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USM

PhD Research Proposal

Title Exploring and Developing Practice Model on

Induced Lactation in Malaysia

Proposed by: Norsyamlina Che Abdul Rahim

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CONTENTS: SUMMARY ...................................................................................................... 3

1. OBJECTIVES AND RESEARCH QUESTIONS .......................................... 3

1.1 GENERAL OBJECTIVE ................................................................................ 3

1.2 SPECIFIC OBJECTIVES ............................................................................... 3

1.3 RESEARCH QUESTIONS ............................................................................ 4

2. BACKGROUND .......................................................................................... 4

2.2 LITERATURE REVIEW ................................................................................ 5

2.3 THEORETICAL FRAMEWORK ..................................................................... 11

3. METHODOLOGY ...................................................................................... 14

3.1 STUDY DESIGN: LONGITUDINAL QUALITATIVE CASE STUDY ................. 14

3.2 SAMPLING AND RECRUITMENT SITES ........................................................ 18

3.3 INCLUSION & EXCLUSION CRITERIA ........................................................... 18

3.4 RECRUITMENT PROCESS ......................................................................... 18

3.5 SAMPLING METHOD AND SAMPLE SIZE DETERMINATION .............................. 19

3.6 DATA COLLECTION METHOD: INTERVIEW/ PHONE CALLS/ EMAIL ................... 17

3.6.1 Interview guide .............................................................................. 20

3.6.2 Pilot interview ................................................................................ 22

3.6.3 Timing for data collection .............................................................. 22

3.7 DATA ANALYSIS ...................................................................................... 23

4. THE IMPORTANCE AND THE BENEFIT OF THE RESEARCH .............. 22

5. GANNT CHART ........................................................................................ 28

6. REFERENCES .......................................................................................... 30

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Summary The title of this study is „Exploring and Developing Practice Model on Induced

Lactation in Malaysia‟. This study aims to explore and develop practice model on

induced lactation in Malaysia based on the current practices of a woman who wanted

to nurse her adopted baby. This study focuses on the experiences of the women

who undergoing induced lactation, how their support person (spouse/ husband/

family members) give their support along the process and to identify the various

regimes that are practiced by the practitioners for induced lactation in Malaysia. This

topic is chosen because despite induced lactation is becoming more commonly

practiced, there is no standardised regime used in Malaysia. Furthermore, this study

is able to highlight the success and challenges of going through the process of

induced lactation. This is a longitudinal qualitative research which utilizes in-depth

interview, phone calls and email in the data collection method. The women who

undergoing induced lactation, their support person and practitioners who manage

induced lactation are interviewed. Five states are selected based on their regions

and they represent regions in Malaysia; South, Central, North, East and East

Malaysia. The interviews are synthesised using thematic analysis.

1. Objectives and Research Questions

1.1 General Objective

To explore and develop practice model on induced lactation in Malaysia. 1.2 Specific Objectives

1. To explore the practice of practitioners on induced lactation in Malaysia.

2. To explore the experience of women undergoing induced lactation in

Malaysia.

3. To explore the perception of support person on induced lactation in Malaysia.

4. To develop practice model on induced lactation in Malaysia.

5. To assess the validity of developed induced lactation practice model in

Malaysia.

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1.3 Research Questions

1. How the treating practitioners‟ practice induced lactation in Malaysia?

2. What is the experience of women on induced lactation in Malaysia?

3. What is the perception of support person on induced lactation in Malaysia?

4. What is the suitable practice model on induced lactation has been developed

in Malaysia?

5. What is the validity of newly developed induced lactation practice model in

Malaysia?

2. Justification of the Study

Induced lactation is the ability of a woman to breastfeed without prior pregnancy

(Auerbach, 1981). It is the process by which a woman who has not been pregnant

with the infant she intends to breastfeed and who is not currently breastfeeding

another child produces breast milk (Cheales-Siebenaler, 1999). It is becoming more

common in Malaysia. Based on personal communication with a few practitioners

commonly manage women who underwent induced lactation, there is no specific

national induced lactation data in Malaysia. Practitioners from National Lactation

Centre, Ministry of Health Malaysia reported only 24 mothers underwent induced

lactation in 2013. The cases has increased to 68 cases in 2014. This indicates an

increase in the adoptive women who come to get consultancy for induced lactation.

