To investigate perspectives of mothers with opioid use disorder regarding breastfeeding and rooming-in during the birth hospitalization and identify facilitators and barriers.We conducted in-depth qualitative interviews with 25 mothers with opioid use disorder 1-12 weeks after delivery. Grounded theory analysis was used until thematic saturation was reached. Findings were triangulated, with experts in the field and a subset of informants themselves, to ensure data reliability.Among 25 infant-mother dyads, 36% of infants required pharmacologic treatment, 72% of mothers initiated breastfeeding, and 40% continued until discharge. We identified the following themes: (1) information drives maternal feeding choice; (2) the hospital environment is both a source of support and tension for mothers exerting autonomy in the care of their infants; (3) opioid withdrawal symptoms negatively impact breastfeeding; (4) internal and external stigma negatively impact mothers' self-efficacy; (5) mothers' histories of abuse and trauma affect their feeding choice and bonding; (6) mothers' recovery makes caring for their infants emotionally and logistically challenging; and (7) having an infant is a source of resilience and provides a sense of purpose for mothers on their path of recovery.Future interventions aimed at increasing breastfeeding and rooming-in during the birth hospitalization should focus on education regarding the benefits of breastfeeding and rooming-in, supporting mothers' autonomy in caring for their infants, minimizing stigma, and maximizing resilience.
Background: Compared with non-Hispanic white, Hispanic and non-Hispanic black mothers of very preterm infants are less likely to provide mother's milk at the point of hospital discharge; the perspectives of these mothers are poorly understood. Objectives: To examine the perceived barriers and facilitators of providing milk for very preterm infants during the hospitalization among Hispanic and non-Hispanic black mothers. Materials and Methods: We conducted 23 in-depth, semistructured interviews of English and Spanish-speaking Hispanic and non-Hispanic black mothers that initiated milk production for their very preterm infants, ≤1,750 g at birth. Following thematic saturation, results were validated through expert triangulation and member checking. Results: Twelve mothers were Hispanic, where three were English speaking and nine were Spanish speaking. Eleven mothers were non-Hispanic black and English speaking. We found themes pertaining to general experiences: (1) Breastfeeding intent impacts mothers' success in providing milk throughout the hospitalization; (2) Pumping milk for a hospitalized infant is repetitive, exhausting, and does not elicit the same emotional connection as breastfeeding; (3) Hospital providers are an important source of support, when sufficient time is spent to address ongoing issues; (4) Providing milk creates a unique sense of purpose when mothers otherwise feel a lack of control; and we found themes pertaining to the experiences of Hispanic and non-Hispanic black mothers: (1) Breastfeeding as a cultural norm influences mothers' intent to initiate and continue breastfeeding; (2) Hospital staff are viewed as more supportive when interactions and treatment are perceived as racially/ethnically unbiased and (3) when communication occurs in the primary language; and (4) Mother-infant separation creates logistical challenges that negatively impact ongoing milk production. Conclusions: While providing milk for a hospitalized very preterm infant is exhausting, and logistically challenging, Hispanic and non-Hispanic black mothers are inspired to do so because of their intent to breastfeed, support from hospital providers, and feelings of purpose.
The effective practice of evidence-based medicine requires the application of ‘current best evidence’ to individual patient care.1 While there is consensus that it is critical to include patients' individual preferences in medical decision-making,1,–,4 the best way to involve patients in the process is unclear. Patient preferences may be dictated by specific circumstances, such as age, as well as by past experiences and cultural values. Increasingly, evidence shows that both health outcomes and patient decision-making are strongly associated with health literacy,5,–,12 which is not routinely assessed during clinical encounters.
Health literacy is defined by the Institute of Medicine as ‘the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.’5 Problems with health literacy are common, and the Institute of Medicine estimates that more than 90 million adults in the USA have difficulties reading, interpreting or managing health-related information.5
Low health literacy is associated with poor health outcomes, even when findings are adjusted …
Mobile technology is ubiquitous, but its impact on family life has not been thoroughly addressed in the scientific literature or in clinical practice guidelines. We aimed to understand parents' views regarding mobile technology use by young children, aged 0 to 8 years, including perceived benefits, concerns, and effects on family interactions, with the goal of informing pediatric guidelines.
METHODS
We conducted 35 in-depth, semistructured group and individual interviews with English-speaking caregivers of diverse ethnic backgrounds, educational levels, and employment statuses. After thematic saturation, results were validated through expert triangulation and member checking.
RESULTS
Participants included 22 mothers, 9 fathers, and 4 grandmothers; 31.4% were single parents, 42.9% were of nonwhite race or ethnicity, and 40.0% completed high school or less. Participants consistently expressed a high degree of tension regarding their child's mobile technology use, from which several themes emerged: (1) effects on the child—fear of missing out on educational benefits vs concerns about negative effects on thinking and imagination; (2) locus of control—wanting to use digital devices in beneficial ways vs feeling that rapidly evolving technologies are beyond their control (a tension more common in low-income caregivers); and (3) family stress—the necessity of device use in stressed families (eg, to control a child's behavior or as an inexpensive learning/entertainment tool) vs its displacement of family time.
CONCLUSIONS
Caregivers of young children describe many novel concepts regarding use of mobile technology, raising issues not addressed by current anticipatory guidance. Guidance may be more effectively implemented if it takes into account parents' uncertainties, locus of control, and functional uses of mobile devices in families.
