Breastfeeding is recognised as a complex behaviour. Maternal motivation and professional support is critical in overcoming early challenges in the initiation and sustainment of breastfeeding. The influence of culture remains under-researched and more knowledge is required to explore the relationship between culture, breastfeeding and motivation. The aim of this research was to explore the motivational and cultural influences on breastfeeding in a Thai cultural setting. Two literature reviews were used (meta-narrative and meta-synthesis) to explore the evidence of the benefits of breastfeeding and cultural influences on maternal motivation. An information analysis was completed to examine national policy, organisational policy and routine practice in breastfeeding instruction. The meta-narrative review suggested a lack of robust methodological evidence with an over-emphasis on the benefits of breastfeeding. Meta-synthesis evidence showed a significant influence from cultural and community practices on breastfeeding behaviour. Global policies were incorporated into national and local breastfeeding policies. The ARCS model of motivational design in breastfeeding was adapted to inform the analysis of maternal motivational influences in a University hospital in Northern Thailand. The study was regarded as "Iow risk". Ethical approval was obtained from Ulster University and Chiang Mai University. Seventy five hours of observation (n=204) were completed in seven breastfeeding environments. Thematic and content analysis were conducted through the implementation of a systematic theoretical goal structure. A Breastfeeding Motivational Scale was translated and adapted using WHO guidelines and was administered to a convenience sample (n=195) to measure maternal value, expectation for success and midwife support. Descriptive and inferential analyses were undertaken using SPSS v21. Routine instruction emphasised the benefits and value of breastfeeding for mothers, infants and the wider Thai society. Cultural beliefs and practices were included in routine breastfeeding instruction. The motivational analysis determined Thai women had a higher than expected value for breastfeeding. This research demonstrates that national, organisational and cultural influences have a significant positive effect on women's motivation to breastfeed.

This thesis reports findings arising from the question: ‘How do socio-cultural characteristics and maternal health influence the parenting patterns of families of Pakistani origin living in Bradford?’ Parents play a significant role in the lives of their children and a number of studies have been conducted on parenting and child development and factors that influence parenting practices, among white indigenous groups; but little is known about those of Pakistani families, and the influencing factors. There is a particularly high concentration of Pakistani families in Bradford, and the available BIB cohort database was important in selecting participants for this study, which was attached to the Maternal and Child Health theme of the BIB Research Cohort study and funded by CLARCH. Using a qualitative methodology, including face-to-face interviews and ethnographic observations the study explores the impact of health, level of education, religion, acculturation and social support on Pakistani families’ parenting patterns. The data was analysed by an initial coding, identifying themes, grouping of patterns, and arriving at meaningful explanations. The findings show that length of stay in the UK did not determine either the choice of language spoken at home or the level of acculturation. Higher levels of education were observed in the mothers who came to the UK than in those born in Bradford. Participants with a high level of education were more likely to be in work and able to provide robust, mentally stimulating learning environments. Most of the participants reported having experienced or currently experiencing depression, the majority do not seek professional help, but that of their family. Family support, particularly with childcare and religion, strongly shape Pakistani families’ parenting patterns. The study concludes that the sacred-secular bridge should be minimised by getting religious leaders involved in teaching key aspects of change or behaviour, in order to better secure the Pakistani communities’ attention and interest. A range of educational opportunities should be made available for Pakistani women who wish to access higher education, and institutions should engage with the community to know how they can best serve them.

BACKGROUND: There is a mismatch between health recommendations that babies are breastfed for up to 2 years or beyond, and UK employment law provisions, in which maternity leave is commonly up to one year with maternity employment protections normally ceasing after return to work. AIM: The study explored the perspectives and views of employers and managers concerning the context for lactation breaks, access to relevant policies, the legal position and views of managers around sustaining lactation on return to work. OBJECTIVE: To examine the context of lactation breaks in one public sector organisation from the perspectives of employer and manager. RESEARCH QUESTIONS: (1) What issues are triggered for managers by employees combining breastfeeding or lactation and employment? (2) How do managers understand and access the law concerning lactation breaks? (3) What views do managers express with regard to the different ways in which a mother may sustain lactation on her return to work? METHODOLOGY & METHODS: This qualitative study utilised snowballing sampling strategy to access and recruit participants. Interviews were conducted with twenty seven managers and key personnel of a large family-friendly organisation in 2013, selected for the deviant level of support for lactation breaks. Documentary analysis was also utilised. Interviews were audio recorded and transcribed verbatim. Inductive thematic analysis was applied using NVIVO to discern themes. RESULTS: There are some gaps in provision for lactation breaks and potential barriers for staff contemplating them. Participants described support and concerns, demonstrating conflicted attitudes. Themes include support for combining lactation and employment; concerns about lactation; following organisational policy; questioning social policy and reservations about communication. There is some degree of contradiction between these over-arching themes. There was limited call for law reform and the topic was perceived as primarily a human resources issue. All forms of lactation break were associated with ambiguous attitudes and reservations. IMPLICATIONS: Despite a high level of support for the concept of lactation breaks among managers there were concerns over potentially problematic issues. Breastfeeding at work triggers a workplace risk assessment rather than consideration of the potential risks of stopping breastfeeding early.