There is no specific national induced lactation data in Malaysia.

In many cases, the women decided to induce lactation when they decided to adopt

newborn babies. Some of them are well planned with the adoption while others who

are not may not have adequate time for breast preparation. The regime for induced

lactation developed by Newman, 2007 is applicable for planned adoption but is not

suitable for unplanned induced lactation. The National Lactation Centre is adopting

Newman‟s protocol (Newman, 2007) but there is no order to medical doctors that

they have to follow this protocol for induced lactation.

Despite there is no standard protocol for women who have at least six months

preparation before the arrival of the adopted baby (unplanned induced lactation), due

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to the awareness and demand, medical practitioner in Malaysia have been treating

women who requested to becoming adopting nursing mothers. Some of them were

successful while others were not. Futhermore, research indicates that even if

adoptive mothers cannot produce a milk supply adequate to exclusively breastfeed

their child, most women undertaking lactation induction consider their endeavor

successful on the basis of the maternal-infant bonding experienced (Auerbach &

Avery, 1981; Thearle & Weissenberger, 1984; Cheales-Siebenaler, 1999). Thus, by

exploring the perception of the support person, the experiences from the women and

the doctors, and how the doctors manage induce lactation cases, this study is able to

identify suitable practice model which may help to improve the success and safely

implementation of induced lactation regime for Malaysian women. Futher validation

is also required so that developed induced lactation practice model is well described

with appropriate terminology, thus facilitating the work of practitioners, managers,

policy makers and researchers.

2.2 Literature Review

Induced lactation commonly practiced among women who plan for adoption. The

women claimed that the ability to breastfeed their adoptive babies make them feel

complete as women besides it improves the maternal-infant bonding with the

adopted babies (Auerbach, 1981). It is important for Muslim to ensure the adopted

babies are their mahram. Mahram means the adopted baby is considered as part of

the family members in which they do not have to observe the hijab among the family

members. Mahram is observed when the women breastfeed her adopted baby for at

least five time complete meal. Perhaps induced lactation has become an emerging

practice in Malaysia not only because of the awareness of mahram status, but also

the availability of services.

There have been a few studies related to the practice on induce lactation that were

conducted mostly in Western countries and in Papua New Guinea. Among these, the

largest study on induced lactation that described the women experience in a

quantitative survey retrospectively was conducted on 250 adoptive nursing women

(Auerbach & Avery, 1981). The two main reasons for the adoptive women to induce

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lactation were related to bonding and relationship between mother-infant dyad

(Auerbach & Avery, 1981). Most of the women were satisfied with the experiences

but since this was a quantitative study the experienced were not explored.

Another study which described the experienced of 29 women who were counseled

for induced lactation (Livingstone, 1999). It was a retrospective qualitative study in

which the women were interviewed via phone calls regarding their experiences with

induced lactation. Most of them were satisfied with their experiences. They described

it as a memorable, worth the effort and bonding enhancement with their adopted

babies. All these women were prescribed with estrogen patch, progesterone pills and

Domperidone initially for six to ten weeks. Then the women continue with

Domperidone and starting on nipple stimulation when the baby arrived.

Newman (1990) developed induced lactation protocol based on the experienced of a

woman who wanted to nurse her adopted baby. Since then, the protocol has been

improved. Newman‟s protocol is based on the baby‟s estimated date of arrival, age

of the mother and whether the mother has functioning ovaries or not. Based on these

parameters, Newman developed three protocols namely; regular protocol,

accelerated protocol and menopausal protocol (2001). Regular protocol is for women

who have at least six months preparation before the arrival of the adopted baby,

accelerated protocol is for those who have less than six months preparation time and

menopausal protocol is for women who have reach menopausal naturally or

prematurely and those who had their ovaries and or uterus removed.

