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Problem: Separating women and babies immediately after birth contributes to poor birth experience and reduced satisfaction., Background: A negative birth experience can impact a woman's transition to motherhood and emotional well-being beyond the newborn period. Separating women from their baby at birth is known to reduce birth satisfaction and is more likely to happen at caesarean section births., Question: What is the experience of women who are separated from their baby after caesarean section birth without medical necessity?, Methods: Unstructured, in-depth phenomenological interviews were conducted with fifteen women who had been separated from their well-baby at caesarean section birth. Data was analysed using a Modified van Kaam approach. A novel feminist phenomenological framework with two birthing theories was used to explore the experience of the participants., Findings: Four major themes emerged - Disconnection, Emotional Turmoil, Influence, and Insight. These demonstrated significant trauma that both the separation and perinatal care created., Discussion: The participants recognised their vulnerability and the lack of power and control they had over themselves and their baby, which was seemingly not acknowledged. Provider and hospital needs were valued above those of the women., Conclusion: Woman-centred care was not evident in the treatment of these women despite the attendance of a midwife at each birth. This research challenges midwives and other health care providers to support and advocate for those birthing by caesarean section to return power and control and support them to remain in close physical contact with their baby immediately after birth., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Problem: Despite the pressing need to grow the Australian midwifery workforce, the rising cost of living is making midwifery education programs unaffordable for many. Understanding of the financial hardships faced by Australian midwifery students is currently limited., Background: Attrition from midwifery programs is high and rising. In Australia, this is further compounded by the financial pressures brought about by the cost-of-living crisis. Attending compulsory unremunerated clinical placements and being 'on call' for continuity of care experiences contributes to the financial challenges of midwifery students., Aim: To identify and synthesise available literature addressing financial hardship faced by Australian midwifery students during their studies., Methods: Arksey and O'Malley's framework guided this scoping review. Six databases were searched between January 2020 and April 2024. The key findings of eight included papers were thematically analysed., Findings: Four themes were identified; "Attending placements and supporting COCE's as key contributors to financial hardship", "Impacts of financial hardship on midwifery students and their wider family", "Impacts upon the future growth and diversity of the profession" and "The need for universal financial support"., Discussion: The findings highlight the nature of financial challenges, causational factors and the consequences of financial hardship associated with completing midwifery programs in Australia. Appropriate universal financial support is urgently needed if we are to grow and sustain the midwifery workforce., Conclusion: With no primary studies specifically exploring financial hardship faced by Australian midwifery students, further research is required to understand the challenges they face and evaluate the efficacy of funding initiatives., Competing Interests: Conflict of Interest The authors declare no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Although digital educational resources are used worldwide to educate new parents, the impact of digital resources tailored specifically to women's needs on breastfeeding practices is not well explored., Aim: The study aimed to evaluate the effectiveness of using a women-centred Web-Based Breastfeeding Educational Resource (WEBBER) in increasing the rate of exclusive breastfeeding at one month after birth., Methods: A quasi-experimental study with before and after intervention was conducted in one metropolitan hospital in Saudi Arabia. Participants were primiparous women (n=290) aged 18 or above who intended to breastfeed. The intervention involved introducing the WEBBER to pregnant women and reinforcing its uses as a routine breastfeeding educational resource. Women's characteristics and infant feeding data were collected at one month after birth via an online survey., Findings: The rate of exclusive breastfeeding at one month postpartum among the women who received the WEBBER intervention was nearly three times higher compared to the women prior to the introduction of the intervention (66 % vs. 26 %, p-value <.001). Furthermore, other predictors of exclusive breastfeeding at one month were the mother being unemployed, the baby not receiving infant formula in the hospital, and the mother having postnatal intention to continue breastfeeding for 6 months or more., Discussion and Conclusion: Using WEBBER as a routine breastfeeding educational resource increased the rate of exclusive breastfeeding one month after birth. Embedding woman-centred digital resources into routine breastfeeding education is an effective intervention for women in Saudi Arabia., Competing Interests: Conflict of Interest None to declare., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: In response to the increasing diversity in nursing education, the Legitimation Code Theory (LCT) offers a transformative approach to understanding and addressing the unique learning needs of students from various backgrounds., Objectives: To identify how Legitimation Code Theory has informed the design of professional education in biological and health sciences., Design: An integrative review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and guided by the five-step process by Whittemore and Knafl., Data Sources: A comprehensive search of eight databases was conducted (IEEEXplore, Scopus, Web of Science, ProQuest central, EBSCOHost, MEDLINE with full text, CINAHL and INFORMIT) using key concepts: Legitimation Code Theory and professional education from inception until November 2023., Review Methods: All studies were reviewed by two researchers independently. The same authors appraised the studies using the Mixed Methods Appraisal Tool with a third author providing consensus. The findings were coded and analysed using narrative synthesis., Results: From the initial 518 records screened, 11 studies were identified where Legitimation Code Theory was used in biological and health science education. There were four themes identified in the review: a) Legitimation Code Theory as a framework for data analysis; b) Identifying and enhancing learning outcomes through Legitimation Code Theory; c) Pedagogy design informed by Legitimation Code Theory; and d) Legitimation Code Theory to contextualise disciplinary knowledge., Conclusion: This review highlights the significant influence of Legitimation Code Theory on professional education, particularly in the biological and health sciences. The versatility and effectiveness of Legitimation Code Theory are evident across various disciplines, including nursing education. As a comprehensive framework, Legitimation Code Theory not only aids in pedagogy design but also facilitates the transfer of learning, thereby promoting critical thinking. This demonstrates its robustness as a tool in the realm of professional education., Competing Interests: Declaration of competing interest No conflict of interest has been declared by the authors., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aim: To describe the pre-implementation context and implementation approach, for a clinician researcher career pathway., Background: Clinician researchers across all health disciplines are emerging to radically influence practice change and improve patient outcomes. Yet, to date, there are limited clinician researcher career pathways embedded in clinical practice for nurses and midwives., Methods: A qualitative descriptive design was used., Data Sources: Data were collected from four online focus groups and four interviews of health consumers, nursing and midwifery clinicians, and nursing unit managers (N = 20) between July 2022 and September 2023., Results: Thematic and content analysis identified themes/categories relating to: Research in health professionals' roles and nursing and midwifery, and Research activity and culture (context); with implementation approaches within coherence, cognitive participation, collective action and reflexive monitoring (Normalization Process Theory)., Conclusions: The Pathway was perceived to meet organizational objectives with the potential to create significant cultural change in nursing and midwifery. Backfilling of protected research time was essential., Implications for the Profession And/or Patient Care: The Pathway was seen as an instrument to empower staff, foster staff retention and extend research opportunities to every nurse and midwife, while improving patient experiences and outcomes., Impact: Clinicians, consumers and managers fully supported the implementation of clinician researchers with this Pathway. The Pathway could engage all clinicians in evidence-based practice with a clinician researcher leader, effect practice change with colleagues and enhance patient outcomes., Reporting Method: This study adheres to relevant EQUATOR guidelines using the COREG checklist., Patient or Public Contribution: Health consumers involved in this research as participants, did not contribute to the design or conduct of the study, analysis or interpretation of the data, or in the preparation of the manuscript., (© 2024 The Author(s). Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Background: Researchers conducting studies involving pregnant women often find recruitment challenging. The COVID-19 pandemic added further complexity to studies requiring face-to-face participation., Aim: To demonstrate how to maintain the principles of practice development (PD) when a study must switch from face-to-face to remote methods of collecting data., Discussion: The number of participants in the authors' study increased when they moved from face-to-face to telephone engagement during the COVID-19 pandemic. They continued using PD principles when they changed method and the quality of the data they collected remained constant, even once lockdown restrictions were in place., Conclusion: PD principles can offer ways for nurse researchers to engage, collaborate with and reflect with people for research projects, including when constraints compete with participation. They can also assist researchers in optimising and maintaining recruitment and data collection when face-to-face research methods are impossible., Implications for Practice: The telephone can be a valuable alternative medium for recruiting participants and collecting data when face-to-face methods are impossible to use. PD principles can be maintained and response rates and participation may even be greater when using it., Competing Interests: None declared, (© 2024 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

