Академический Документы
Профессиональный Документы
Культура Документы
By
Nanor Aghjian
Cynthia Zanazanian
Shant Leblebjian
Research Proposal
FHSC288
August 2009
1
Table of Contents
Acknowlegements________________________________________________________3
Introduction_____________________________________________________________4
Literature review_____________________________________________________________4
Ratinale and Hypotheses_______________________________________________________8
Research Question___________________________________________________________________8
Hypotheses________________________________________________________________________8
Objective__________________________________________________________________________8
Methodology____________________________________________________________9
Study Design_________________________________________________________________9
Target Population____________________________________________________________9
Attainable population________________________________________________________ 9
Data Collection_____________________________________________________________10
Ethical Issues_______________________________________________________________10
Variables___________________________________________________________________10
Limitations_________________________________________________________________11
Plan of Analysis_____________________________________________________________11
Conclusion_____________________________________________________________11
References_____________________________________________________________12
Appendices_____________________________________________________________13
Questionnaire_____________________________________________________________ 13
Informed Consent___________________________________________________________15
2
Acknowledgements
We would like to thank our mentor Dr. Sani Hleis for his support and advice,
guidance about the ethical issues, and for his insight and valuable input along the
semester.
3
Literature Review
standard, women pay too much attention to their look and measure their value according
Nowadays, a woman’s power has been related to her beauty and not her brain.
Women themselves have socialized this concept in their lives, because they worry a lot
about their prettiness. That’s why many females are obsessed with their body image and
this affects their lifestyles leading to many health problems such as eating disorders,
increasing worldwide and most women pay billions of dollars to maintain their youth
(Giddens, 2006).
“Body image can basically be defined as the mind’s picture of the personal body
and accompanying thoughts, feelings, and perceptions” (Roth, 2006). Body image can be
classified into 3 major categories: body esteem which states whether the person feels
positive or negative about her body, body satisfaction and body distortion (Roth, 2006).
The way in which a woman perceives her body constitutes an important part of her
personality: Does her shape make her self-confident? Does she appreciate her body more
young infants with the nutrients they need for healthy growth and development”. The
breast milk has many benefits for both the infant and the mother. For the infant it causes
less allergic reactions, the antibodies found in this milk protect the body against
4
acids, sugars and fats, it improves the mental development of the child, especially the IQ.
As for the mother, breastfeeding helps her to resist different types of cancers, especially
breast cancer, increases maternal and fetal attachment, it is inexpensive and aids in losing
weight. Research has shown that “breastfeeding is an easy way to burn an extra 500-600
calories a day” (Zahorick, Il, and Webber, 2000). Moreover, according to The
Breastfeeding Answer Book, mothers who breastfeed till three to six months after
delivery lose more weight than formula-feeding mothers who consume fewer calories. A
study done on one month postpartum women had shown that the hips of the breastfeeding
mothers were slimmer and they had lower weights than those who relied on formula-
feeding methods. It may be surprising to some women that lactation can even burn the fat
cultural standards, traditional family practices, religious teachings, and most importantly,
There are many psychological and physiological changes that take place during
pregnancy. For instance, the size of the abdomen and body weight increase. Most women
done previously, the progression of pregnancy leads to the feeling of having negative
body image and this emotion peaks after delivery (Huang, Wang, and Chen, 2004). For
this reason, they might choose not to breastfeed thinking that such a feeding causes
There has been a correlation between body satisfaction and the method of infant-
feeding chosen. Those women who care about other’s judgments of their bodies tend to
5
bottle-feed their infants, because they can’t imagine themselves “as a vessel of infant
nourishment” (Roth, 2006). Thus, a woman’s satisfaction with her body can be
influenced by societal standards. Moreover, some mothers believe that the act of
During pregnancy and breastfeeding, fat is stored in women’s bodies for the
purpose of infant nourishment. This fact has been proved by a new research which has
affirmed that fat cells do not form only during infancy and puberty, but also during the
last trimester of pregnancy (Zahorick, Il, and Webber, 2000). That’s why many mothers
don’t lose their weight easily after pregnancy, even if they were able to control their
weight before. This can be a real problem, because “fat cells are always ready and eager
to store energy” (Zahorick, Il, and Webber, 2000). However, through diet and exercise