In all protocols, the women are given oral contraceptive pills everyday for a specified

time to help the growth of the lactating glands and prescribed medicine,

Domperidone to help with the milk supply. According to Newman (2001), the earlier

the breast preparation before the arrival of the baby, the higher the chance of

successful induced lactation. An ideal protocol takes place around six to nine months

before the arrival of the newborn. The protocol in Newman however does not include

„ad hoc‟ regime. Newman‟s specify 3 main protocols: normal, accelerated and

menopausal as shown in Figure 1.

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However, in Malaysia the women usually consult a doctor for induced lactation after

they have adopted the newborns in which they do not have an adequate time for

breast preparation. It may be because in Malaysia a woman who adopts a baby is

not eligible for maternity leave. Therefore, for women who are working, they need to

apply for leave if they need adjustment period with the arrival of the new baby and

give attention on induced lactation regime.

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Figure 1: Newman Protocol for induced lactation.

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A different protocol which has been shown to be helpful with limited

preparation time was studied in the Papua New Guinea (1994). They studied

27 adoptive women who were given an injection of Depo Povera and a week

following that, the women were prescribed Metoclopromode. However,

women who had previous breastfeeding experience, were only prescribed

Metoclopromide without the intramascular injection.

In theory, a woman who undergoes the process of induced lactation will not

go through any physiological changes which occur during pregnancy, nor will

her breasts undergo the memogenesis phase (where the milk glands grow),

lactogenesis (production of milk) phase and galactopoiesis phase

(maintaining milk production). However, there are medication that can be

taken to allow the body to experience the same changes and thus stimulate

the production of milk (Zaharah & Tengku Alina, 2011).

Two main methods of stimulating milk production are the hormone stimulation

and the breast stimulation methods in Figure 2.

Figure 2: Summary of induced lactation methods by Zilal S. &

Farahwahida M.Y. (2014). Induced Lactation by Adoptive Mothers: A

Case Study.

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Generally, there are two types of medication used, the contraceptives and

galactagogues. Contraceptives are used to replicate the pregnancy stage

where high levels of estrogens and progesterone exist Wittig, Nurse, & Spatz,

2008). After changes are felt in the breast, such as tightening and swelling,

the contraceptive intake will be stopped and replaced with galactagogues, to

produce the hormone prolactin, Metoclopramide and domperidone are two

things that are frequently used as galactagogue. Several herbs such as

fenugreek and blessed thistle are also used (Byrant, 2006).

At the same time, stimulation of the breasts must be carried out, whether by

using breast pump or by suckling (Campbell-Yeo et al., 2006). For

clarification, the author demonstrates the phases of replication which are

carried out during the induced lactation period in Figure 3.

Figure 3: Phase of induced lactation.

(Adopted from: Sarah L. Wittig and Diane L. Spatz (2008). Induced

Lactation: Gaining a Better Understand).

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2.3 Theoretical Framework

The main tenets of Bandura‟s theory are that: people learn by observing

others. The same set of stimuli may provoke different responses from different

people, or from the same people at different times the world and a person‟s

behaviour are interlinked personality is an interaction between three factors:

the environment, behaviour, and a person‟s psychological processes.

Social Cognitive Theory revolves around the notion that learning correlates to

the observation of role models. In education, for example, teachers play the

role of a model in a child‟s learning acquisition. In everyday life, the model

could be media sources or those with whom you interact. Effective modelling

teaches general rules and strategies for dealing with different situations.

Social cognitive theory (SCT) refers to a psychological model of behavior that

emerged primarily from the work of Albert Bandura (1977; 1986). SCT rests

on several basic assumptions about learning and behavior.

People are viewed as self-organizing, proactive, self-reflecting and self-

regulating rather than as reactive organisms shaped and shepherded by

environmental forces or driven by concealed inner impulses. This is the

foundation of Bandura's (1986) conception of reciprocal determinism, the view

that (a) personal factors in the form of cognition, affect, and biological events,

(b) behavior, and (c) environmental influences create interactions that result in

a triadic reciprocality (Figure 4).

The reciprocal nature of the determinants of human functioning in social

cognitive theory makes it possible for therapeutic and counseling efforts to be

directed at personal, environmental, or behavioral factors. Strategies for

increasing well-being can be aimed at improving emotional, cognitive, or

motivational processes, increasing behavioral competencies, or altering the

social conditions under which people live and work.