Aim: To use Legitimation Code Theory as a framework to inform the design of nursing education and gain insights into student perspectives of this design., Background: Internationally, the World Health Organization's breastfeeding recommendations are not being met. One contributing factor is that healthcare providers including registered nurses lack the knowledge to support breastfeeding women on an ongoing basis and rely on their personal experiences to inform the care they provide. Undergraduate nursing students should receive education to assist breastfeeding women in practice., Design: The study is underpinned by case-study methodology. The Legitimation Code Theory (LCT) dimension of Semantics and the concepts of semantic gravity and semantic density were used to theoretically frame and develop an intervention module to teach undergraduate nurses about breastfeeding., Methods: This module was part of an elective seven-week paediatric nursing course. University Human Research Ethics Committee (HREC201/203) reviewed the study. Participants (n = 9) completed semi-structured interviews and thematic analysis helped us to understand their experiences of the module. The Template for Intervention and Description and Replication (TIDeR) framework was used to report the intervention., Results: The breastfeeding module was positively received by participants who noted the module's structure differed from previous courses. Three main themes were identified in the student experience. These are: a) threads and links; b) engaging structure; and c) seedlings., Conclusion: Legitimation Code Theory is an effective course development framework to harness the learners' prior informal knowledge and weave learning activities between theory and contextual practice to develop cumulative knowledge., Impact: With an increased understanding of how undergraduate nursing students develop knowledge, the LCT dimension of Semantics can be ussed to structure content knowledge in instructional design. This approach builds explicit bridges between knowledge development in the nursing curriculum and learners' informal knowledge and contextual practice in clinical settings., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Respectful maternity care (RMC) is a crucial strategy in improving postpartum experiences of mothers. This study aimed to explain women's perception of determining aspects and determinants of disrespect and abuse (D&A) during childbirth. This study was carried out from October 2019 to February 2020 in Tabriz-Iran. A total of 12 postpartum women were enrolled in this qualitative study by purposive sampling. The data were collected through in-depth semi structured interviews and simultaneously analyzed with a conventional content analysis approach. Thirty eight sub-themes and 11 main themes extracted from data analysis. The main themes included: "physical abuse," "psychological violence," "discrimination," "violation of privacy," "unmet needs and preferences," "nonparticipation in decision-making," "abandonment of women," "Lack of sympathy," "shortage of human and non-human resources," "unpleasant psychological atmosphere of the ward" and "facilitators of D&A." The results of our study indicated the importance of sympathy with mothers and professional ethics. Moreover, healthcare providers, administrators, and policy-makers should design patient-centered interventions in order to secure the material, psychological, and legal needs of women to receive respectful maternity care.

Background: Woman-centered care (WCC) is the cornerstone of the midwifery profession. However, no study has been conducted on WCC provided by Iranian midwives and its associated factors. Thus, this study aimed to determine WCC and factors associated with midwives' WCC for midwives working in urban health centers and public and private hospitals in Tabriz, Iran., Methods: This cross-sectional study was the first part (i.e., the quantitative phase) of a sequential explanatory mixed-method study conducted on 575 midwives working in urban health centers and public and private hospitals in Tabriz-Iran from November 2022 to January 2023. The required data was collected by distributing a socio-demographic and job characteristics questionnaire and woman-centered care scale-midwife self-report (WCCS-MSR). To determine the factors associated with WCC, an independent t-test or one-way analysis of variance (ANOVA) was used in bivariate analysis, and a general linear model (GLM) was employed in multivariate analysis to control possible confounding variables., Results: The statistical population consisted of 575 midwives, with a response rate of 88.2%. According to the GLM, the total mean WCCS-MSR score of single [β (95% CI) 23.02 (7.94 to 38.10)] and married [β (95% CI) 21.28 (6.83 to 35.72)] midwives was significantly higher than that of divorced midwives after adjusting their demographic and job characteristics. Also, the total mean WCCS-MSR score of midwives with sufficient income was significantly higher than those with insufficient income [β (95% CI) 8.94 (0.12 to 17.77). In addition, the total mean WCCS-MSR score of midwives with < 5 years of work experience [β (95% CI) - 7.87 (- 14.79 to - 0.94)], and midwives with official-experimental employment status [β (95% CI) - 17.99 (- 30.95 to - 5.02)], was significantly lower than those with more than 5 years of work experience and contractual employment status., Conclusions: The findings indicate that marital status, level of income, years of practice, and employment status were significantly related to WCC provided by midwives. Focusing only on the midwifery community is insufficient to ensure the improved quality of WCC. However, arrangements should be made at three levels, including policy-makers, managers, and health care provider (midwives)., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Aim: The present study aimed to evaluate the status of WCC provided by Iranian midwives., Design: A sequential explanatory mixed method study protocol., Methods: The present study was conducted in three phases: quantitative, qualitative and mixed. The first phase is a cross-sectional study that will be performed on midwives working in health centres, public and private hospitals in Iranian. The second phase is a qualitative study, in which purposeful sampling will be used, meaning that the midwives who are part of the extreme cases according to the results of quantitative phase and are willing and able to express their own experiences regarding WCC will be selected. Also, pregnant and parturient women under their cover will also be interviewed. Finally, in the mixed phase, we will use a combination of two quantitative and qualitative studies, a literature review and expert opinion using a Delphi method to provide strategies to improve and promote WCC in midwives., Results: Achieving this goal is expected to provide positive outcomes such as strengthening the midwives professional relationship with women and reducing health care costs. No Patient or Public Contribution., (© 2023 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Aim: To explore adolescent pregnant women's perception of health practices., Design: A qualitative study., Method: Fifteen pregnant women in Tehran (capital of Iran) were selected based on purposive sampling to participate in semi-structured, in-depth interviews. The content of interviews was recorded and transcribed and then analysed using conventional content analysis., Results: The first theme extracted was health practice with main categories of balanced rest/activity pattern, observance of an appropriate diet, sensitivity to personal health, observance of an appropriate pattern of social interactions, religious and spiritual orientations, recreational and leisure time activities, and stress management; second theme was perceived benefits with main categories of a sense of physical health improvement, a sense of mental health improvement, positive attitudes towards the effect of nutrition on pregnancy and childbirth health; and third theme was effective factors with main categories of facilitators of health practices and inhibitors of health practices., Conclusions: Most pregnant adolescents' perception of health practices is at a satisfactory level; however, some inhibitors of health practice were explored in this study. These should be improved by adopting appropriate approaches in health policies. No Patient or Public Contribution., (© 2023 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Aim: The purpose of this study was to investigate the cultural and linguistic appropriateness of the content, images and layout of the web-based breastfeeding educational resource for Saudi women using a consensus development approach., Background: Although the World Health Organization highly recommends exclusive breastfeeding, there is a decline in breastfeeding rates in Saudi Arabia, especially during hospital stay. The combining of health professional support with e-technology tools has been proposed as a method to increase exclusive breastfeeding. However, the cultural and linguistic appropriateness of an e-technology-based approach has not been explored in Saudi women., Methods: After developing a content draft of the web-based breastfeeding educational resource specific to Saudi culture, an online consensus development conference was organised with ten participants including two university researchers and eight health care providers to investigate the cultural and linguistic appropriateness of the educational content. The participants from Saudi Arabia were Saudi mothers who had breastfeeding experiences and were key maternity health professionals employed at the Maternity and Children Hospital of Dammam, Saudi Arabia. The SQUIRE checklist was used in the reporting of this study., Results: Feedback received prior to the meeting showed that 81% of the content was acceptable and minor changes were required. Changes were made to the content based on the suggestions and feedback received. The consensus group accepted all the changes and the content was finalised., Conclusions: The online consensus development conference was found to be a very convenient way to decide on the cultural and linguistic appropriateness of the content of the web-based breastfeeding educational resource allowing the participation of experts from different countries; this was considered a critical step in ensuring the successful implementation of the intervention., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Lack of perceived support and control during labor and childbirth is known as an important predictor of post-traumatic stress disorder following childbirth. However, there is no standard scale to measure perceived support and control for Iranian women. This study determined the validity and reliability of the support and control in birth questionnaire for Iranian women., Materials and Methods: Support and control in the birth questionnaire were translated into Persian by the forward and backward translation method in 2019. Among a total of 102 healthcare centers in Tabriz, 50 urban and 10 rural centers were selected randomly. Then, 660 women with vaginal childbirth during the postpartum period were extracted by each center and selected randomly. The validity of the Persian version was evaluated in terms of face, content, and construct validity. Internal consistency and reliability were assessed by Cronbach's alpha coefficient and intraclass correlation coefficient, respectively. Exploratory and confirmatory factor analyses were used for evaluating the construct validity of the tool., Results: Cronbach's alpha coefficient (0.95) and intraclass correlation coefficient (0.99) were acceptable. In an exploratory analysis, three factors were extracted and these three factors explained 63.1% of the total variance. Items 14 and 17 were removed from the Persian version due to low factor loading and impact factor values. Confirmatory factor analysis supported the three factors extracted in the exploratory analysis. Confirmatory factor analysis showed suitable indexes of fitness for 31 items., Conclusion: Persian version of the support and control in the birth questionnaire is a valid and reliable tool for the Iranian women population., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Education and Health Promotion.)

