Tapping into authentic presence: key components arisingfrom a concept analysis of online breastfeeding support

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background. The internet is widely used by women to guide infant-feeding decisions and practice, but there is no clearunderstanding of women’s self-directed use of the internet to support breastfeeding.Aim. To conceptualise online breastfeeding support.Methods. With ethical approval, a mixed methods triangulated study was undertaken based on a concept analysis that usedan eight-step framework. The study was designed in three phases – Phase 1: a concept analysis to identify components ofonline breastfeeding support; Phase 2: testing of tentative components arising from the concept analysis through observationof breastfeeding-related online discussions (based on 126 threads containing 1230 messages generated by 510 individuals);Phase 3: confirmation of the resultant model through online interviews with 12 women.Findings. In total, 16 components of online breastfeeding support emerged indicating that women who engaged in this practicehad antecedents of: a breastfeeding goal; a breastfeeding query or interest in discussion/debate; inadequate face-to-face supportor seeks additional/optional support; willingness to seek and offer support online. Attributes manifested as a tailored menu ofsupport or enablement of debate by more experienced others, in an accessible, responsive, optionally anonymous environmentsustained by indirect reciprocity. Confirmed consequences were: reconstruction of breastfeeding experience; impact onbreastfeeding outcomes and other aspects of parenting; becoming expert and enabling face-to-face support. Together, thesecomponents constitute an authentic presence of support created by a global community of breastfeeding women.Conclusion. To our knowledge, this study is unique and has potential to impact on strategies targeting maternal and childhealth at a national and international level. The study provides new theoretical knowledge about women’s behaviour and usageof online support to enable them to achieve desired breastfeeding goal(s). This study provides empirical evidence of ‘womangenerated’,sustainable, online breastfeeding support and opens the doors for targeted public health research investment.
LanguageEnglish
Pages76-83
JournalEvidence Based Midwifery
Volume13
Issue number3
Early online date5 Feb 2017
Publication statusE-pub ahead of print - 5 Feb 2017

Fingerprint

Breast Feeding
Internet
Parenting
Public Health
Mothers
Interviews

Keywords

  • Key words: Breastfeeding
  • support
  • online
  • mixed methods
  • concept analysis
  • antecedents
  • attributes
  • consequences
  • indirect
  • reciprocity
  • evidence-based midwifery