Background Early initiation of breastfeeding within one hour after birth is one of the recommended interventions for saving newborn lives. Despite WHO standards, there are still inconsistencies between surveys in how the indicator is measured. This thesis identified challenges and accuracy issues in the measurement of early initiation indicator and proposed improvements to household survey tools. Objectives Individual studies included in this thesis assessed the following: the evidence-base for the ‘one hour’ time limit in defining the indicator; mothers’ perception of the survey question; newborn care practices other than breastfeeding; and data collectors’ experiences of asking mothers the early initiation question. Methods Mixed methods were used and data was collected using a critical review of the literature, cognitive interviews, semi-structured interviews, focus group discussions, key informant interviews and a self-administered questionnaire. All primary data was collected from Ethiopia. Results Nine out of 11 studies included in the review provided evidence supporting the ‘one hour’ time limit in the early initiation indicator. Primary data collection in Ethiopia revealed that some mothers did not understand the question as intended. Considerable probing was required and there were inter-personal variations among data collectors in how they asked the question. In the context of home births, other competing newborn care practices were given priority over breastfeeding initiation. Conclusion This thesis provided evidence supporting the ‘one hour’ time limit for the indicator and accordingly, consistent use of standard WHO definition is recommended. To avoid ambiguity, the early initiation question should be revised as “how long after birth did you first put [name] to the breast even if your breastmilk did not arrive yet?” Standard probes or follow on questions are required to avoid misinterpretation of the indicator by data collectors. Probes should be designed using other newborn care practices as reference points to improve maternal recall.

Background : Socially disadvantaged children are more likely than their advantaged peers to have delayed language development. Parent talk to children has been found to be related to child language abilities and to socioeconomic status. Based on an interactionist theory of language development, it is proposed that child language may be supported, in part, by encouraging parents to talk to their baby. Speech and language therapy services in the UK have developed a range of preventative services to this end but there is little evidence of effectiveness. In this study, a randomised controlled trial (RCT) was carried out to investigate efficacy of the Babytalk Home Visit (BTHV) on parent talk to children and on child expressive vocabulary. Method: 69 parent/baby dyads were randomised to BTHV and control groups, videoed and parent talk transcribed in their homes at baseline, post intervention and when their child was aged 2 years. Baseline to post-intervention change in parent word types spoken and parent report of child expressive vocabulary at age 2 years were compared between groups. Results: No significant difference was observed between groups for either outcome measure. Subgroup analysis indicated a possible temporary effect on parental talk for parents from low socioeconomic backgrounds. This effect was not sustained at the 2 year follow up, however, and no effect on child language outcomes at age 2 was observed. In line with previous studies, a highly significant relationship was found between parent talk and child language. Discussion: These results highlight the need to understand the potential and mechanism for change in parent talk and the need for further research into the nature of the relationship between parent talk and child language. They also highlight the value of controlled studies to inform commissioning of speech and language therapy services using the MRC’s guidance for complex interventions.

This PhD thesis develops a relational approach to the study of childhood and children. Drawing on the ecumenical approaches of non-representational theory, material culture studies and hybrid geographies, it explores the assemblages of human and nonhuman entities through which childhood comes into being. More specifically, this thesis considers the socio-material assemblages involving children and toys, principally through an ethnographic study of children's everyday practices with this particular type of object. To this end, it addresses a paucity of empirical work conducted with child consumers. To unpack how and why these (often highly commodified) objects matter to children, I address the precise contributions of toys to relational agency in terms of the creative capabilities they possess. Toys, like objects in general, motivate particular inferences, interpretations and responses. These are a function of three broadly conceived prompts to object agency: the sensual and material properties of the toy itself; and the socio-material relations in which the toy is embedded. Through a series of case studies involving cuddly toys, model aeroplanes, trading cards, Bratz fashion dolls, Harry Potter media, dollhouses and video games, I trace the various agencies of toys. This discussion of object agency is then extended through an examination of toys as technologies, which are productive in terms of the co-configuration of imaginative spaces of play in and of the everyday. In this regard, I address magical lands, miniature worlds and virtual spaces of play. By attending to the intimate, embodied ways in which toys matter to children, this thesis examines children's engagements with consumer cultures. In so doing it presents an alter-tale to contemporary debates about the demoralised character of contemporary childhoods and children.