Background: Breastfeeding protects against a range of conditions in the infant, including sudden infant death syndrome (SIDS), diarrhoea, respiratory infections and middle ear infections [1, 2]. The World Health Organization (WHO) recommends exclusive breastfeeding until six months of age, with continued breastfeeding recommended for at least two years and other complementary nutritious foods [3]. The 2017-18 National Health Survey (NHS) and 2018-19 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) reported that the proportion of breastfeeding in Aboriginal and Torres Strait Islander infants (0-2 years) were less than half that of non-Indigenous infants (21.2% vs. 45%, respectively)[4]. There is a lack of research on interventions supporting Aboriginal women to breastfeed, identifying an evaluation gap related to peer support interventions to encourage exclusive breastfeeding in Aboriginal women., Methods: We will evaluate the effect of scheduled breastfeeding peer support for and by Aboriginal women, on breastfeeding initiation and the prevalence of exclusive breastfeeding. This MRFF (Medical Research Future Fund) funded project is designed as a single-blinded cluster randomised controlled trial recruiting six sites across New South Wales, Australia, with three sites being randomised to employ a peer support worker or undertaking standard care. Forty pregnant women will be recruited each year from each of the six sites and will be surveyed during pregnancy, at six weeks, four and six months postnatally with a single text message at 12 months to ascertain breastfeeding rates. In-depth interviews via an Indigenous style of conversation and storytelling called 'Yarning' will be completed at pre- and post-intervention with five randomly recruited community members and five health professionals at each site" [5]. Yarns will be audio recorded, transcribed, coded and thematic analysis undertaken. Health economic analysis will be completed to assess the health system incremental cost and effects of the breastfeeding intervention relative to usual care., Discussion: Evidence will be given on the effectiveness of Aboriginal peer support workers to promote the initiation and continuation of breastfeeding of Aboriginal babies. The findings of this study will provide evidence of effectiveness and cost-effectiveness of including peer support workers in postnatal care to promote breastfeeding practices., Trial Registration: ACTRN12622001208796 The impact of breastfeeding peer support on nutrition of Aboriginal infants., (© 2023. The Author(s).)

Background: Disrespect and abuse during childbirth is regarded as harassment of women and a violation of their rights. The aim of this study was to assess the psychometric properties of the disrespect and abuse questionnaire in Iranian parturient women., Materials and Methods: This cross-sectional study was conducted on 265 postpartum women in both private and public hospitals in Tabriz, Iran. The scale was translated from English into Farsi. In the quantitative face validity, the impact score was determined for each item. Moreover, in the quantitative content validity, the Content Validity Ratio (CVR) and Content Validity Index (CVI) were assessed based on the comments of experts on the relevance, clarity, and simplicity of items (CVI) and the necessity of items (CVR). Construct validity was assessed through exploratory and confirmatory factor analyses., Results: In the face validity assessment, all items received a minimum impact score of 1.5. In assessing the content validity, all the items attained the minimum acceptable value of CVR (>0.69) and CVI (>0.79). According to the exploratory factor analysis, the Disrespect and Abuse Questionnaire has 23 items and five factors, including abandoning the mother, improper care, mother's immobility, not talking to the mother, and mother's deprivation. The construct validity of the scale was confirmed by the confirmatory factor analysis, in which X 2 /df <5 and root mean square error of approximation <0.08., Conclusions: The Farsi version of the disrespect and abuse questionnaire can be used as a valid tool for assessing instances of lack of respectful maternity care in the postpartum period., Competing Interests: Nothing to declare., (Copyright: © 2023 Iranian Journal of Nursing and Midwifery Research.)

Introduction: Despite the health benefits of breastfeeding, Saudi women do not exclusively breastfeed their babies. The purpose of this article was to synthesize Saudi women's breastfeeding knowledge, attitude, and practices and identify the factors that women reported for their breastfeeding cessation., Methodology: A systematic review and meta-analysis of randomized clinical trials and cross-sectional studies was undertaken., Results: Saudi women reported poor knowledge in managing breastfeeding challenges and had a positive attitude toward formula feeding. Giving premade formula and sugar water was a common practice. The breastfeeding initiation rate (31.5%, 95% confidence interval [CI]: [22%, 41.8%]) and exclusive breastfeeding at 6 months were low (15.15, 95% CI: [8%, 24%]). Perceived low milk supply, returning to work, and using contraception were the main reasons for early breastfeeding cessation., Discussion: The integration of Islamic, political, and economic cultures in Saudi Arabia can influence women's breastfeeding practices. There is a need for culturally appropriate breastfeeding educational programs for Saudi women.

