Determinants of breastfeeding knowledge and clinical self-confidence among residents of seven health care specialities in Spain: a cross-sectional study

The prevalence of breastfeeding in Europe is below World Health Organization recommendations. The level of knowledge of health professionals in this field is one of the most determining and modifiable factors for optimising support to families and contributing to the achievement of public health breastfeeding goals. The objectives of this study were to assess breastfeeding knowledge and self-confidence in solving breastfeeding problems among health professionals undergoing specialisation in Spain and to identify some of their determinants. The coordinators of all the resident training units of four medical and three nursing specialities in Spain (608 training units with 18,976 residents in total) were asked to circulate an invitation to participate in an anonymous online survey among residents. Breastfeeding knowledge, clinical self-confidence and potential determinants of both (i.e., training, observational experience and motivation) were assessed with a validated scale, the ECOLA. Data were analysed with univariate and multivariate methods (i.e., structural equation modelling). A total of 609 residents (87.4% female) participated in the survey. Among participants, 50.3% showed insufficient knowledge. Significant gaps were identified. Only 39.4% of participants knew that offering free samples or starter infant formula to mothers in health care centres constitutes a violation of the International Code of Marketing of Breastmilk Substitutes. Just 44.3% of respondents were able to mention five characteristics of effective latching. Only 50.9% of respondents considered that, in the maternity ward, the fact that a newborn over 15 h old needs to be consistently woken up to be fed is a risk factor. The main determinant of the level of knowledge identified by the model was experience in observing breastfeeds, followed by the number of breastfeeding courses taken and the level of motivation to become an expert in the field. Experience in observing breastfeeds was the main determinant of self-confidence in addressing specific breastfeeding challenges. Half of the future specialists who responded to the questionnaire did not have enough knowledge to provide adequate care and support to breastfeeding mothers. Clinical observations of breastfeeding sessions are one of the essential elements of breastfeeding training of health professionals.