Table 3.
Summary of qualitative findings (factors influencing sustainability of DHM donation to HMB) and CERQual assessment.
| 17 Factors | Summary of Review Finding | Sustainability Factors | Reported Impact on Donation Sustainability: Increases + Decreases − |
Studies Contributing to the Review | Study Design | CERQual Assessment of Confidence in the Evidence * | Explanation of CERQual Assessment |
|---|---|---|---|---|---|---|---|
| FACTORS RELATED TO DONORS’ INFANTS’ FEATURES | |||||||
| #14 Baby feeding frequency | The frequency of the baby’s feeding was self-reported by some donors as potentially having a positive or negative influence on the frequency of milk extraction and milk production. | Frequency of milk Extraction and milk production | +/− | Alencar and Seidl, 2010 [26] | Quantitative | Very low confidence ⊕○○○ | One study with no or very minor concerns about coherence, moderate concerns regarding relevance, and serious concerns regarding adequacy and methodological limitations. |
| #15 Growth of the baby | The baby’s growth was self-reported by some donors as potentially having a negative influence on the frequency of milk extraction and production. | Frequency of milk extraction and milk production | − | Alencar and Seidl, 2010 [26] | Quantitative | Very low confidence ⊕○○○ | One study with no or very minor concerns about coherence, moderate concerns regarding relevance, and serious concerns about methodological limitations and adequacy. |
| FACTORS RELATED TO DONORS’ FEATURES: Health | |||||||
| #16 Self-hydration | Self-hydration was self-reported by donors as potentially having a negative and/or positive influence on the frequency of milk extraction and milk production. | Frequency of milk extraction and milk production | +/− | Alencar and Seidl, 2010 [26] | Quantitative | Very low confidence⊕○○○ | One study with serious concerns about methodological limitations. No or very minor concerns about coherence. Thin data from 1 country. Serious concerns regarding adequacy and moderate concerns regarding relevance. |
| #17 Diet | Diet was self-reported by donors as having potentially a negative and/or positive influence on the frequency of milk extraction and production. | Frequency of milk extraction and milk production | +/− | Alencar and Seidl, 2010 [26] | Quantitative | Very low confidence ⊕○○○ | One study with serious concerns about methodological limitations. No or very minor concerns about coherence. Thin data from 1 country. Serious concerns regarding adequacy and moderate concerns regarding relevance. |
| #18 Physical fatigue | Fatigue was self-reported by donors as potentially having a negative influence on the frequency of milk extraction and production. | Frequency of milk extraction and milk production | − | Alencar and Seidl, 2010 [26] | Quantitative | Very low confidence ⊕○○○ | One study with serious concerns about methodological limitations. No or very minor concerns about coherence. Thin data from 1 country. Serious concerns regarding adequacy and moderate concerns regarding relevance. |
| #19 Presence of negative emotions | Some donors self-reported that the presence of negative emotions could negatively influence the frequency of milk extraction and production. | Frequency of milk extraction and milk production | − | Alencar and Seidl, 2010 [26] | Quantitative | Very low confidence ⊕○○○ | One study with serious concerns about methodological limitations. No or very minor concerns about coherence. Thin data from 1 country. Serious concerns regarding adequacy and moderate concerns regarding relevance. |
| FACTORS RELATED TO DONOR’S FEATURES: Motivation to donate | |||||||
| #20 Availability of time | Donors self-reported that the availability of time (to pump) could negatively or positively influence the frequency of milk extraction and production. | Frequency of milk extraction and milk production | +/− | Alencar and Seidl, 2010 [26] | Quantitative | Very low confidence ⊕○○○ | One study with serious concerns about methodological limitations. No or very minor concerns about coherence. Thin data from 1 country. Serious concerns regarding adequacy and moderate concerns regarding relevance. |
| FACTORS RELATED TO DONORS’ FEATURES: Breastfeeding and milk expression | |||||||
| #21 Experience of breastfeeding simultaneously | Donors reported a decrease in donation frequency as their milk production decreased due to the process of breastfeeding itself (less excess than previously). | Obstacle to remaining a donor: frequency of donation | − | Machado et al., 2015 [29] | Qualitative | Low confidence ⊕⊕○○ | One study with minor concerns about methodological limitations. No or very minor concerns about coherence. Thin data from 1 country. Serious concerns regarding adequacy and moderate concerns regarding relevance. |