Introduction: The objective of this review is to synthesise and present the best available evidence on the prevalence, predictors and information needs about sexual health among female Arab cancer survivors., Methods: The databases searched included MEDLINE, Embase and CINAHL from inception of the database until March 2020. The review was undertaken according to the JBI guidelines. Proportional meta-analysis using a random effects model was used for statistical pooling through JBI SUMARI., Results: Seven studies involving female Arab cancer survivors were included in the review. The overall prevalence of sexual dysfunction ranged from 16.7 to 67% (pooled estimate 51%, 95% CIs 21.7% to 80.2%). Dyspareunia and erectile dysfunction were the two main types of sexual dysfunction reported after diagnosis, and the overall prevalence ranged from 42.5% to 65% and 38% to 61%, respectively. The prevalence of vaginal dryness was ranged from 19.8% to 54.2%, and dyspareunia ranged from 22.2% to 65%. The lack of sexuality information and communication with health care providers (HCPs) was also reported in the included studies., Conclusion: Cancer and its treatment may result in significant difficulties with sexual activity and sexual functioning among cancer survivor. Communication between the health care professionals and cancer survivors is essential to overcome this problem and improve the quality of life of female Arab cancer survivors., (© 2022 The Authors. European Journal of Cancer Care published by John Wiley & Sons Ltd.)

Background: The prevalence of cesarean birth in Iran is very high. Having a negative childbirth experience is one of the reasons that primiparous women provide to prefer caesarean birth over a vaginal birth. This study is aimed to understand women's perspective on what determines a positive or negative birth experience for them., Methods: This qualitative study is a part a mixed method study that was conducted among primiparous women with a previous vaginal birth experience. The purpose of the main study was to develop a guideline based on Iranian primiparous women's birth experiences. The quantitative phase of the study was a cross-sectional study where women's childbirth experiences was measured in a survey via the Childbirth Experience Questionnaire-2. In the qualitative part of the study, women were invited for an in-depth interview via a random stratified sampling method based on their childbirth mean score (women with 10% of the upper bound score which indicated a positive birth experience and 10% of the lower bound indicating negative birth experience, n = 17). Conventional content analysis was used for data analysis., Results: We extracted three main themes: (a) "Internal control", (b) "External control", and (c) "Support". Possessing internal control, having a balanced external control to feel cared and feeling supported were the main reasons for women to feel positive about their birth experiences. Whereas, loss of internal control, imbalanced external control and unsupportive environment were related to their negative childbirth experiences., Conclusion: Considering that women's sense of control, the care and support that they receive can influence their childbirth experiences, there is a need for changing maternity policies and practices to highlight the importance of a woman-centred care to create a pleasant, respectful and positive memory for primirparous women who experience normal vaginal births., (© 2022. The Author(s).)

Aim: The aim of this review was to explore the preregistration nursing students' breastfeeding knowledge and the sources they used to develop that knowledge as a health care professional., Background: New registered nurses do not feel prepared to support breastfeeding women in neonatal and paediatric settings., Results: Preregistration nursing students have sufficient knowledge of the physiology of lactation but insufficient knowledge on supporting women to decide on the practical aspects of breastfeeding and its challenges for healthy or sick babies. The sources of knowledge included the students' personal experiences and the education and training that they received during their nursing course. The two themes extracted from the data that related to the sources of knowledge were: a) informal knowledge through experience and b) formal education., Conclusions: There is a need for new ways to align the students' informal sources of breastfeeding knowledge to their formal education, focusing on supporting women to make decisions on the practical aspects of breastfeeding, including the most common challenges., Tweetable Abstract: Nursing students' knowledge of breastfeeding practice: an integrative review., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Assessment of women's childbirth experience is an important indicator in maternity services. Positive childbirth experiences improve mothers' health, whereas negative childbirth experiences can cause psychological stresses and, in extreme cases, may lead to postpartum depression., Methods: In this cohort study, 204 women at 35-37 weeks of gestation were selected using cluster sampling from the health centers of Tabriz, Iran. Women were divided into three groups (68 women in each group) based on their attendance in childbirth preparation classes: (a) non-attenders (did not attend any sessions), (b) irregular attenders (attended 1-3 sessions), and (c) regular attendants (attended 4-8 sessions). Interviews were conducted at one month postpartum to complete the Childbirth Experience Questionnaire (CEQ) and Edinburgh Postnatal Depression Scale (EPDS). The general linear model (GLM) was used to identify associations between women's attendance to the classes and either their childbirth experience or postpartum depression scores., Results: Based on the GLM, the mean score of childbirth experience among the regular attenders was significantly higher than women who were irregular attenders ( p = .032) or non-attenders ( p < .001). In addition, the mean score of postpartum depression scale was significantly lower among regular attenders compared with non-attenders ( p < .001). However, there was no significant difference in postpartum depression score among regular and irregular attenders ( p = .257)., Conclusions: Attending prenatal classes was associated with positive childbirth experience and low postpartum depression score.

Background: Many women stop breastfeeding earlier than what they intended prior to birth. Although there are many studies that focus on the factors that influence women's antenatal breastfeeding decisions, the factors that influence women's decisions during the continuum of antenatal and postnatal period are less known., Aim: To understand and synthesise the contemporary factors that influence women's decisions on infant feeding from the antenatal period and across the breastfeeding continuum., Method: Five online databases (CINAHL, Medline, PubMed, Scopus and Web of Science) were searched. We included original search articles that were published since 2015 to August 2021 and were available in English. The framework of Whittemore and Knafl was used to guide this integrative literature review. Out of the 872 articles identified, 14 studies met the inclusion criteria of our study. We used theory of birth territory and midwifery guardianship to synthesise the interactions between the themes., Findings: Five main themes were identified: (a) Women's own views, (b) Family and friend's preferences and advice, (c) Health professional's preference, advice and practice, (d) Sociocultural norms, and (e) Media representation. The interaction between the themes was explained based on women's intrinsic and extrinsic power outlined in the birth territory and midwifery guardianship theory., Conclusion: The factors that influence women's decisions towards infant feeding methods are complex and multi-dimensional. Promoting and supporting women towards breastfeeding need to focus on the factors that are tailored for a woman within her social network where she can feel safe about her breastfeeding decisions., (Copyright © 2021 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Background: Persuasive design principles are increasingly employed in mHealth apps for motivating users and promoting healthy behaviours among individuals. However, how the persuasive design principles are perceived by the mHealth app users remains unclear., Aim: To develop and validate the content validity of an instrument designed to measure the user's perceptions of the persuasive design principles assimilated in a breastfeeding mHealth app., Methods: A critical review of the literature guided the development of the research instrument. The developed instrument was refined and validated through a two-round modified Delphi process. Ten experts drawn from academic and clinical settings evaluated the items through two content validity indicators, relevance, and clarity and provided narrative feedback. The content validity of the instrument was determined by calculating the Content Validity Index (CVI). Content validity indicators at the scale-level (S-CVI) and item-level (I-CVI) were calculated., Results: The results demonstrated high content validity index of individual items in the instrument. All items in the instrument reached an excellent I-CVI ≥ 0.78 for both relevance and clarity except one item. The overall content validity index of the instrument using the average approach was moderate to high (S-CVI/Ave was 0.89 and 0.92 for relevance and clarity, respectively). The developed research instrument is composed of 5 constructs representing 24 items: (1) primary task support, (2) dialogue support, (3) system credibility support, (4) social support and (5) perceived persuasiveness., Conclusions: Using a modified Delphi approach, the development and validation of the research instrument demonstrated moderate to high content validity for measuring users' perceptions of the persuasive design principles assimilated in a breastfeeding mHealth app. The evidence from this study supports that the research instrument is valid, relevant, and clear., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: There is no comprehensive guideline for respectful maternity care (RMC) promotion in Iran. This study aimed to design a RMC guideline based on a multiphase study., Methods: In this multiphase mixed-methods study, recommendations were made for RMC promotion through the data obtained from Phase I (i.e., the quantitative section with a cross-sectional design), Phase II (i.e., the qualitative section with a content analysis method), and Phase III (i.e., focus group discussions with birth attendants as well as opinions of the specialized panel through the Delphi technique). The composed recommendations were then analyzed and finalized by relevant specialists in terms of execution capacity, approvability, and cost-effectiveness within the current context of Iran. Eventually, the resultant guideline were evaluated and approved by two members of the research team specializing in the research area in accordance with the Appraisal of Guideline for Research and Evaluation (AGREE)., Results: The results of this multiphase study led to 80 recommendations for RMC promotion. The recommendations were classified as eight areas called recommendations for the pregnancy period, recommendations for the labor period and delivery, recommendations for the neonatal period, occupational recommendations, supervision recommendations, national policy recommendations, recommendations for training students and staff, and general public recommendations., Discussion: Based on the outcomes of disrespect and abuse, it is recommended to provide comprehensive guideline for policymakers and planners to formulate plans through the RMC promotion approach. Healthcare service policymakers can use this guideline to design some interventions to meet women's financial, psychological, and legal needs., (© 2022. The Author(s).)

