Breastfeeding knowledge, attitudes and perceptions of breastfeeding education among undergraduate nursing students in mainland China: A cross-sectional study

Breastfeeding knowledge, attitudes and perceptions of breastfeeding education among undergraduate nursing students in mainland China: A cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Breastfeeding knowledge, attitudes and perceptions of breastfeeding education among undergraduate nursing students in mainland China: A cross-sectional study Yuanyuan Yang, Huijuan Liu, Jing Yang, Bian Li, Zhijuan Shen, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4011960/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background China has the largest population in the world. While breastfeeding statistics have improved in the most recent decade, the exclusive breastfeeding rates remain low. Nurses with baccalaureate degrees are becoming the mainstay of China's nursing workforce and are an important force in supporting breastfeeding. To date, there is little evidence regarding breastfeeding education for undergraduate nursing students in mainland China. This study aims to explore the breastfeeding knowledge level and attitudes of undergraduate nursing students in mainland China, as well as their perceptions on breastfeeding education. Methods This was a descriptive cross-sectional study. An online questionnaire survey was conducted from October to December 2023 among 428 undergraduate nursing students from 22 medical universities/colleges in different regions of mainland China. Results Most student participants (96.96%) expressed supportive attitudes toward breastfeeding. The average correct response rate of the breastfeeding knowledge questionnaire was 54.80%. Students who reported having received breastfeeding education/training at school, or having obstetric or pediatric internship experience had significantly higher mean knowledge scores compared to others (p < 0.05). Overall, 92.99% (398/428) of students surveyed stated they would like more education on breastfeeding within the undergraduate nursing school curriculum. Case-based learning (CBL) and simulation were the most desired teaching methods for theoretical classes and practical classes, respectively. Conclusions The breastfeeding knowledge of undergraduate nursing students needs to be improved. Breastfeeding education included in the nursing curriculum should be strengthened, to adequately prepare students to support breastfeeding. breastfeeding knowledge nursing education undergraduate cross-sectional study Introduction Breast milk is the optimal source of nutrition for infants under 6 months of age [ 1 ]. Breastfeeding is of great value for promoting the growth and development of infants and young children, reducing the risk of disease in mothers and infants, and improving the health of mothers and infants [ 2 ]. World Health Organization (WHO) recommends that infants should be exclusively breastfed until 6 months of age, after which complementary foods should be added and breastfeeding should continue until 2 years of age [ 3 ]. In China, the National Health and Hygiene Commission advocated in the National Nutrition Program (2017–2030) that the rate of exclusive breastfeeding for infants aged 0–6 months should reach 50% by 2020; and by 2030, it should be increased by 10% based on 2020 [ 4 ]. However, the data in 2020 reported that the exclusive breastfeeding rate at 6 months in 17 cities across China from 2007 to 2017 ranged from 0.5–33.45% [ 5 ]. Although there has been some improvement in the “any breastfeeding” rate in the most recent decade due to a series of initiatives and measures to promote breastfeeding, the “exclusive breastfeeding” rates are below the national goal [ 5 ]. Breastfeeding is influenced by various factors, among which the support of healthcare providers plays an important role. Studies have shown that comprehensive breastfeeding guidance provided by healthcare providers to pregnant and postpartum women can help improve their breastfeeding efficacy, thus prolonging the duration of breastfeeding [ 6 , 7 ]. The lack of breastfeeding knowledge and insufficient awareness of breastfeeding among nursing students and medical staff have seriously hindered their ability to support breastfeeding [ 8 , 9 ]. Nurses are the health care providers who have the most contact with pregnant women and maternity, undertaking important work such as breastfeeding education during pregnancy and childbirth, direct guidance on breastfeeding after delivery, and postnatal visits, all of which are closely related to the development of breastfeeding and play a pivotal role in the promotion of breastfeeding. In China, there are currently more than 5 million registered nurses, 34.2% of whom have a bachelor's degree; moreover, the proportion of nurses with a bachelor's degree is increasing year by year due to the increasing enrollment of undergraduate nursing students [ 10 , 11 ]. Nurses with bachelor's degrees are becoming the main force of the nursing workforce in China Inadequate breastfeeding knowledge among undergraduate nursing students will somewhat limit their ability to play the role of breastfeeding support and promotion in their future clinical work. At present, there have been countries and regions to strengthen breastfeeding education for undergraduate nursing students, such as Professor Spatz at the University of Pennsylvania in the United States has opened a course on breastfeeding and human lactation for undergraduate nursing students (including 28h of breastfeeding course work and 14h of clinical study), and students reflect that the course has laid a foundation for them to work as a nurse [ 12 ]. In China, Hunan University of Traditional Chinese Medicine offers an elective course on breastfeeding [ 13 ], and West China Second University Hospital, Sichuan University builds an online course entitled Breastfeeding [ 14 ]. Neither of them is limited to nursing students. In addition, some higher education institutions have increased the content of breastfeeding knowledge in existing courses or improved teaching methods to achieve better breastfeeding education. For example, Bozzette et al. [ 15 ] from Seattle University in the United States found that adding a 1.5-h multimedia breastfeeding education theoretically guided by evidence-based practice model in obstetric nursing, improved the students' breastfeeding knowledge level. The University of South Alabama used standardized patients to teach how to help mothers with difficulty in breastfeeding, resulting in improved breastfeeding knowledge and attitudes among students [ 16 ]. Some scholars have also developed breastfeeding educational resources to support breastfeeding teaching. Deloian et al. developed the "Breastfeeding Basics" website [ 17 ], and the University of Miami, provided breastfeeding education to undergraduate nursing students based on the Blackboard website [ 18 ]. Malcolm College of the City Colleges of Chicago [ 19 ] designed a breastfeeding toolkit based on the core competencies for professionals as defined by the American Breastfeeding Association to provide breastfeeding education through blended learning. A study in Hong Kong, China, showed that 10-hour theoretical instruction and 8-week perinatal clinical rotation had no significant effect on nursing undergraduates' attitudes toward breastfeeding and formula feeding, but significantly improved breastfeeding knowledge [ 20 ]. In Taiwan, a 3-hour on-campus theoretical learning, with six hours of laboratory-based skills learning on breastfeeding, and 40-hour clinical placement in the postnatal unit increased nursing students’ knowledge and improved positive attitudes towards breastfeeding [ 21 ]. However, little research has been reported on breastfeeding education for undergraduate nursing students in mainland China. Nursing undergraduates will be the force of nurses, and their breastfeeding knowledge and attitudes will have an important impact on their future work in breastfeeding development. Given this, it is necessary to have a systematic understanding of the current level of breastfeeding knowledge, attitudes and perception of receiving breastfeeding education among undergraduate nursing students in China, to further clarify the necessity of breastfeeding courses in undergraduate nursing education in China, and provide a reference basis for clarifying the content and form of their education. Methods Participants This is a descriptive, cross-sectional questionnaire survey carried out from October to December 2023 at 22 medical universities/colleges in Mainland China. These educational institutions provide undergraduate nursing education for students. A convenience sampling technique was used in this study. The inclusion criteria were a) full-time undergraduate nursing students enrolled in medical universities/colleges who are during clinical placement of the final academic year, b) no cognitive function or mental disorder, and c) participating in this study voluntarily. Nursing undergraduates on leave or repeating a grade were excluded. The sample size was calculated using the sample calculation formula for cross-sectional surveys n = [Max (number of items) × (5–10)] × [1 + (10%-30%)] [ 22 ]. The breastfeeding knowledge questionnaire in this study had 32 items, the general demographic and sociological information had 5 items, and there were 7 items for learning needs. The maximum number of items of 32 was taken to calculate the sample size. The sample size was 176–416 cases. The study was approved by the Bioethics Committee of XX (No.: IRB00001052-23137). Instruments The questionnaire has three sections. The first section consists of 7 items to evaluate the neonatal students’ gender, school, obstetric or pediatric internship experience, receiving breastfeeding education experience