we can shrink but not completely remove them. This issue of fat accumulation during
pregnancy can become a big concern specifically for obese females, where statistics has
shown that those with higher body mass index before pregnancy lean towards more
negative body image during pregnancy (Huang, Wang, and Chen, 2004). Hence, such
women are more inclined towards choosing bottle-feeding, because they think that
breastfeeding will increase their weight. Since obese mothers are dissatisfied with their
bodies they are more prone to post-partum depression and stress. According to general
body image research, a positive correlation has been noted between body dissatisfaction
and stress. In addition, these women make their lives miserable by putting themselves on
strict diet to lose weight quickly since they put a high priority on regaining their pre-
pregnancy weight and shape, thus avoiding breastfeeding. As a matter of fact, stressful
women might find it difficult to breastfeed, since stress impairs the onset of lactation. On
6
the other hand, many women do not know the fact that breastfeeding decreases stress and
facilitates adaptation to life with the infant (Roth, 2006). Moreover, it is important to
mention that women who breastfeed tend to lose weight more in the first postpartum
year. Also, stopping breastfeeding is not a solution for loosing weight because if a mother
follows a well-balanced diet during nursing her child will be able to maintain her weight
(Zahorick, Il, and Webber, 2000). Researchers who have conducted many studies of body
image have proved that “women without body image disturbance were 1.25 times [CI:
1.09, 1.42] more likely to breastfeed than women who had marked concerns about their
body shape” (Roth, 2006). According to the advocates of breastfeeding, such a method
can help to elevate the woman’s self-esteem; thus it may be a crucial mediating factor for
Body image is also linked with sexuality. Certain societies define some body
shapes as fashionable where the shape and the size of the breast are highly emphasized.
addition, one of the indicators of female attractiveness in these cultures has been the size
of the breasts. That’s why the breasts are viewed primarily as sexual objects and both
more likely for females in these societies to use their breasts for erotic purposes rather
than for feeding an infant since the breasts are regularly viewed as sexual items, then this
(Battersby). Hence, even if these women decide to breastfeed, there is high probability of
stopping nursing and shifting their focus on themselves due to their encounter of negative
sexual messages about their bodies (Roth, 2006). According to Breastfeeding and Human
7
Lactation, breasts are described as “part of a woman’s internalized body image…
representing a woman’s deepest sense of woman hood. Any change in her breasts…
threatens this feminine internal view of self” (Roth, 2006). It should be mentioned that
that the changes that come with lactation modify how women view their body
attractiveness (Roth, 2006). However, what these women do not know is that during
breastfeeding the woman’s nipples will be less sensitive to sexual arousal; Thus, the
breasts can not be regarded as sexual stimuli during nursing. In addition, since no
research has proved that breastfeeding withdrawal can reduce the breast size and since
breastfeeding has many benefits than any other method of feeding, then it is more
Hypothesis:
affected by woman’s conception about her body image? Many studies have shown a very
high association between body image and the method of infant feeding chosen (Zahorick,
Il, and Webber, 2000). In this research we are going to test the following hypothesis:
Objectives:
physical image.
8
Assess whether other different variables like: education, parity, occupation,
socioeconomic status, and prenatal class attendance also affect women’s decision
in breastfeeding.
Methodology
Study design:
population because it allows us to assess the relationship between breastfeeding and body
image and other factors of interest as they exist in the specified population at a particular
Target population:
Our sample will include post-partum women who gave birth in 2 Lebanese
criteria of the study will be only those women who are multi-parous and have the ability
Attainable population:
We will recruit all women presenting for delivery from the list of hospitals and fitting
the eligibility criteria until the sample size is satisfied. All women participating in the
study will have to complete a fifteen minute questionnaire, assessing their misconception
about breastfeeding.
9
Data collection:
minutes each. The data will be collected in the year 2010 in November.
Ethical issues:
The informed consent prepared should be clearly read and signed by the
protected whereby no one should have access to them and to any other private or contact
information without the approval of the principle investigator. All results and conclusions
advantages. The assessors will be ready to answer any question related to the topic and
any women having concerns will be provided by a contact number. There must be
confidentiality, anonymity and privacy whereby each woman should complete the
questionnaire alone. The woman has the freedom not to answer any question that she
Variables:
Our dependent variable is the breastfeeding and the independent variable is the
parts. The first part gathers demographic data about the participants where it also
integrates an item that indicates the choice for infant feeding method. This closed
(breast and bottle) feeding. The second part includes questions that assess mothers’
attitude towards breastfeeding, body image, sexuality and other factors of interest.