Problem: Women with gestational diabetes have higher rates of introducing infant formula before leaving hospital., Background: Despite health professional support, less women with gestational diabetes exclusively breastfeed in hospital., Aim: To find factors that positively influence in-hospital exclusive breastfeeding practices among women with gestational diabetes., Methods: An online search was performed in Medline, Scopus, Pubmed, CINAHL and Cochrane databases. Studies containing the keywords gestational diabetes and breastfeeding were retrieved., Findings: Authors identified 1935 papers from search criteria. Twenty-six papers with no restrictions on research design met inclusion criteria and were included in the review. Factors were divided into personal, antenatal, intrapartum and postnatal factors. The main modifiable factors that were associated with improved in-hospital exclusive breastfeeding rates were having a strong intention to breastfeed, being confident, feeling supported and having continuity of education and support. Women's main reasons to introduce formula were related to baby's hypoglycaemia, delayed lactogenesis II and perceived low milk supply. Skin-to-skin contact after birth combined with frequent breastfeeds were effective ways to improve in-hospital exclusive breastfeeding rates., Conclusion: Influencing factors such as women's breastfeeding intention, confidence and ongoing support are no different to the general population of women. However, promoting skin-to-skin contact after birth combined with frequent feeds are crucial for women with gestational diabetes who are more likely to introduce formula due to delayed lactogenesis II and fear of neonatal hypoglycaemia. There is a need for developing educational and supportive interventions that are tailored specifically for women who have gestational diabetes., (Copyright © 2021 Australian College of Midwives. All rights reserved.)

Objective: to evaluate the perceptions of primiparous women about the effect of childbirth preparation classes on their childbirth experience., Design: descriptive qualitative study., Participants and Setting: 13 Iranian women who participated in childbirth preparation classes and had a vaginal delivery were interviewed., Measurements: semi-structured interviews were used to collect data., Findings: six main themes were extracted from the data analysis: incentive and learning about pregnancy and childbirth; active participation in labour; sense of self-control; use of non- medical pain relief methods during labour; preferring vaginal birth to caesarean section; and positive childbirth experience., Key Conclusions: women reported that participation in childbirth preparation classes prepared them well for a vaginal birth, and these classes were perceived to be associated with a positive childbirth experience., Implications for Practice: attendance at childbirth preparation classes is perceived to have a positive effect on vaginal birth. Therefore, encouraging and supporting women to attend the full course of classes has the potential to increase women's preference towards vaginal birth, resulting in a reduction in the caesarean section rate., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2021. Published by Elsevier Ltd.)

Objective: Sex and intimacy are basic needs and important aspects of quality of life among humans. This focus of this review was to synthesise and present the best available qualitative evidence on the sexual life experiences and needs of Chinese adults living with cancer. Moreover, the first-hand experience, meaning and perspective about the sexual life changes and support needs during the survival and extended treatment period were synthesised in this study., Methods: A systematic review of qualitative studies was undertaken using the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI-SUMARI). A comprehensive search of five databases: CINAHL, MEDLINE, PubMed, Scopus and Google Scholar were undertaken from 2010 until February 2020 using defined criteria. Methodological quality and data extraction were undertaken using JBI-SUMARI., Results: Eight studies were included in the review. A total of 39 findings were extracted and aggregated into eight categories based on similarity of meaning. Three synthesised themes were generated: (i) misconceptions and lack of education or information regarding sexual activity exists for patients with cancer, (ii) concerns for overall health and well-being as well as physical and psychological changes can alter sexual desire and behaviours in patients with cancer and (iii) lack of sexual activity and intimacy can create relationship problems., Conclusions: Sexual relationships are intimate, personal and private in Chinese culture and beliefs. Chinese adults living with cancer report many neglected issues on sexual well-being in various domains. Adequate and consistent education about sexual intimacy issues from health care providers was identified as an important need. Unaddressed needs might affect adults' coping strategies in managing their sexual relations during various stages of cancer treatment and beyond. It must be noted that there are many Chinese ethnic minorities living with cancer outside the Greater China region. The evidence provides valuable recommendations to health care providers globally to consider the specific sexual needs and initiate culturally sensitive sexuality education and care support for Chinese adults living with cancer., (© 2021 John Wiley & Sons Ltd.)

