and identify the quality of the findings presented in terms research rigour, suitability of data collection method and research design.
Gallegos, Vicca and Streiner (2015) aimed to investigate about breastfeeding experience among refugee women living in two major capital cities in Australia. Qualitative descriptive research method using thematic content analysis method was employed to gain understanding regarding breastfeeding experience in the target group. Data was collected from two sites of Australia (Perth and Brisbane) and women from Africa living in Perth and Brisbane were recruited through women’s community group. Informed consent and ethical approval requirement was maintained. Participants from all age group were taken who had children either in Australia or in their own country. Interview was used as the main method to collect research data and comprehensive data was collected regarding cultural beliefs, facilitators, barriers and personal experiences of participants regarding breast feeding. The interview data was transcribed verbatim and group-based discussion was audio-taped and recorded. Use of inductive approach helped in developing themes from the research data. The findings of the research gave idea about the complexity of breastfeeding behaviour among women. Stigma and shame was identified as a barrier to breastfeeding as many African women avoided breastfeeding in public according to Australian culture. Loss of family support was also identified as a barrier to breast feeding within the Australian context.
Gallegos, Vicca and Streiner (2015) used descriptive qualitative research approach to explore about breastfeeding experience among African mothers living in Australia. Qualitative research design is appropriate according to the purpose of research as qualitative inquiry favours gaining detail insight regarding the experience of individual regarding a phenomenon of interest (Creswell & Creswell, 2017). Furthermore, use of thematic content analysis enhanced the quality of research data as it helped in identifying patterns across dataset as well as critically evaluate the research content in terms of richness of information and relevance to the research question. Content analysis favoured transformation of data from being just descriptive data to an interpretive data (Vaismoradi, Turunen & Bondas, 2013). During the stage of sample recruitment, all ethical considerations related to informed consent and approval from Human Research Ethics Committee was done. This promoted the reliability of research. The rigor in data collection is understood by the use of both interview and group based discussion to collect data. Both the method helped to understand cultural perspective of research participants regarding breast feeding. Thematic analysis was done using the inductive approach and the main advantage of inductive reasoning during data analysis is that it helps to deduce various data to provide a conclusion regarding research outcomes. The credibility of the research is also understood by the use of two researchers to review and another researcher to verify the information. Such steps helped to minimize biases during interpretation of research data (Vaismoradi et al., 2013).
McKellar, Fleet and Dovez (2017) gave insight into breastfeeding experience of Australian mothers by conducting a qualitative study to explore breastfeeding in rural Australia. Focus group study design was used to collect research data. Although the study was a mixed method study which used both quantitative and qualitative data to determine breastfeeding rate and explore breastfeeding experience respectively, however McKellar, Fleet and Dovez (2017) reported mainly about qualitative aspects of the results. For collection of qualitative research data, a focus group was developed by distribution of information to target group. Women got the option to nominate them in the focus group session and they were informed regarding the purpose of the session too. Convenience sampling strategy was taken to recruit nine participants and questionnaire was used to explore participant’s experience related to breastfeeding. Another focus group session was also done with health care professionals. Thematic approach was used to critically evaluate transcribed interview data and effectively present participants experience related to breastfeeding. The main findings from the research was that women regarded continuing with breastfeeding as luck and the study also gave indication regarding differences in the breastfeeding practices based on the kind support they got from home and community.
Focus group is a type of research methodology where small number of participants is targeted to explore their feelings or thoughts related to a phenonmenon. As McKellar, Fleet and Dovez (2017) mainly aimed to evaluate breastfeeding experience among rural Australian women, the choice of research design is appropriate. In accordance with the research design, the sample size for the study is also appropriate. Conducting interview with nine participants helped to promote extensive discussion related to breastfeeding practices. For focus group study, it is essential that participants be selected in a very careful manner so that they represent the target of population of interest. In accordance with the research design, use of convenience sampling strategy was appropriate because random sampling is not used in focus group studies. Convenience sampling is a non-probability sampling where sample is collected based on ease of contact (Emerson, 2015). The option of providing women the chance to self-select themselves as per the information distributed eliminated selection bias in research. Informed consent requirement and ethical approval was fulfilled too. Thematic approach and presentation of research data using themes was also suitable according to the purpose of investigation. Thematic approach provided the advantage of representing research outcomes as per common themes identified and it enhances the quality of the work too (Vaismoradi et al., 2016).
