Breastfeeding initiation rates in the United States remain below the Healthy People 2010 goals. Research indicates patient interaction with health care providers may play an important role in womens ultimate feeding choice. This study sought to examine the impact of provider counseling regarding breastfeeding during the prenatal period on feeding outcome by evaluating: 1) if providers addressed womens concerns regarding breastfeeding; and 2) how providers responded to a womans feeding choice. We also sought to examine whether the type of counseling provided by providers regarding infant feeding is influenced by patient socio-demographics and stated feeding plans. This study is cross-sectional with convenience sampling of all English or Spanish speaking women on the postpartum floor at Yale-New Haven Hospital. A total of 130 women participated. Overall, 95.4% of women identified a concern they had about breastfeeding during the prenatal period, and one quarter of patients had their concerns about breastfeeding addressed. The majority of patients (74.6%) were asked about their feeding plans, and 50.5% were encouraged to breastfeed. Unlike the majority of studies that indicate young, African American, poorly educated, unmarried and low income women are less likely to receive counseling from providers to breastfeed, providers in our study area focused their efforts on this population. In multivariate analysis, neither having concerns addressed nor being encouraged to breastfeed were associated with increased likelihood of breastfeeding. Addressing patients concerns may be most relevant in the small subset of patients who make their feeding choice during pregnancy. Finally, women who were asked about their plans and had their concerns addressed (p=.010) or were encouraged to breastfeed (p=.040) were more likely to make their decision during pregnancy compared to before pregnancy than women whose providers did not discuss these issues. Likewise, mixed feeders were more likely to make their decision regarding infant feeding during rather than before pregnancy. This data suggests providers may be encouraging women to think more thoroughly about the possibility of breastfeeding, thus delaying their decision. In conclusion, many women are not being encouraged to breastfeed or having their concerns about breastfeeding addressed. All women would benefit from prenatal discussion of these topics; however, the effect may be most profound in women who make their decision regarding feeding during pregnancy.

Orientador: Maria Helena Baena de Moraes Lopes / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-20T23:10:47Z (GMT). No. of bitstreams: 1 Alves_AngelaFerreiraSilvaMiranda_M.pdf: 8133917 bytes, checksum: 2ddba523f4ac0561b3078da05e510508 (MD5) Previous issue date: 2012 / Resumo: A gravidez na adolescência é um problema de saúde pública, que traz complicações não somente aos adolescentes, mas à criança, à família e a toda a sociedade. De acordo com a Organização Mundial de Saúde (OMS) a adolescência corresponde como sendo a segunda fase da vida e varia as idades entre 10 e 19 anos. Pesquisadores demógrafos desenvolveram um modelo especial conhecido como estudo CAP (Conhecimento, Atitude e Prática), que pretende medir o conhecimento, atitude e prática de uma população, permitindo fazer um diagnóstico e mostrar o que as pessoas sabem, sentem e como elas se comportam perante determinado tema. Determinadas características de personalidade contribuem para a adesão ou não da anticoncepção na adolescência, e isso é o que a escala de lócus de controle pretende avaliar, ou seja, quem ou o quê é responsável pelo controle de sua própria vida. Pode ser interna, no caso do indivíduo acreditar que mantém o controle sobre sua vida; ou externa, no caso do sujeito atribuir o controle da sua vida a outras pessoas, entidades ou até mesmo sorte ou destino. O presente estudo visa avaliar a relação entre o lócus de controle; conhecimento, atitude e prática na anticoncepção em um grupo de adolescentes do ensino médio de escolas públicas no interior de Minas Gerais, a fim de melhor subsidiar o desenvolvimento de intervenções específicas para esse público alvo. Tratou-se de um estudo descritivo e transversal, com abordagem quantitativa. A amostra foi composta por 1193 adolescentes. Iniciaram as relações sexuais 494 (41,4%) adolescentes, e dentre os que haviam iniciado, 424 (87%) relatou ter usado algum método contraceptivo na primeira relação sexual. Os métodos mais utilizados foram o preservativo masculino e a pílula anticoncepcional. Observou-se que 282 (74,7%) dos adolescentes buscam informações por meio de sugestões da família, do companheiro e de informações dadas pelos profissionais de saúde. Analisando o conhecimento em relação à prática, observou-se uma correlação positiva fraca (p<0,0001 e r=0,361), indicando que quanto maior os índices de conhecimento, maiores os de prática. Considerando-se a relação entre atitude e conhecimento, o adolescente que tem uma atitude positiva apresentou maior conhecimento sobre os métodos (p=0,0002). Em relação à prática, a atitude positiva também estava relacionada a uma prática mais adequada (p<0,0001), indicada pelos índices mais elevados de acerto das questões relacionadas. Comparando a pílula e o preservativo, há um maior conhecimento e prática em relação ao preservativo. Quanto ao lócus de controle, as adolescentes do sexo feminino tiveram maior Externalidade Outros