Aim: To determine the relationship of health practices with depression and maternal-fetal attachment in adolescent pregnant women., Methods: This prospective study was conducted on 316 adolescent pregnant women with medical records at the health centers in Tehran, Iran. The participants were selected through the complete enumeration. Data were collected using the socio-demographic and obstetrics questionnaire, the Health Practices Questionnaire-II (HPQ-II), the Edinburgh Postnatal Depression Scale (EPDS), and the Cranley's Maternal-Fetal Attachment Scale (MFAS). The data were analyzed with the Pearson correlation test, the independent t-test, one-way ANOVA, and the general linear model., Results: The mean scores of health practices, depression, and maternal-fetal attachment were 135.3 (SD 9.1, range 34-170), 10.1 (SD 5.4, range 0-30), and 91.6 (SD 8.6, range 24-120), respectively. The results of Pearson correlation test showed that health practices had a significant relationship with depression (r = -0.29) and maternal-fetal attachment (r = 0.37). Results of general linear model showed that an increase in the health practices score led to a significant decrease in depression score during pregnancy [β = -0.10; 95% CI: -0.17 to -0.04] and a significant increase in maternal-fetal attachment score [β = 0.30; 95% CI: 0.19 to 0.40]., Conclusion: There is significant relationship between health practices and depression, as well as maternal-fetal attachment in adolescent pregnant women. Therefore, intervention to improve one of them may improve the other one(s)., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Aim: To compare primiparous women's childbirth knowledge and their satisfaction with the childbirth preparation classes between regular and irregular attenders., Design: A cross-sectional study., Method: This study was conducted on 136 primiparous pregnant women attending health centres in Tabriz, Iran. Women's knowledge on childbirth and their satisfaction with childbirth preparation classes were measured by using reliable tools via interviews. An independent t test was applied to compare women's knowledge and satisfaction scores between regular and irregular attenders., Results: The mean score of knowledge was significantly higher among women who were regular attenders compared to irregular attenders (p < .001). Although there were no significant differences in total satisfaction score between the women (p = .342), women with regular attendance reported that childbirth preparation classes reduced their anxiety about labour., Conclusions: Regular attendance at childbirth preparation classes is associated with higher women's knowledge and lower feelings of anxiety regarding labour and birth., (© 2021 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Aim: The aim was to explore the experiences of new graduate nurses who provide support to breastfeeding women in neonatal care settings. The objective of this study was to explore the enablers and barriers that influenced new graduate nurses' self-efficacy., Background: Nurses have important roles in promoting and educating breastfeeding women in neonatal care settings. Although there are many studies that focused on nursing students and registered nurses' experiences in supporting breastfeeding women, there is limited research about the experiences of new graduate nurses during their transition from universities to neonatal care settings as a registered nurse where they learn how to educate and support breastfeeding women., Design: A qualitative descriptive study., Methods: Nine new graduate nurses who support breastfeeding women in neonatal care settings within Australia were recruited. Data was collected through semi-structured interviews via videoconference or telephone. Braun & Clarke's thematic analysis was used to analyse the data., Results: This study found four themes: Preparedness, Emotions, Ongoing Learning, and Confidence. Barriers and enablers included support, time, consistency of information, and impact of stereotyping. The new graduate nurses did not initially feel prepared to support breastfeeding women due to their lack of knowledge. Participants' self-efficacy enhancing strategies to help build knowledge and confidence supporting breastfeeding women included: a) frequent practice, b) having role models and seeking support, c) receiving encouragement and positive feedback, and d) interpreting their emotional feelings as a normal reaction to the learning process., Conclusion: Additional education should be provided during pre-registration education and on commencement of employment in neonatal settings to improve new graduate nurses'knowledge supporting breastfeeding women. Self-efficacy enhancing strategies can be used in partnerships between educational institutions and hospitals to support new graduate nurses to feel more confident providing breastfeeding support in neonatal care settings., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Women's satisfaction with childbirth experience is considered as one of the quality indicators of the maternity services across the world. However, there is no guideline for improving the experience of childbirth in Iran that is suitable for women with different cultural, economic, and social statuses. The aim of this study is to make recommendations for practice and propose a clinical guideline for improving the experience of women with vaginal births., Methods/design: The study design was a mixed method study with a sequential explanatory approach consisting of three phases. The first phase of the study was a cross-sectional study to identify the predictors of traumatic vaginal childbirth experience among 800 primiparous women from Tabriz health centers who had vaginal birth. Data collection tools in this phase were Childbirth Experience Questionnaire (CEQ) and Support and Control in Birth (SCIB). Both tools were validated for Farsi language. The second phase was a qualitative study with 17 in-depth individual interviews among women who took part in the first phase to better understand their reasons that influenced their childbirth experience either positively or negatively. The third phase of the study was to develop recommendations for a proposed clinical guideline through a Delphi study where maternal health experts were selected and invited to take part in the panel. They first rated the proposed recommendations individually and provided written responses on their own agreement or disagreement with each statement in terms of its impact on childbirth experience, feasibility, acceptability, and cost-effectiveness. After three confirmation rounds, the final conscience was reached by the panel members., Results: The results of the quantitative phase showed that the probability of negative experience of childbirth was increased when physical exercise was not implemented during pregnancy, lacking pain relief options, having fear of childbirth, lacking skin to skin contact with the newborn and being unable to initiate breastfeeding in the first hour after birth (P < 0.05). The analysis of qualitative data revealed 13 major theme categories which were related to women's sense of internal control, external control and support. In the third phase of the study, culturally appropriate recommendations were made and an evidence-based clinical guideline was proposed. The proposed guideline was based on the combination of the quantitative and qualitative phases, a review of the literature, and the opinions of Iranian experts using the Delphi technique., Conclusion: Given the high prevalence of negative childbirth experience among Iranian primiparous women, the present study may be of great interest for managers, leaders, policymakers, and care providers to improve the quality of the maternity services. However, further studies are required to translate the recommendations into practice and identify enablers and barriers during the implementation of the proposed guideline. To adopt the recommendations at national level, there is a need to further studies to assess the effectiveness of the proposed guideline within different communities across the region and the country.

Background: Breastfeeding provides the healthiest start to life, but breastfeeding rates amongst Aboriginal and Torres Strait Islanders is lower than non-Indigenous women., Aim: To assess the accuracy, quality and appropriate presentation of online breastfeeding information for Aboriginal and Torres Strait Islander women in Australia., Methods: An online search conducted in Google, Bing and Yahoo search engines to identify any breastfeeding websites that provided information for Aboriginal and Torres Strait Islander women. Relevant websites were evaluated against: a) National Health and Medical Research Council clinical guidelines, b) the quality of health information on the Internet by using DISCERN instrument, and c) appropriate key design features for Aboriginal and Torres Strait Islander women., Results: The search located 348 sites with 31 being eligible for inclusion. Websites from governmental organizations had the highest accuracy while YouTube videos had the lowest accuracy. Three quarters (74%, n=23) of sites incorporated the national clinical guidelines adequately, and most of the sites (77.8%, n=24) were considered high quality. Only 23% (n=7) of sites had sufficient key design features appropriate for Aboriginal and Torres Strait Islander women. Four websites were considered exemplary for their accuracy, quality and cultural appropriateness of information for Aboriginal and Torres Strait Islander women., Conclusion: Some websites are tailored to provide breastfeeding information and support to Aboriginal and Torres Strait Islander women. However, only a few contain culturally appropriate key design features. Further participatory action research is required to design online platforms for women from different cultural backgrounds that take into account cultural principles, beliefs and values., (Copyright © 2020 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Cyclic mastalgia is one of the most prevalent problems in women of reproductive age and sometimes it is so severe that it influences their activities and requires treatment. The available drug treatments for mastalgia are not satisfactory and most patients have inclined towards complementary and alternative medicine including herbal medicines. Therefore, in order to evaluate the effectiveness and side effects of herbal medicines conducting systematic review studies and meta-analysis seems essential, thus this systematic review was conducted with the aim of determining the effect of herbal medicines on cyclic mastalgia and its probable side effects. The databases of Pubmed, Medline, Embase, ProQuest, Scopus, Web of science, Complementary Medicine Database, SID (Scientific information database), Magiran and Iranmedex were searched from 1997 to 2020 and limited only for English and Persian languages. The studies were appraised according to the Cochrane Collaboration's tool. Meta-analysis was conducted using RevMan software. Standardized mean difference (SMD) was calculated to assess an overall estimate of effectiveness for the continuous data. Odds ratio (OR) was calculated for dichotomous data. Thirty papers were included in the study. Meta-analysis of data demonstrated that herbal medicine was an effective method in reducing the severity of mastalgia compared to the placebo (SMD: -3.26, 95% CI: -5.05 to -1.46, p=0.00004). Subanalysis of data showed no difference between the effectiveness of herbal medicine on the severity of mastalgia compared to the pharmacologic treatment. This research demonstrated efficacy of herbal medicines in alleviating cyclic mastalgia. Therefore, these herbal medicines can be regarded as an alternative treatment for women suffering from cyclic mastalgia. However, due to the limited number of studies in relation to each specific herbal treatment, conducting further studies in this area is recommended., (© 2021 Walter de Gruyter GmbH, Berlin/Boston.)

