Aim
The aim of this study is to explore partners’ experiences regarding breastfeeding.
Design
This study has an exploratory, longitudinal and qualitative design and reports data from interviews and diary entries collected at two time points: during pregnancy and two months after the infant’s birth. Data were analysed by content analysis as described by Elo and Kyngäs (2008)(19). The study includes partners who participated in a breastfeeding intervention study (20), where couples were offered breastfeeding support based on the Ten Steps (10). Data for this study were collected from March to December 2021.
Sample/participants
Setting/breastfeeding support policies
The study setting and healthcare system in the region have previously been described in detail (20).
The intervention
The breastfeeding support programme in the intervention group (IG) is described below and in Figure 1.
1. Antenatal care:
a. Pregnant women received structured breastfeeding counselling during normal visits at pregnancy weeks 28, 32 and 38 (5–10 min).
b. An individual breastfeeding plan was established in cooperation with the parents-to-be. The plan included:
1) Self-studies during pregnancy,
2) QR-codes for four short online breastfeeding lectures, and
3) QR-codes for two leaflets.
c. The midwife followed up on the breastfeeding plan during the normal visit 8–12 weeks postpartum.
2. Child health centre:
a. Parents received structured breastfeeding counselling during the normal visits at two and six weeks, as well as three and five months postpartum (5–10 min).
b. The child healthcare nurse (CHCN) followed up on the breastfeeding plan at each visit.
Standard care in the control group (CG).
The midwife at antenatal care talked about breastfeeding, and women received a leaflet during the visit in pregnancy week 28.
During the years 2020–2022, partners were not allowed to attend at the visits to the antenatal care due to the Covid-19 pandemic.
Sample
The 16 partners (8 IG and 8 CG), who consented to participate, were partners to the women described in the breastfeeding intervention study. The women were recruited using maximum variation purposive sampling based on education, age and parity (21). There were no dropouts. The inclusion criteria were that all women were healthy and, at pregnancy week 24, planned to initiate breastfeeding after birth. Another criterion was that the partner could communicate in Swedish. Characteristics of the participating partners are displayed in Table 1. Five out of seven infants in the IG and four out of eight in the CG were exclusively breastfed or received only human milk at the age of two months (Table 2).
Table 1. Characteristics of partners and mothers.
|
Intervention
|
Control
|
|
n = 8*
|
n = 8
|
Partners
|
|
|
Age, mean (range)*
|
35 (29–36)
|
32 (29–45)
|
University education, n (%)*
|
2 (25.0)
|
4 (50.0)
|
Household income >40,000 SEK/4000 EUR per month n (%)*
|
6 (85.7)
|
5 (62.5)
|
Male sex
|
8 (100.0)
|
7 (87.5)
|
Born in Sweden*
|
5 (71.4)
|
7 (87.5)
|
Interviews during pregnancy, n (%)
|
4 (50.0)
|
3 (37.5)
|
Diaries during pregnancy, n (%)
|
0 (0)
|
1 (12.5)
|
Interviews 2 months postpartum, n (%)
|
5 (62.5)
|
3 (37.5)
|
Diaries 2 months postpartum, n (%)
|
1 (12.5)
|
3 (37.5)
|
Mothers
|
|
|
Previous experience of breastfeeding n (%)
|
4 (50.0)
|
4 (50.0)
|
Plan at gestational week 24 for duration of exclusive breastfeeding*
|
|
|
No plan
|
2 (25.0)
|
0 (0.0)
|
Four to five months
|
1 (12.5)
|
5 (62.5)
|
Six months
|
4 (50.0)
|
3 (37.5)
|
|
|
|
* Data from one mother is missing
Table 2. Feeding during the first two months.
|
Intervention
|
Control
|
|
n = 8*
|
n = 8
|
Exclusive breastfeeding, n (%)
|
3 (43.0)
|
4 (57.1)
|
Breastfeeding/ Human milk, n (%)
|
2 (29.0)
|
0 (0.0)
|
Breastfeeding/ Human milk and Formula, n (%)
|
2 (29.0)
|
4 (50.0)
|
* Data from one mother is missing
Data collection
Since recruitment of partners at antenatal care was impossible due to the Covid-19 pandemic, they were contacted by a member of the research team (IB) by telephone and invited to participate. After consent was obtained, partners could choose whether they wanted to be contacted for an initial telephone interview at a time that suited them or to complete diary entries with the same questions via mail. (Table 1). Partners who chose an interview were informed that the interviewer was a female midwife (IB) with experience of providing support to breastfeeding families, as well as qualitative telephone interviews. Submission of an online diary was considered as consent to participate. The pregnant women also provided their written consent, and baseline data were collected (Table 1).
The telephone interviews started by providing information about the purpose of the study and obtaining consent to record the interview. Data were collected using a semi-structured interview guide. The interview guides and diary questions focused on partners’ experiences of breastfeeding with questions such as, ‘Could you please explain if you have experienced any advantages of breastfeeding’. ‘Could you please explain if you have experienced any disadvantages of breastfeeding’. Probing questions were used, for example, ‘Could you please tell me more about that’. The woman was not present during the interview, which had a mean duration of 26 mins; following the interview, field notes were taken. The questions were based on a literature review and experiences within the research group. One pilot interview was conducted in the IG and one in the CG to test the technique and the questions. No changes were made, so the pilot interviews were included in the study.
Data analysis
A content analysis with an inductive approach was chosen to determine partners’ experiences regarding breastfeeding (19). During the data collection period, the researchers discussed the field notes, sharing their reflections and initial insights. In the first step, interviews were transcribed, and the transcripts from all interviews and the text from the diaries were read and re-read until it became familiar and got a sense of “meaning” (19). In step two, authors (IB and EF) coded the data separately. Narratives related to the aim were highlighted (19). In step three, the contents of the different narrative units were described using initial codes (19). In step four, a discussion within the research group led to agreement on coding (Figure 2). Codes were merged into preliminary sub-categories. In step five, the sub-categories were merged into generic categories and further into combined sub-categories based on similarities and differences in the content (Figure 3) (19). The research team discussed the coding until an agreement was reached. In step six, all researchers participated in the abstraction process, which resulted in the main category: Striving to be part of the family and important that the family’s everyday life was well-functioning (Figure 4).
In the last step, the number of codes in the combined sub-categories was quantified to provide insights of similarities and differences in the IG and CG, using summary content analysis (22), (Figure 4). A professional translator translated the quotes into English.
Rigour
The research team used credibility and dependability to enhance the trustworthiness of the study. To improve credibility, the researchers combined data from the semi-structured interviews and diaries during pregnancy and after birth (21), which gave access to partners’ experiences of breastfeeding over time. To improve credibility during the analysis process, the researchers engaged in a continuous movement back and forth between the codes and sub-categories and between the sub-categories and generic categories as well as between the generic categories and combined sub-categories during the analysis. The research group discussed the coding until agreement was reached (23). The background and previous experiences within the research team are important aspects of qualitative research (21, 23, 24). Our team consists of two female midwives, one female CHCN and a male physician. Two of the authors (IB and EF) have extensive professional experience to support breastfeeding among expectant couples and families. They had positive experiences of breastfeeding and partner support themselves. To reduce the risk of bias, one of the authors, an expert in content analysis who had no prior knowledge about the intervention, took part in the analysis. The team was reflective during the data collection and analysis according to their prior understanding and own experience of breastfeeding. To improve dependability, the research team developed the semi-structured interview guide (23). The study follows the Consolidated Criteria for Reporting Qualitative Research (COREQ) for interviews and focus groups (24).