The main objective of the study by Forster and McLachlan (2010) was to explore women’s view and experiences if breastfeeding. The qualitative study was done by collecting data from a randomized controlled trial where a education intervention did not increased breastfeeding among women. Hence, this data was pooled and analyzed as a cohort. The sample for the study included Australian primiparous women residing in a tertiary women’s hospital in Melbourne, Australia. The inclusion criteria for selection of participants included having a first child, between 16 and 24 week pregnant and ability to speak and write in English. Data related to women’s breastfeeding intention were collected before randomization process. Primary and secondary data from participants were collected by interview during the time of delivery at hospital and by telephone interview using structured questionnaires. The overall question that was asked by the use of questionnaire include how women feel about breastfeeding. Data was analyzed using thematic analysis. Ethical approval for research was also taken. The research findings mainly gave rise to theme of positive views, negative views and agreement on breastfeeding as good for the baby.
The study used a specific cohort from a randomized control to evaluate experience related to breastfeeding. The advantage of using prospective cohort research design was that it helped to get a clear insight regarding relation between exposure and outcome. For the study by Forster and McLachlan (2010), the main exposure was breastfeeding and outcome was experiences of women. The research design helped to examine multiple effects of the exposure to breastfeeding practices (Hartas, 2015). Sample recruitment is an important element of qualitative research and quality of research data is enhanced by taking a recruitment strategy that ensures that whole population of interest is analysed. However, the limitation found in sample recruitment is that women from single hospital were analyzed and research participants were limited to only those who speak in English. This reduced the possibility to evaluate breastfeeding experience of cultural groups who lives in Australia following migration. Inclusion of participants speaking other language was important because evidence has revealed that migrant women leaving in Australia experience tension in their breastfeeding and knowing the reason behind such experience was important (Schmied et al., 2012). However, thematic analysis to present research data is a strength of the research as it enables adopting flexible approach to present complex account of data. Findings from thematic analysis are quickly interpreted too (Nowell et al., 2017).
Conclusion:
The critical evaluation of the above two studies gave an idea about the breast feeding experience of mothers living in Australia. The strength of the research methodology was identified by appropriateness of research design, use of rigour in research and use of strong method for sample recruitment. Taking extra steps to enhance the quality and reliability of data was also judged. Among the three articles, the article by Gallegos, Vicca and Streiner (2015) and McKellar, Fleet and Dovez (2017) are considered good quality of research evidence as the study had appropriate sample size, little scope of bias and rich data to understand women’s breastfeeding experience in Australia. For example use of convenience sampling and provide the option to self-invite in research as per research information distributed served the purpose of focus group research design. On the whole, all the three research articles highlighted about positive or negative views related to breastfeeding.
References:
Akinyinka, M. R., Olatona, F. A., & Oluwole, E. O. (2016). Breastfeeding Knowledge and Practices among Mothers of Children under 2 Years of Age Living in a Military Barrack in Southwest Nigeria. International journal of MCH and AIDS, 5(1), 1.
Creswell, J. W., & Creswell, J. D. (2017). Research design: Qualitative, quantitative, and mixed methods approaches. Sage publications.
Emerson, R. W. (2015). Convenience sampling, random sampling, and snowball sampling: How does sampling affect the validity of research?. Journal of Visual Impairment & Blindness (Online), 109(2), 164.
Forster, D. A., & McLachlan, H. L. (2010). Women’s views and experiences of breast feeding: positive, negative or just good for the baby?. Midwifery, 26(1), 116-125.
Gallegos, D., Vicca, N., & Streiner, S. (2015). Breastfeeding beliefs and practices of African women living in Brisbane and Perth, Australia. Maternal & child nutrition, 11(4), 727-736.
Hartas, D. (Ed.). (2015). Educational research and inquiry: Qualitative and quantitative approaches. Bloomsbury Publishing.
McKellar, L., Fleet, J., & Dove, S. (2017). It’s more than just luck: A qualitative exploration of breastfeeding in rural Australia. Women and Birth.
Nowell, L. S., Norris, J. M., White, D. E., & Moules, N. J. (2017). Thematic analysis: Striving to meet the trustworthiness criteria. International Journal of Qualitative Methods, 16(1), 1609406917733847.
Schmied, V., Olley, H., Burns, E., Duff, M., Dennis, C. L., & Dahlen, H. G. (2012). Contradictions and conflict: A meta-ethnographic study of migrant women’s experiences of breastfeeding in a new country. BMC pregnancy and childbirth, 12(1), 163.
The Department of Health (2018). Breastfeeding. Retrieved from: https://www.who.int/nutrition/topics/exclusive_breastfeeding/en/
Vaismoradi, M., Jones, J., Turunen, H., & Snelgrove, S. (2016). Theme development in qualitative content analysis and thematic analysis. Journal of Nursing Education and Practice, 6(5), 100.
Vaismoradi, M., Turunen, H., & Bondas, T. (2013). Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nursing & health sciences, 15(3), 398-405.
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