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Exploration of Breastfeeding Concepts Among Current and Future Parents University of Tennessee, Knoxville TRACE: Tennessee Research and Creative Exchange Doctoral Dissertations Graduate School 8-2013 Exploration of Breastfeeding Concepts among Current and Future Parents: Results of Questionnaires Administered to Chinese and US University Students and to New Mothers in China Zixin Lou [email protected] Follow this and additional works at: https://trace.tennessee.edu/utk_graddiss Part of the Human and Clinical Nutrition Commons, International and Community Nutrition Commons, and the Maternal and Child Health Commons Recommended Citation Lou, Zixin, "Exploration of Breastfeeding Concepts among Current and Future Parents: Results of Questionnaires Administered to Chinese and US University Students and to New Mothers in China. " PhD diss., University of Tennessee, 2013. https://trace.tennessee.edu/utk_graddiss/2451 This Dissertation is brought to you for free and open access by the Graduate School at TRACE: Tennessee Research and Creative Exchange. It has been accepted for inclusion in Doctoral Dissertations by an authorized administrator of TRACE: Tennessee Research and Creative Exchange. For more information, please contact [email protected]. To the Graduate Council: I am submitting herewith a dissertation written by Zixin Lou entitled "Exploration of Breastfeeding Concepts among Current and Future Parents: Results of Questionnaires Administered to Chinese and US University Students and to New Mothers in China." I have examined the final electronic copy of this dissertation for form and content and recommend that it be accepted in partial fulfillment of the equirr ements for the degree of Doctor of Philosophy, with a major in Nutritional Sciences. Katherine F. Kavanagh, Major Professor We have read this dissertation and recommend its acceptance: Marsha L. Spence, Melissa B. Hansen-Petrik, John G. Orme Accepted for the Council: Carolyn R. Hodges Vice Provost and Dean of the Graduate School (Original signatures are on file with official studentecor r ds.) Exploration of Breastfeeding Concepts among Current and Future Parents: Results of Questionnaires Administered to Chinese and US University Students and to New Mothers in China A Dissertation Presented for the Doctor of Philosophy Degree The University of Tennessee, Knoxville Zixin Lou August 2013 To My Parents For Their Love and Support ii Acknowledgement The completion of this dissertation would not have been possible without the help from my advisor, my lab mates, my committee members, Prof. Zeng’s lab, and my family. Above all, I am grateful for my advisor, Dr. Katherine Kavanagh, for her consistent encouragement and support. Dr. Kavanagh has patiently helped me to refine research ideas and revise manuscripts. She has always unconditionally given me advice, and her excellence as an advisor made my 4-year PhD study an amazing journey. In addition, her rigorous research spirit has inspired me to pursue an academic position in the future. Furthermore, I would like to thank all the students in Dr. Kavanagh’s lab for volunteering to help me distribute questionnaires and enter data. In addition, my committee members, Dr. Spence, Dr. Hansen-Petrik and Dr. Orme, have given me valuable advice on how to qualify as a PhD Candidate, how to conduct the dissertation project, and how to analyze data. I am very thankful for their help. I also owe my thanks to Dr. Zeng, from Sichuan University, China, and all the students in her lab. After my arrival in China, the graduate students in Dr. Zeng’s lab helped me find a place to live and took care of me during my stay in Chengdu. They also helped me interview mothers in China and enter data. I am thankful to my parents and my husband. They are always there to support me, in times of difficulty and happiness. Their love has encouraged me to overcome challenges and to pursue my career goals. iii Finally, I want to thank Dr. Whelan, Dr. Chen’s lab, and everybody else who contributed to the completion of this project. Additionally, I want to acknowledge the funding provided by the Department of Nutrition, Office of the Dean in College of Education, Health, and Human Sciences, and Office of Research at the University of Tennessee, Knoxville. Defending my dissertation would not have been possible without the help and support of every person who invested their time and dedication for this purpose. iv Abstract The objectives were to explore breastfeeding knowledge, attitudes, and intention of future parents, and to investigate indicators and causes of perceived insufficient milk (PIM) supply among Chinese mothers. Objectives were accomplished using a cross-sectional study design. Two questionnaires were developed, one targeting Chinese and US undergraduates, and a second targeting Chinese mothers. In total, 597 undergraduates (395 Chinese; 202 US) and 392 Chinese mothers participated in the study. Data cleaning resulted in a final sample size of 572 for undergraduates (383 Chinese; 189 US) and 341 for Chinese mothers. Results showed that undergraduates in both countries possessed some breastfeeding knowledge and expressed similar concerns. These concerns included perceived inconvenience and embarrassment associated with breastfeeding. In general, US students demonstrated a greater knowledge level than their Chinese counterparts. However, Chinese students possessed better attitudes about breastfeeding. For both groups, greater breastfeeding knowledge and attitudes, and having been breastfed as an infant, were associated with a greater likelihood of breastfeeding, or supporting a partner to breastfeed, a future child. The results of the questionnaire administered among Chinese mothers showed that perceived insufficient milk (PIM) supply was a common occurrence, as it was reported by over half of these mothers. In addition, nearly half of those reporting PIM experienced it within 2 days postpartum. Subjective indicators were frequently used by mothers to assess milk quantity, examples of which included not feeling the presence of milk, receiving a hungry look from the infant after a breastfeed, and having an infant that cried after a breastfeed. Objective indicators, such as the number of wet/soiled diapers, were rarely used. Most mothers were unable to explain why they experienced PIM. However, among those who did report perceived reasons for PIM, v these were often diet-related, including having a poor appetite or not being able to “eat enough soup”. Results from both samples indicate the need to develop culturally relevant interventions to address identified misperceptions of future parents and to assist new mothers in correctly identifying and addressing PIM. vi Table of Contents Chapter 1 Introduction ....................................................................................................................... 1 Chapter 2 Literature Review ............................................................................................................. 9 Part 1: Life Course Perspective ............................................................................................................... 10 Defining Life Course Perspective .......................................................................................................................... 10 Life Course Perspective: Maternal and Child Health .................................................................................... 12 Role of Breastfeeding in the Life Course Perspective ................................................................................... 13 Part 2: Breastfeeding Trends ................................................................................................................... 18 Breastfeeding in the United States ....................................................................................................................... 18 Breastfeeding in China ............................................................................................................................................... 20 Part 3: Barriers to Breastfeeding ............................................................................................................ 23 Individual-level Factors ............................................................................................................................................. 23 Interpersonal-level Factors ..................................................................................................................................... 29 Institutional Factors .................................................................................................................................................... 31 Social Factors ................................................................................................................................................................. 32 Conclusion ...................................................................................................................................................... 34 References ...................................................................................................................................................... 36 Chapter 3 Breastfeeding Knowledge, Attitudes, and Intention in A Sample of Undergraduate Students in Mainland China ............................................................................. 55 Abstract ........................................................................................................................................................... 56 Background ...................................................................................................................................................
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