10
Responses were based on a 5-point Likert scale, with 1= strongly disagree, 2= disagree,
3= neutral, 4= agree, 5= strongly agree. High scores indicate a more positive body image
employed outside home, socioeconomic status (low, middle, high), and prenatal class
attendance.
Limitations:
relationships, that is, it cannot identify why women think that breastfeeding disturbs body
image. Another drawback of our study is that changes and trends over time cannot be
Plan of analysis:
A univariate analysis will be performed where the mean and standard deviation
association between breastfeeding and body image controlling for confounders. SPSS
Conclusion:
An interesting question that would emerge from our study would concern whether
or not factors such as emotional and physical support at birth and rooming-in affect
women’s perception of their baby and change their attitude about breastfeeding. A
follow-up investigation of how many women change their intended feeding method also
11
would be of interest after 1 month by use of telephone interview. We suggest that both
Reference List
Abdul Khalek, F & Madi, H.. (2009). Misconceptions about the use and effects of
Huang, H.C., Wang, S.Y., & Chen, C.H. (2004). Body Image, Maternal-Fetal
http://www.llli.org/llleaderweb/LV/LVFebMar06p4.html
12
Zahorick, M, Il, R. & Webber, V. (2000). Postpartum Body Image and Weight Loss. New
http://www.llli.org/NB/NBSepOct00p156.html
Appendices
Questionnaire about
Breastfeeding and body image
Assessor: _______________
Questionnaire No ____
Date of interview: ___________
13
Breastfeeding is beneficial for the child’s health.
Strongly disagree Disagree Neutral Agree Strongly agree
WHO recommends that infants should be breastfed for 2 years. My attitude regarding this issue
is:
Strongly disagree Disagree Neutral Agree Strongly agree
You feel badly about yourself because you don’t like your body because of breastfeeding.
Strongly disagree Disagree Neutral Agree Strongly agree
Breasts should be used for erotic purposes rather than for infant feeding.
Strongly disagree Disagree Neutral Agree Strongly agree
14
Health professionals should actively encourage all mothers in their practices to try
breastfeeding.
Strongly disagree Disagree Neutral Agree Strongly agree
15
UNIVERSITY OF BALAMAND
Faculty of Health Sciences
June 2009
CONSENT FORM
Dear Participant,
You are invited to participate in a study that will examine misconceptions about
breastfeeding. We hope to understand better the benefits of breastfeeding and some issues
that stop women from breastfeeding.
You were selected as a possible participant in this study because we would like to assess
your knowledge about breastfeeding and understand better your concerns and decisions
about whether to breastfeed or not. This is why we would like you to fill this
questionnaire. This study is conducted by the Faculty of Health Sciences at the University
of Balamand.
The interview will take approximately 15 minutes. We will ask you questions about:
• Your decision to breastfeed or not.
• Your preferred/favored method of infant feeding.
• Your knowledge about the benefits and concerns in relation to breastfeeding.
Any personal information provided by you will remain totally confidential and will be
disclosed only with your permission. The information provided will be used only for
research purposes. Your name, address, and other personal information will be removed
from the questionnaire, and only a code will be used to connect your name and your
answers without identifying you.
Your decision whether or not to participate is voluntary. If you decide to participate, you
are free to discontinue participation at any time without prejudice.
If you have any questions, please do not hesitate to contact us at any time. If you have
any additional questions later, please contact Ms. Nanor Aghjian, Ms. Cynthia
Zanazanian or Mr. Shant Leblebjian at 03-074288 who will be happy to answer them.
You will be offered a copy of this form to keep.
Thank you
16
Nanor Aghjian, Cynthia Zanazanian and Shant Leblebjian
Faculty of Health Sciences, University of Balamand
Beirut Lebanon
Agreed ( ) Refused ( )
_____________________________________________________________________
You are making a decision whether or not to participate. Your signature indicates that
you have read the information provided above and have decided to participate. You may
withdraw at any time without penalty or loss of benefits to which you may be entitled
after signing this form should you choose to discontinue participation in this study.
____________________________________
Signature of Participant
_____________________________________ ___________________________
Signature of Assessor Date
17