Publication Date




Embargo Period


Degree Type


Degree Name

Doctor of Philosophy (PHD)


Nursing (Nursing)

Date of Defense


First Committee Member

Rosina Cianelli

Second Committee Member

Nilda Peragallo Montano

Third Committee Member

Karina Gattamorta

Fourth Committee Member

Jacqueline M. McGrath


Nurses are the largest group of healthcare professionals who support breastfeeding and lactating mothers in maternity facilities. Yet, the most effective instructional methodology to deliver the 20-hour WHO/UNICEF breastfeeding training for maternal-child nurses is still not determined. Breastfeeding knowledge gain and perception of breastfeeding support are two key modifiable outcomes of breastfeeding training that are commonly identified in the nursing literature. The purpose of this study was to evaluate the impact of instructional methodology (classroom versus computer-based) on the maternal–child nurse’s breastfeeding knowledge gain and perception of breastfeeding support for nurses that participated in the 20-hour WHO/UNICEF breastfeeding training. A secondary analysis was conducted on a sample of 521 cases of attendance by three types of maternal–child nurses- labor and delivery, postpartum, and neonatal- at a metropolitan hospital. Commercial breastfeeding knowledge tests had been administered pre- and post each session. A perception of breastfeeding support questionnaire, the Iowa Infant Feeding Attitude Scale, and demographic information had been collected at the end of each session. Instructional methodology significantly impacted breastfeeding knowledge gain for one content-specific breastfeeding session. The best predictor of perception of breastfeeding support was not instructional methodology, but infant feeding attitude. Type of maternal-child nurse significantly impacted breastfeeding knowledge gain and perception of breastfeeding support. These findings will have significant applications in choice of instructional methodology for breastfeeding education in the acute care setting, as well as continuing breastfeeding education post the 20-hour training.


breastfeeding; maternal-child; WHO/UNICEF; BabyFriendly; lactation; nursing education