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Table 3 Summary, Quality Assessment, and Study Design of Secondary School Articles Reviewed

From: Stakeholder views of breastfeeding education in schools: a systematic mixed studies review of the literature

   Study population Study quality Questionnaire
First author & year Country N
(% female)
Age or class type Type
(MMAT rating)
Designed by & setting Topics covered
Alnasir [26], 1992 Bahrain 100 (100) Age 15 to 17 Quantitative
descriptive
(4.1, 4.2, 4.4)
Researcher designed questionnaire and individual interviews Knowledge
Attitude
Intention
Breast milk fed
Personal exposure
Bailey [55], 2007 England 92 (100) Age 14 to 15 Quantitative
non-randomized
(3.1, 3.2, 3.3, 3.4)
Iowa Infant Feeding Attitude Scale and researcher designed questionnaire. Self-administered in a classroom in the presence of researcher Attitude
Bomba [45], 2009 United States 510 (76) University of Mississippi family and consumer science class students Quantitative
descriptive
(4.3)
Researcher designed questionnaire, based on literature. Self-administered in classroom Knowledge
Public breastfeeding
Sources of information
Connolly [25], 1998 Ireland 177 (35) Age 16 to 19 Mixed methods
(1.1, 1.2)
(4.1, 4.2, 4.3, 4.4)
(5.1, 5.2)
Researcher designed questionnaire based on TRA and TPB. Self-administered Knowledge
Attitude
Intention
Personal exposure
Sources of information
Forrester [38], 1997 United States 590 (69) 346 age 13 to 19 (high school), 244 age 17 to 43 (college) Quantitative
descriptive
(4.1, 4.2, 4.3)
Researcher designed Questionnaire. Self-administered, teacher supervised Attitude
Intention
Breast milk fed
Public breastfeeding
Sources of information
Education in schools
Frew [48], 2005 United States 37 (unknown) High school students (age not given) Quantitative
descriptive
(4.1, 4.2, 4.3)
Questionnaire adapted from a K-12 breastfeeding curriculum. Self-administered in school auditorium prior to presentation on breastfeeding Knowledge
Attitude
Public breastfeeding
Gale [10], 2013 England 81 (60) Age 13 to 15 Quantitative
descriptive
(4.1, 4.3)
Researcher designed questionnaire. Self-administered in presence of health teacher. Participants voluntarily attended a session during school break. Knowledge
Attitude
Intention
Personal exposure
Sources of information
Education in schools
Giles [36], 2007 Northern Ireland Qualitative: 48 (54)
Quantitative: 121 (50)
Age 13 to 14 Mixed methods
(1.1, 1.2, 1.3, 1.4)
(4.1, 4.2, 4.3, 4.4)
(5.1, 5.2, 5.3)
Researcher designed and led focus groups based on TPB / Researcher designed questionnaire based on TPB and modal beliefs elicited in semi-formatted focus groups. Self-administered in classroom in presence of researcher Knowledge
Attitude
Intention
Personal exposure
Public breastfeeding
Giles [22], 2010 Northern Ireland 2021 (58) Age 13 to 14 Quantitative
descriptive
(4.1, 4.2, 4.3)
Researcher designed questionnaire based on TPB and modal beliefs elicited in semi-formatted focus groups. Self-administered in the presence of the researcher Knowledge
Attitude
Intention
Personal exposure
Public breastfeeding
Sources of information
Giles [54], 2015 Northern Ireland Qualitative: 48 (54)
Quantitative: 2021 (58)
Age 13 to 14 Mixed methods
(1.1, 1.2, 1.3, 1.4)
(4.1, 4.2, 4.3, 4.4)
(5.1, 5.2, 5.3)
Researcher designed and led semi-formatted focus groups based on TPB. Researcher designed questionnaire based on TPB and modal beliefs elicited in focus groups. Self-administered in the presence of the researcher Knowledge
Attitude
Intention
Personal exposure
Public breastfeeding
Sources of information
Giles [49], 2014 Northern Ireland 698 (not given) Age 13 to 14 Quantitative randomized
(2.1, 2.2, 2.3, 2.4)
