Section B: Problem Description

Section B: Problem Description

When carrying out a focused search for a clinical topic based on a PICOT question, researchers can enter multiple elements into the search system. Unfortunately, Melnyk and Fineout-Overholt (2015) elaborate that, this method makes it hard to determine the concept with the most evidence. In view of this, it is recommended to enter the terms from a PICOT question one at a one, identify the number of hits, and ensure that evidence is available to answer the clinical question. In addition, databases can be very large making it hard to retrieve only the desired articles even after using the best search strategies. In light of this, a limit function is used to help the researcher narrow down from a large list of citations to find relevant studies to the PICOT question. Search limits are several forms including limiting the search to a type of study design, availability of the study article, or subject headings. Along with that, clinicians use conditions called inclusion and exclusion criteria based on specific conditions set to determine the most relevant evidence. With this knowledge, we provide a description of the search method used with the research studies. Secondly, we summarize the research studies used as evidence and the essential components of the studies. Lastly, we provide a description of the validity of both internal and external research.

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PICOT Question

For pregnant women, how does formal prenatal breastfeeding education compared to no education or informal individual research (C) affect a mother’s ability to initiate breastfeeding (O) and increase breastfeeding duration (T)?

Description of the Search Method

For the purpose of the study, we searched the EBSCOHost database. The following keywords were used for the search criteria; “prenatal breastfeeding education”, AND “mother’s ability to initiate breastfeeding”, AND “increase breastfeeding duration”. The inclusion and exclusion criteria considered studies from January 2015 to January 2019. The search criteria generated a hit of 469 results, which were evaluated based on their relevance and applicability to the PICOT question.

Summary of the Research Studies used as Evidence

The studies reviewed helped to inform the background of the problem. The study sought to explain why addressing the PICOT question was important and why it deserves attention. The review of literature considered articles between 2015 and 2019. Two articles were systematic reviews, one a review, and the last one was a qualitative study. Out of the two articles that were based on systematic reviews, one article focused on stakeholder views of breastfeeding education in schools. The article by Singletary, Chetwynd, Goodell, and Fogleman (2016) informed the background of the problem by providing an overview of the current state on global breastfeeding rates. The strength of the study was in the quality appraisal tool that was used to test for validity, efficiency, and reliability of the articles reviewed. The limitation of the study was identified as its inability to include studies published in other languages apart from English.

The second systematic review was by Burgio et al. (2016) and focused on evaluating the importance and success rate of breastfeeding education. The strength of the review was based on the research databases, which included Scopus, PubMed, MEDLINE, Google Scholar, and Science Direct. The limitation or the weakness of the study was in the lack of a critical appraisal tool to evaluate the article. Besides, the article considered studies dating back several years back to 1980.

The third article by Anstey et al. (2017) was a review that focused on understanding breastfeeding and breast cancer risk reduction. The article informed the research about the risks associated with failure to breastfeed, as well as, benefits associated with breastfeeding. The strength of the article was based on the fact that the majority of the references cited within the article were recent and within the past five years from the date of publication. A limitation of the study was using older sources to gather information to support the research.

The article used was a qualitative study by Radzyminski and Callister (2016), that collected data using interviews. The study sought to find out the impact of a mother’s beliefs, attitudes, and decisions on infant feeding choices, with a special focus on breastfeeding and formula feeding. The strength of the article was based on the number of participants interviewed and the fact that they were randomly selected from a large tertiary medical center.

Description of the Validity of Internal and External Search

Evidence-Based Practice experts have outlined various ways to rate the varying levels of evidence and strength of evidence. The assessments provide a mechanism to help clinicians and health care providers in evaluating evidence for its applicability to healthcare decision making (Melnyk & Fineout-Overholt, 2015). Ideally, when searching for evidence, it is important to consider the internal and external validity of the search. Considering quality as the domain used to measure internal validity, the review methods used were of high quality. In particular, the review methods considered articles within the last five years and considered the strengths of the studies. On the other hand, and considering the external validity of the search, the selected sample of articles that were used was representative of the articles from which they were drawn. The articles were identified from 469 hits, which were searched using the same criteria.  


Anstey, E. H., Shoemaker, M. L., Barrera, C. M., O’Neil, M. E., Verma, A. B., & Holman, D. M. (2017). Breastfeeding and Breast Cancer Risk Reduction: Implications for Black Mothers. American Journal of Preventive Medicine, 53(3), S40-S46.

Burgio, M. A., Laganà, A. S., Sicilia, A., Prosperi, P. R., Porpora, M. G., Ban, F. H., DI, V. G., … Triolo, O. (2016). Breastfeeding Education: Where Are We Going? A Systematic Review Article. Iranian Journal of Public Health, 45(8), 970-977.

Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer.

Radzyminski, S., & Callister, L. C. (2016). Mother’s Beliefs, Attitudes, and Decision Making Related to Infant Feeding Choices. The Journal of Perinatal Education, 25(1), 18-28.Singletary, N., Chetwynd, E., Goodell, L. S., & Fogleman, A. (2016). Stakeholder views of breastfeeding education in schools: a systematic mixed studies review of the literature. International Breastfeeding Journal, 12(1), 1-13.

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