Letramento Funcional em Saúde e amamentação : um estudo com mães de crianças prematuras

Abstract

Introduction: The Understanding associations between maternal Functional Health Literacy (FHL) and the breastfeeding process of premature babies may contribute to the development of strategies to cope with low breastfeeding rates and to promote health. Objective: To verify the association between mothers FHL and breastfeeding, that is, how understanding about breastfeeding influences the breastfeeding history of children who were born prematurely and also younger than 24 months old which were followed up in a follow-up clinic. Methods: This is an observational study carried out in two stages. The first step consists of an integrative literature review. The second one consists of a cross-sectional descriptive study based on interviews with 66 mothers of premature children, seen at the Outpatient Clinic for Children at Risk - ACRIAR, located at Bias Fortes Hospital, attached to the Hospital das Clínicas from the Federal University of Minas Gerais (HC-UFMG), in Belo Horizonte. In the first stage, an integrative literature review was carried out based on the following guiding question: “What is the effect of mothers health literacy on breastfeeding of children in early childhood?”. To answer that, bibliographic searches were carried out in Medline databases via PubMed, COCHRANE, CINAHL, SCOPUS, Web of Science and VHL. In the second stage, data collection relied on the following instruments: socio-demographic and clinical-assistance characterization questionnaire; Brazil Economic Classification Criteria; SAHLPA-18 (Short Assessment of Health Literacy for Portuguese-speaking Adults); Interactive Breastfeeding Scale adapted and Complementary Questionnaire on the breastfeeding pattern. The degree of Health Literacy was considered the variable response and the explanatory variables were clinical, caring, sociodemographic, economic and breastfeeding factors. Descriptive, bivariate and logistic regression analyses were performed. Results: Regarding the 1st stage, 729 articles were obtained and after applying the exclusion criteria, 6 articles were selected, all of which are international. The main design was cross-sectional and all presented quantitative analysis. Four studies pointed out the non-association between SL and breastfeeding but demonstrated a consonance of adequate maternal SL with characteristics such as schooling and maternal income. In 2 studies, an association was found between mothers' SL and breastfeeding self-efficacy. In the second stage, the average age of the mothers was 30 years old, which the majority were married/stable union, housewives and with high school education (complete or incomplete). Primiparous women, carriers of some comorbidity and mostly single who planned their pregnancies. 17 mothers (25.8%) had inadequate FHL. Most of the children were male, with c- section being the main method of delivery. At hospital discharge, 60.6% of them were exclusively breastfed, but at the time of the interview, the use of artificial milk was predominant (42.4%). No statistically significant association was found between LFS and breastfeeding. Increased maternal age and education, being married or in a stable relationship increased the chances of the mother having adequate FHL, while sepsis and pregnancy planning showed an inverse relationship. Conclusion: Regarding the first stage, there was a shortage of studies involving maternal SL and breastfeeding, with the need of further investigation of the subject, especially in other parts of the world and in Brazil. In the second stage, no association was found between FHL and breastfeeding, although the variables maternal age and education remained associated with adequate FHL.