Cite this

@article{80963b953bad4c92bdf62c57978e8017,
title = "Tapping into authentic presence: key components arisingfrom a concept analysis of online breastfeeding support",
abstract = "Background. The internet is widely used by women to guide infant-feeding decisions and practice, but there is no clearunderstanding of women’s self-directed use of the internet to support breastfeeding.Aim. To conceptualise online breastfeeding support.Methods. With ethical approval, a mixed methods triangulated study was undertaken based on a concept analysis that usedan eight-step framework. The study was designed in three phases – Phase 1: a concept analysis to identify components ofonline breastfeeding support; Phase 2: testing of tentative components arising from the concept analysis through observationof breastfeeding-related online discussions (based on 126 threads containing 1230 messages generated by 510 individuals);Phase 3: confirmation of the resultant model through online interviews with 12 women.Findings. In total, 16 components of online breastfeeding support emerged indicating that women who engaged in this practicehad antecedents of: a breastfeeding goal; a breastfeeding query or interest in discussion/debate; inadequate face-to-face supportor seeks additional/optional support; willingness to seek and offer support online. Attributes manifested as a tailored menu ofsupport or enablement of debate by more experienced others, in an accessible, responsive, optionally anonymous environmentsustained by indirect reciprocity. Confirmed consequences were: reconstruction of breastfeeding experience; impact onbreastfeeding outcomes and other aspects of parenting; becoming expert and enabling face-to-face support. Together, thesecomponents constitute an authentic presence of support created by a global community of breastfeeding women.Conclusion. To our knowledge, this study is unique and has potential to impact on strategies targeting maternal and childhealth at a national and international level. The study provides new theoretical knowledge about women’s behaviour and usageof online support to enable them to achieve desired breastfeeding goal(s). This study provides empirical evidence of ‘womangenerated’,sustainable, online breastfeeding support and opens the doors for targeted public health research investment.",
keywords = "Key words: Breastfeeding, support, online, mixed methods, concept analysis, antecedents, attributes, consequences, indirect, reciprocity, evidence-based midwifery",
author = "Sinclair, {Marlene .} and WG Kernohan and Maria Herron",
note = "Reference text: Barclay L, Longman J, Schmied V, Sheehan A, Rolfe M, Burns E, Fenwick J. (2012) The professionalising of breastfeeding: where are we a decade on? Midwifery 28(3): 281-90. Bolling K, Grant C, Hamlyn B, Thornton A. (2007) Infant-feeding survey 2005. A survey conducted on behalf of The Information Centre for Health and Social Care and the UK health departments by BMRB Social Research. The Information Centre: London. Callaghan JE, Lazard L. (2012) ‘Please don’t put the whole dang thing out there!’: a discursive analysis of internet discussions around infant feeding. Psychology and Health 27(8): 938-55. Copyright, Designs and Patents Act 1988. The Stationary Office: London. See: legislation.gov.uk/ukpga/1988/48/section/29 (accessed 10 August 2015). Coursaris CK, Liu M. (2009) An analysis of social support exchanges in online HIV/AIDS self-help groups. Computers in Human Behavior 25(4): 911-8. Cross-Barnet C, Augustyn M, Gross S, Resnik A, Paige D. (2012) Long-term breastfeeding support: failing mothers in need. Maternal and Child Health Journal 16(9): 1926-32. Ekeh PP. (1974) Social exchange theory: the two traditions. Harvard University Press: Cambridge. Esquivel A, Meric-Bernstam F, Bernstam EV. (2006) Accuracy and selfcorrection of information received from an internet breast cancer list: content analysis. British Medical Journal 332(7547): 939-42. Eysenbach G, K{\"o}hler C. (2002) How do consumers search for and appraise health information on the world wide web? Qualitative study using focus groups, usability tests, and in-depth interviews. British Medical Journal 324(7337): 573-7. Eysenbach G, Powell J, Englesakis M, Rizo C, Stern A. (2004) Health-related virtual communities and electronic support groups: systematic review of the effects of online peer-to-peer interactions. British Medical Journal 328(7449): 1166. Ferguson T, Frydman G. (2004) The first generation of e-patients: these newmedical colleagues could provide sustainable healthcare solutions. British Medical Journal 328(7449): 1148-9. Fox S, Duggan M. (2013) Health online 2013. See: pewinternet. org/2013/01/15/health-online-2013 (accessed 10 August 2015). Freelon DG. (2010) ReCal: intercoder reliability calculation as a web service. International Journal of Internet Science 5(1): 20-33. Giglia R, Binns C. (2014) The effectiveness of the internet in improving breastfeeding outcomes: a systematic review. Journal of Human Lactation 30(2): 156-60. Gill SL. (2001) The little things: perceptions of breastfeeding support. Journal of Obstetric, Gynecologic, and Neonatal Nursing 30(4): 401-9. Gillen P, Sinclair M, Kernohan WG. (2004) A concept analysis of bullying in midwifery. Evidence Based Midwifery 2(2): 46-51. Gouldner AW. (1960) The norm of reciprocity: a preliminary statement. American Sociological Review 25(2): 161-78. Gribble KDK. (2001) Mother-to-mother support for women breastfeeding in unusual circumstances: a new method for an old