| #22 Frequency of milk expression | Some donors self-reported that the frequency of milk expression had a potentially positive influence on the frequency of milk extraction and milk production. | Frequency of milk extraction and milk production | + | Alencar and Seidl, 2010 [26] | Quantitative | Very low confidence ⊕○○○ | One study with serious concerns about methodological limitations. No or very minor concerns about coherence. Thin data from 1 country, serious concerns regarding adequacy, and moderate concerns regarding relevance. |
| #23 Nothing interferes with milk production | Some donors self-reported that nothing interfered with milk production, which was seen as a positive influence on the frequency of milk extraction and production. | Frequency of milk extraction and milk production | + | Alencar and Seidl, 2010 [26] | Quantitative | Very low confidence ⊕○○○ | One study with serious concerns about methodological limitations. No or very minor concerns about coherence. Thin data from 1 country. Serious concerns regarding adequacy and moderate concerns regarding relevance. |
| #24 Time of day for expressing milk | Donors self-reported that the time of day possibly influenced the frequency of milk extraction and production (increased production at night) | Frequency of milk extraction and milk production | + | Alencar and Seidl, 2010 [26] | Quantitative | Very low confidence ⊕○○○ | One study with serious concerns about methodological limitations. No or very minor concerns about coherence. Thin data from 1 country. Serious concerns regarding adequacy and moderate concerns regarding relevance. |
| FACTORS RELATED TO DONORS’ FEATURES: Other | |||||||
| #25 Mother’s routines (going out, contraceptive use, return to work) | Some donors self-reported that going out, using contraception, or returning to work may have negatively influenced the frequency of milk extraction and production. | Frequency of milk extraction and milk production | − | Alencar and Seidl, 2010 [26] | Quantitative | Very low confidence ⊕○○○ | One study with serious concerns about methodological limitations. No or very minor concerns about coherence. Thin data from 1 country. Serious concerns regarding adequacy and moderate concerns regarding relevance. |
| MILK BANK and HEALTH CARE–RELATED FACTORS: Support | |||||||
| #26 Milk bank support to donation | The mother’s environment (support offered by MB staff) had a positive influence on her willingness to continue donating. | Donor willingness to continue donating milk | + | Machado et al., 2015 [29] | Qualitative | Low confidence ⊕⊕○○ | One study with minor concerns about methodological limitations. No or very minor concerns about coherence. Thin data from 1 country. Serious concerns regarding adequacy and moderate concerns regarding relevance. |
| #27 Family support to donation | The support mothers received from their family positively influenced their willingness to continue donating. | Donor willingness to continue donating milk | + | Machado et al., 2015 [29] | Qualitative | Low confidence ⊕⊕○○ | One study with minor concerns about methodological limitations. No or very minor concerns about coherence. Thin data from 1 country. Serious concerns regarding adequacy and moderate concerns regarding relevance. |
| #28 Work impact and support | Donors reported that incomprehension and lack of support at their workplace was an obstacle to remaining a donor. | Obstacle to remaining a donor | − | Machado et al., 2015 [29] | Qualitative | Low confidence ⊕⊕○○ | One study with minor concerns about methodological limitations. No or very minor concerns about coherence. Thin data from 1 country. Serious concerns regarding adequacy and moderate concerns regarding relevance. |
| MILK BANK and HEALTH CARE–RELATED FACTORS: Logistics | |||||||
| #29 Distance from milk bank | Donors reported that the distance they had to travel to deliver their milk to the milk bank (no home collection service being available) was an obstacle to becoming and remaining a milk donor. | Obstacle to remaining a donor | − | Machado et al., 2015 [29] | Qualitative | Low confidence ⊕⊕○○ | One study with minor concerns about methodological limitations. No or very minor concerns about coherence. Thin data from 1 country. Serious concerns regarding adequacy and moderate concerns regarding relevance. |
| #30 Human resources | Health care providers felt that a shortage of human resources in milk banks negatively affected the volume of the milk collected. | Volume of milk donated | − | Mondkar et al., 2018 [30] | Qualitative | Low confidence ⊕⊕○○ | One study with minor concerns about methodological limitations. No or very minor concerns about coherence. Thin data from 1 country. Serious concerns regarding adequacy and moderate concerns regarding relevance. |
* The confidence level scale ranges from: ⊕○○○ very low confidence; ⊕⊕○○ low confidence.