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Table 1 Summary of the characteristics of the included studies

From: Breastfeeding knowledge and attitudes of health professional students: a systematic review

Author(s) and country Aim Sample and setting Design Methods/instrument Outcomes CASP
Kakrani [20], 2015
India
To examine the knowledge levels of medical and nursing students about 10 steps of Baby-Friendly Hospital Initiative (BFHI) and to find out the gap in their knowledge about BFHI steps. Fourth-year nursing students (n = 96) and third-year medical students (n = 102) in 1 medical college Cross-sectional study Questionnaire that was used to assess the knowledge gap with multiple choice questions regarding the 10 steps of successful breastfeeding The average level of awareness among nursing (mean score: 5.84) as well as medical (mean score: 5.39) students about the ten steps. 9/14
Amin [17], 2014
Saudi Arabia
To explore the attitudes and knowledge of undergraduate female medical and education students about breastfeeding. Medical students (n = 198) and students from College of Education (n = 323) from one university Cross-sectional study 1. The 14 closed-ended breastfeeding knowledge questions (true-false and don’t know options or multiple choice options)
2. 17-item Iowa Infant Feeding Attitude Scale (IIFAS)
Students in the advanced years at both colleges, those who were married (22.1%) and those of rural origin (44.7%) had higher positive attitudes towards breastfeeding. 8/14
Dodgson [27], 2014
USA
To examine the beliefs and attitudes of health science university students toward formula feeding and breastfeeding. Health science undergraduate students (n = 405; nursing student n = 84) and graduate students (n = 102; nursing student n = 52) recruited across 5 different programs at the colleges. Cross-sectional study Web-based validated survey instruments were used to assess the Theory of Planned Behaviour variables. These were:
1. The 19-item beliefs scale about the outcomes of breast and formula feeding
2. A 6-item breastfeeding and 6-item formula-feeding attitudes 7-point Likert scale
Significantly more positive breastfeeding attitudes and beliefs were found in graduate students (p = 0.0083) 9/14
Pajalic [15], 2014
Sweden
To describe nursing students’ perspectives on promoting successful breastfeeding. Nursing students (n = 65) Qualitative study (Data retrieved form of written reflections) All the students received a paper with one open-ended question: What do you consider success factors that promote breastfeeding in Sweden? Information about the benefits of breastfeeding, traditions and cultural acceptance of breastfeeding practice, and government prohibition of infant formula were important factors in promoting successful breastfeeding. 7/10
Vandewark [13], 2014
USA
To examine the relationships and change between breastfeeding knowledge and attitudes in undergraduate nursing students at the beginning and at the end of their clinical education. Sophomore (n = 40) and senior (n = 49) nursing students from two cohorts (Second-degree and traditional 4-year students) Mixed methods study 1. The 22-item breastfeeding knowledge instrument was adapted from Brodribb et al.’s Breastfeeding Knowledge Questionnaire (BKQ)
2. The attitude component of this survey was based on 17-item IIFAS with 3 additional questions by Ahmed and El Guindy
3. Five open-ended questions
Only knowledge scores increased with progression in their nursing studies.
Attitude scores did not differ significantly between two groups.
Senior students reported to be more knowledgeable about breastfeeding following their nursing education, and sophomore students believed that they would learn about breastfeeding during their course work.
10/14
Ahmed [6], 2011
USA
To assess breastfeeding knowledge among senior nursing students and to identify the types of breastfeeding knowledge among these students.
To investigate the relationship between the different types of breastfeeding knowledge.
Nursing students (n = 115) who had completed maternal/child nursing didactic and clinical courses at two universities Cross-sectional study Questionnaire adapted from BKQ consisted of 24 items were classified into 3 subscales: benefits of breastfeeding, physiology of lactation, and breastfeeding management There was a significant difference in students’ knowledge levels regarding the benefits of breastfeeding and breastfeeding management.
There was also a positive relationship between students’ knowledge about physiology of lactation and breastfeeding management.