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Figure 4: Social Cognitive Theory

A closely related assumption within SCT is that people have an agency or

ability to influence their own behavior and the environment in a purposeful,

goal-directed fashion (Bandura, 2001). SCT does not deny the importance of

the environment in determining behavior, but it does argue that people can

also, through forethought, self-reflection, and self-regulatory processes, exert

substantial influence over their own outcomes and the environment more

broadly.

Infant feeding practices are influenced by a multitude of factors that,

according to Social Cognitive Theory can be broadly classified into two

categories: internal personal and socio-environmental as shown in Figure 4.

The theoretical framework adopted from Bandura shows how infant feeding

choices are reciprocally determined by internal personal and socio-

environmental factors.

Internal personal factors which influence the decision to breast- or formula-

feed may include; cognitive/ affective (e.g., knowledge, attitudes, beliefs),

outcome expectations (e.g., best for baby), self-efficacy (e.g., confidence,

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previous experience), biological (e.g., age), or psychosocial (e.g., comfort with

breastfeeding in public). Socio-environmental factors such as institutional

(e.g., healthcare practices, policy), social (e.g., family support/dynamics),

socio-demographic (e.g., education, income, ethnicity), physical (e.g., fatigue,

nipple pain) and others (e.g., cost, availability) may also play important roles

in infant feeding choices (Figure 5).

Figure 5: The framework on breastfeeding behavior as adopted from

Bandura (Williams, 1999)

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3. Methodology

3.1 Study Design: Longitudinal Qualitative Case Study

Qualitative longitudinal research is predicated on the investigation and

interpretation of change over time and process in social contexts. Qualitative

longitudinal methods can offer fresh perspectives into established arenas of

social enquiry, drawing attention to the psychological and biographical

processes (lived through experience) through which social outcomes are

generated and mediated.

3.2 Flow Chart of the Study

There are four phases in the study which is shown in Figure 6. Phase 1 is

starting first day treatment on induced lactation. This phase utilise face-to-face

interview as the method for data collection. In this phase involved

practitioners, women and support person. In Phase 2 at 1 month of treatment,

the women and practitioners only will be interviewed regarding their

experiences, perceptions and practices throughout the process of induced

lactation. In Phase 3 at 3 months of induced lactation process, the women will

be interviewed regarding their effort, motivation and support required to by

them to successfully induce lactation. Practitioners also involving for this

phase. In Phase 4 at 6 months of induced lactation, interview with women and

support persons conducted through phone call and email. The treating

practitioners will be interviewed regarding their practices along the process.

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FLOW CHART OF THE STUDY

Exclusion criteria:

Previous induced

lactation experience

Previous breastfeeding

experience

Reference Sample: List of National Breastfeeding Practitioners in Malaysia from National Lactation Centre,

Ministry of Health Malaysia

Five states are selected based on their regions in Malaysia

South Region

Central Region

North Region

East Region

East Malaysia

Selecting the practitioner for each region

Inclusion Criteria:

Managing induced lactation cases for

their clients at least the last 6 months

during data collection

Able to communicate in English or

Malay

Consented for interview

Selecting the women for each region

Inclusion Criteria:

Able to communicate in English or

Malay

Currently under induced lactation

program

Consented for interview

Selecting the support person for each region

Inclusion Criteria:

Able to communicate in English or

Malay

Consented for interview

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PHASE 1: 1

st Day of

Registration IL

Women Practitioners Support Persons

Data Collection Method: Face-to-face interview

Explain the process of

face-to-face interview

Explain the audio-

recording

The samples will sign

an informed consent

Interviews are transcriptions and coding

1. Main reason for the adoptive women to induce lactation. 2. Explore perception on induced lactation. 3. Preparation after deciding to nurse her adoptive child.

1. Year of services. 2. Basis regime that practitioners common use. 3. Instructions for the adoptive women regarding medications, herbs, breastfeeding and/or pumping.

1. Perception on induced lactation. 2. Important reason for involvement support person in induced lactation.

PHASE 2:

At 1 Months

Data Collection Method: Through emails or phone

calls for follow up

1. Reactions of her spouse/ husband/ family members about the induced lactation process. 2. Support or oppose her decision. 3. Opinion and her view about induced lactation process (easy/ difficult).