at school, and breastfeeding attitudes. The second section includes questions to measure breastfeeding knowledge. These items were designed by the investigators in accordance with the Guideline for Infant and Young Child Feeding and Nutrition [ 1 ]. This section consists of 32 questions covering the importance of breastfeeding (5 questions), breast anatomy and lactation physiology (6 questions), lactation techniques (9 questions), methods of judging if breastfeeding is successful (2 questions), diets for breastfeeding mothers (3 questions), breastfeeding precautions (4 questions), and storage of breastmilk (3 questions), totaling 7 dimensions. The students responded to the items by selecting “I agree”, “I disagree” or “I don’t know”. They were evaluated as “knowing” or “not knowing” each item based on their responses. Each known item (correct responses) received a score of 1 point, while unknown items (incorrect responses or “I don’t know” responses) were scored as 0, resulting in a total score ranging from 0 to 32. Higher scores indicate a higher knowledge level. The reliability of the questionnaire analyzed in the pre-test with 50 samples was 0.830. The content validity of the questionnaire was assessed by six breastfeeding experts. They were asked to offer their opinions for each item as highly relevant (4), quite relevant (3), somewhat relevant (2), and not relevant (1). The Content Validity Index (CVI) was calculated by dividing the number of experts assigning 3 or 4 points to the items by the total number of experts [ 23 ]. The CVI of the questionnaire, as calculated in accordance with expert judgment, was 0.92. Items in the questionnaire were modified to improve its clarity according to the experts' review. Evaluation of the revised version by the panel resulted in no further modifications. The third section includes questions to assess perception of breastfeeding education, including the knowledge and teaching approaches. This section consists of 7 items: 5 multiple-choice sequencing questions, 1 single-choice question, and 1 yes/no statement. Data collection This was an online questionnaire survey. A link to this questionnaire was established on the Questionnaire Star platform. Questionnaire Star is a secure, web-based application designed to support data capture for research studies. The researcher provided uniform training to the chief instructor in charge of nursing internships in each hospital to explain the requirements for completing the questionnaire. The questionnaire was sent to the nursing students via WeChat by the chief internship instructor. The purpose and significance of the study were stated in the introduction of the questionnaire. If students chose to participate, they filled out the questionnaire anonymously and independently. A total of 457 questionnaires were recovered. Excluding invalid questionnaires (e.g., the same option was used consecutively for different items, and there were obvious logical errors), 428 valid questionnaires were collected. The effective recovery rate was 93.65%. Data analysis SPSS (Statistical Package for the Social Sciences) for Windows version 21.0 package software was used to perform the data analysis. Descriptive analysis was performed for all the variables. One-way ANOVA or independent samples t-tests were used to compare nursing students' breastfeeding mean knowledge according to their gender, educational institution level, obstetric or pediatric internship experience, and receiving breastfeeding education experience at school. The results were evaluated within a 95% confidence interval and p values <0.05 were considered statistically significant. The average score of the options was used to analyze multiple-choice sequencing questions. This is calculated by multiplying the frequency times the weights divided by the number of times the question was filled in. The weights are determined by the number of options in the question. For example, there are five options in the sequencing, selecting the item as the first choice (referred to as NO.1) is assigned a value of 5 points, selecting the item as the second choice (referred to as NO.2) is assigned a value of 4 points, selecting the item as the third choice (referred to as NO.3) is assigned a value of 3 points, selecting the item as the fourth choice (referred to as NO.4) is assigned a value of 2 points, and selecting the item as the fifth choice (referred to as NO.5) is assigned a value of 1 point. The average score is (the number of people who chose the NO.1 *5 + the number of people who chose the NO.2 *4 + the number of people who chose the NO.3 *3 + the number of people who chose the NO.4 *2 + the number of people who chose the NO.5 *1 / the number of people who filled in the question) [ 24 ]. Results Demographic statistics In total, 428 undergraduate nursing students from 22 medical universities/colleges in mainland China, participated in the study. Among these educational institutions, 9 were first-level, 10 were second-level, and 3 were third-level. The enrollment scores of the first-level institutions are higher than those of the second-level institutions which are higher than those of the third-level institutions. The nursing programs at these institutions are all four years in length. The average age of the participants was 21.36 ± 0.68 years old. All of them were unmarried. Sample characteristics are given in Table 1 . Table 1 Characteristics of undergraduate nursing students (N = 428) n % Gender Female 351 82.01 Male 77 17.99 Educational institution level First-level 171 39.95 Second-level 225 52.57 Third-level 32 7.48 Receiving breastfeeding education experience Yes 343 80.14 No 85 19.86 Separate breastfeeding courses are offered(n = 343) Yes 8 2.33 No 335 97.67 obstetric or pediatric internship experience Yes 205 47.90 No 223 52.10 Breastfeeding attitudes of undergraduate nursing students Most student participants (415, 96.96%) expressed supportive attitudes toward breastfeeding. Less than half of the participants (190, 44.39%) encouraged breastfeeding until 2 years old. Breastfeeding knowledge of undergraduate nursing students The mean knowledge score of the nursing students participating in the study was 17.16 out of 32 (SD = ± 3.92; range = 1–25). The average correct response rate of all the participants was 54.80%. The most known items among students were those in dimensions of breastfeeding precautions, with the correct response rate of 69.98%. The least known items were those in dimensions of methods of judging if breastfeeding is successful, with the correct response rate of 33.20%. The knowledge scores and correct response rates of the seven dimensions are given in Table 2 . Table 2 Breastfeeding knowledge of undergraduate nursing students (N = 428) Dimensions Number of items Average score Correct response rate(%) Breastfeeding precautions 4 2.80 ± 1.12 69.98 Breast anatomy and lactation physiology 6 4.00 ± 0.97 66.67 The importance of breastfeeding 5 3.22 ± 1.12 64.48 Diets for breastfeeding mothers 3 1.86 ± 0.53 62.03 Storage of breastmilk 3 1.37 ± 0.78 45.56 Lactation techniques 9 3.76 ± 1.47 41.74 Methods of judging if breastfeeding is successful 2 0.66 ± 0.51 33.20 Total 32 17.67 ± 3.92 54.80 Comparison of students' knowledge scores according to their descriptive characteristics When knowledge scores were evaluated according to gender, there was no significant difference between the scores of the female 17.33 (SD = ± 3.43) and male 16.30 (SD = ± 5.80) students (Table 3 ). Evaluation of knowledge scores according to educational institution level revealed that the mean knowledge score was 17.24 (SD = ± 1.10) among students in first-level college, 17.516 (SD = ± 3.73) among those in second-level college, and 16.88 (SD = ± 4.39) among those in third-level college. There were no statistically significant differences in knowledge scores between students in different educational institution levels (p>0.05). Students who reported having received breastfeeding education/training at school, or having obstetric or pediatric internship experience, had significantly higher mean knowledge scores compared to others (p<0.01) (Table 3 ). Table 3 Comparison of students' knowledge scores according to their descriptive characteristics (N = 428) Characteristic n X ± SD t/F P Gender Female 351 17.33 ± 3.43 0.836 0.407 Male 77 16.30 ± 5.80 Educational institution level First-level 171 17.24 ± 1.10 1.439 0.239 Second-level 225 17.16 ± 3.73 Third-level 32 16.88 ± 4.39 Receiving breastfeeding education experience at school 3.293 0.006** Yes 343 17.51 ± 1.93 No 85 15.58 ± 3.87 Obstetric or pediatric internship experience 2.687 0.001** Yes 205 17.74 ± 3.23 No 223 16.47 ± 4.36 **p<0.01 Students’ perception of receiving breastfeeding education Overall, 92.99% (398/428) of students surveyed stated they would like more education on breastfeeding within the undergraduate nursing school curriculum. Table 4 presents a descriptive summary of the students’ desire of the way to receive breastfeeding education. Students reported being most interested in learning about breastfeeding from their school teachers. Table 4 Student current and desired way to receive breastfeeding education(N = 428) n % n % Current way Desired way Clinical preceptor 177 41.35 School teacher 330 77.10 School teacher 217 50.70 Clinical preceptor 296 69.16 Book 132 30.84 Book 208 48.60 Internet 218 50.93 Internet 202 47.20 Family and friends 148 34.58 Family and friends 130 30.37 The results of the nursing students' needs for breastfeeding knowledge and teaching methods are shown in Table 5 , with higher scores indicating that the students considered it more important. The most desired knowledge reported by students was lactation techniques. The most preferred teaching approaches for theoretical courses and practical skills training were CBL and