10/14
Ahmed [16], 2011
Egypt
To assess breastfeeding knowledge, attitudes and perceived adequacy of breastfeeding education of nursing students, and to investigate their self-confidence to provide breastfeeding support for mothers. Nursing students (n = 92) who had completed maternal/child nursing didactic and clinical courses. Cross-sectional study A 24-item breastfeeding knowledge questionnaire adapted from BKQ, 17-item IIFAS, and three questions related to self-confidence and adequacy of breastfeeding education. Low mean knowledge score of 52%. Students’ breastfeeding attitudes were unexpectedly neutral. 12/14
Brodribb [18], 2008
Australia
To describe the relationship between the cumulative length of personal breastfeeding duration and the breastfeeding knowledge, attitudes, confidence of Australian general practice (GP) registrars Australian GP registrars (n = 483) in their final year of training. Cross-sectional study Investigator-developed Australian Breastfeeding Knowledge and Attitude Questionnaire (ABKAQ) consisting of 40-item knowledge scale and 20-item attitude scale. The length of personal breastfeeding duration was found to influence confidence with breastfeeding.
Registrars with brief personal breastfeeding duration (< 26 weeks) had lower breastfeeding attitudes, their knowledge levels were similar to doctors who had never breastfed.
9/14
Spear [19], 2006
USA
To assess basic breastfeeding knowledge and selected attitudes of junior and senior baccalaureate nursing students.
To determine the need for inclusion of more in-depth information about breastfeeding in the undergraduate obstetric nursing course curriculum.
Junior (n = 32) and senior (n = 48) baccalaureate nursing students at a private university in the United States. Cross-sectional study 1. Modified version of Smith’s (2004) 20-item breastfeeding knowledge questions
2. One open-ended attitude question about breastfeeding
Higher knowledge score was associated with positive attitudes toward breastfeeding. 9/14
Cricco-Lizza [14], 2006
USA
To explore the breastfeeding attitudes and beliefs of junior nursing students. Nursing students (n = 12) newly enrolled in an urban university baccalaureate nursing program in the United States. Qualitative study (in-depth semi structured interview) Broad open-ended questions were used to elicit the participants’ thoughts, feelings, and experiences with breast-feeding and formula feeding. Nursing students’ personal experiences were important in developing their breastfeeding attitudes and beliefs.
Students came from a predominantly breastfeeding family had the most positive attitudes towards breastfeeding.
9/10
Davis [23], 2015
USA
To determine the effect of an evidence-based educational intervention on baccalaureate nursing students’ knowledge and attitudes in relation to breastfeeding support provided for mothers. Baccalaureate nursing students: Intervention group (n = 56); Control group (n = 57), at a public university Intervention:1 h lecture for all students.
Experimental group -simulation role-play with a standardized patient
Control group - watched a breastfeeding video
Pre/post-test
ABKAQ: 36 items for knowledge and 18 items for attitude
Significant difference in pre-test and post-test scores in intervention group students’ breastfeeding knowledge and attitudes towards breastfeeding. 11/14
Cianelli [22], 2014
USA
To analyse the development of an online computer based breastfeeding training (BT) among undergraduate nursing students and the preliminary outcomes of this training. Undergraduate nursing students (n = 82) Intervention:16 h of online computer based breastfeeding training consisted of five modules, in-person (web) Pre/post-test with no comparison group.
74 multiple choice knowledge questions, and 9 items related to confidence.
Statistically significant difference between pre and post-test knowledge assessments in all of the five modules of the breastfeeding training. 8/14
Bozzette [21], 2013
USA
To examine changes in nursing students’ knowledge after receiving content on breastfeeding and lactation in obstetrical course during their baccalaureate nursing education. Fourth-year nursing students (n = 24) Intervention:1.5 h of lecture utilizing audiovisual and written materials, in-person Pre/post-test
20-item breastfeeding knowledge questions (true-false option) adapted from the knowledge instrument developed by Marzalik (2004)
The breastfeeding education program significantly increased students’ breastfeeding knowledge of the benefits and nutritional value and management of lactation. 9/14
Dodgson [24], 2007
Hong Kong
To determine the effectiveness of an infant feeding educational intervention on nursing students’ knowledge levels Nursing students:
Intervention group (n = 111, fourth-year); Control group (n = 162, first and second-year)
Intervention:10 h of didactic instruction, in-person; 8 weeks of perinatal clinical placement Post-test
19-item knowledge survey (true-false and don’t know options)
A 6-item breastfeeding and 6-item formula-feeding attitudes 7-point Likert scale
Control group scored significantly lower on breastfeeding knowledge than the intervention group. 8/14