This study aims to explore whether a video-feedback intervention, namely Video Interaction Guidance, can improve both parent-child relationships and child behaviour outcomes and reduce parental stress. Three mother-child dyads were involved in this study, each receiving an individualised intervention using Video Interaction Guidance. The mothers involved in this intervention had previously completed the Incredible Years BASIC Parent Programme, however they continued to report difficulties at home in supporting their children’s social, emotional and behavioural development. Video Interaction Guidance was delivered to three mother-child dyads on an individual basis, across three cycles. Pre-, post-intervention and 6 months follow-up measures were administered. Parents also participated in semi-structured interviews prior to the intervention. Findings indicated each of the mothers showed positive changes in relation to parent stress and dysfunctional discipline. Two of the parents showed statistically and clinically significant changes in relation to parent stress. Each of the children showed positive changes in relation to the child behaviour outcomes, and two of the children showed statistically and clinically significant changes across a variety of domains on the behavioural outcome measure. Meaningful successes were documented when using VIG as an intervention for these parents. This study highlights the usefulness of incorporating a video feedback intervention for parents and children who did not see desired outcomes on completion of a parent-training programme alone.

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This thesis aimed to provide an integrated model of infant feeding, centred on women's experiences. Two studies were employed in order to meet this aim. Firstly, a questionnaire-based longitudinal study within a Social Cognitive framework was carried out in order to understand the internal and external processes involved in the infant feeding experience. Eighty-five first time mothers participated in this study. Participants were assessed at three stages; once during pregnancy, once at six to eight, and again at four to six moths postpartum. The results of the longitudinal study supported the use of the Social Cognitive framework, and more specifically the applications of both the Theory of Reasoned Action (Ajzen & Fishbein, 1980), and Self-Efficacy Theory (Bandura, 1977). Further, analysis revealed support for the conceptualisation of Social Support in this study, and enhanced understanding of the role of external variables. The second study contained within this thesis was a qualitative interview-based study of the infant feeding experiences of eight participants of the longitudinal study who volunteered to be interviewed. The combination of the results of the quantitative longitudinal study and the qualitative study gave rise to a reconceptualisation of infant feeding encompassing three phases; the decision phase, the initiation phase, and the maintenance phase that were formed and are themselves guided by internal and external processes based on women's individual experiences. It is proposed that this integrated model can be used as a platforn1 for the furthering of women-centred theoretically based infant feeding research, and furthermore, the development of women-centred, evidence-based practice.

Background: Undernutrition is a global public health challenge with life-long consequences. For a child chronically undernourished within the first 1000 days of its life, the consequences include lower school attainment, shorter adult height, reduced adult income and national economic productivity. Investing in preventing child undernutrition has both immediate and later life benefits for children and society. To prevent child undernutrition, promote optimal growth and development, nutrition interventions should target the 1000-days window of opportunity. Aim and objectives: This thesis aimed to assess infant feeding practices in the Matebeleland region of Zimbabwe. The objectives were to (i) explore factors associated with exclusive breastfeeding, (ii) estimate nutrient intake and assess nutritional quality of infants' diets and (iii) formulate and pilot food-based feeding recommendations for infants. Methods: This thesis employed mixed methods. The breastfeeding study and piloting of feeding recommendations were qualitative, whilst the food intake and linear programming studies were quantitative. Results: Diets consumed by infants in the Matebeleland region are predominantly plant-based and poor in both diversity and micronutrient density. The diets do not meet calcium, iron, zinc, and vitamin B3 requirements for 9-11 month-old infants. Urban infants and those from wealthier households had higher median nutrient intakes than infants from rural and poor households did, respectively. Conclusion: Diets consumed by infants in the Matebeleland region are poor in diversity and micronutrient density and cannot meet calcium, iron, zinc, and vitamin B3 requirements for the 9-11 months target group. Maize meal fortification improved the micronutrient density of the diets.