simulation, respectively. Table 5 Student desire for breastfeeding knowledge and teaching approach(N = 428) Items Person-times % Average score Knowledge Lactation techniques 306 71.50 7.18 Benefits of breastfeeding 285 66.59 6.75 Breast anatomy and lactation physiology 277 64.72 6.51 Methods of judging if breastfeeding is successful 297 69.39 5.59 Diets for breastfeeding mothers 308 71.96 5.41 Breastfeeding precautions 319 74.53 5.30 Storage of breastmilk 299 69.86 3.49 Teaching approaches for theoretical courses Case-based learning (CBL) 254 59.35 7.94 Problem-based learning (PBL) 217 50.70 6.94 Offline and online blended learning 245 57.24 6.75 Didactic instruction 194 45.33 6.72 Flipped classroom 179 41.82 6.39 Online videos 169 39.49 5.97 lectures 234 54.67 5.95 Self-learning 254 59.35 3.71 Practical skills training approaches Simulation 285 66.59 4.14 Video teaching and student operation 269 62.85 3.88 Maternal health education through community-based practices 283 66.12 3.67 virtual simulation teaching and learning 277 64.72 3.38 Evaluation methods Operational Skills Examination 285 66.59 4.30 Traditional Theory Examination 268 62.62 4.28 Thesis 208 48.60 3.47 Oral examination 202 47.20 3.28 Discussion The present study is the first study to date to investigate the breastfeeding knowledge and attitudes among undergraduate nursing students in mainland China. Specially, this study reveals students’ breastfeeding education needs and provides valuable clues on how breastfeeding knowledge and skills are best facilitated in undergraduate curricula. Nursing students' breastfeeding attitudes may affect their readiness to serve as breastfeeding promoters in the future. In our study, most student participants expressed supportive attitudes toward breastfeeding. This is inconsistent with the reports among nursing students in Israel and in USA [ 9 , 25 ]. What is concern is that only 44.39% of the students encouraged breastfeeding until 2 years old, which is the basic concept about breastfeeding that WHO recommended [ 2 ]. Previous studies have shown that many mothers give up breastfeeding early because they do not know how old their children should be breastfed [ 26 ], and if professionals can provide them with targeted guidance, it can help prolong the duration of their breastfeeding [ 7 ]. With regard to knowledge towards breastfeeding, the average correct response rate of all the participants was 54.80%. This indicates the lack of knowledge of breastfeeding among undergraduate nursing students. This is in line with the previous reports that nursing students lack of knowledge and have various misconceptions about breastfeeding [ 9 ]. Yang’s review found that this phenomenon is common in health professional students including nursing students [ 27 ]. Studies have shown that a breastfeeding knowledge base can be established during basic nursing education [ 15 , 25 , 27 , 28 ]. Whether a nursing student has or has not completed a class about human lactation during the nursing program, significantly influences their attitudes and knowledge towards breastfeeding [ 9 ]. This is reconfirmed in our study that students who reported having received breastfeeding education/training, or having obstetric or pediatric internship experience had significantly higher mean knowledge scores compared to others. Yang’s study revealed that the current breastfeeding education program in Taiwan, both theoretical and clinical components, increased nursing students’ knowledge and improved positive attitudes towards breastfeeding [ 21 ]. This implies that studying breastfeeding as part of the core program is indeed beneficial. The majority (92.99%) of the students participating in our study stated they need to receive more breastfeeding education at medical school. The value of including undergraduate breastfeeding education has been perceived by health professional students previously in various countries [ 29 – 32 ]. However, currently, most of the breastfeeding education in mainland China is decentralized, and educational hours are limited [ 33 ], which can’t meet students’ needs. Therefore, there is a need to integrate a breastfeeding curriculum into undergraduate nursing education with adequate course hours to enhance students' knowledge of breastfeeding. Regarding the teaching methods in theoretic courses, most students in our study preferred CBL, followed by PBL and offline and online blended learning. These teaching methods have been recommended to in breastfeeding education for medical students [ 34 , 35 ]. CBL and PBL can deepen students' understanding of knowledge by solving specific cases or problems, and also help to mobilize students' motivation to learn and cultivate their ability of independent learning, independent thinking, and independent problem-solving [ 36 ]. Online teaching is flexible and rich in network resources, which is conducive to expanding students' knowledge, while offline teaching has the advantage of strong interaction between teachers and students. Online and offline blended learning can combine the advantages of the two to improve the quality of teaching [ 37 ]. Schools should choose appropriate teaching methods according to the different contents of teaching, and actively explore teaching methods suitable for breastfeeding education. A variety of forms of integrated teaching methods can also be adopted to improve students' learning initiative and enhance their breastfeeding knowledge. The nursing students in our sample desired an integrated learning approach to include both theoretical knowledge and practical skills. This is consistent with the study on medical students in breastfeeding education [ 29 ]. Kim et al [ 34 ] found that incorporating breastfeeding knowledge into clinical placements through a variety of pathways in a survey of medical students in South Korea significantly increased the level of breastfeeding knowledge and their confidence in effectively instructing breastfeeding in the medical students. The most favoured teaching approach as students reported was simulation. Simulation is a learning modality that provides the student with a non-threatening learning experience for the learner to develop clinical skills. Due to the interactive nature of breastfeeding management, applying counseling skills and breastfeeding techniques with real patients is a critical component of nursing or medical training. A scoping review of the application-based breastfeeding skills training identified that the use of real patients was a common method, followed by role-playing and use of standardized patients [ 38 ]. However, working in clinical environments with real patients will be perceived as stressful for students. Simulated clinical environments and patients allow students to learn skills without worrying about making mistakes that could harm patient safety. Sadovnikova et al. found that clinical education with high-fidelity breastfeeding simulators could be the ideal learning modality for trainees and hospital staff to build confidence in clinical lactation skills. Lactation simulation education has the potential to improve clinical practice and patient outcomes [ 39 ]. Simulation not only helps students to consolidate the theoretical foundation and improve operational skills but also helps to cultivate students' ability to respond calmly in emergencies [ 40 ]. Limitations This study has several limitations. First, the breastfeeding knowledge questionnaire was designed by the researchers. This is due to the fact that a questionnaire with good reliability and designed based on the latest breastfeeding guidelines was not retrieved when carrying out this study. Although the questionnaire showed good reliability, it still needs to be further validated in future studies. Second, although the undergraduate nursing students who participated in this study are from nursing schools at different levels and in different regions in mainland China, the sample size of the study was still small considering the large total number of nursing students, and therefore the generalizability of the results to all undergraduate nursing students in China needs to be cautious. Conclusions In light of the results of the study, it can be concluded that nursing undergraduate students in mainland China need more breastfeeding knowledge. This study highlights a need for reinforcing breastfeeding education and training for nursing undergraduate students. Additionally, thanks to the results obtained, it provides evidence for structuring needs-oriented breastfeeding education curricula in the undergraduate nursing program. Colleges and teaching hospitals should improve the curriculum of breastfeeding-related courses so that students can receive systematic breastfeeding education. Moreover, considering the trend of pedagogical technology and the teaching needs as well as preferences of students, the teaching method should be innovated, teaching methods such as CBL, and PBL be integrated into the theoretical classroom, and the simulation method be adopted in the practical class to enhance the teaching effect. Building on the findings of this study, future research could examine the effectiveness of education and training in improving nursing students' knowledge levels. Declarations Ethics approval and consent to participate This study was approved by the Peking University Institutional Review Board [No.: IRB00001052-23137]. All data were collected anonymously. Consent for publication Not applicable. Availability of data and materials The datasets used and analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no conflict of interests in this section. Funding The study did not receive any external funding. Authors' contributions YY conceived the study, analysed and interpreted the data, and wrote the original draft. HL, JY, BL and ZS collected the data. HL (corresponding author) conceived the study, contributed to the analysis tools and data interpretation, and edited the manuscript. All authors read and approved the final manuscript. Acknowledgments The authors were very grateful to all participants in this research. Authors' information Yuanyuan Yang 1,2 , Huijuan Liu 3 , Jing Yang 4 , Bian Li 5 , Zhijuan Shen 6 , Xiaoling Zhou 1 , Hong Lu 1* 1 Peking University School of Nursing, Beijing, China 2 Peking University Health Science Center for Evidence-Based Nursing, Beijing, China 3 Neonatal Disease Diagnosis and Treatment Center, Fifth Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China 4 School of Nursing, Xinjiang Medical University, Wulumuqi, China 5 Peking University First Hospital, Beijing, China 6 Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China * Corresponding author References China Preventive Medicine Association. Guide to infant feeding and nutrition [J]. Chin J Woman Child Health Res. 2019;30(04):392–417. Gartner LM, Morton J, Lawrence RA, Naylor AJ, O'Hare D, Schanler RJ, Eidelman AI. Breastfeeding and the use of human milk. Pediatrics. 