Poderosos quando comparados com os adolescentes masculinos (p=0,0015). Na correlação do lócus de controle com a idade, os adolescentes com idade acima de 17 anos tem maior Externalidade Acaso (p=<0,0001) que os de menor idade. Os estudantes que fizeram uso de algum método anticoncepcional na primeira relação sexual apresentaram maior Externalidade Outros Poderosos (p=0,0107) e o uso de coito interrompido, como uso de contraceptivo, relacionou-se com maior Externalidade Acaso (p=0,0013). Os que faziam uso atual de algum método apresentavam maior Externalidade Outros Poderosos (p=0,0217) e Externalidade Acaso (p=0,0077), o uso atual de preservativo masculino também esteve associado a maior Externalidade Acaso (p=0,0001). A Internalidade foi inversamente proporcional à prática (p=< 0,05 e r= -0,075), porém a correlação foi ínfima. Não houve associação entre a atitude e as dimensões do lócus de controle. Conclui-se que os adolescentes iniciam atividade sexual precocemente, mas buscam informações sobre anticoncepção. Apesar do conhecimento dos adolescentes sobre anticoncepção, existe uma necessidade de ampliar o acesso a serviços especializados, como também, enfocar sobre a importância do processo educativo referente à sexualidade, promoção da saúde e a inclusão da família e da comunidade nesse processo. As dimensões do lócus de controle influenciam a prática contraceptiva nesse grupo de adolescentes, assim, elas podem ser consideradas nas intervenções relacionadas à anticoncepção / Abstract: Teenage pregnancy is a public health problem, which brings complications not just for adolescents but to the child, family and society as a whole. According to World Health Organization (WHO), the adolescence corresponds as the second phase of life and ages ranging between 10 to 19 years old. Researches demographers have developed a special study known as KAP (Knowledge, Attitudes and Practices), which aims to measure knowledge, attitude and practice of a population, allowing a diagnosis and to show what people know, feel and how they behave towards certain theme. Certain traits of personality contribute to the membership or not of contraception in adolescence, and this is what the scale of lócus of control to evaluate, and, who or what is responsible for controlling their own lives. It can be internal, in the case that the individual believe that he maintains the control over his life, or external, in the case of the subject to assign control over his life to other people, entities or even luck or fate. The present study evaluates the relation between lócus of control, knowledge, attitude and practice on contraception in a group of high school adolescents from public schools in the interior of Minas Gerais state, in order to better inform the development of specific interventions for this public target. This was a descriptive and transversal study with a quantitative approach. The sample comprised 1,193 adolescents. Of all these adolescents, 494 (41.4%) had already the first intercourse, and among those who had started, 424 (87%) reported having use a contraceptive method at first intercourse. The methods used were the condom and the birth control pill, observed that 282 (74,7%) of the teenagers seek information through suggestions from family, partner and information given by health professionals. Analyzing knowledge regarding the practice, there was a weak positive correlation (p <0.0001 and r = 0.361), indicating that the higher rates of knowledge, the largest of practice. Considering the relationship between attitude and knowledge, the teenager who has a positive attitude showed greater knowledge about methods (p = 0.0002). Regarding practice, positive attitude was also related to a more appropriate practice (p <0.0001), indicated by higher rates of correct questions. Comparing the birth control pill and condoms, there is a greater knowledge and practice about condom use. Regarding the lócus of control, female adolescents were more Powerful than Others Externality compared to male adolescents (p=0.0015). In the correlation of lócus of control with age, adolescents aged of 17 years have more chance externality (p=<0.0001) than those of younger age. Students who used a contraceptive method at first intercourse had higher Powerful Others Externality (p=0.0107) and the use of coitus interruptus, and contraceptive use, was related to greater Externality by Chance (p=0.0013). Those who were currently using some method had higher Powerful Others Externality (p=0.0217) and Chance Externality (p=0.0077), current use of condoms was also associated with greater externality Chance (p=0.0001). The Internality was inversely proportional to the practice (p=<0.05 and r=-0.075), but the correlation was insignificant. There was no association between the attitude and the dimensions of lócus of control. It is concluded that adolescents initiate sexual activity early, but seek information about contraception. Despite the knowledge of adolescents about contraception, there is a need to expand that access to specialized services, but also focus on the importance of the educational process about sexuality, health promotion and inclusion of the family and community in this process. The dimensions of lócus of control influence contraceptive practice in this group of adolescents, so they can be considered in interventions related to contraception / Mestrado / Enfermagem e Trabalho / Mestra em Ciências da Saúde