model. Breastfeeding Review: professional publication of the Nursing Mothers’ Association of Australia 9(3): 13-9. Guest G, Bunce A, Johnson L. (2006) How many interviews are enough? An experiment with data saturation and variability. Field Methods 18(1): 59-82. Harrison MJ, Neufeld A, Kushner K. (1995) Women in transition: access and barriers to social support. Journal of Advanced Nursing 21(5): 858-64. Hegney D, Fallon T, O’Brien ML. (2008) Against all odds: a retrospective case controlled study of women who experienced extraordinary breastfeeding problems. Journal of Clinical Nursing 17(9): 1182-92. Herron M, Sinclair M, Kernohan WG, Stockdale DJ. (2011) Ethical issues in undertaking internet research of user-generated content: a review of the literature. Evidence Based Midwifery 9(1): 9-15. Herron M. (2013) A conceptual analysis and interpretation of women’s experience of online breastfeeding support. Unpublished PhD thesis. University of Ulster. Hine C. (2008) Virtual ethnography: modes, varieties, affordances: In: Fielding N, Lee RM, Blank G. (Eds.). The SAGE handbook of online research methods. Sage: London. Hsieh HF, Shannon SE. (2005) Three approaches to qualitative content analysis. Qualitative Health Research 15(9): 1277-88. Internet World Statistics. (2014) Internet usage statistics. See: internetworldstats.com/stats.htm (accessed 10 August 2015). LaCoursiere SP. (2001) A theory of online social support. Advances in Nursing Science 24(1): 60-77. Lampert MD, Ervin-Tripp SM. (1993) Structured coding for the study of language and social interaction: In: Edwards JA, Lampert MD. (Eds.). Talking data: transcription and coding in discourse research. Lawrence Erlbaum: Hillsdale. Landis JR, Koch GG. (1977) The measurement of observer agreement for categorical data. Biometrics 33(1): 159-74. Leahy-Warren P, Mulcahy H, Phelan A. (2009) A review of breastfeeding support services provided by public health nurses in Ireland. See: breastfeeding.ie/uploads/files/Review_of_Breastfeeding_Support_ Services_2009.pdf (accessed 10 August 2015). Lin TC, Hsu JSC, Cheng HL, Chiu CM. (2015) Exploring the relationship between receiving and offering online social support: a dual social support model. Information & Management 52(3): 371-83. Lombard M, Snyder-Duch J, Bracken CC. (2002) Content analysis in mass communication. Human Communication Research 28(4): 587-604. Meedya S, Fahy K, Kable A. (2010) Factors that positively influence breastfeeding duration to six months: a literature review. Women and Birth 23(4): 135-45. Murthy D. (2008) Digital ethnography: an examination of the use of new technologies for social research. Sociology 42(5): 837-55. Nelson AM. (2006) A metasynthesis of qualitative breastfeeding studies. Journal of Midwifery and Women’s Health 51(2): e13-e20. Nowak MA, Roch S. (2007) Upstream reciprocity and the evolution of gratitude. Proceedings of the Royal Society of London, Series B: Biological Sciences 274(1610): 605-10. O’Brien MR, Clark D. (2010) Use of unsolicited first person written illness narratives in research: systematic review. Journal of Advanced Nursing 66(8): 1671-82. O’Connor H, Madge C, Shaw R, Wellens J. (2008) Internet-based interviewing: In: Fielding N, Lee RM, Blank G. (Eds.). The SAGE handbook of online research methods. Sage: London. O’Connor H, Madge C. (2001) Cyber-mothers: online synchronous interviewing using conferencing software. Sociological Research Online 5(4). Renfrew MJ, McCormick FM, Wade A, Quinn B, Dowswell T. (2012) Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database of Syst Rev 5: CD001141. Rourke L, Anderson T, Garrison DR, Archer W. (2001) Methodological issues in the content analysis of computer conference transcripts. International Journal of Artificial Intelligence in Education 12(1): 8-22. Salzer MS, Palmer SC, Kaplan K, Brusilovskiy E, ten Have T, Hampshire M, Metz J, Coyne JC. (2010) A randomised, controlled study of internet peerto- peer interactions among women newly diagnosed with breast cancer. Psycho-Oncology 19(4): 441-6. Schmied V, Beake S, Sheehan A, McCourt C, Dykes F. (2011) Women’s perceptions and experiences of breastfeeding support: a metasynthesis. Birth 38(1): 49-60. Scott JA, Mostyn T. (2003) Women’s experiences of breastfeeding in a bottlefeeding culture. Journal of Human Lactation 19(3): 270-7. Scullard P, Peacock C, Davies P. (2010) Googling children’s health: reliability of medical advice on the internet. Archives of Disease in Childhood 95(8): 580-2. Stockdale J, Sinclair M, Kernohan WG, Keller JM. (2007) Exploring the potential of the internet to motivate breastfeeding. Evidence Based Midwifery 5(1): 10-5. Suler J. (2004) The online disinhibition effect. Cyberpsychology & Behavior 7(3): 321-6. Uehara ES. (1995) Reciprocity reconsidered: Gouldner’s moral norm of reciprocity and social support. Journal of Social and Personal Relationships 12(4): 483-502. van Uden-Kraan CF, Drossaert CHC, Taal E, Lebrun CEI, Drossaers-Bakker KW, Smit WM, Seydel E, van de Laar M. (2008) Coping with somatic illnesses in online support groups: do the feared disadvantages actually occur? Computers in Human Behavior 24(2): 309-24. Walker LO, Avant KC. (2005) Strategies for theory construction in nursing (fourth edition). Pearson Prentice Hall: Upper Saddle River, NJ. Wasko MML, Faraj S. (2000) ‘It is what one does’: why people participate and help others in electronic communities of practice. The Journal of Strategic Information Systems 9(2): 155-73.",
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}