2005;115(2):496–506. 10.1542/peds.2004–2491 . WHO. 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Chin J Social Med. 2017;34(05):478–82. Yang SF, Salamonson Y, Burns E, et al. Breastfeeding knowledge and attitudes of health professional students: a systematic review [J]. Int Breastfeed J. 2018;13:8. https://doi.org/10.1186/s13006-018-0153-1 . Campbell SH, Bernardes NO, Tharmaratnam T, et al. Educational Resources and Curriculum on Lactation for Health Undergraduate Students: A Scoping Review [J]. J Hum Lact. 2022;38(1):89–99. 10.1177/0890334420980693 . Biggs KV, Fidler KJ, Shenker NS, et al. Are the doctors of the future ready to support breastfeeding? A cross-sectional study in the UK. Int Breastfeed J. 2020;15(1):46. 10.1186/s13006-020-00290-z . Kakrani VA, Rathod Waghela HK, Mammulwar MS, Bhawalkar JS. Awareness about ten steps for successful breastfeeding among medical and nursing students. Int J Prev Med. 2015;6:40. 10.4103/2008-7802.156838 . Ogburn T, Espey E, Leeman L, Alvarez K. A breastfeeding curriculum for residents and medical students: a multidisciplinary approach. J Hum Lact. 2005;21(4):458–64. 10.1177/0890334405280990 . Viaro VD, Linhares FMP, Marinus MWLC, Guedes TG, Vanderley LSL. Limits and possibilities for teaching and learning about breastfeeding. Rev Bras Enferm. 2019;72(1):3–8. 10.1590/0034-7167-2018-0017 . Zhu Q, Tian C, Xiong DD, et al. Current status of breastfeeding teaching in undergraduate nursing students [J]. Chin J Nurs Educ. 2020;17(12):1138–42. Kim YJ. Important role of medical training curriculum to promote the rate of human Milk Feeding [J]. Pediatr Gastroenterol Hepatol Nutr. 2017;20(3):147–52. 10.5223/pghn.2017.20.3.147 . Moukarzel S, Mamas C, Warstadt MF, Bode L, Farhat A, Abi Abboud A, et al. A case study on breastfeeding education in Lebanon's public medical school: exploring the potential role of social networks in medical education. Med Educ Online. 2018;23(1):1527629. 10.1080/10872981.2018.1527629 . Allchin D. Problem- and case-based learning in science: an introduction to distinctions, values, and outcomes [J]. CBE Life Sci Educ. 2013;12(3):364–72. 10.1187/cbe.12-11-0190 . Lin D, Lijing Z, Tianxin X, et al. Blended learning vs traditional teaching: The potential of a novel teaching strategy in nursing education-a systematic review and meta-analysis. Nurse Educ Pract. 2022;63:103354. https://doi.org/10.1016/j.nepr.2022.103354 . Chuisano SA, Anderson OS. Assessing application-based breastfeeding education for physicians and nurses: A scoping review. J Hum Lact. 2020;36(4):699–709. 10.1177/0890334419848414 . Sadovnikova A, Chuisano SA, Ma K, Grabowski A, Stanley KP, Mitchell KB, et al. Development and evaluation of a high-fidelity lactation simulation model for health professional breastfeeding education. Int Breastfeed J. 2020;15(1):8. 10.1186/s13006-020-0254-5 . Silva GO, Oliveira FSE, Coelho ASG, et al. Influence of simulation design on stress, anxiety and self-confidence of nursing students: Systematic review with meta-analysis [J]. J Clin Nurs. 2023;32(17–18):5668–92. 10.1111/jocn.16681 . 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4011960","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":276563909,"identity":"f5fcbfd7-5db4-4209-9307-cbbf9c9fd55d","order_by":0,"name":"Yuanyuan Yang","email":"","orcid":"","institution":"Peking University School of Nursing","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yuanyuan","middleName":"","lastName":"Yang","suffix":""},{"id":276563910,"identity":"96565572-3402-4a0b-98a7-f62e9a7987b4","order_by":1,"name":"Huijuan Liu","email":"","orcid":"","institution":"Neonatal Disease Diagnosis and Treatment Center, Fifth Medical Center of Chinese People's Liberation Army General Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Huijuan","middleName":"","lastName":"Liu","suffix":""},{"id":276563911,"identity":"2219a529-b3f5-4079-9d04-74672c625554","order_by":2,"name":"Jing Yang","email":"","orcid":"","institution":"Xinjiang Medical University School of Nursing","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Yang","suffix":""},{"id":276563912,"identity":"4ae4cdf5-807a-4bb2-8518-8f0f09fa8d90","order_by":3,"name":"Bian Li","email":"","orcid":"","institution":"Peking University First Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Bian","middleName":"","lastName":"Li","suffix":""},{"id":276563913,"identity":"2251461c-ef36-4af5-aa64-5b3b80ba9b18","order_by":4,"name":"Zhijuan Shen","email":"","orcid":"","institution":"Xiangyang Central Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zhijuan","middleName":"","lastName":"Shen","suffix":""},{"id":276563914,"identity":"2f5469b7-3259-40c1-97b8-ea7d058ba703","order_by":5,"name":"Xiaoling Zhou","email":"","orcid":"","institution":"Peking University School of Nursing","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xiaoling","middleName":"","lastName":"Zhou","suffix":""},{"id":276563915,"identity":"7b1e9336-0377-4aca-91d3-780de7df0aab","order_by":6,"name":"Hong Lu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyElEQVRIiWNgGAWjYBACPgYeEGWTwNgAotmI0MIG0ZJGupbDCTAuEVokcg8+Lvh1Po952hkDhg9lhxn4ZzcQ0pKXbDyz73Yx4+wcA8YZ5w4zSNw5QEhLjpk0b8/txEagFmbetsMMBhIJRGk5B9Hyl2gtPD8OQLQwEqWF542xMW9DMtAvaQUHe86l80jcIKCFnz3H8DHPH7s8w9nJGx/8KLOW459BQAsYMLYxMBg2MDAcALJ5iFAPAn8YGOSJVDoKRsEoGAUjEAAAJM0+s4LovnsAAAAASUVORK5CYII=","orcid":"","institution":"Peking University School of Nursing","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Hong","middleName":"","lastName":"Lu","suffix":""}],"badges":[],"createdAt":"2024-03-04 14:06:54","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4011960/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4011960/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":52210211,"identity":"e8cc79ea-55fa-4b5e-9f8d-99b4bf5124c7","added_by":"auto","created_at":"2024-03-08 00:38:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":375581,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4011960/v1/647eae1f-5c5a-4062-94f2-4bb497f705f0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Breastfeeding knowledge, attitudes and perceptions of breastfeeding education among undergraduate nursing students in mainland China: A cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBreast milk is the optimal source of nutrition for infants under 6 months of age [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Breastfeeding is of great value for promoting the growth and development of infants and young children, reducing the risk of disease in mothers and infants, and improving the health of mothers and infants [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. World Health Organization (WHO) recommends that infants should be exclusively breastfed until 6 months of age, after which complementary foods should be added and breastfeeding should continue until 2 years of age [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In China, the National Health and Hygiene Commission advocated in the National Nutrition Program (2017\u0026ndash;2030) that the rate of exclusive breastfeeding for infants aged 0\u0026ndash;6 months should reach 50% by 2020; and by 2030, it should be increased by 10% based on 2020 [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, the data in 2020 reported that the exclusive breastfeeding rate at 6 months in 17 cities across China from 2007 to 2017 ranged from 0.5\u0026ndash;33.45% [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Although there has been some improvement in the \u0026ldquo;any breastfeeding\u0026rdquo; rate in the most recent decade due to a series of initiatives and measures to promote breastfeeding, the \u0026ldquo;exclusive breastfeeding\u0026rdquo; rates are below the national goal [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBreastfeeding is influenced by various factors, among which the support of healthcare providers plays an important role. Studies have shown that comprehensive breastfeeding guidance provided by healthcare providers to pregnant and postpartum women can help improve their breastfeeding efficacy, thus prolonging the duration of breastfeeding [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The lack of breastfeeding knowledge and insufficient awareness of breastfeeding among nursing students and medical staff have seriously hindered their ability to support breastfeeding [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Nurses are the health care providers who have the most contact with pregnant women and maternity, undertaking important work such as breastfeeding education during pregnancy and childbirth, direct guidance on breastfeeding after delivery, and postnatal visits, all of which are closely related to the development of breastfeeding and play a pivotal role in the promotion of breastfeeding.