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문제 정의
- Interpretation and generalization of these findings require special caution because the research subjects were breastfeeding mothers from limited areas and the study did not include subjects who did not attend a postpartum care center. In addition, this study did not compare the maternal attachment of women who did not breastfeed because it focused on the association between breastfeeding and maternal attachment in breastfeeding women. Further research should compare maternal attachment between breastfeeding and non-breastfeeding women.
- The purpose of this study was to investigate the associations of factors related to mothers' breastfeeding with maternal attachment.
- Therefore, if attachment is confirmed at 1 month postpartum, attachment formation can be improved and attachment disorders can be prevented by early interventions. The study aimed at analyzing maternal attachment at 1 month postpartum and the characteristics of breastfeeding behavior that affected attachment.
제안 방법
- Hierarchical regression analysis was carried out to investigate the relative effects of various factors on maternal attachment. First of all, after examining the Durbin-Watson statistic, the tolerance, variance inflation factor (VIF), and the unemployed status variable were entered into the hierarchical regression analysis. However, the maternity leave status variable was excluded because multicollinearity between unemployed status and maternity leave status was suspected.
- The effects of the subcategories of breastfeeding adaptation and willingness to breastfeed on maternal attachment in the second step of the hierarchical regression analysis were tested while adjusting for demographic and breastfeeding characteristics. Of the breastfeeding adaptation subcategories, an emotional exchange with one's baby (β=.
- Finally, the dropout rate of this study was lower than expected. The reason for this was that postpartum care nurses were employed as research assistants, who kindly requested participants to participate, had an intimate relationship with the postpartum mothers that continued after the mothers left the postpartum care center, and communicated through an easy and fast methods (one of the most used SNS in Korea) with one or two additional reminders within 1 week.
- The research employed cross-sectional and descriptive analyses to investigate the factors associated with the attachment of infants and breastfeeding mothers.
- CUIRB-2018-0011, from the Bioethics Committee of the institution). The survey participants voluntarily clicked the link to the survey, where they were able to read a description of the research that presented its purpose and methods and explained confidentiality and anonymity, revocability, and the benefits and disadvantages of participating. Once participants voluntarily agreed to participate, they were allowed to begin the survey.
- This tool included 27 questions divided into eight subcategories: four items for an emotional exchange with one's baby, five for breastfeeding confidence, three for sufficient breast milk, four for the baby's feeding capability and growth, four for being familiar with one's baby, three for discomfort in breastfeeding, two for maintenance of breast milk volume, and two for getting support.
대상 데이터
- Only subjects who were breastfeeding at the time of the survey were eligible to participate in the online survey. A total of 219 subjects responded to the survey, two of whom did not complete the survey.
- The research subjects were mothers who had been breastfeeding a healthy infant since birth and had no maternal complications. The size of the sample was calculated using G*Power 3.
- The contact information of the subjects included their cellphone number or e-mail address. The researcher sent a guide letter and the link to 240 mothers who were in their fourth or fifth week after birth, with one or two more reminders, using SNS messages or e-mail. Only subjects who were breastfeeding at the time of the survey were eligible to participate in the online survey.
- Considering about 15% dropout rate, the targeted number of subjects was 240. The study analyzed materials from 217 of 219 survey respondents, excluding two dropouts.
- To recruit subjects, the directors of five postpartum care centers in Seoul metropolitan city and three other metropolitan cities were asked for support. The researcher visited the directors and explained the purpose of the research and how to collect the data, and delivered a publicity poster for recruiting volunteers.
데이터처리
- Thus, the KruskalWallis test followed by the Mann-Whitney U test with the Bonferroni correction were used to analyze differences in maternal attachment according to demographic and breastfeeding variables. Correlations among maternal attachment, breastfeeding adaptation, and willingness to breastfeed were analyzed by Pearson correlation coefficients, and hierarchical multiple regression analysis was used to determine the factors that affected maternal attachment. In step 1, unique associations of demographic and breastfeeding characteristics with maternal attachment were tested.