Tapping into authentic presence: key components arisingfrom a concept analysis of online breastfeeding support. / Sinclair, Marlene .; Kernohan, WG; Herron, Maria.

In: Evidence Based Midwifery, Vol. 13, No. 3, 05.02.2017, p. 76-83.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Tapping into authentic presence: key components arisingfrom a concept analysis of online breastfeeding support

AU - Sinclair, Marlene .

AU - Kernohan, WG

AU - Herron, Maria

N1 - Reference text: Barclay L, Longman J, Schmied V, Sheehan A, Rolfe M, Burns E, Fenwick J. (2012) The professionalising of breastfeeding: where are we a decade on? Midwifery 28(3): 281-90. Bolling K, Grant C, Hamlyn B, Thornton A. (2007) Infant-feeding survey 2005. A survey conducted on behalf of The Information Centre for Health and Social Care and the UK health departments by BMRB Social Research. The Information Centre: London. Callaghan JE, Lazard L. (2012) ‘Please don’t put the whole dang thing out there!’: a discursive analysis of internet discussions around infant feeding. Psychology and Health 27(8): 938-55. Copyright, Designs and Patents Act 1988. The Stationary Office: London. See: legislation.gov.uk/ukpga/1988/48/section/29 (accessed 10 August 2015). Coursaris CK, Liu M. (2009) An analysis of social support exchanges in online HIV/AIDS self-help groups. Computers in Human Behavior 25(4): 911-8. Cross-Barnet C, Augustyn M, Gross S, Resnik A, Paige D. (2012) Long-term breastfeeding support: failing mothers in need. Maternal and Child Health Journal 16(9): 1926-32. Ekeh PP. (1974) Social exchange theory: the two traditions. Harvard University Press: Cambridge. Esquivel A, Meric-Bernstam F, Bernstam EV. (2006) Accuracy and selfcorrection of information received from an internet breast cancer list: content analysis. British Medical Journal 332(7547): 939-42. Eysenbach G, Köhler C. (2002) How do consumers search for and appraise health information on the world wide web? Qualitative study using focus groups, usability tests, and in-depth interviews. British Medical Journal 324(7337): 573-7. Eysenbach G, Powell J, Englesakis M, Rizo C, Stern A. (2004) Health-related virtual communities and electronic support groups: systematic review of the effects of online peer-to-peer interactions. British Medical Journal 328(7449): 1166. Ferguson T, Frydman G. (2004) The first generation of e-patients: these newmedical colleagues could provide sustainable healthcare solutions. British Medical Journal 328(7449): 1148-9. Fox S, Duggan M. (2013) Health online 2013. See: pewinternet. org/2013/01/15/health-online-2013 (accessed 10 August 2015). Freelon DG. (2010) ReCal: intercoder reliability calculation as a web service. International Journal of Internet Science 5(1): 20-33. Giglia R, Binns C. (2014) The effectiveness of the internet in improving breastfeeding outcomes: a systematic review. Journal of Human Lactation 30(2): 156-60. Gill SL. (2001) The little things: perceptions of breastfeeding support. Journal of Obstetric, Gynecologic, and Neonatal Nursing 30(4): 401-9. Gillen P, Sinclair M, Kernohan WG. (2004) A concept analysis of bullying in midwifery. Evidence Based Midwifery 2(2): 46-51. Gouldner AW. (1960) The norm of reciprocity: a preliminary statement. American Sociological Review 25(2): 161-78. Gribble KDK. (2001) Mother-to-mother support for women breastfeeding in unusual circumstances: a new method for an old model. Breastfeeding Review: professional publication of the Nursing Mothers’ Association of Australia 9(3): 13-9. Guest G, Bunce A, Johnson L. (2006) How many interviews are enough? An experiment with data saturation and variability. Field Methods 18(1): 59-82. Harrison MJ, Neufeld A, Kushner K. (1995) Women in transition: access and barriers to social support. Journal of Advanced Nursing 21(5): 858-64. Hegney D, Fallon T, O’Brien ML. (2008) Against all odds: a retrospective case controlled study of women who experienced extraordinary breastfeeding problems. Journal of Clinical Nursing 17(9): 1182-92. Herron M, Sinclair M, Kernohan WG, Stockdale DJ. (2011) Ethical issues in undertaking internet research of