\u003c/p\u003e \u003cp\u003eIn China, there are currently more than 5\u0026nbsp;million registered nurses, 34.2% of whom have a bachelor's degree; moreover, the proportion of nurses with a bachelor's degree is increasing year by year due to the increasing enrollment of undergraduate nursing students [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Nurses with bachelor's degrees are becoming the main force of the nursing workforce in China Inadequate breastfeeding knowledge among undergraduate nursing students will somewhat limit their ability to play the role of breastfeeding support and promotion in their future clinical work. At present, there have been countries and regions to strengthen breastfeeding education for undergraduate nursing students, such as Professor Spatz at the University of Pennsylvania in the United States has opened a course on breastfeeding and human lactation for undergraduate nursing students (including 28h of breastfeeding course work and 14h of clinical study), and students reflect that the course has laid a foundation for them to work as a nurse [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In China, Hunan University of Traditional Chinese Medicine offers an elective course on breastfeeding [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], and West China Second University Hospital, Sichuan University builds an online course entitled \u003cem\u003eBreastfeeding\u003c/em\u003e [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Neither of them is limited to nursing students.\u003c/p\u003e \u003cp\u003eIn addition, some higher education institutions have increased the content of breastfeeding knowledge in existing courses or improved teaching methods to achieve better breastfeeding education. For example, Bozzette et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] from Seattle University in the United States found that adding a 1.5-h multimedia breastfeeding education theoretically guided by evidence-based practice model in obstetric nursing, improved the students' breastfeeding knowledge level. The University of South Alabama used standardized patients to teach how to help mothers with difficulty in breastfeeding, resulting in improved breastfeeding knowledge and attitudes among students [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSome scholars have also developed breastfeeding educational resources to support breastfeeding teaching. Deloian et al. developed the \"Breastfeeding Basics\" website [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], and the University of Miami, provided breastfeeding education to undergraduate nursing students based on the Blackboard website [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Malcolm College of the City Colleges of Chicago [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] designed a breastfeeding toolkit based on the core competencies for professionals as defined by the American Breastfeeding Association to provide breastfeeding education through blended learning.\u003c/p\u003e \u003cp\u003eA study in Hong Kong, China, showed that 10-hour theoretical instruction and 8-week perinatal clinical rotation had no significant effect on nursing undergraduates' attitudes toward breastfeeding and formula feeding, but significantly improved breastfeeding knowledge [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In Taiwan, a 3-hour on-campus theoretical learning, with six hours of laboratory-based skills learning on breastfeeding, and 40-hour clinical placement in the postnatal unit increased nursing students\u0026rsquo; knowledge and improved positive attitudes towards breastfeeding [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, little research has been reported on breastfeeding education for undergraduate nursing students in mainland China. Nursing undergraduates will be the force of nurses, and their breastfeeding knowledge and attitudes will have an important impact on their future work in breastfeeding development. Given this, it is necessary to have a systematic understanding of the current level of breastfeeding knowledge, attitudes and perception of receiving breastfeeding education among undergraduate nursing students in China, to further clarify the necessity of breastfeeding courses in undergraduate nursing education in China, and provide a reference basis for clarifying the content and form of their education.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e \u003cb\u003eParticipants\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis is a descriptive, cross-sectional questionnaire survey carried out from October to December 2023 at 22 medical universities/colleges in Mainland China. These educational institutions provide undergraduate nursing education for students. A convenience sampling technique was used in this study. The inclusion criteria were a) full-time undergraduate nursing students enrolled in medical universities/colleges who are during clinical placement of the final academic year, b) no cognitive function or mental disorder, and c) participating in this study voluntarily. Nursing undergraduates on leave or repeating a grade were excluded.\u003c/p\u003e \u003cp\u003eThe sample size was calculated using the sample calculation formula for cross-sectional surveys \u003cem\u003en = [Max (number of items) \u0026times; (5\u0026ndash;10)] \u0026times; [1 + (10%-30%)]\u003c/em\u003e [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The breastfeeding knowledge questionnaire in this study had 32 items, the general demographic and sociological information had 5 items, and there were 7 items for learning needs. The maximum number of items of 32 was taken to calculate the sample size. The sample size was 176\u0026ndash;416 cases. The study was approved by the Bioethics Committee of XX (No.: IRB00001052-23137).\u003c/p\u003e\n\u003ch3\u003eInstruments\u003c/h3\u003e\n\u003cp\u003eThe questionnaire has three sections. The first section consists of 7 items to evaluate the neonatal students\u0026rsquo; gender, school, obstetric or pediatric internship experience, receiving breastfeeding education experience at school, and breastfeeding attitudes. The second section includes questions to measure breastfeeding knowledge. These items were designed by the investigators in accordance with the Guideline for Infant and Young Child Feeding and Nutrition [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This section consists of 32 questions covering the importance of breastfeeding (5 questions), breast anatomy and lactation physiology (6 questions), lactation techniques (9 questions), methods of judging if breastfeeding is successful (2 questions), diets for breastfeeding mothers (3 questions), breastfeeding precautions (4 questions), and storage of breastmilk (3 questions), totaling 7 dimensions.\u003c/p\u003e \u003cp\u003eThe students responded to the items by selecting \u0026ldquo;I agree\u0026rdquo;, \u0026ldquo;I disagree\u0026rdquo; or \u0026ldquo;I don\u0026rsquo;t know\u0026rdquo;. They were evaluated as \u0026ldquo;knowing\u0026rdquo; or \u0026ldquo;not knowing\u0026rdquo; each item based on their responses. Each known item (correct responses) received a score of 1 point, while unknown items (incorrect responses or \u0026ldquo;I don\u0026rsquo;t know\u0026rdquo; responses) were scored as 0, resulting in a total score ranging from 0 to 32. Higher scores indicate a higher knowledge level.\u003c/p\u003e \u003cp\u003eThe reliability of the questionnaire analyzed in the pre-test with 50 samples was 0.830. The content validity of the questionnaire was assessed by six breastfeeding experts. They were asked to offer their opinions for each item as highly relevant (4), quite relevant (3), somewhat relevant (2), and not relevant (1). The Content Validity Index (CVI) was calculated by dividing the number of experts assigning 3 or 4 points to the items by the total number of experts [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The CVI of the questionnaire, as calculated in accordance with expert judgment, was 0.92. Items in the questionnaire were modified to improve its clarity according to the experts' review. Evaluation of the revised version by the panel resulted in no further modifications.\u003c/p\u003e \u003cp\u003eThe third section includes questions to assess perception of breastfeeding education, including the knowledge and teaching approaches. This section consists of 7 items: 5 multiple-choice sequencing questions, 1 single-choice question, and 1 yes/no statement.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eThis was an online questionnaire survey. A link to this questionnaire was established on the Questionnaire Star platform. Questionnaire Star is a secure, web-based application designed to support data capture for research studies. The researcher provided uniform training to the chief instructor in charge of nursing internships in each hospital to explain the requirements for completing the questionnaire. The questionnaire was sent to the nursing students via WeChat by the chief internship instructor. The purpose and significance of the study were stated in the introduction of the questionnaire. If students chose to participate, they filled out the questionnaire anonymously and independently. A total of 457 questionnaires were recovered. Excluding invalid questionnaires (e.g., the same option was used consecutively for different items, and there were obvious logical errors), 428 valid questionnaires were collected. The effective recovery rate was 93.65%.