Design of the study
This was a randomized clinical trial study on 38 fathers attended to a health center in Karaj-Iran.
The participants: Seventy-six fathers were participated in the studies that were randomly selected for the intervention (38 fathers) or control (38 fathers) groups. They were recruited from attendees to the health centers for receiving postpartum care services, and had 3 to 5 days old neonates. The inclusion criteria were: men with primiparous wife, lack of known medical and mental diseases, speaking in Persian with a healthy single neonate without any prohibition for breastfeeding. The exclusion criteria were: hospitalization of neonate, dying of infant or a family member during the study, or couple’s separation during the study, taking medicine which prevents breastfeeding, feeding neonate with other milks except maternal milk, using pacifier and unwanted pregnancy.
Sampling
Sample size was calculated 76 subjects (38 subjects for each control and intervention group) considering 95% confidence interval and power 80 percent.
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Randomized sampling was performed to select the health centers and also for devoting the subjects of the study to control or intervention groups using excel randomization option.
Tools of the study: Tools for data collection were: “Demographic and Maternal-Infant Information Questionnaire”, and a “Fathers’ support for Breastfeeding Assessment Tool”, a “Checklist to Assess Mothers’ Breastfeeding Performance” and an “Exclusive Breastfeeding Questionnaire”. The intervention was: fathers’ education about “breastfeeding” and “the ways of support including encouragement and planning for breastfeeding”.
Maternal-Infant Information Questionnaire
It has 14 questions about demographic and maternal and infants’ information. Validity of the questionnaire was assessed and confirmed by 10 midwifery and reproductive health experts.
Fathers’ support for Breastfeeding Assessment Tool
The questionnaire has 12 items to assess fathers’ encouragement and planning for nursing mothers’ nutrition and rest and their involvement in household issues and the infant care. The items were assessed by a 5 level likert scale from never to always that scored 1 to five. The total scores were calculated and converted to percent. Validity of the questionnaire was assessed by 10 reproductive health experts. The validity was confirmed by S-CVI = 0.76 and S-CVR = 0.79 respectively. Reliability of the questionnaire was assessed by using test retest stability assessment method. Fifteen men with two-week interval filled the questionnaire and Pearson 0.86 confirmed the reliability of the questionnaire.
Checklist to Assess Mothers’ Breastfeeding Performance
This checklist has 26 items to assess breastfeeding performance and status, and with “yes” or “no” responses. The total score was calculated and converted to percent. Validity of the questionnaire was assessed by 10 reproductive health experts. The validity was confirmed by S-CVI = 0.78 and S-CVR = 0.83 respectively. Reliability of the checklist was confirmed by using intra-rater stability assessment method. Breastfeeding performance of 15 mothers was rated by two researchers and ICC = 0.72 confirmed the stability of the checklist. Internal consistency assessment showed Cronbach’s α = 0.78 of the tool.
Exclusive Breastfeeding Questionnaire
It had 3 questions about inclusive or inclusive breast feeding.
Procedure of the study
Before intervention, both groups completed the demographic and maternal- infant information questionnaire and the fathers’ involvement in planning and encouragement for breastfeeding questionnaire (FIPEB-6). Then fathers (with the mothers) in the intervention group were educated about breastfeeding. they were educated using face to face method, in two sessions, with 40 minutes’ duration and one-week interval. In the control group only mothers were educated with the same instruction.
Fathers in the intervention group were educated about breast milk composition, the importance and the benefits of exclusive breastfeeding for maternal and neonatal health, the correct positions for breastfeeding, their critical role in promoting and continuing of breastfeeding. They were also advised about the ways of their participation; such as mothers’ encouragement, or planning for a regular exclusive breastfeeding, or serving mothers in household tasks to free adequate time for nursing mothers’ rest. They were explained about for mother and infant.
Four months later, all fathers in both groups completed the questionnaires to assess breastfeeding status and also the checklists to assess breastfeeding performance were completed.
This study was approved by the ethics committee of Shahid Beheshti University of Medical sciences. The participants had the option to exclude any time they want. Besides, all participants were explained about the confidentiality of the information. An informed written consent was given by all participants.
Data were analyzed by using SPPS 22, as well as statistical tests such as t test, Chi2, ANOVA and repeated measure ANOVA.