Advertisement

Using Rasch analysis to identify midwifery students’ learning about providing breastfeeding support

      Abstract

      Aim

      To report on a study measuring midwifery students’ self-reported abilities in teaching and supervising breastfeeding mothers. Abilities were assessed at two time intervals, before and after completing a maternal and infant nutrition topic with simultaneous clinical opportunities to consolidate their skills.

      Method

      A convenience sample of midwifery students in an Australian university completed a pre- and post-intervention survey to assess their self-rated ability to teach and supervise breastfeeding mothers. Rasch analysis was used to gain conjoint estimates of students’ self-reported abilities to teach and supervise breastfeeding mothers across 37 items with varying complexity of care needs. Rasch analysis was used to determine validity and reliability of the 37-item tool, to develop a hierarchical linear scale reflecting difficulty of breastfeeding supportive activities, and to determine student learning between the two time points.

      Results

      From 95 responses, 34 of the 37 items met the requirement for unidimensionality. Outcomes identified that midwifery students’ self-efficacy measures for breastfeeding support abilities can be reliably estimated. A hierarchical scale for learning these clinical skills has been generated to inform curricula development and learning processes. While there was an overall increase in the ease of difficulty of 21 items in the survey at time point two, eight items were identified as becoming more difficult.

      Conclusion

      The findings of this study challenge midwifery educators to reconsider the educational activities provided for midwifery students’ that aim to develop the requisite skills to provide effective breastfeeding support, including the provision of specific clinical opportunities to learn from breastfeeding women.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Women and Birth
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Renfrew M.J.
        • McFadden A.
        • Bastos M.H.
        • Campbell J.
        • Channon A.A.
        • Cheung N.F.
        • et al.
        Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care.
        Lancet. 2014; 384: 1129-1145https://doi.org/10.1016/S0140-6736(14)60789-3
        • Australian Health Ministers’ Conference
        The Australian National Breastfeeding Strategy 2010–2015.
        Australian Government Department of Health and Ageing, Canberra2009
      1. UNICEF, WHO, UNESCO, UNFPA, UNDP, UNAIDS, et al. Facts for life. 4th ed. 2010.

