124 participants were included. Majority of participants were women (75.8%), from Medicine academic degree (39.5%) and average age was 20 (+/- 5.1) years old. Table 1 describes with more detail the characteristics of the sample.
Table 1
Characteristics of the students (n = 124)
Degree
|
Women
|
Men
|
Total
|
n (%)
|
n (%)
|
n (%)
|
Medicine
|
31 (63.3)
|
18 (36.7)
|
49 (39.5)
|
Nutrition
|
34 (81.0)
|
8 (19.0)
|
42 (33.9)
|
Nursing
|
29 (87.9)
|
4 (12.1)
|
33 (26.6)
|
Total
|
94 (75.8)
|
30 (24.2)
|
124 (100.0)
|
Free-lists analysis showed a total of 608 words or expressions. Among them, 235 were different (38.65%), and 373 were similar (61.35%). The results show the consensus reached. Eleven participants did not complete the free-lists: one participant did not write the fourth word of the list of five; ten more participants did not write the fifth word. This represents 2% of missing data by omission, being within the admissible range required to use these participant’s information (21).
a). Analysis of Similitude
The analysis of similitude for the words that were mentioned in the free lists is shown in Fig. 1. The coincidence showed the word “baby” as the one with the highest co-ocurrence, making it the main element in the graph.
Figure 1. Graphic representation of the similitude of the words related to breastfeeding.
Within this analysis Fig. 1, the words “mother” and “milk” occupy the second place, indicating a similar co-ocurrence degree, followed by the word “food”. A second group of words with high co-occurrence degree with the word “nutrition” organizes another set of words, such as “love”, “attachment” and “health”; these words are connected to other elements, as well.
Some semantic units related to the breastfeeding SR were organized according to the meaning of the expressed words Fig. 2. This analysis showed that the students’ SR is organized mainly by elements like “baby”, “mother”, “breastfeeding”, “milk”, “food” and “nutrients”. These notions have high co-occurrence levels among the participants. Furthermore, these words are connected to other elements, providing new approaches to breastfeeding SR in each one of the semantic units. As shown in Fig. 2, “baby” is organising the most substantial semantic unit, organising words like “development”, “to provide”, “breastfeeding”, “mother’s milk”, “immune system”, “food”, “growth”, “to breastfeed”, “health”, “to need”, “better”, and “unique”.
Figure 2. Graphic representation of the meaning of the words related to breastfeeding.
The word “mother” has a key semantic unit within these connections, and provides an important meaning within the SR. The elements connecting this notion are: “child”, “bond”, “love”, “link”. The rest of the notions that emerged from this graph are connected to other words that provide different approaches to SR, as well.
b). Prototypical Analysis
The prototypical analysis organizes a 2x2 matrix of the SR social representation, by pondering the words by order of appearance (evocation rank) and number of mention (evocation frequency). The present study had a minimum evocation frequency of two, and the evocation rank was 2.79, while 56 different words were evoked Table 2.
Table 2
Prototypical Analysis of the Social Representations on Breastfeeding (n = 124).
|
Evocation rank ≤ 2.79
|
Evocation rank > 2.79
|
|
Central Core
|
First periphery
|
|
Evoked term
|
Frequencya
|
Evocation averageb
|
Evoked term
|
Frequencya
|
Evocation averageb
|
Frequency ≥ 7.4
|
Baby
|
53
|
2.5
|
Love
|
22
|
3.2
|
Mother
|
38
|
2.5
|
Feeding
|
22
|
2.8
|
Milk
|
33
|
2.4
|
Protection
|
11
|
3.1
|
Nutrition
|
28
|
2.4
|
Food
|
9
|
3.2
|
Breasts
|
16
|
2.6
|
Link
|
9
|
3.4
|
Health
|
14
|
2.5
|
Natural
|
8
|
2.9
|
Attachment
|
8
|
2.2
|
|
|
|
|
Contrast elements
|
Second Periphery
|
|
Evoked term
|
Frequencya
|
Evocation averageb
|
Evoked term
|
Frequencya
|
Evocation averageb
|
Freqcuency ≤ 7.4
|
Breast-feed
|
6
|
2.2
|
Bond
|
7
|
3.6
|
Antibodies
|
5
|
2.6
|
Calostrum
|
7
|
3.7
|
Life
|
5
|
2.4
|
6 months exclusive
|
6
|
3
|
Connection
|
5
|
2.6
|
Sweetie
|
6
|
3.7
|
Nutrients
|
5
|
2.2
|
Development
|
5
|
3.8
|
Meal
|
4
|
2.2
|
Immunity
|
5
|
2.8
|
Pregnancy
|
4
|
2
|
Techniques
|
4
|
3
|
Nutritious
|
3
|
2.7
|
Motherhood
|
4
|
3
|
Important
|
3
|
2.7
|
Defenses
|
4
|
2.8
|
Awareness
|
2
|
2.5
|
Union
|
4
|
3.8
|
Necessary
|
2
|
2
|
Care
|
4
|
3
|
Normal
|
2
|
2.5
|
Woman
|
3
|
4
|
Newborn
|
2
|
1
|
Taboo
|
3
|
3.7
|
Mother and son
|
2
|
1.5
|
Responsibility
|
3
|
5
|
Immunoglobulin IgA
|
2
|
2
|
Prevention
|
3
|
3.3
|
|
|
|
Pain
|
3
|
4
|
|
|
|
Increase
|
3
|
3.3
|
|
|
|
Breast cancer prevention
|
3
|
4.3
|
|
|
|
Wellbeing
|
2
|
3.5
|
|
|
|
Immune system
|
2
|
3.5
|
|
|
|
Pink
|
2
|
5
|
|
|
|
Benefits
|
2
|
4
|
|
|
|
Mammary glands
|
2
|
4
|
|
|
|
Fundamental
|
2
|
3
|
|
|
|
Contact
|
2
|
3
|
|
|
|
Nourish
|
2
|
3
|
|
|
|
Economic
|
2
|
4.5
|
|
|
|
Nipple
|
2
|
3
|
Legend: |
a. Number of times (frequency) in which the studied sample evoked each term. |
b. Each word can appear in positions 1 to 5 (first or last of the five words evoked). This data is the average of the value of a given item's position in the evocations of the same item made by the subjects in the sample. |
Table 2. Prototypical Analysis of the Social Representations on Breastfeeding (n = 124).