Objective: To describe the experiences of registered nurses (RNs) who support breastfeeding women and to understand the factors that they believe affect practices that support breastfeeding., Data Sources: We conducted an online search using five databases: Scopus, MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), the Cochrane Database of Systematic Reviews, and Joanna Briggs Institute of Systematic Reviews., Study Selection: We included original research articles on the experiences of RNs who support breastfeeding women that were published in 2009 or after and were available in English. After title and abstract review of 785 articles, we included 22 articles for full text review. Nine articles met the eligibility criteria and were included in the review., Data Extraction: We used Whittemore and Knafl's five-step framework and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines to guide this integrative review. Three authors reviewed and appraised the articles independently., Data Synthesis: We categorized the findings into three themes: Workplace Issues, Personal Experiences, and Breastfeeding Knowledge and Education. Workplace Issues included the subthemes Lack of Time and Workload and Infant Health Stability. Personal Experiences included the subthemes Attitudes, Individual Experiences With Breastfeeding, and The Experiences of Family and Friends. Breastfeeding Knowledge and Education included the subthemes Prelicensure Education and Workplace Education and Training. Most researchers identified deficits in knowledge and education among RNs. The concept of confidence was influenced by all the other themes. Participants in the included studies reported that they developed confidence after learning from lactation consultants and having role models who supported the development of their knowledge and skills., Conclusion: Despite the heterogeneity among the studies, findings highlighted the need for an increased focus on the preparation of RNs to support women to effectively breastfeed within health care organizations. Multitargeted efforts, such as orientation programs and in-depth breastfeeding education using role modeling, mentorship, and role playing with practical scenarios, may improve RNs' abilities and confidence to support breastfeeding women., Competing Interests: Conflict of Interest The authors report no conflicts of interest or relevant financial disclosures., (Copyright © 2021 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Background: Childbirth is considered a significant experience in women's life. Different models of care and interventions without pharmacological approaches have been used to enhance women's positive childbirth experiences, but the most effective interventions have not been clearly identified. Objective: To assess the effectiveness of nonpharmacological approaches in improving women's childbirth experiences. Methods: We searched Cochrane Library, Medline, Web of Science, Embase, Scopus, ProQuest, Google Scholar, and Persian databases (Magiran, Scientific Information Database, and Barakat) from inception until December 2017. Randomized controlled trials and quasi-randomized controlled trials comparing interventions designed to improve women's childbirth experiences with standard cares were included in this review. Pharmacological interventions were excluded from the study. The outcome measure was women's childbirth experience. Heterogeneity was determined using the Cochrane's test and I 2 We included 19 studies (10,141 women) in the review. Results of the meta-analysis of 18 studies (8487 women) demonstrated that all the interventions with nonpharmacological approaches improved childbirth experiences (standardized mean difference: 0.49; 95% confidence interval: 0.33-0.66). But, subgroup meta-analysis showed that different models of midwifery care, support during labor and natural therapies were the most effective interventions in improving women's childbirth experience. Results: Nonpharmacological interventions that enable women to feel supported, safe and respected can lead to improved childbirth experiences. However, there is a need for further studies with larger sample sizes and standardized tool to better assess the effectiveness of specific interventions on women's childbirth experiences.Conclusions: Nonpharmacological interventions that enable women to feel supported, safe and respected can lead to improved childbirth experiences. However, there is a need for further studies with larger sample sizes and standardized tool to better assess the effectiveness of specific interventions on women's childbirth experiences.

Objective : To determine the effects of an exercise intervention on physical performance and reported fall incidents among individuals living with dementia in nursing homes. Methods : The study was a randomized controlled trial to determine the effect of the physical activity on physical performance and reported fall incidents. A sample of 60 participants from two nursing homes in Australia were randomly allocated to either: (1) Intervention Group 1: physical exercise intervention for 45 min, once a week; (2) Intervention Group 2: physical exercise intervention for 15 min, three times a week; or (3) usual care Control Group. Physical performance was assessed before and after the intervention (12 weeks) using: Six Meter Walk test, Five-Times-Sit-to-Stand test, Timed Up and Go (TUG) test, (Modified) Functional Reach test, timed static pedaling (TSP). The number of reported falls was determined by review of incident reports completed by nursing home staff. Results : The physical performance outcome measures demonstrated positive trends over time in favor of the intervention groups, though the observed changes were only statistically significant for TSP and TUG Test. The number of reported falls demonstrated a significant difference between groups during the intervention period. Conclusions : The results demonstrated that the physical exercise intervention could be beneficial for individuals living with dementia, and as little as 45 min per week could be effective for this population group. However, cautious interpretation was drawn as the pool of participants was not sufficiently large enough to generate a meaningful effect size.

Background: Childbirth preparation classes can reduce pregnant women's anxiety and fear for their childbirth. However, to evaluate women's feedback and their satisfaction with these classes, there is a need for a standard instrument that is suitable for Iranian context. This study is aimed to translate and conduct a psychometric analysis of the Satisfaction with the Childbirth Education Class Questionnaire (SCECQ) for Iranian population., Methods: The questionnaire was translated from English into Persian through the forward-backward translation method. The cluster sampling method was employed to select 205 pregnant women with gestational age of 35-37 weeks from all health complexes of Tabriz, Iran. The face, content, and construct validity of the research instrument were assessed through exploratory and confirmatory factor analyses. Internal consistency and test-retest reliability were measured to evaluate the overall reliability of the questionnaire., Results: The impact scores of all items were above 1.5. The content validity index (CVI) and content validity ratio (CVR) of the questionnaire were 0.88 and 0.94, respectively. The convergent construct validity of the whole questionnaire and those of its three subscales were confirmed through the exploratory factor analysis (EFA). The factor loadings of no items were below 0.3, and the X 2 /df ratio was smaller than 5. The overall model validity was confirmed by having the Root Mean Square Error of Approximation (RMSEA) smaller than 0.08. Cronbach's alpha and intraclass correlation coefficient (ICC) were 0.93 and 0.96, respectively, indicating the acceptable reliability of the questionnaire., Conclusion: The Persian version of this questionnaire, entitled SCECQ is a valid and reliable instrument for measuring Iranian women's satisfaction with childbirth education classes.

Background: The absence of Respectful Maternity Care (RMC) deters mothers from seeking maternity care services. Given the importance of RMC and the lack of a standard tool for its assessment in Iran, the present study was conducted to translate and assess the psychometric properties of the RMC questionnaire in Iranian women., Methods: Forward-backward method was used for translating the questionnaire from English into Persian. A total of 265 postpartum women entered the study by simple random sampling from public and private hospitals in Tabriz, Iran. The validity of the questionnaire was confirmed through the face, content and construct validity. Construct validity was assessed through exploratory and confirmatory factor analyses. The internal consistency and test-retest reliability were used to confirm the reliability of the questionnaire. Internal consistency was examined by measuring the Cronbach's alpha in a sample of 20 mothers, and test-retest stability by calculating the Intraclass Correlation Coefficient (ICC) in the same group of mothers, who had completed the questionnaire twice with a two-week interval., Results: The exploratory factor analysis led to the extraction of one factor. Item 12 was eliminated due to its low factor loading. X 2 /df was less than 5, and RMSEA was less than 0.08, which confirms the validity of this model. The Cronbach's alpha coefficient was obtained as 0.93 and ICC (with 95% confidence interval) as 0.98 (0.96 to 0.99)., Conclusion: The results of the study demonstrated that the Iranian RMC scale can be used as a valid and reliable instrument to assess RMC in Iran.