1. Manage the difficult cases. 2. Important factors that have helped practitioners handling induced lactation patient.

Interviews are transcriptions and coding

PHASE 3:

At 3 Months

Data Collection Method: Face-to-face interview

1. Memorable experience through the process. 2. Suggestion this induced lactation to other women. 3. Advice for other spouse/ husband/ family members whose wife plan for induced lactation.

Advice for women who planned for

adopted nursing.

Interviews are transcriptions and coding

Women Practitioners

Women Practitioners

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Figure 6: Flow Chart of the Study

IL PRACTICE MODEL VALIDATION

Data Analysis: Thematic Approach

(Identifiying, analysing and reporting pattern (themes) within the data)

PHASE 4: At 6

Months

Women Practitioners Support Persons

Data Collection Method: Through emails or phone

calls for follow up

Interviews are

transcriptions and coding

1. Opinion about emotional support from support persons. 2. Dealing with the other emotions and stresses of a sudden placement along the induced lactation process.

Available information to

patients who are decided to use

induced lactation method in making practical choices.

Challenges, obstacles and supports that are needed by a women to successfully induce lactation.

Induced Lactation Practice Model

The experience of women on induced lactation

The practice of practitioner on induced lactation

The perception of support person on induced lactation P

RA

CTI

CE

MO

DEL

INFLUENCE FACTORS

Cognitive / affective such as Knowledge, attitudes,

beliefs

Self-efficacy such as confidence, time commitment of frequent

nursing

Social such as family support/ dynamics

Socio-demographic such as education, income, ethnicity

Physical such as fatigue, nipple pain, stress

Different regime practices by practitioners

Instruction regarding

medications, herbs & etc

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3.3 Sampling and Recruitment Sites

A simple random sampling method will be used in selecting the states. For

selecting the participants (women who decided to nurse their children using

induced lactation method, their support person and the practitioners who

treated) purposive sampling will be used.

3.4 Inclusion Criteria

3.4.1 Practitioner who are treating women for induced lactation:

Managing induced lactation cases for their clients at least the last 6

months during data collection

Able to communicate in English or Malay

Consented for interview

3.4.2 Women and their support person:

Able to communicate in English or Malay

Currently under induced lactation program

Consented for interview

3.5 Exclusion Criteria

3.5.1 Women and their support person:

Previous induced lactation experience

Previous breastfeeding experience

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3.6 Recruitment Process

The invitation to join the study will come from the research through personal

identification. Before interviews take place, I will take inform consent from the

participants. Even after agreeing, participants can withdraw at any time, for

whatever reasons without consequences. It shall be made clear the interview

will be audio-recorded and confidentiality to the recoded interview is assured.

Furthermore, it is the participants‟ rights to access to the materials if

requested.

Participation in the interview is entirely voluntary. Participants were selected

after deciding to use induce lactation method one month before data

collection. During data collection, I will follow up them every 1, 3 and 6

months. In the beginning, I can enquire about their experience on infant

feeding of their choice. After 1 months, I can follow up them about the main

interest to explore their experiences in deciding regarding infant feeding

methods were. With this, I can examine factors that may contribute to their

choices and obstacles they faced. At 3 months, in depth-interview will be

conducted face-to-face with the participants and I will get the information on

induced lactation progress after 3 months of treatment. And for the final

phase, an interview based on the factors that contribute to the success or

failure of induced lactation carried out for 6 months. From these interviews I

will get the information first timing milk is produced and determine whether the

mothers successfully breastfeed their baby by satisfying completion of five

when induced lactation is started. I also can explore whether breastfeeding

behavior and support from support person can contribute successful induced

lactation among adoptive mothers in Malaysia.

3.7 Sampling Method and Sample Size Determination

I will utilise purposive, non-probability sampling, a method that is widely used

in qualitative research sampling. Individuals who volunteered to participate

and had rich information were the target because they were able to provide

extensive data (Patton, 2002). In my sampling, I also applied a maximum

variation technique to ensure there is a variety of individual taking into

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consideration their education achievement, ethnic background and

socioeconomic status. Maximum variation sampling, which considers the

widest possible range of the respondents‟ characteristics, is also used so that

the research is able to capture a thorough sample of the real population

(Merriam, 2009).

