تاثير بازديد از منزل بر حمايت اجتماعي درك‌ شده مادران و تداوم تغذيه انحصاري با شير مادر: يك مطالعه كارآزمايي كنترل‌ شده تصادفي‌ سازي

Effects of home visit on perceived social support of mothers and the continuation of exclusive breastfeeding: A randomized clinical trial study

ﻫﺪف: ﺷﯿﺮدﻫﯽ اﻧﺤﺼﺎري در 6 ﻣﺎه اول ﺗﻮﻟﺪ در ﺑﺴﯿﺎري از ﻣﻮارد اﻧﺠﺎم ﻧﻤﯽﺷﻮد و ﺑﻪ ﻧﻈﺮ ﻣﯽرﺳﺪ ﻋﻮاﻣﻞ زﯾﺎدي در آن دﺧﯿﻞ ﺑﺎﺷﻨﺪ اﻣﺎ ﻣﺪاﺧﻼﺗﯽ ﮐﻪ در دوران ﺷﯿﺮدﻫﯽ ﺟﻬﺖ اﻓﺰاﯾﺶ ﺣﻤﺎﯾﺖ اﺟﺘﻤﺎﻋﯽ از ﻣﺎدران ﻣﯽﺷﻮد ﻣﯽﺗﻮاﻧﺪ ﺑﺮ ﻣﯿﺰان ﺗﻐﺬﯾﻪ ﺑﺎ ﺷﯿﺮ ﻣﺎدر ﻣﻮﺛﺮ ﺑﺎﺷﺪ. اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺎ ﻫﺪف ﺗﻌﯿﯿﻦ ﺗﺎﺛﯿﺮ ﺑﺎزدﯾﺪ از ﻣﻨﺰل ﺑﺮ ﺣﻤﺎﯾﺖ اﺟﺘﻤﺎﻋﯽ و ﺗﺪاوم ﺗﻐﺬﯾﻪ اﻧﺤﺼﺎري در ﺷﻬﺮﺳﺘﺎن ﺑﻮﮐﺎن اﻧﺠﺎم ﺷﺪ. ﻣﻮاد و روشﻫﺎ: 108ﻧﻔﺮ از ﻣﺎدران داراي ﺷﯿﺮﺧﻮار 3ﺗﺎ 5 روزه ﻣﺮاﺟﻌﻪﮐﻨﻨﺪه ﺑﻪ 8 ﻣﺮﮐﺰ ﺑﻬﺪاﺷﺘﯽ درﻣﺎﻧﯽ ﺷﻬﺮﺳﺘﺎن ﺑﻮﮐﺎن از ﻃﺮﯾﻖ ﺗﺨﺼﯿﺺ ﺗﺼﺎدﻓﯽ ﺑﺎ اﺳﺘﻔﺎده از ﺑﻠﻮكﺑﻨﺪي ﺗﺼﺎدﻓﯽ وارد ﻣﻄﺎﻟﻌﻪ ﺷﺪﻧﺪ و در دو ﮔﺮوه ﻣﺪاﺧﻠﻪ و ﮐﻨﺘﺮل ﻗﺮار ﮔﺮﻓﺘﻨﺪ. ﻣﺪاﺧﻠﻪ ﺷﺎﻣﻞ 6 ﺑﺮﻧﺎﻣﻪ آﻣﻮزﺷﯽ ﺑﺎزدﯾﺪ از ﻣﻨﺰل ﺣﺪود 30 دﻗﯿﻘﻪاي ﺑﻮد. اﺑﺰارﻫﺎي ﻣﻮرد اﺳﺘﻔﺎده ﺷﺎﻣﻞ ﭘﺮﺳﺶﻧﺎﻣﻪ دﻣﻮﮔﺮاﻓﯿﮏ و ﺗﺎرﯾﺨﭽﻪ ﻣﺎﻣﺎﯾﯽ، اﺑﺰار ﺣﻤﺎﯾﺖ اﺟﺘﻤﺎﻋﯽ ادراك ﺷﺪه زﯾﻤﺖ و ﭘﺮﺳﺶﻧﺎﻣﻪ ﻣﺤﻘﻖﺳﺎﺧﺘﻪ ﺗﻐﺬﯾﻪ اﻧﺤﺼﺎري ﺑﺎ ﺷﯿﺮ ﻣﺎدر ﺑﻮد. ﯾﺎﻓﺘﻪﻫﺎ: اﮐﺜﺮ ﻣﺎدران در ﮔﺮوه ﻣﺪاﺧﻠﻪ ﺗﻐﺬﯾﻪ اﻧﺤﺼﺎري را ﺗﺎ ﻣﺎه ﭼﻬﺎرم و اﮐﺜﺮﯾﺖ در ﮔﺮوه ﮐﻨﺘﺮل ﺗﻐﺬﯾﻪ اﻧﺤﺼﺎري را ﻓﻘﻂ ﺗﺎ ﻣﺎهﻫﺎي اول و دوم اداﻣﻪ دادﻧﺪ. ﺑﻪﻃﻮر ﮐﻠﯽ ﻣﯿﺎﻧﮕﯿﻦ ﺗﻌﺪاد ﻣﺎهﻫﺎي ﺷﯿﺮدﻫﯽ در ﮔﺮوه ﻣﺪاﺧﻠﻪ 3/15±1/01 ﻣﺎه و در ﮔﺮوه ﮐﻨﺘﺮل 1/0±71/906 ﻣﺎه ﺑﻪدﺳﺖ آﻣﺪ. ﻫﻢﭼﻨﯿﻦ اﻏﻠﺐ اﻓﺮاد ﮔﺮوه ﻣﺪاﺧﻠﻪ )76%( روزاﻧﻪ ﺑﯿﺶ از 8 ﺑﺎر ﺷﯿﺮدﻫﯽ داﺷﺘﻨﺪ، درﺣﺎﻟﯽﮐﻪ اﮐﺜﺮ ﻣﺎدران ﮔﺮوه ﮐﻨﺘﺮل )88%( ﮐﻢﺗﺮ از 8 ﺑﺎر ﺷﯿﺮدﻫﯽ داﺷﺘﻨﺪ. ﻧﻤﺮه ﺣﻤﺎﯾﺖ اﺟﺘﻤﺎﻋﯽ درﯾﺎﻓﺖ ﺷﺪه ﻣﺎدران ﺷﯿﺮده در ﮔﺮوه ﮐﻨﺘﺮل و ﻣﺪاﺧﻠﻪ ﺗﻔﺎوت آﻣﺎري ﻣﻌﻨﯽداري ﻧﺪاﺷﺖ. ﻧﺘﯿﺠﻪﮔﯿﺮي: ﺑﺎزدﯾﺪ از ﻣﻨﺰل و ﭘﯿﮕﯿﺮيﻫﺎ ﺑﺎﻋﺚ ﻣﯽﺷﻮد ﮐﻪ ﺗﻐﺬﯾﻪ اﻧﺤﺼﺎري ﺑﺎ ﻣﺪت ﻃﻮﻻﻧﯽﺗﺮ و دﻓﻌﺎت ﺑﯿﺶﺗﺮي در ﺷﺒﺎﻧﻪروز اﻧﺠﺎم ﺷﻮد. ﮐﻪ ﻣﯽﺗﻮان ﺑﺎزدﯾﺪ در ﻣﻨﺰل را ﺟﻬﺖ ارﺗﻘﺎ وﺿﻌﯿﺖ ﺷﯿﺮدﻫﯽ در ﻧﻈﺮ ﮔﺮﻓﺖ در اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺎزدﯾﺪ از ﻣﻨﺰل ﺑﺮ ﺣﻤﺎﯾﺖ اﺟﺘﻤﺎﻋﯽ درك ﺷﺪه ﻣﺎدران اﺛﺮي ﻧﺪاﺷﺖ ﮐﻪ ﺑﻪ ﻧﻈﺮ ﻣﯽرﺳﺪ ﻣﻄﺎﻟﻌﺎت ﺑﯿﺶﺗﺮي در آﯾﻨﺪه در اﯾﻦ زﻣﯿﻨﻪ ﺑﺎ زﻣﺎن ﭘﯿﮕﯿﺮي ﻃﻮﻻﻧﯽﺗﺮ و ﯾﺎ اﻧﺠﺎم ﻣﻄﺎﻟﻌﻪ ﮐﯿﻔﯽ ﮐﻪ ﺑﺎ ﻧﻔﻮذ در ﻻﯾﻪﻫﺎي ﻋﻤﯿﻖﺗﺮ ﺑﺴﺘﺮ ﻓﺮﻫﻨﮕﯽ ﺷﻬﺮ ﺑﻮﮐﺎن در ﮐﺮدﺳﺘﺎن ﭘﺮداﺧﺘﻪ ﺷﻮد ﺗﺎ ﺑﻪ ﺑﻬﺒﻮد ﺣﻤﺎﯾﺖ اجتماعي در بازديد منزل كمك كرد.