Background: Intrapartum respectful maternity care is defined as a fundamental human right that can affect the mother's experiences. This study aimed to determine the status of respectful maternity care and its relationship with childbirth experience among Iranian women., Methods: This prospective cohort study recruited 334 postpartum women in postpartum wards of two public and four private hospitals in Tabriz, Iran. Quota sampling was used based on the number of births in each hospital. Data were collected through interviews with the use of the following tools: sociodemographic and obstetrics characteristics questionnaire, respectful maternity care scale (6 to 18 h postpartum), and childbirth experience questionnaire (30 to 45 days postpartum). The General Linear Model was used to determine the relationship between respectful maternity care and childbirth experience., Results: The mean respectful maternity care score was 62.58 with a range of 15 to 75, and the total childbirth experience score was 3.29 with a range of 1 to 4. After adjusting for sociodemographic and obstetrics characteristics, a statistically significant direct correlation was found between respectful maternity care and a positive childbirth experience (P < 0.001)., Conclusions: The findings reveals a direct relationship between respectful maternity care and positive childbirth experience. Therefore, it is recommended that mangers and policy makers in childbirth facilities reinforce facilitating a respectful maternity care to improve women's child birth experience and prevent potential adverse effects of negative childbirth experiences.

Background: Disrespectful maternity care is a key impediment to achieving a good quality care. Identifying predicting factors can be used in mitigating any potential risk in for disrespect and abuse in maternity care. The present study was conducted to determine prevalence and predictors of perceived disrespectful maternity care among Iranian women., Methods: A cross-sectional study was conducted in three public and three private hospitals in the city of Tabriz involving 334 postpartum women. Tools included socio-demographic, pregnancy, labour and birth characteristics questionnaires, and disrespect and abuse scales. Data were collected in 6 to 18 h after birth. Multivariate logistic regression was used to determine predictors of disrespectful maternity care., Results: A majority of the women (253; 75.7%) reported one or several types of perceived disrespectful maternity care. The most frequent types related to not allowing women to choose labour positions (142; 44.3%) and not allowing them to move during labour (148; 42.5%). Nighttime childbirth (aOR 3.07; 95% CI 1.61 to 5.88) increased the likelihood of perceived disrespectful maternity care. However, presence of spouses to accompany their wives in waiting rooms (aOR 0.32; 95% CI 0.11 to 0.88), the attendance of private physicians (aOR 0.05; 95% CI 0.02 to 0.12), and midwives (aOR 0.22; 95% CI 0.11 to 0.45) decreased the likelihood of perceived disrespectful maternity care., Conclusion: The results showed high levels of perceived disrespectful maternity care in postpartum women. Therefore, appropriate interventions, such as encouraging spouses' presence, increasing the number of night shift staff, and training obstetric residents and midwives by holding ethics classes, with particular emphasis on empathy with patients.

Background: Lack of knowledge and fear of the unknown during pregnancy and childbirth make mothers fearful, worried, and anxious. Maternal fear and anxiety can lead to problems such as preterm childbirth and low birth weight. Increasing women's knowledge through prenatal education can prepare them for childbirth and improve their health. The present study was conducted to compare fear of childbirth, anxiety and depression during pregnancy in three groups of primiparous pregnant women who were either not attending, irregularly attending, or regularly attending childbirth preparation classes., Methods: A total of 204 primiparous pregnant women attending health centers in Tabriz, Iran, were selected by cluster sampling and assigned to the following three groups: Not attending, irregularly attending (attending one to three sessions of classes) and regularly attending (attending four to eight sessions of classes). Childbirth fear, pregnancy anxiety and depression questionnaires were completed for them through interviews. The general linear model was used to compare their fear of childbirth and prenatal anxiety and depression., Results: According to the general linear model, the scores of fear of childbirth (p <  0.001), anxiety (p <  0.001) and depression (p = 0.006) were significantly lower in the group of pregnant women regularly attending the classes compared to the non-attending group of women. No significant differences were observed between the regularly-attending and irregularly-attending groups in terms of fear of childbirth (p = 0.066), anxiety (p = 0.078), and depression (p = 0.128)., Conclusion: Prenatal training can reduce fear, anxiety and depression in primiparous women. Incorporating such training into prenatal care helps improve maternal health.

Background: Supporting women to initiate and continue breastfeeding is a global challenge. A range of breastfeeding interventions employing electronic technologies (e-technologies) are being developed, which offer different delivery modes and features over the internet; however, the impact of internet-based e-technologies on breastfeeding outcomes remains unclear., Objective: This study aimed to identify the characteristics of current internet-based breastfeeding interventions employing e-technologies and investigate the effects of internet-based e-technologies on breastfeeding outcomes., Methods: A systematic search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in the following databases: Scopus, Web of Science, the Cochrane Database of Systematic Reviews, ScienceDirect, Google Scholar, the Association for Computing Machinery, SpringerLink, and Institute of Electrical and Electronics Engineers Xplore., Results: This systematic review included 16 studies published between 2007 and 2018, with 4018 women in 8 countries. The characteristics of the interventions were grouped based on (1) mode of delivery (web-based, mobile phone apps, and computer kiosk), (2) purpose of the interventions (education and support), and (3) key strategies (monitoring and breastfeeding tracking, personalization, online discussion forum, web-based consultation, and breastfeeding station locators). Combining educational activities with web-based personalized support through discussion forums appeared to be the most effective way to improve breastfeeding outcomes and long-term exclusive breastfeeding rates. Monitoring and breastfeeding trackers appeared to be the least effective ways., Conclusions: This study demonstrated a variety of internet-based e-technologies that professionals can use to promote, educate, and support breastfeeding women. Future internet-based breastfeeding interventions employing e-technologies might consider improving interaction with mothers and personalizing the content of the proposed interventions., (©Alaa Ali Almohanna, Khin Than Win, Shahla Meedya. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 29.05.2020.)

The Cohen-Mansfield Agitation Inventory was a tool originally developed for use in research to measure agitation and subsequently used in clinical settings. It was the primary outcome measure for a randomised controlled trial which evaluated the effects and feasibility of a physiotherapist-led physical exercise intervention on agitation and physical performance of individuals living with dementia in nursing homes. The study produced weak results in regards to the Cohen-Mansfield Agitation Inventory due to small sample size and perceived issues with the use of the Cohen-Mansfield Agitation Inventory. Therefore, the focus of this paper is consideration of the identified issues by the research team: learnt effect and Hawthorn effect, misunderstanding of behaviours and inaccurate recall and observation. It is important that tools originally developed for research are still valid and reliable in the clinical setting.

Background: The childbirth experience has significant effects on the life of the mother and family. However, there are no Iranian studies which evaluate and measure women's childbirth experiences to provide accurate data on this important matter. The aim of this study is to develop a new guideline to improve women's childbirth experiences by meeting their needs and expectations., Methods/design: The present study will use the mixed method with the explanatory sequential approach. Phase one is a cross-sectional survey with random cluster sampling of the health centers in Tabriz. Eight hundred primiparous women will be selected to measure their childbirth experiences and predictors factors. Phase two is a qualitative study to explore women's perceptions of the aspects and determinants of the childbirth experience. Phase two participants will be selected using purposive sampling from the women who participated in phase one. Phase three involves developing a new guideline to improve women's childbirth experiences. The new guideline will be developed based on the following elements: a) the results of the qualitative and quantitative data from phase one and two, b) a review of the related literature, and c) expert opinions that have been collected using the Delphi technique., Discussion: By exploring women's childbirth experiences and the influencing factors, a culturally sensitive evidence-based guideline can be developed. The provision of the evidence-based guideline resulting from this study might be effective in improving the quality care of the services for pregnant women., Ethical Code: IR.TBZMED.REC.1396.786.