Browsing by Author "Duffett-Leger, Linda A."

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    Association between Breastfeeding Self-Efficacy and Human Milk Feeding in Mothers of Moderate and Late Preterm Infants in a Level II NICU
    (2019-05-14) Delhenty, Samantha Elizabeth; Benzies, Karen Marie; Duffett-Leger, Linda A.; Fenton, Tanis R.
    Introduction: There is a positive association between breastfeeding self-efficacy (BSE) and breastmilk feeding duration in mothers of healthy, full-term infants. BSE refers to a mother’s perceived ability to successfully breastfeed her infant and is associated with four main factors: (a) performance accomplishments, (b) vicarious experience, (c) verbal persuasion, and (d) physiological and affective states. Limited research explores the relationship between BSE and breastmilk feeding duration for mothers of pre-term infants. Aim: The aim of this research was to explore the association between BSE and human milk feeding at discharge in mothers of moderate and late pre-term infants in a level II NICU. Methods: This study was part of a larger study known as the Family Integrated Care (FICare) study, a cluster randomized controlled trial conducted in 10 level II neonatal intensive care units (NICUs) in Alberta. BSE and breastmilk feeding rates were secondary outcomes. I conducted an observational study that involved secondary data analysis. Participants in this study included 221 maternal-infant dyads from the five control sites. BSE was collected using the modified breastfeeding self-efficacy scale – short form and human milk feeding outcomes were collected using categories recommended by Labbok and Krasovec. I aimed to look at predictors of human milk feeding at discharge and how previous breastfeeding experience may affect feeding outcomes. Results: The primary hypothesis for this study was supported and with all models (multivariable, crude, and stratified by parity analyses), BSE at admission was significantly associated with human milk feeding at discharge (p < 0.05). The secondary hypothesis was not supported since there was no important difference in the association between higher modified BSES-SF scores at admission and providing human milk at discharge when stratified by parity (p > 0.05). Conclusion: using the modified BSES-SF at admission in level II NICUs has potential as a clinical tool to support healthcare providers in identifying mothers of moderate and late pre-term infants at risk of early discontinuation of human milk feeding at discharge. Further research is needed to support the association between higher modified BSES-SF scores at admission and type of feeding at discharge with this maternal-infant dyad.
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    Developing an Online Resource to Support Parents’ Search for Apps in The First Year of Parenthood
    (2020-08-19) Virani, Anila; Duffett-Leger, Linda A.; Letourneau, Nicole Lyn; Stroulia, Eleni
    Background: Parents’ mobile application (app) use is on the rise due to the affordability of smartphones and the convenience of accessing parenting support 24 hours a day. While apps can assist in parenting, it is hard for parents to find good quality apps that meet their expectations. Therefore, the purpose of this study was to co-create a parenting app directory to supports parents' search for apps in the first year of parenthood and co-design a user interface to feature the directory. Methods: Spinuzzi's (2005) stages of the participatory design methodology guided this study and the project was divided into three phases. Phase one, parenting app review, was conducted to gain insight into the available apps for parents. Phase 2, focus group discussions with 18 first-time Canadian parents (15 mothers, 3 fathers) allowed researchers to understand parents' needs and preferences. Phase three, design sessions were conducted with three parents (two fathers and one mother) to learn about parents' preferred design elements. Results: In phase one, app review, 4,300 apps were identified on the initial search, of which only 16 (0.4%) apps met the quality criteria reflecting the extent of the problem parents face in finding quality parenting apps. The quality apps were further reviewed by parents in phase two, focus group discussions, to finalize the selection of apps and resulted in the co-development of the partnering app directory. The focus group discussions also explored parents’ needs and preferences and the inductive thematic analysis resulted in four themes. Phase three, design sessions, led to the co-creation of a user interface to feature the app directory. Conclusion: Despite the availability of evidence-based apps, parents continue to report difficulties in finding desired quality apps. The app directory is one of the solutions that establishes easy access to quality parenting apps. Initiatives should be taken within the healthcare system to equip front-line nurses and other healthcare professionals with adequate knowledge and training to support contemporary parents’ needs via digital means.
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    Effectiveness of Play2Sleep with Mothers and Fathers of Infants: A Mixed Methods Study
    (2019-04-25) Keys, Elizabeth; Benzies, Karen Marie; Duffett-Leger, Linda A.; Kirk, Valerie G.