        • Ward K.N.
        • Byrne J.P.
        A critical review of the impact of continuing breastfeeding education provided to nurses and midwives.
        J Hum Lact. 2011; 27: 381-393
        • World Health Organisation
        Evidence for the ten steps to successful breastfeeding.
        World Health Organisation, Geneva1998
        • Britton C.
        • McCormick F.M.
        • Renfrew M.J.
        • Wade A.
        • King S.E.
        Support for breastfeeding mothers.
        Cochrane Database Syst Rev. 2007; 1
        • Dillaway H.E.
        • Douma M.E.
        Are pediatric offices supportive of breastfeeding? Discrepancies between mothers’ and healthcare professionals’ reports.
        Clin Pediatr (Phila). 2004; 43: 417-430
        • Hailes J.
        • Wellard S.
        Support for breastfeeding in the first postpartum month: perceptions of breastfeeding women.
        Breastfeed Rev. 2000; 8: 5-9
        • Smale M.
        • Renfrew M.J.
        • Marshall J.L.
        • Spiby H.
        Turning policy into practice: more difficult than it seems. The case of breastfeeding education.
        Matern Child Nutr. 2006; 2: 103-113
        • Bernaix L.W.
        Nurses’ attitudes: subjective norms, and behavioral intentions toward support of breastfeeding mothers.
        J Hum Lact. 2000; 16: 201-209
        • Freed G.L.
        • Clark S.J.
        • Sorrenson J.
        • Lohr J.A.
        • Cefalo R.
        • Curtis P.
        National assessment of physicians’ breast-feeding knowledge: attitudes, training, and experience.
        JAMA. 1995; 273: 472-476
        • Freed G.L.
        • Clark S.J.
        • Harris B.G.
        • Lowdermilk D.L.
        Methods and outcomes of breastfeeding instruction for nursing students.
        J Hum Lact. 1996; 12: 105-110
        • Cantrill R.M.
        • Creedy D.K.
        • Cooke M.
        An Australian study of midwives’ breast-feeding knowledge.
        Midwifery. 2003; 19: 310-317
        • Cantrill R.M.
        • Creedy D.K.
        • Cooke M.
        How midwives learn about breastfeeding.
        Aust J Midwifery. 2003; 16: 11-16
        • Dodgson J.E.
        • Tarrant M.
        Outcomes of a breastfeeding educational intervention for baccalaureate nursing students.
        Nurse Educ Today. 2007; 27: 856-867
        • Brodribb W.
        • Jackson C.
        • Fallon A.
        • Hegney D.
        What do Australian medical programs teach medical students about breastfeeding?.
        Focus Health Prof Educ. 2007; 9: 83-93
        • Bernaix L.W.
        • Beaman M.L.
        • Schmidt C.A.
        • Harris J.K.
        • Miller L.M.
        Success of an educational intervention on maternal/newborn nurses’ breastfeeding knowledge and attitudes.
        J Obstet Gynecol Neonatal Nurs. 2010; 39: 658-666
        • Ormrod J.E.
        Educational psychology: developing learners.
        5th ed. Pearson/Merrill Prentice Hall, Upper Saddle River, NJ2006
        • Bandura A.
        Social foundations of thought and action: a social cognitive theory.
        W.H. Freeman, New York1986
        • Dennis C.L.
        The breastfeeding self-efficacy scale: psychometric assessment of the short form.
        J Obstet Gynecol Neonatal Nurs. 2003; 32: 734-744
        • Yates S.
        Rasch and attitude scales: explanatory style.
        in: Alagumalai S. Curtis D. Hungi N. Applied Rasch measurement: a book of exemplars. Springer Press, The Netherlands2005
        • World Health Organization (WHO) and UNICEF
        Baby-friendly hospital initiative: revised, updated and expanded for integrated care.
        WHO, Geneva2009
        • Linacre J.
        Optimizing rating scale category effectiveness.
        J Appl Meas. 2002; 3: 85-106
        • Linacre J.M.
        Winsteps® Rasch measurement computer program.
        (Beaverton, OR)2012
        • Bond T.
        • Fox C.
        Applying the Rasch model: fundamental measurement in the human sciences.
        2nd ed. Lawrence Erlbaum & Associates, New Jersey2007
        • Hagquist C.
        • Bruce M.
        • Gustavsson J.P.
        Using the Rasch model in nursing research: an introduction and illustrative example.
        Int J Nurs Stud. 2009; 46: 380-393
        • Nicholson P.
        • Gillis S.
        • Dunning A.M.T.
        The use of scoring rubrics to determine clinical performance in the operating suite.
        Nurse Educ Today. 2009; 29: 73-82
        • Nicholson P.
        • Griffin P.
        • Gillis S.
        • Wu M.
        • Dunning T.
        Measuring nursing competencies in the operating theatre: instrument development and psychometric analysis using Item Response Theory.
        Nurse Educ Today. 2013; 33: 1088-1093
        • Blackman I.R.
        • Mannix T.
        • Sinclair P.M.
        Developing renal nurses’ buttonhole cannulation skills using e-learning.
        J Ren Care. 2014; 40: 55-63
        • Beck C.
        • Gable R.
        Comparative analysis of the performance of the postpartum depression screening scale with two other depression instruments.
        Nurs Res. 2001; 50: 242-250
        • Pallant J.F.
        • Tennant A.
        An introduction to the Rasch measurement model: an example using the Hospital Anxiety and Depression Scale (HADS).
        Br J Clin Psychol. 2007; 46: 1-18
        • Blackman I.
        • Hall M.
        Estimating the complexity of applied English language skills to the perceived ability of non-English speaking background student nurses, using Rasch analysis.
        in: Matthews B. Gibbons T. The process of research in education. Shannon Press, 2009
        • Jamieson S.
        Likert scales: how to (ab)use them.
        Med Educ. 2004; 38: 1217-1218
        • Merbitz C.
        • Morris J.
        • Grip J.C.
        Ordinal scales and foundations of misinference.
        Arch Phys Med Rehabil. 1989; 70: 308-312
        • Svensson E.
        Guidelines to statistical evaluation of data from rating scales and questionnaires.
        J Rehabil Med. 2001; 33: 47-48
        • Grimsby G.
        The use of raw scores for ordinal scales: time to end malpractice?.
        J Rehabil Med. 2012; 9: 7-8
        • Shevlin M.
        • Miles J.N.V.
        • Davies M.N.O.
        • Walker S.
        Coefficient alpha: a useful indicator of reliability?.
        Pers Indiv Differ. 2000; 28: 229-237
        • Sijtsma K.
        On the use: the misuse, and the very limited usefulness of Cronbach's alpha.
        Psychometrika. 2009; 74: 107-120
        • Curtis D.
        Comparing classical and contemporary analyses and Rasch measurement.
        in: Alagumalai S. Curtis D. Hungi N. Applied Rasch measurement: a book of exemplars. Springer Press, The Netherlands2005
        • Keeves J.P.
        The design and conduct of the second science study.
        in: Keeves J.P. The IEA study of science III: changes in science education and achievement: 1970 to 1984. 1992
        • Turner J.L.
        • Dankoski M.E.
        Objective structured clinical exams: a critical review.
        Fam Med. 2008; 40: 574-578
        • Mitchell M.L.
        • Jeffrey C.A.
        • Henderson A.
        • Glover P.
        • Nulty D.D.
        • Kelly M.A.
        • et al.
        Using an objective structured clinical examination for bachelor of midwifery students’ preparation for practice.
        Women Birth. 2014; 27: 113