In practice, the sample size is determined by saturation theory. In saturation

theory, data collection will stop when no more new data are being generated

(Padgett, 1998). However, the recruitment will only stop after reaching data

saturation or after one year of starting data collection whichever comes first.

3.8 Data Collection Method: Face-to-face Interview, phone call and email

A face-to-face interview is one-to-one communication between two individuals

(P. Liamputtong, 2007). It is the most commonly used qualitative method of

data collection. It is frequently use method in feminist research, which can

either stand-alone or use in combination (MacPherson, 1983). The main aim

in interview is to get thick description from „individuals who are able to provide

information-rich accounts of their experiences‟ (P Liamputtong, 2011). The

interview is informal and can take place either at the participants‟ house, at

the participating centre or anywhere comfortable in order to establish rapport

between the interviewer and interviewee (Yow, 1994).

The interview also can be conducted through phone calls and email. For in

depth interview will only start after the participant signs the inform consent

form. It is estimated the interview will take the most 60-90 minutes for each

participant. During data collection, for the beginning I will start with informal

questions about their infant and their work. Then I can further enquire about

their experience on infant feeding of their choice and explore their

experiences in deciding regarding infant feeding methods were. An interview

guide will be used as shown in Table 1.

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3.8.1 Interview Guide

Participating practitioners and women can choose to have the interview

sessions in English or Malay. For the practitioners, I would like them to share

how they decide on the regime and how frequent do they need to follow up

each women. For the women, I would like them to share how they undergo all

the process. All participating practitioners and women will be followed up,

either through emails or phone calls. During the follow up contact, participants

will be offered to view their interview transcripts. The main aim is to get their

opinion on what is written about their interviews. This is an important checking

mechanism because it acts as a way to ensure data validity.

Researcher

Opening Greet participant Explain the process of face-to-face interview Explain the audio-recording The participant will sign an informed consent Say „I am going to start recording now‟ but reiterate that they can refuse, or make requests to stop the recording at any time

Warming up Before we go into the details, would you like to tell me about yourself? Can you tell me a bit more about your job, the kind of work that you have to do, and also about your child?

Practitioners’ issues Women’s and the support person’s issues

Phase 1: at first day registration in induced lactation program

1. What is the prevalence of induced lactation? Can you tell me how long you have helped women with induced lactation?

1. What make you decide to go for induced lactation? (W)

2. How do you find IL?

Phase 2: at 1 month of induced lactation process at 3 months of induced lactation process

2. What is the basis of your regime? How do you decide what regime suits who?

3. How are the reactions of your spouse/ family? Do they support or oppose your decision? What was your stand?(W) 4. How easy/ difficult it is, from your view?

3. How do you manage the difficult cases? In your opinion, what are the important factors that have helped you in your work?

5. What was the most memorable experience through the process? (W and S)

Phase 3: at 3 months of induced lactation process

4. Other matters What would be your advice for women who planned for adopted nursing?

6. Would you suggest this induced lactation to other women? Why? 7. What do you advice for other spouse whose wife plan for IL?

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Phase 4: at 6 months of induced lactation process

Factors that contribute to the success or failure of induced lactation carried out for 9 months.

Explore whether breastfeeding behavior and support from support person can contribute successful induced lactation among adoptive mothers in Malaysia.

Closing Is there anything else that you would like to tell me? Thank you. If you wish to have a copy of the interview transcript, I can send it to you.

Table 1: Method of data collection (Face-to-face interview, through phone calls and email). Guide questions for the interviewer.

3.8.2 Pilot Interview

In order to test the effectiveness of the interview guide, I will conduct three

pilot interviews; one each with the woman, her spouse and her treating

practitioners. Based on the transcripts I may need to make necessary

changes to the guide. Each recording from the pilot interview session will be

transcribed accordingly. The session will take approximately 60 to 90 minutes

each. In any interview, be it pilot or actual, interviewees were given

information prior to the session, as shown in Table 2.