    Infant sleep disturbances distress approximately one in four Canadian families and are associated with poorer parental health, family well-being, and child developmental outcomes. Assisting families to manage infant sleep disturbances may improve well-being, as well as support child development. However, addressing only sleep-related parenting behaviors and interactions may be ineffective in improving broader parenting difficulties that may underlie infant sleep disturbances. Play2Sleep combines personalized infant sleep information with examples from a self-modelled video recorded structured parent-infant play session to provide feedback aimed at enhancing parental ability to identify and respond appropriately to their infant’s specific sleep-related and social cues. This approach could help address broader parenting difficulties that may underlie infant sleep disturbances. An explanatory sequential mixed methods design combining a randomized controlled trial with thematic analysis of semi-structured family interviews was used to answer the following research questions: Quantitative - Does one dose of Play2Sleep delivered during home visits with mothers and fathers of 5-month-old infants with infant sleep disturbances reduce the number of night wakings at age 7 months? Qualitative - What are parental perceptions of family experiences, processes, and contexts related to Play2Sleep and infant sleep disturbances? Mixed Methods - How do parental perceptions of family experiences, processes, and contexts related to infant sleep explain the effectiveness of Play2Sleep? Play2Sleep was not effective in reducing parent-reported night wakings; however, it was effective in reducing maternal-reported infant nocturnal wakefulness and the number of paternal-reported naps. With Play2Sleep, there were significant subjective improvements in problematic infant sleep that were not observed in the comparison group. Three themes (information overwhelm, learning infant cues, and working together with a sub-theme of father involvement) were developed to propose a potential mechanism for Play2Sleep. Six themes describe broader parental experiences of infant sleep disturbances: developing routines; changed attitudes and beliefs; fears, concerns, and anxieties; support; sleep associations; and context of infant sleep disturbance. Play2Sleep shows promise to reduce infant sleep disturbances. Including fathers was novel and the qualitative analysis contributed to understanding the how and why of intervention effects. Areas for future research are prevention, precision-care models, workforce development, and parent engagement.
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    Explanatory Variables of Infant Care Competence among Mothers with Postpartum Depression
    (2018-03) Jones, Debbie Annette; Letourneau, Nicole; Secco, M. Loretta; Duffett-Leger, Linda A.
    Abstract Introduction. Postpartum Depression (PPD), characterized by feelings of sadness, guilt, decreased energy, decreased mood and appetite, occurs in 10-15% of new mothers with onset in the three months postpartum. Although it can last into the second postpartum year, symptoms have been shown to decrease with treatment. The impact of the mother’s depressive symptoms has negative consequences that can affect her infant care competence (ICC), i.e. how a mother perceives and performs her ability to care for her infant, potentially explaining the observed negative health and developmental outcomes of children whose mothers were affected by PPD. Aim. The aim of this master’s thesis is to complete two papers; both examining explanatory variables that impact/influence ICC in mothers with PPD. The first paper addresses the question: What are explanatory variables of perceived infant care competence in mothers affected by PPD? The second paper addresses the question: “How do depression and other variables influence and/or explain perceived ICC?” Methods. For paper one, a secondary correlational study of women aged 16 to 45 years (n = 55), who were initially recruited for a peer support intervention on women with PPD from May 2011-October 2013 was conducted. Perceived ICC was measured using the Infant Care Questionnaire (ICQ), which is comprised of three domains called responsiveness, emotionality, and mom & baby. The predictor variables that were examined include: severity of depressive symptoms measured using Edinburgh Postnatal Depression Scale (EPDS), social support using the Social Provisions scale (SPS), child development measured using the Ages and Stages Questionnaire (ASQ), family functioning measured using the Family Functioning Scale (FFS) and sociodemographic covariates. Regression analysis was used to determine associations between outcomes (responsiveness, emotionality, mom & baby) on the ICQ and explanatory variables. For paper two, a narrative systematic review was undertaken employing the following six databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PsycINFO, PubMed, SocINDEX, and the Cochrane Library. The search was conducted examining articles about depressed mothers’ feelings and perceptions of their abilities to care for and interact with their infants as well as performed infant care abilities. After reviewing the selected articles, data were grouped identifying ICC (performed and perceived), how depression was measured, study designs, samples, and explanatory variables. Knowledge Transfer. Two papers were derived for this thesis, one entitled: “Explanatory variables of perceived infant care competence among mothers with postpartum depression” and the other entitled “A narrative systematic review of explanatory variables of infant care competence for mothers with PPD.” These will be prepared for publication in peer-reviewed journals. Papers will also be presented at peer-reviewed national conferences. Results. In the secondary analysis paper, child development across all domains, but perhaps most robustly fine motor skills, predicted responsiveness as an aspect of ICC. The best model fit was for responsiveness with 37% of the variance explained by infant fine motor skills, family functioning and nurturance. The second best model fit was for emotionality, with gross motor, problem solving, social interaction and reliable alliance explaining 16% of the variance. In the systematic review paper, 21 papers yielded variables that explained ICC in mothers including: depression, depression severity, timing of symptoms, social support, maternal adversities, infant characteristics, as well as demographic variables such as education and income. Conclusion. Identifying variables that explain ICC can ultimately give guidance to early preventative measures for mothers, and ultimately decrease possible negative influences on children’s health and development. Depressed mothers with children who have developmental deficits may influence a mother’s perceptions, perhaps further decreasing her confidence in performed infant care tasks. Interventions are needed to enhance a mother’s perceptions by educating mothers on detection of early infant milestones and to respond to infant cues and signals of responsiveness. Perinatal healthcare professionals can advocate for, increase awareness and educate mothers and families about predictors of and interventions to improve ICC. Keywords: postpartum depression, infant care competence, maternal competence, maternal-infant interaction, predictors
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    Exploring Informational Needs of Parents of Children with Intestinal Failure: A Thematic Analysis
    (2020-12-10) Ragan, Lily Anne; Duffett-Leger, Linda A.; Laing, Catherine M.; Boctor, Dana L.