Researcher designed and led semi formatted focus groups based on TPB. Researcher designed questionnaire based on TPB and modal beliefs elicited in focus groups. Self-administered in the presence of the researcher Knowledge
Attitude
Intention
Personal exposure
Public breastfeeding
Sources of information
Gostling [27], 2003 England 217 (62) Age 13 to 15 Quantitative
descriptive
(4.1, 4.2, 4.4)
Researcher designed online questionnaire administered by technology teacher Attitude
Intention
Breast milk fed
Personal exposure
Public breastfeeding
Goulet [28], 2003 Canada 439 (54) Age 12 to 19 Quantitative
descriptive
(4.1, 4.2, 4.3, 4.4)
Researcher designed questionnaire (based on TRA). Self-administered during class time Attitude
Breast milk fed
Personal exposure
Public breastfeeding
Greene [40], 2003 Northern Ireland 419 (57) Age 14 to 18 Quantitative
descriptive
(4.1, 4.2, 4.3, 4.4)
Researcher designed questionnaire (based on focus groups with pregnant women). Self-administered in school Attitude
Public breastfeeding
Sources of information
Education in schools
Hadley [35], 2008 Ethiopia 2077 (49) Age 13 to 17 Quantitative
descriptive
(4.1, 4.2, 4.3, 4.4)
Secondary analysis of survey data based on the WHO Infant and Young Child Feeding Behavior Model. Interview by researcher in home. Knowledge
Intention
Ho [31], 2014 Taiwan 1319 (61) Age 15 to 17 Quantitative
descriptive
(4.1, 4.2, 4.3, 4.4)
Iowa Infant Feeding Attitude Scale. Self-administered, distributed to teachers Attitude
Intention
Personal exposure
Sources of information
Education in schools
Ho [56], 2016 Taiwan 204 (100) Age 16+, mean 16.9 Quantitative
non-randomized
(3.2, 3.3, 3.4)
Iowa Infant Feeding Attitude Scale and researcher designed Breastfeeding Knowledge Scale. Self-administered in the classroom in the presence of the researcher Knowledge
Attitude
Breast milk fed
Personal exposure
Sources of information
Kapil [33], 1990 India 152 (100) Adolescence (age not described) Quantitative
descriptive
(4.1, 4.2, 4.4)
Researcher designed questionnaire. Read out loud and explained in classroom Knowledge
Attitude
Kim [50], 1998 Korea 412 (100) Age 16 Quantitative
non-randomized
(3.1, 3.2, 3.3, 3.4)
Adapted from previous questionnaires. Self-administered in the presence of the researcher Attitude
Intention
Personal exposure
Leffler [32], 2000 United States 100 (100) Age 14 to 19 Quantitative
descriptive
(4.1, 4.2, 4.3, 4.4)
Researcher designed questionnaire. Self-administered after individual recruitment in cafeteria or supervised study periods Attitude
Intention
Breast milk fed
Personal exposure
Public breastfeeding
Education in schools
Lockey [51], 2003 England 101 (48) Age 13 to 15 Mixed methods
(1.1, 1.3)
(4.2, 4.4)
(5.2)
Open dialogue in focus groups Knowledge
Attitude
Martens [52], 2001 Canada 45 (53) Mean age 13 Quantitative randomized
(2.1, 2.3)
Questionnaire adapted from previous work with same population. Self-administered in classroom Attitude
Intention
Breast milk fed
Personal exposure
Public breastfeeding
Nkanginieme [29], 1993 Nigeria 824 (62) Age 15 to 20 Quantitative
descriptive
(4.1, 4.2, 4.4)
Researcher designed questionnaire, self-administered in classroom Knowledge
Attitude
Intention
Breast milk fed
Personal exposure
Public breastfeeding
Sources of information
November [57], 2013 England   Age 13 to 16 Mixed methods
(1.1, 1.2, 1.3)
(3.1, 3.2, 3.3, 3.4)
(5.1)
Iowa Infant Feeding Attitude Scale. Anonymous written feedback. Self-administered in classroom. Qualitative responses at end of session on post-it notes in the presence of the researcher Attitude
Intention
Breast milk fed
Ojofeitimi [37], 2001 Nigeria 34 (100) Age 15 to 19 Quantitative
descriptive
(4.1, 4.4)