PROJECT TITLE:

Exploring and Developing Model Practice on Induced Lactation in Malaysia

Participation in the interview is entirely voluntary.

You are free to stop the interview at any time.

The interview will take approximately 60-90 minutes at a location convenient for you.

The Interview will be digitally recorded.

The interview will be largely semi-structured; allowing you to reflect and respond in your own words.

The interview will be exploratory, based on the issues raised by the interviewee.

The interviewer will adopt a neutral stance (avoiding leading statements or questions) while expressing complete interest in the interviewee responses.

Permission will be sought to confirm/clarify aspects of the interview at a later stage if necessary.

Table 2: Face-to-face interview information for the interviewee 3.8.3 Timing For Data Collection

In every month, the interview will be conducted in the first week and second

week. Week three and week four will be allocated for transcribing and coding.

Members checking and any amendments before the next interview will take

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place. In total data collection will take 17 months. Pilot study will be in the first

month. The next 16 months will be the actual data collection (Figure 8).

Figure 8: The diagram of data collection activities and sample size 3.9 Data Analysis

Thematic analysis is „a method for identifying, analysing and reporting

patterns (themes) within the data‟ (Braun & Clarke, 2006). It is widely used in

qualitative analysis and is based on participants‟ conceptions of actual

communication episodes; a theme is identified based on recurrence,

repetition, and forcefulness of the data.

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There are three main steps in the analysis procedure. First, data from the

interviews will be transcribed verbatim and careful reading and reread in order

to fully understand the ideas in the conversation. Then similar patterns of

quotes identified and are group into the same theme (Aronson, 1994). „Theme

that emerge from the informants‟ stories are pieced together to form a

comprehensive picture of their collective experience‟ (Taylor & Bogdan,

1984). Later, related patterns are combined into subthemes in order to carry

out a comprehensive thematic analysis. Therefore thematic analysis is very

helpful in this study as it helps to describe and organise data simultaneously.

I will explore for themes within and across participants‟ stories. In order to do

that, I need to read and reread the transcripts to create appropriate themes

that are able to assist in answering research questions. I will define each

theme precisely and apply the theme in the same way every time I use them.

In order to ensure validity, the interviews transcripts and emerge themes will

be made available to participants for comments and confirmation. I will not

use any data management software in managing my data.

3.10 Validity Of The Developed Induced Lactation Practice Model

The practice model designed to provide an overview of the induced lactation

process among practitioners, woman and support person. The developed

practice model also contains the factors that influence the success of the

induced lactation.

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Figure 9: The Recommended Newly Develop Induced Lactation Practice

Model in Malaysia

3.10.1 Study Design: Mixed-Methods (Qualitative and Quantitative Study)

3.10.2 Sampling and Recruitment Sites

Sampling procedures are purposeful. No random sample but aim to include

people in the sample whose experiences are relevant to validate the newly

develop induced lactation practice model.

3.10.3 Focus Group Discussion

Focus group discussion is a qualitative method with the primary aim of

describing and understanding perceptions, interpretations and beliefs of a

select population to gain understanding of a induced lactation practice model

from the perspective of the experiences practitioners in Malaysia. This focus

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group discussion involve 10 persons of International Board Certified Lactation

Consultant (IBCLC) members. IBCLC is a health care professional who

specializes in the clinical management of breastfeeding. They work in a wide

variety of health care settings, including hospitals, pediatric offices, public

health clinic and private practice in Malaysia. They gather together to discuss

about “Newly Develop Induced Lactation Practice Model” with the help of a

moderator in a particular setting where participants feel comfortable enough to

engage in a dynamic discussion for at least one to two hours.

3.10.4 Questionnaire Questionnaire is a tool for collecting information. Questionnaire describes,

compares, or explains knowledge, attitude and practice of a particular group

of people. Questionnaire designing is a step in a survey project to get

information. For validating newly develop Induced Lactation Practice Model in

this study, the question types are rating scales and agreement scales among

25 persons IBCLC members in Malaysia.

