Development, validation and efficacy of maternal diet and infant allergy prevention module among breastfeeding peer counsellors in Pahang

Abstract

Breastfeeding is recognised to be beneficial for infants as it provides many essential nutrients which can protect from allergies such as asthma and eczema. However, current evidence found that allergies are also prevalent among exclusively breastfed infants. This is due to the fact that the maternal diet during pregnancy and breastfeeding was found to influence the quality and content of breast milk. The risk of allergy among exclusively breastfed infants may be reduced via modulation of maternal diet. Therefore, this study aimed to develop and validate a maternal diet guideline module and evaluate the efficacy of its content in improving the knowledge and attitude of breastfeeding peer counsellors (BPC) in Pahang. This study consists of four phases including Phase 1: Needs Assessment, Phase 2: Module Development and Module Validation, Phase 3: Questionnaire Development and Questionnaire Validation and Phase 4: Intervention Study. Phase 1: Needs Assessment, was conducted among 15 Malaysian Breastfeeding Peer Counsellors (MBFPC) via self-administered questionnaire as preliminary requirement. In Phase 2: Module Development and Module Validation, the module was developed based on needs assessment, theories of reasoned action and planned behavior and current literature review. The validation of the module was done among ten experts. The content of the module was validated using the content validity index (CVI) which are Item-level Content Validity Index (I-CVI) and scale-content validity index (S-CVI). The item-level (I-CVIs) was considered in this study due to its consistency which further calculated into modified kappa statistics. The items with an I-CVI of 0.78 or higher was considered evidence of good content validity. The result showed that the validity of the module had achieved I-CVI of 0.89 which was considered as having excellent content validity with majority of excellent kappa statistic. In Phase 3: Questionnaire Development and Questionnaire Validation, the questionnaire was developed based on four domains which are knowledge, attitude, maternal diet and allergy prevention. The pilot study was done among ten participants of BPC. The content validity of questionnaire were assessed by the six experts and 14 experts for reliability analysis. The I-CVI for questionnaire is 0.97 and overall Cronbach alpha is 0.894 which is considered as having excellent content validity and reliable instrument. In Phase 4: Intervention Study, the cross-sectional study was conducted in all districts in Pahang using convenient sampling method. The self-administered questionnaire were distributed among 72 respondents that fulfilled the criteria. The module was implemented in the intervention study, and the knowledge and attitude (KA) were assessed before and after the intervention. Mean, standard deviation, t-test, ANOVA and correlation test were used as statistical tools in treating the data for knowledge and attitude. In the pre-intervention, majority of the participants had good level of knowledge (n=37, 51.4%) and positive attitude (n=32, 44.4%) towards maternal diet and allergy. The significant association was found between socio-demographic factors and KA in post-intervention (p<0.05). There is also a moderate positive correlation between knowledge and attitude for both pre- and post-intervention (r=0.668, p<0.001) and (r=0.547, p<0.001) respectively. The moderate knowledge and positive attitude on maternal diet and allergy had improved after the intervention using the module from 34.7% to 38.9% and from 44.4% to 61.1% respectively. Thus, the developed module had provided a guideline for the BPC in allergy prevention among exclusively breastfed infants. This study also had produce a module with acceptable validity of its content and an instrument used also have acceptable reliability and validity. The knowledgeable BPC will become a center for conveying the knowledge for mothers to reduce the health burden among breastfed infants for better health outcome and reduce the allergy prevalence