As shown in Table 2, the central core is formed by the notions of “baby”, “mother”, “milk”, “nutrition”, “breasts”, “health” and “attachment”. For the students of the health sector these notions define and give coherence to the Social Representations of breastfeeding. Based on this analysis notions like “baby”, “mother”, and “attachment” are identified as the normative instrumentalist factors. On the other, “nutrition”, “breasts”, “health” and “milk” are functional elements of breastfeeding’s SR.
Some of the elements within the first peripheral zone are: "love", "food", "protection", "bond" and "natural". These words seem related to expression of feelings or demonstrations of affection that are born from breastfeeding. These elements composed the main themes above the central core, except for the word "natural", which adds a different and new meaning to the previous elements.
In the second peripheral zone, the largest number of the SR’s words is found, as well as normative and functional elements. These elements are built upon a scientific base, and are associated to the benefits of breastfeeding, such as “development”, “growth”, “immunity”, “care”, “prevention”, “immune system”, and “benefit”. These elements are anchored to the specialized knowledge acquired in health sciences related studies. Other founded elements are related to socio-cultural aspects, such as “normal”, “important”, “techniques”, “economic”, “awareness”, “responsibility”, “woman”, “pink” “maternity”. These words describe actions, qualities and behaviours inherent to breastfeeding, and contributed to the normative and functional elements.
Within the contrast zone, we founded words like “breastfeeding”, “antibodies”, “life”, “connection”, “nutrients”, “food”, “pregnancy”, “nutritious”, “important”, “awareness” and “necessary”. These elements are important for the SR, as they are considered elements with a high potential for change to turn into central core elements.
The elements afore mentioned contribute to the understanding of the structure and contents of the participant’s Social Representation of breastfeeding.
C). Categorical Analysis
The set of words resulting from the prototypical analysis (56 words) were used to do the categorical analysis and were further organized in seven categories. These categories are meant to interpret dimensions of breastfeeding’s SR by students that participated in the study. In Table 3 the categories and words are detailed.
Table 3
Thematic categories of the social representation of breastfeeding in health students.
Category name
|
Words mentioned by the participants
|
Baby
|
Baby (53), Newborn (2)
|
Mother
|
Mother (38), Motherhood (4), Pregnancy (4), Woman (3)
|
Affective bond
|
Love (22), Protection (11), Link (9), Attachment (8), Bound (7), Sweetie (6), Connection (5), Union (4), Care (4), Mother and son (2), Contact (2)
|
Feeding
|
Milk (33), Nutrition (28), Feeding (22), Food (9), Colostrum (7), Breast-feed (6), Nutrients (5), Meal (4), Nutritious (3), Nourish (2)
|
Health
|
Health (14), 6 months exclusive (6), Antibodies (5), Immunity (5), Development (5), Defenses (4), Prevention (3), Breast cancer prevention (3), Immune system (2), IgA Immunoglobulin (2), Benefits (2)
|
Body
|
Breasts (16), Pain (3) Mammary gland (2), Nipple (2)
|
Sociocultural aspects
|
Natural (8), Life (5), Techniques (4), Taboo (3), Responsibility (3), Important (3), Increase (3), Normal (2), Fundamental (2), Necessary (2), Wellbeing (2), Economic (2), Awareness (2), Pink (2)
|
Legend: According to the prototypical analysis, the number of times the word has been mentioned is indicated in parentheses. |
The perspectives of breastfeeding showed the meaning of lactation’s social representation. One of the emerging perspectives, “mother”, connects words around the social and biological role of the mother during the period of breastfeeding. The perspective categorized as “affective bond” connects words defining breastfeeding as a practice where emotions and feelings are crucial to the connection between mother and her child. The “food” category refers to the nutritional characteristics that human milk provides to the infant, containing words like “nourishing”, “feeding”, and “nutrients”. Further developing breastfeeding SR, the category of “sociocultural aspects” provides a perspective of lactation defined by words like “nature”, “normal”, and “important” for “life”, including concepts like “responsibility”, and where the elements of “economy” and “taboo” become relevant. Lastly, other perspectives define breastfeeding as “healthy”, and involved elements of the “body”.
Based on this analysis, the main categories defining the social representation of the students are “feeding” and “affective bond” Fig. 3. On the other hand, “milk” and “nutrition”, as well as the act of “feeding” are closely linked to the love a mother provides to the baby through her milk.
Figure 3. Thematic categories of the social representations of breastfeeding in health student.
Legend: The weight of each category is the total number of words that have been mentioned.
Furthermore, a relation among “feeding” and “affective bond” was found. Both categories influence more to the SR of breastfeeding among the students of nutrition, medicine, and nursing, in comparison to the technical knowledge, or the biologistic sense of scientific-based arguments supporting breastfeeding.
Participants considered that women have not make the choice of breastfeed even it is considered as natural, normal and essential for the baby. It is perceived by them as a responsibility and a self-awareness that must be developed by the mother.