Exclusive breastfeeding does not continue until six months in many places. It is seem, many factors are involved. The interventions for increase mothers’ social support during breastfeeding could be effective. The aim of this study was to examine effect of home visit on social support and the continuity exclusive breastfeeding in Bokan city from kurdestan province. Materials and Methods: In this research, 108 mothers which have 3-5 day’s old neonates that were referred to 8 health care centers of Bokan (Iran). They were entered into the study by random allocation using randomized block design and were divided into intervention and control groups. The intervention consisted of six home-based training programs of about 30 minutes. The instruments used included demographic questionnaire and midwifery history, perceived social support tool of Zimet, and a researcher-made questionnaire on exclusive breastfeeding. Results: Most mothers in the intervention group continued exclusive breastfeeding until the fourth month, and the majority in the control group continued exclusive breastfeeding until the first and second months. In general, the mean number of breastfeeding months in the intervention group was 3.15±1.01 months and in the control group 1.71±0.906 months. Also, most people in the intervention group (76%) had more than 8 times breastfeeding per day, while most mothers in the control group (88%) had less than 8 times breastfeeding. Mothers’ perception social support score were not significant difference in two groups. Conclusion: Home visit and follow-ups have led to a long-term exclusive breastfeeding and more often overnight, so itchr('39')s possible to set up such plans to enhance breastfeeding status. Home visit did not effect on mothers’ perceive social support and fathers’ attitude. It is seem to need future further interventions in this field with long time follow up and qualitative study with influence in deep layer in culture people in Bokan city