    Information seeking has been observed to be important for the coping and empowerment of parents of children with rare diseases. This study was conducted to better understand the education needs of families of children with pediatric intestinal failure (IF) and how technology might be effectively leveraged to address these needs. We hypothesized families would benefit from an electronic education platform encompassing the aspects of medical and management knowledge required by parents. A qualitative methodology using thematic analysis (Braun & Clarke, 2006) was utilized. Purposeful sampling was adopted to recruit 10 parents/caregivers of children with IF who then participated in a 1:1 semi-structured interview. Interviews were recorded, transcribed and themes identified through open and focused coding. Four qualitative themes emerged: (1) reliable electronic or printed information resources relevant to their child’s unique needs are lacking; (2) educational program with in-person and hands-on learning is preferred for transition to home; (3) practical and relatable information was valued over medical knowledge as children’s needs evolved; and (4) creation of electronic resources would be useful for information seeking and sharing. This study revealed that parents of children with IF have high informational and educational needs and sought information beyond what they received. Participants stressed the importance of their informational needs related to practical day-to-day management rather than medical knowledge. Although digital resources were considered valuable, a blended approach of care team discussions and electronic tools was preferred for receiving knowledge and skills. Parents’ connections with other caregivers was also noted as important for practical day-to-day management information, as well as supporting their well-being. Gaining an understanding of parents’ informational needs will assist in the creation of a digital education tool that is accessible, user-friendly, and emphasizes practical information. Other practice implications include developing additional strategies to enhance parental coping and resiliency to reduce the stress associated with the uncertainty of their child’s diagnosis.
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    Exploring the Use of Social Media: Implications for Participatory Design with Undergraduate Students
    (Proceedings of the 30th Australian Computer-Human Interaction Conference Proceedings, 2018-12-06) Duffett-Leger, Linda A.; Beck, Amy J.
    This paper presents our experience of working with young adults, using Participatory Design (PD), to develop a wearable technology to reduce back injury among nurses. We reflect on how participation was enacted with Nursing Students (NS) throughout the study and examine research activities that either promoted or hindered meaningful participation. We propose social media as an opportunity to foster participation in young adults.
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    Making Sense of Sensor Data for Recreational and Competitive Runners: Detecting Typical and Atypical Running Biomechanics
    (2019-06-21) Clermont, Christian Arthur; Ferber, Reed; Bouyer, Laurent; Duffett-Leger, Linda A.; Hettinga, Blayne A.; MacMullan, Paul A.
    Running-related injuries can result from a combination of intrinsic and extrinsic risk factors (e.g., running biomechanics, performance level, fatigue). Unfortunately, running biomechanics research has traditionally been performed in the lab. Therefore, the main objectives of this thesis were to establish novel methods to quantify typical running biomechanics for competitive and recreational runners and identify atypical changes due to fatigue and muscle soreness from a marathon race. In Chapter Three, it was found that competitive and recreational runners can be classified with greater than 80% accuracy using machine learning and lower-limb kinematic data. The translation of these methods to wearable sensor data can improve the generalizability of these findings. Therefore, in Chapter Four, centre of mass (CoM) acceleration data was used to classify competitive and recreational runners in sex-specific subgroups with greater than 80%. Thus, these experiments sought to establish specific subgroup running gait patterns both inside and out of the laboratory setting. Chapter Five expanded upon these findings and used a commercially-available wearable sensor and new statistical methods to detect alterations in subject-specific running biomechanics over the course of a fatigue-inducing marathon race. The culmination of these studies was Chapter Six wherein CoM acceleration data identified subject-specific typical running patterns prior to the marathon and determined whether fatigue-induced changes in gait patterns persist in the days following the race. The findings indicated an atypical shift in the runners’ CoM motion toward the mediolateral axis with only two days of recovery. In conclusion, it is evident that wearable sensor data, signal processing, and sophisticated analyses can be used to detect typical and atypical running biomechanics that may be associated with changes in performance and/or potential heightened risks of injury.