A Mixed Method Approach to Develop and Validate a Multidisciplinary Framework for Evaluation of Barriers and Facilitators to Awareness, Implementation, Initiation and Continuity of Exclusive, Breastfeeding in Newborn Stage in Saudi Arabia

 

¹*Lamya AlAbdulkarim, ²Hazel Villagracia, ³Reem AlGhamdi, ⁴Hanan AlZahrani, ⁵Nora AlSudairi, ⁶Nazirah Omar Nouh, ⁷Albandari AlMutairi, ⁸Kholoud AlHaji and ⁹Lubna AlFaleh

¹Dr.King Saud University, Saudi Arabia, laalabdulkarim@ksu.edu.sa

²Dr.King Saud University, Saudi Arabia, hnv2013academia@gmail.com

³Ms,King Saud University, Saudi Arabia, areem@ksu.edu.sa

⁴Ms,King Saud University, Saudi Arabia, hanan-midwife@outlook.com

⁵Ms,King Saud University, Saudi Arabia, nalsudairy@ksu.edu.sa

⁶Ms,King Saud University, Saudi Arabia, nnouh@ksu.edu.sa

⁷Ms,King Saud University, Saudi Arabia, alafi@ksu.edu.sa

⁸Ms,King Saud University, Saudi Arabia, kalhaji2020@gmail.com

⁹Dr.,King Saud University, Saudi Arabia, lalfaleh@ksu.edu.sa

*Corresponding author

Abstract

Background: Exclusive breastfeeding has been a major international health initiative as regulated and launched by the World Health Organization and UNICEF since 1992.  As a vital component of the reproductive process, exclusivity in breastfeeding for at least 6 months has shown implications for the well-being of the infants as well as the mothers.  It has been observed that in Saudi Arabia, few hospital new born units practice exclusive breast feeding leading to design a well-structured approach in solving issues and concerns.  As such, still there is no strong and unique multidisciplinary theoretical framework with a family-centred service delivery and sustainable quality health outcome philosophy seen in the hospitals in the country.  Aim: This study aims to provide a more efficient multidisciplinary research method for collecting and analyzing both quantitative and qualitative focus group data in developing and validating a framework to evaluate the barriers and facilitators to awareness, implementation, initiation and continuation of exclusive breastfeeding practices in new born stage in Saudi Arabia. Methods: Quantitative-qualitative research methods were utilized to design and validate a framework for barriers and facilitators to exclusive breastfeeding.  For the quantitative methods, previously published multidisciplinary international standards, guidelines and evidence based research and practice were reviewed, analyzed, tabulated and coded into systems, constructs and themes resulting in 257 comprehensive items. A coding criteria and ranking was used for validating the framework.  The developed framework was validated by a six sessions focus groups of multidisciplinary experts in the fields of speech pathology, rehabilitation, paediatrics, neonatology, obstetrics and nursing for consensus’ verification and re-verification of the classifications and codes of the pre-classified framework. Another team of co-researchers re-read, reviewed and reclassified the focus group re-verification data with > 90% reliability.  Results: A focused and quantifiable consensus and validation was obtained from the focus groups discussions.  Focus groups consensus revealed a high (> 85%) content validity and reliability.  All statements in each category were rated from 9 to 10 as highly important. The literature referenced pre-determined framework and coding criteria helped focus group participants and researchers to design and focus a valid standard framework with modification of less than 15% of the original. Conclusion: This study provides a validated mixed methodology in medical research to design and validate frameworks with results informing modification of the framework and identification and organization of appropriate exclusive breast feeding constructs and themes. Establishing a framework is hoped to lead to the development of tools to evaluate barriers and facilitators to breastfeeding to sustain the nutritional needs of the infant and likewise the health of the mother.  Utilization of the mixed method design is recommended as a focused and efficient research tool to elicit, process and validate reliable data.

 

Keywords: mixed research design, quantitative-qualitative, focus group, exclusive breastfeeding, mother-child-health care.