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eSPSS (Statistical Package for the Social Sciences) for Windows version 21.0 package software was used to perform the data analysis. Descriptive analysis was performed for all the variables. One-way ANOVA or independent samples t-tests were used to compare nursing students' breastfeeding mean knowledge according to their gender, educational institution level, obstetric or pediatric internship experience, and receiving breastfeeding education experience at school. The results were evaluated within a 95% confidence interval and p values \u0026lt;0.05 were considered statistically significant.\u003c/p\u003e \u003cp\u003eThe average score of the options was used to analyze multiple-choice sequencing questions. This is calculated by multiplying the frequency times the weights divided by the number of times the question was filled in. The weights are determined by the number of options in the question. For example, there are five options in the sequencing, selecting the item as the first choice (referred to as NO.1) is assigned a value of 5 points, selecting the item as the second choice (referred to as NO.2) is assigned a value of 4 points, selecting the item as the third choice (referred to as NO.3) is assigned a value of 3 points, selecting the item as the fourth choice (referred to as NO.4) is assigned a value of 2 points, and selecting the item as the fifth choice (referred to as NO.5) is assigned a value of 1 point. The average score is (the number of people who chose the NO.1 *5\u0026thinsp;+\u0026thinsp;the number of people who chose the NO.2 *4\u0026thinsp;+\u0026thinsp;the number of people who chose the NO.3 *3\u0026thinsp;+\u0026thinsp;the number of people who chose the NO.4 *2\u0026thinsp;+\u0026thinsp;the number of people who chose the NO.5 *1 / the number of people who filled in the question) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cb\u003eDemographic statistics\u003c/b\u003e \u003c/p\u003e \u003cp\u003e In total, 428 undergraduate nursing students from 22 medical universities/colleges in mainland China, participated in the study. Among these educational institutions, 9 were first-level, 10 were second-level, and 3 were third-level. The enrollment scores of the first-level institutions are higher than those of the second-level institutions which are higher than those of the third-level institutions. The nursing programs at these institutions are all four years in length. The average age of the participants was 21.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68 years old. All of them were unmarried. Sample characteristics are given in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of undergraduate nursing students (N\u0026thinsp;=\u0026thinsp;428)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e351\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational institution level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst-level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecond-level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThird-level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReceiving breastfeeding education experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e343\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeparate breastfeeding courses are offered(n\u0026thinsp;=\u0026thinsp;343)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e335\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eobstetric or pediatric internship experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47.90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eBreastfeeding attitudes of undergraduate nursing students\u003c/h3\u003e\n\u003cp\u003eMost student participants (415, 96.96%) expressed supportive attitudes toward breastfeeding. Less than half of the participants (190, 44.39%) encouraged breastfeeding until 2 years old.\u003c/p\u003e\n\u003ch3\u003eBreastfeeding knowledge of undergraduate nursing students\u003c/h3\u003e\n\u003cp\u003eThe mean knowledge score of the nursing students participating in the study was 17.16 out of 32 (SD\u0026thinsp;=\u0026thinsp;\u0026plusmn;\u0026thinsp;3.92; range\u0026thinsp;=\u0026thinsp;1\u0026ndash;25).\u003c/p\u003e \u003cp\u003eThe average correct response rate of all the participants was 54.80%. The most known items among students were those in dimensions of breastfeeding precautions, with the correct response rate of 69.98%. The least known items were those in dimensions of methods of judging if breastfeeding is successful, with the correct response rate of 33.20%. The knowledge scores and correct response rates of the seven dimensions are given in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBreastfeeding knowledge of undergraduate nursing students (N\u0026thinsp;=\u0026thinsp;428)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDimensions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of items\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAverage score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCorrect response rate(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreastfeeding precautions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.80\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e69.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreast anatomy and lactation physiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe importance of breastfeeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e64.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiets for breastfeeding mothers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e62.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStorage of breastmilk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLactation techniques\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.76\u0026thinsp;\u0026plusmn;\u0026thinsp;1.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMethods of judging if breastfeeding is successful\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.66\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e17.67\u0026thinsp;\u0026plusmn;\u0026thinsp;3.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e54.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eComparison of students' knowledge scores according to their descriptive characteristics\u003c/h3\u003e\n\u003cp\u003eWhen knowledge scores were evaluated according to gender, there was no significant difference between the scores of the female 17.33 (SD\u0026thinsp;=\u0026thinsp;\u0026plusmn;\u0026thinsp;3.43) and male 16.30 (SD\u0026thinsp;=\u0026thinsp;\u0026plusmn;\u0026thinsp;5.80) students (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEvaluation of knowledge scores according to educational institution level revealed that the mean knowledge score was 17.24 (SD\u0026thinsp;=\u0026thinsp;\u0026plusmn;\u0026thinsp;1.10) among students in first-level college, 17.516 (SD\u0026thinsp;=\u0026thinsp;\u0026plusmn;\u0026thinsp;3.73) among those in second-level college, and 16.88 (SD\u0026thinsp;=\u0026thinsp;\u0026plusmn;\u0026thinsp;4.39) among those in third-level college. There were no statistically significant differences in knowledge scores between students in different educational institution levels (p\u0026gt;0.05).\u003c/p\u003e \u003cp\u003eStudents who reported having received breastfeeding education/training at school, or having obstetric or pediatric internship experience, had significantly higher mean knowledge scores compared to others (p\u0026lt;0.01) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of students' knowledge scores according to their descriptive characteristics (N\u0026thinsp;=\u0026thinsp;428)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eX\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003et/F\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e351\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e17.33\u0026thinsp;\u0026plusmn;\u0026thinsp;3.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.836\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.407\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e16.30\u0026thinsp;\u0026plusmn;\u0026thinsp;5.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational institution level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst-level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e17.24\u0026thinsp;\u0026plusmn;\u0026thinsp;1.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.439\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.239\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecond-level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e17.16\u0026thinsp;\u0026plusmn;\u0026thinsp;3.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThird-level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e16.88\u0026thinsp;\u0026plusmn;\u0026thinsp;4.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReceiving breastfeeding education experience at school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.293\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.006**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e343\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e17.51\u0026thinsp;\u0026plusmn;\u0026thinsp;1.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e15.58\u0026thinsp;\u0026plusmn;\u0026thinsp;3.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObstetric or pediatric internship experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.687\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e17.74\u0026thinsp;\u0026plusmn;\u0026thinsp;3.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e16.47\u0026thinsp;\u0026plusmn;\u0026thinsp;4.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e**p\u0026lt;0.01\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eStudents’ perception of receiving breastfeeding education\u003c/h3\u003e\n\u003cp\u003eOverall, 92.99% (398/428) of students surveyed stated they would like more education on breastfeeding within the undergraduate nursing school curriculum. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents a descriptive summary of the students\u0026rsquo; desire of the way to receive breastfeeding education. Students reported being most interested in learning about breastfeeding from their school teachers.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStudent current and desired way to receive breastfeeding education(N\u0026thinsp;=\u0026thinsp;428)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent way\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDesired way\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical preceptor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eSchool teacher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e330\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e77.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchool teacher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e217\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eClinical preceptor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e296\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e69.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBook\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eBook\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e48.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInternet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eInternet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e47.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily and friends\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eFamily and friends\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e30.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe results of the nursing students' needs for breastfeeding knowledge and teaching methods are shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, with higher scores indicating that the students considered it more important. The most desired knowledge reported by students was lactation techniques. The most preferred teaching approaches for theoretical courses and practical skills training were CBL and simulation, respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStudent desire for breastfeeding knowledge and teaching approach(N\u0026thinsp;=\u0026thinsp;428)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePerson-times\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAverage score\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLactation techniques\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e306\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBenefits of breastfeeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e285\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBreast anatomy and lactation physiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e277\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMethods of judging if breastfeeding is successful\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e297\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiets for breastfeeding mothers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e308\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBreastfeeding precautions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e319\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStorage of breastmilk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e299\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeaching approaches for theoretical courses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCase-based learning (CBL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e254\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProblem-based learning (PBL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e217\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOffline and online blended learning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDidactic instruction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFlipped classroom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOnline videos\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003electures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e234\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf-learning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e254\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractical skills training approaches\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSimulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e285\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVideo teaching and student operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e269\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaternal health education through community-based practices\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e283\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003evirtual simulation teaching and learning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e277\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEvaluation methods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOperational Skills Examination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e285\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTraditional Theory Examination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e268\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThesis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOral examination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study is the first study to date to investigate the breastfeeding knowledge and attitudes among undergraduate nursing students in mainland China. Specially, this study reveals students\u0026rsquo; breastfeeding education needs and provides valuable clues on how breastfeeding knowledge and skills are best facilitated in undergraduate curricula.\u003c/p\u003e \u003cp\u003eNursing students' breastfeeding attitudes may affect their readiness to serve as breastfeeding promoters in the future. In our study, most student participants expressed supportive attitudes toward breastfeeding. This is inconsistent with the reports among nursing students in Israel and in USA [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. What is concern is that only 44.39% of the students encouraged breastfeeding until 2 years old, which is the basic concept about breastfeeding that WHO recommended [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Previous studies have shown that many mothers give up breastfeeding early because they do not know how old their children should be breastfed [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], and if professionals can provide them with targeted guidance, it can help prolong the duration of their breastfeeding [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWith regard to knowledge towards breastfeeding, the average correct response rate of all the participants was 54.80%. This indicates the lack of knowledge of breastfeeding among undergraduate nursing students. This is in line with the previous reports that nursing students lack of knowledge and have various misconceptions about breastfeeding [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Yang\u0026rsquo;s review found that this phenomenon is common in health professional students including nursing students [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Studies have shown that a breastfeeding knowledge base can be established during basic nursing education [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Whether a nursing student has or has not completed a class about human lactation during the nursing program, significantly influences their attitudes and knowledge towards breastfeeding [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This is reconfirmed in our study that students who reported having received breastfeeding education/training, or having obstetric or pediatric internship experience had significantly higher mean knowledge scores compared to others. Yang\u0026rsquo;s study revealed that the current breastfeeding education program in Taiwan, both theoretical and clinical components, increased nursing students\u0026rsquo; knowledge and improved positive attitudes towards breastfeeding [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This implies that studying breastfeeding as part of the core program is indeed beneficial.\u003c/p\u003e \u003cp\u003eThe majority (92.99%) of the students participating in our study stated they need to receive more breastfeeding education at medical school. The value of including undergraduate breastfeeding education has been perceived by health professional students previously in various countries [\u003cspan additionalcitationids=\"CR30 CR31\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. However, currently, most of the breastfeeding education in mainland China is decentralized, and educational hours are limited [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], which can\u0026rsquo;t meet students\u0026rsquo; needs. Therefore, there is a need to integrate a breastfeeding curriculum into undergraduate nursing education with adequate course hours to enhance students' knowledge of breastfeeding.\u003c/p\u003e \u003cp\u003eRegarding the teaching methods in theoretic courses, most students in our study preferred CBL, followed by PBL and offline and online blended learning. These teaching methods have been recommended to in breastfeeding education for medical students [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. CBL and PBL can deepen students' understanding of knowledge by solving specific cases or problems, and also help to mobilize students' motivation to learn and cultivate their ability of independent learning, independent thinking, and independent problem-solving [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Online teaching is flexible and rich in network resources, which is conducive to expanding students' knowledge, while offline teaching has the advantage of strong interaction between teachers and students. Online and offline blended learning can combine the advantages of the two to improve the quality of teaching [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Schools should choose appropriate teaching methods according to the different contents of teaching, and actively explore teaching methods suitable for breastfeeding education. A variety of forms of integrated teaching methods can also be adopted to improve students' learning initiative and enhance their breastfeeding knowledge.