- In this study, the influence of the subcategories of breastfeeding adaptation on maternal attachment was analyzed after controlling for demographic and breastfeeding characteristics (22.2%) using hierarchical regression analysis. Our findings suggest that women with high breastfeeding adaptation will be better at forming attachment, implying that encouraging breastfeeding will help build attachment.
- For maternal attachment, breastfeeding adaptation, and willingness to breastfeed, mean and standard deviation were used. The normality of the data was analyzed using the Shapiro-Wilk test. The demographic and breastfeeding variables did not have a normal distribution.
이론/모형
- Breastfeeding adaptation was measured using the tool developed by Kim [10]. This tool included 27 questions divided into eight subcategories: four items for an emotional exchange with one's baby, five for breastfeeding confidence, three for sufficient breast milk, four for the baby's feeding capability and growth, four for being familiar with one's baby, three for discomfort in breastfeeding, two for maintenance of breast milk volume, and two for getting support.
- In this study, maternal attachment was measured by the Korean version [18] of the Maternal Attachment Inventory developed by Müller [19] after assessment of its reliability and validity.
- The demographic and breastfeeding variables did not have a normal distribution. Thus, the KruskalWallis test followed by the Mann-Whitney U test with the Bonferroni correction were used to analyze differences in maternal attachment according to demographic and breastfeeding variables. Correlations among maternal attachment, breastfeeding adaptation, and willingness to breastfeed were analyzed by Pearson correlation coefficients, and hierarchical multiple regression analysis was used to determine the factors that affected maternal attachment.
성능/효과
- In this study, subjects who had experienced breastfeeding for 1 month showed a slightly elevated willingness to breastfeed for more than 12 months, but willingness to breastfeed was not a major factor associated with maternal attachment. In this study, willingness to breastfeed referred to mothers' intent and efforts to breastfeed infants for more than 12 months, and the participants in this study were mothers who had breastfed exclusively, partially, or symbolically for only 1 month.
- 024) were shown to have affected maternal attachment. The final model explained 38.4% of variance in maternal attachment. Two subcategories of breastfeeding adaptation explained an additional 22.
- This study revealed that an emotional exchange with one's baby was the most significantly associated factor with maternal attachment among the breastfeeding adaptation subcategories.
- 4% of variance in maternal attachment. Two subcategories of breastfeeding adaptation explained an additional 22.2% variance in maternal attachment beyond the effects of demographic and breastfeeding characteristics (Table 4).
후속연구
- To summarize, this study revealed that there was no relationship between maternal attachment and willingness to breastfeed, and this relationship was not investigated in previous studies. Further research is needed to elucidate the association between willingness to breastfeed and maternal attachment depending on the postpartum time point.
- However, these results should be interpreted cautiously because only one item was used to evaluate maternal depression. Further research is required to confirm the relationship between depression in breastfeeding mothers and maternal attachment by applying a depression measurement tool with high levels of validity and reliability.
- Furthermore, in order to improve attachment, interventions for early postpartum depression are needed. Further research should be conducted using tools with high reliability and validity for the purpose of reinvestigating the correlation of postpartum depression with maternal attachment. This research suggests that it would be promising for further research to consider confounding variables that can affect the relationships among return to the workplace, marital satisfaction, and attachment.
- In addition, this study did not compare the maternal attachment of women who did not breastfeed because it focused on the association between breastfeeding and maternal attachment in breastfeeding women. Further research should compare maternal attachment between breastfeeding and non-breastfeeding women. Finally, the dropout rate of this study was lower than expected.
- Further research should be conducted using tools with high reliability and validity for the purpose of reinvestigating the correlation of postpartum depression with maternal attachment. This research suggests that it would be promising for further research to consider confounding variables that can affect the relationships among return to the workplace, marital satisfaction, and attachment.
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