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4. The Importance And The Benefit Of The Research The finding of this research will be able to:

a. Contribute to new knowledge on the current practice of induced lactation in

Malaysia.

b. Explore the experiences of the women and her support person in

undergoing the treatment.

c. Help other women and their spouses/partners in understanding the

challenges, obstacles and supports that are needed for induced lactation.

d. Contribution of support group can also play an important role in the success

of induced lactation and can help other women and their support person in

understanding of it.

e. Develop induced lactation practice model in Malaysia based on the

experience of a woman who wanted to nurse her adopted baby, the practices

Boynton, P. M et al. BMJ 2004;328:1312-1315

28 | P a g e

of a practitioners and the perception of support person through induced

lactation process.

5. Gannt Chart

The gannt chart for activities in this project is outlined in Table 4. It is

estimated for 36 months, starting from May 2015 until June 2018.

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Table 4: Gantt Chart for Exploring and Developing Best Practices Model on Induced Lactation in Malaysia

Project activities

2015 2016 2017 2018

M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M

Literature review

Scientific Writing

Pilot

Data collection

Data analysis

Data presentation

Thesis Writing

Publication

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6. References Aronson, J. (1994). A pragmatic view of thematic analysis. The Qualitative

Report, 2(1), 1-3. Auerbach, K. G. (1981). Induced lactation: A study of adoptive nursing by 240

women. Archives of Pediatrics & Adolescent Medicine, 135(4), ?only one page.

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology.

Qualitative Research in Psychology, 3(2), 77-101. Bryant, C. a. (2006). Mursing the Adopted Infant. Journal of the American

Board of Family Medicine: ?maksud dia 19(4): 374-9. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16809652.

Cadwell, K. (2007). Personal Communication. Union Institute & University

Doctoral Program. Cincinnati, Ohio: Union Institute & University. Campbell-Yeo M.L., Allen A.C., Joseph K.S.,et al., (2006). Study protocol: a

double blind placebo controlled trial examining the effect of domperidone on the composition of breast milk BMC Pregnancy and Childbirth 2006, Retrieved from: http://www.biomedcentral.com/1471-2393/6/17.

Goldfarb, L. (2007). Newman-Goldfarb Protocols for Induced Lactation:

Decision Tool. Unpublished Manuscript. Union Institute & University Doctoral Program. Cincinnati, Ohio: Union Institute & University.

Hausman, B. L. (2004). The feminist politics of breastfeeding. Australian

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Research Methods. London: SAGE. Liamputtong, P. (2011). Qualitative Research Methods (3rd ed.). South

Melbourne: Oxford University Press Australia and New Zealand. MacPherson, K. I. T. (1983). Feminist methods a new paradigm for nursing

research. Advances in Nursing Science, 5(2 M3 - Article), 17-25. Merriam, S. B. (2009). Qualitative Research. A Guide to Design and

Implementation. San Francisco: Jossey-Bass. Newman, J., & Goldfarb, L.(2002). The Protocols for Induced Lactation: A

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Padgett, D. K. (1998). Qualitative methods in social work research:

Challenges and rewards. Thousand Oaks: SAGE Publications.

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Patton, M. Q. (2002). Qualitative Research and Evaluation Methods. Thousand Oaks: SAGE Publications.

Taylor, S. J., & Bogdan, R. (1984). Introduction to Qualitative Research

Methods: The Search for Meanings. New York: John Wiley & Sons. Wittig, S.L., Nurse, S., & Spatz, D.L. (2008). Induced Lactation: Gaining a

Better Understanding. 33 (2). Yow, V. R. (1994). Recording Oral History: A Practical Guide for Social

Scientist. Thousand Oaks: SAGE Publications. Zaharah, S.,& Tengku Alina, T.I. (2001). 100 Persoalan Mengenai Penyusuan

Susu Ibu (Pertama, p. 178). Kuala Lumpur: Dewan Bahasa dan Pustaka.

Zilal, S., & Farahwahida, M. Y. (2014). Penyusuan Anak Angkat: Satu Analisis. In J. A. Bakar, E. S. M. Al-Battah, S. A. Sukor, M. Lauto, S. Najib, & A. Nadia (Eds.), Prosiding Persidangan Antarabangsa Kekeluargaan dari Perspektif Global (pp. 124–144). Johor Bahru: KPIJ PRESS.