Researcher designed questionnaire, self-administered in the presence of researcher Knowledge
Attitude
Purtell [11], 1994 England 40 (100) Age 16 to 17 Quantitative
descriptive
(4.3, 4.4)
Researcher designed questionnaire, self-administered, half with the researcher, half without. Attitude
Intention
Breast milk fed
Personal exposure
Education in schools
Rasheed [30], 1994 Saudi Arabia 589 (100) Age 16 to 19 Quantitative
descriptive
(4.1, 4.2, 4.3, 4.4)
Researcher designed questionnaire, self-administered Knowledge
Attitude
Intention
Seidel [39], 2013 United States 107 (77) Age 14 to 19 Quantitative non-randomized
(3.1, 3.2)
Researcher designed questionnaire based on literature and TPB. Self-administered in the presence of researcher Knowledge
Attitude
Intention
Spear [43], 2007 United States 515 (65) College students in general education and nursing courses Mixed methods
(1.2)
(4.1, 4.3, 4.4)
(5.2)
Researcher designed questionnaire, self-administered in presence of researcher Attitude
Intention
Breast milk fed
Public breastfeeding
Sources of information
Education in schools
Swanson [34], 2006 Scotland 229 (54) Ages 11 to 18 Quantitative
descriptive
(4.1, 4.2, 4.3, 4.4)
Researcher designed questionnaire based on other studies using TRA/TPB. Self-administered in presence of researcher Knowledge
Attitude
Intention
Breast milk fed
Personal exposure
Public breastfeeding
Tjiang [44], 2001 Australia 136 (100) University students using Indonesian student association mailing list Quantitative
descriptive
(4.1, 4.2, 4.3)
Researcher designed- questionnaire generated from related literature. Self-administered postal survey Knowledge
Attitude
Breast milk fed
Personal exposure
Sources of information
Walsh [53], 2008 Canada 121 (66) Age 15 to 19 Quantitative
non-randomized
(3.2, 3.3, 3.4)
Researcher designed questionnaire, self-administered in presence of researcher Knowledge
Intention
Breast milk fed
Personal exposure
Sources of information
Yeo [41], 1994 Japan and United States 329 (100)
242 Japan, 87 US
Age 16 to 17 Quantitative
descriptive
(4.1, 4.2, 4.3, 4.4)
Questionnaire designed by another researcher (Berger 1980). Self- administered postal survey Attitude
Intention
Breast milk fed
Education in schools
Zeller [42], 2016 United States 39 (13) Age 12 to 13 Quantitative
non-randomized
(3.2, 3.4)
Questionnaire designed by another researcher (Martens 2001). Self-administered in the presence of the researcher Attitude
Intention
Breast milk fed
Personal exposure
Education in schools
  1. The Mixed Method Appraisal Tool (MMAT) was used to evaluate the articles in the review. Listed are the criteria met for each study based on its methodological category. See the MMAT appraisal checklist for full explanation of criteria [13]
  2. • Qualitative (1.1 to 1.4)
  3. • Quantitative randomized controlled (2.1 to 2.4)
  4. • Quantitative non-randomized (3.1 to 3.4)
  5. • Quantitative descriptive (4.1 to 4.4)
  6. • Mixed methods studies include both the qualitative criteria and the appropriate quantitative criteria in addition to criteria specific for mixed methods studies (5.1 to 5.3)
  7. Knowledge: Specific topics including mechanics or immune benefits of nursing, with correct or incorrect answers
  8. Attitude: Attitudes about ease, acceptance, beliefs about benefits, feelings about breastfeeding or breastfeeding education
  9. Intention: Goals for future breastfeeding or support for breastfeeding partner
  10. Breast milk fed: Participant nursed as infant
  11. Personal exposure: Whether participant has seen others feed a baby by bottle or breast
  12. In public: Attitude about breastfeeding in public settings
  13. TRA Theory of Reasoned Action; TPB Theory of Planned Behavior