\u003c/p\u003e \u003cp\u003eThe nursing students in our sample desired an integrated learning approach to include both theoretical knowledge and practical skills. This is consistent with the study on medical students in breastfeeding education [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Kim et al [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] found that incorporating breastfeeding knowledge into clinical placements through a variety of pathways in a survey of medical students in South Korea significantly increased the level of breastfeeding knowledge and their confidence in effectively instructing breastfeeding in the medical students. The most favoured teaching approach as students reported was simulation. Simulation is a learning modality that provides the student with a non-threatening learning experience for the learner to develop clinical skills. Due to the interactive nature of breastfeeding management, applying counseling skills and breastfeeding techniques with real patients is a critical component of nursing or medical training. A scoping review of the application-based breastfeeding skills training identified that the use of real patients was a common method, followed by role-playing and use of standardized patients [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. However, working in clinical environments with real patients will be perceived as stressful for students. Simulated clinical environments and patients allow students to learn skills without worrying about making mistakes that could harm patient safety. Sadovnikova et al. found that clinical education with high-fidelity breastfeeding simulators could be the ideal learning modality for trainees and hospital staff to build confidence in clinical lactation skills. Lactation simulation education has the potential to improve clinical practice and patient outcomes [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Simulation not only helps students to consolidate the theoretical foundation and improve operational skills but also helps to cultivate students' ability to respond calmly in emergencies [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eThis study has several limitations. First, the breastfeeding knowledge questionnaire was designed by the researchers. This is due to the fact that a questionnaire with good reliability and designed based on the latest breastfeeding guidelines was not retrieved when carrying out this study. Although the questionnaire showed good reliability, it still needs to be further validated in future studies. Second, although the undergraduate nursing students who participated in this study are from nursing schools at different levels and in different regions in mainland China, the sample size of the study was still small considering the large total number of nursing students, and therefore the generalizability of the results to all undergraduate nursing students in China needs to be cautious.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn light of the results of the study, it can be concluded that nursing undergraduate students in mainland China need more breastfeeding knowledge. This study highlights a need for reinforcing breastfeeding education and training for nursing undergraduate students. Additionally, thanks to the results obtained, it provides evidence for structuring needs-oriented breastfeeding education curricula in the undergraduate nursing program. Colleges and teaching hospitals should improve the curriculum of breastfeeding-related courses so that students can receive systematic breastfeeding education. Moreover, considering the trend of pedagogical technology and the teaching needs as well as preferences of students, the teaching method should be innovated, teaching methods such as CBL, and PBL be integrated into the theoretical classroom, and the simulation method be adopted in the practical class to enhance the teaching effect. Building on the findings of this study, future research could examine the effectiveness of education and training in improving nursing students' knowledge levels.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Peking University Institutional Review Board [No.: IRB00001052-23137]. All data were collected anonymously.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interests in this section.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study did not receive any external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYY conceived the study, analysed and interpreted the data, and wrote the original draft.\u003c/p\u003e\n\u003cp\u003eHL, JY, BL and ZS collected the data.\u003c/p\u003e\n\u003cp\u003eHL (corresponding author) conceived the study, contributed to the analysis tools and data interpretation, and edited the manuscript.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors were very grateful to all participants in this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYuanyuan Yang\u003csup\u003e1,2\u003c/sup\u003e, Huijuan Liu\u003csup\u003e3\u003c/sup\u003e, Jing Yang\u003csup\u003e4\u003c/sup\u003e, Bian Li\u003csup\u003e5\u003c/sup\u003e, Zhijuan Shen\u003csup\u003e6\u003c/sup\u003e, Xiaoling Zhou\u003csup\u003e1\u003c/sup\u003e, Hong Lu\u003csup\u003e1*\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e1 Peking University School of Nursing, Beijing, China\u003c/p\u003e\n\u003cp\u003e2 Peking University Health Science Center for Evidence-Based Nursing, Beijing, China\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3 Neonatal Disease Diagnosis and Treatment Center, Fifth Medical Center of Chinese People\u0026rsquo;s Liberation Army General Hospital, Beijing, China\u003c/p\u003e\n\u003cp\u003e4 School of Nursing, Xinjiang Medical University, Wulumuqi, China\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e5 Peking University First Hospital, Beijing, China\u003c/p\u003e\n\u003cp\u003e6 Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e*\u003c/strong\u003eCorresponding author\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChina Preventive Medicine Association. 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J Clin Nurs. 2023;32(17\u0026ndash;18):5668\u0026ndash;92. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/jocn.16681\u003c/span\u003e\u003cspan address=\"10.1111/jocn.16681\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"breastfeeding, knowledge, nursing education, undergraduate, cross-sectional study","lastPublishedDoi":"10.21203/rs.3.rs-4011960/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4011960/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eChina has the largest population in the world. While breastfeeding statistics have improved in the most recent decade, the exclusive breastfeeding rates remain low. Nurses with baccalaureate degrees are becoming the mainstay of China's nursing workforce and are an important force in supporting breastfeeding. To date, there is little evidence regarding breastfeeding education for undergraduate nursing students in mainland China. This study aims to explore the breastfeeding knowledge level and attitudes of undergraduate nursing students in mainland China, as well as their perceptions on breastfeeding education.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis was a descriptive cross-sectional study. An online questionnaire survey was conducted from October to December 2023 among 428 undergraduate nursing students from 22 medical universities/colleges in different regions of mainland China.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eMost student participants (96.96%) expressed supportive attitudes toward breastfeeding. The average correct response rate of the breastfeeding knowledge questionnaire was 54.80%. Students who reported having received breastfeeding education/training at school, or having obstetric or pediatric internship experience had significantly higher mean knowledge scores compared to others (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Overall, 92.99% (398/428) of students surveyed stated they would like more education on breastfeeding within the undergraduate nursing school curriculum. Case-based learning (CBL) and simulation were the most desired teaching methods for theoretical classes and practical classes, respectively.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe breastfeeding knowledge of undergraduate nursing students needs to be improved. Breastfeeding education included in the nursing curriculum should be strengthened, to adequately prepare students to support breastfeeding.\u003c/p\u003e","manuscriptTitle":"Breastfeeding knowledge, attitudes and perceptions of breastfeeding education among undergraduate nursing students in mainland China: A cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-07 20:21:15","doi":"10.21203/rs.3.rs-4011960/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2ce9719a-ef75-4406-8184-8263b42a3297","owner":[],"postedDate":"March 7th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-03-08T00:37:57+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-07 20:21:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4011960","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4011960","identity":"rs-4011960","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}