user-generated content: a review of the literature. Evidence Based Midwifery 9(1): 9-15. Herron M. (2013) A conceptual analysis and interpretation of women’s experience of online breastfeeding support. Unpublished PhD thesis. University of Ulster. Hine C. (2008) Virtual ethnography: modes, varieties, affordances: In: Fielding N, Lee RM, Blank G. (Eds.). The SAGE handbook of online research methods. Sage: London. Hsieh HF, Shannon SE. (2005) Three approaches to qualitative content analysis. Qualitative Health Research 15(9): 1277-88. Internet World Statistics. (2014) Internet usage statistics. See: internetworldstats.com/stats.htm (accessed 10 August 2015). LaCoursiere SP. (2001) A theory of online social support. Advances in Nursing Science 24(1): 60-77. Lampert MD, Ervin-Tripp SM. (1993) Structured coding for the study of language and social interaction: In: Edwards JA, Lampert MD. (Eds.). Talking data: transcription and coding in discourse research. Lawrence Erlbaum: Hillsdale. Landis JR, Koch GG. (1977) The measurement of observer agreement for categorical data. Biometrics 33(1): 159-74. Leahy-Warren P, Mulcahy H, Phelan A. (2009) A review of breastfeeding support services provided by public health nurses in Ireland. See: breastfeeding.ie/uploads/files/Review_of_Breastfeeding_Support_ Services_2009.pdf (accessed 10 August 2015). Lin TC, Hsu JSC, Cheng HL, Chiu CM. (2015) Exploring the relationship between receiving and offering online social support: a dual social support model. Information & Management 52(3): 371-83. Lombard M, Snyder-Duch J, Bracken CC. (2002) Content analysis in mass communication. Human Communication Research 28(4): 587-604. Meedya S, Fahy K, Kable A. (2010) Factors that positively influence breastfeeding duration to six months: a literature review. Women and Birth 23(4): 135-45. Murthy D. (2008) Digital ethnography: an examination of the use of new technologies for social research. Sociology 42(5): 837-55. Nelson AM. (2006) A metasynthesis of qualitative breastfeeding studies. Journal of Midwifery and Women’s Health 51(2): e13-e20. Nowak MA, Roch S. (2007) Upstream reciprocity and the evolution of gratitude. Proceedings of the Royal Society of London, Series B: Biological Sciences 274(1610): 605-10. O’Brien MR, Clark D. (2010) Use of unsolicited first person written illness narratives in research: systematic review. Journal of Advanced Nursing 66(8): 1671-82. O’Connor H, Madge C, Shaw R, Wellens J. (2008) Internet-based interviewing: In: Fielding N, Lee RM, Blank G. (Eds.). The SAGE handbook of online research methods. Sage: London. O’Connor H, Madge C. (2001) Cyber-mothers: online synchronous interviewing using conferencing software. Sociological Research Online 5(4). Renfrew MJ, McCormick FM, Wade A, Quinn B, Dowswell T. (2012) Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database of Syst Rev 5: CD001141. Rourke L, Anderson T, Garrison DR, Archer W. (2001) Methodological issues in the content analysis of computer conference transcripts. International Journal of Artificial Intelligence in Education 12(1): 8-22. Salzer MS, Palmer SC, Kaplan K, Brusilovskiy E, ten Have T, Hampshire M, Metz J, Coyne JC. (2010) A randomised, controlled study of internet peerto- peer interactions among women newly diagnosed with breast cancer. Psycho-Oncology 19(4): 441-6. Schmied V, Beake S, Sheehan A, McCourt C, Dykes F. (2011) Women’s perceptions and experiences of breastfeeding support: a metasynthesis. Birth 38(1): 49-60. Scott JA, Mostyn T. (2003) Women’s experiences of breastfeeding in a bottlefeeding culture. Journal of Human Lactation 19(3): 270-7. Scullard P, Peacock C, Davies P. (2010) Googling children’s health: reliability of medical advice on the internet. Archives of Disease in Childhood 95(8): 580-2. Stockdale J, Sinclair M, Kernohan WG, Keller JM. (2007) Exploring the potential of the internet to motivate breastfeeding. Evidence Based Midwifery 5(1): 10-5. Suler J. (2004) The online disinhibition effect. Cyberpsychology & Behavior 7(3): 321-6. Uehara ES. (1995) Reciprocity reconsidered: Gouldner’s moral norm of reciprocity and social support. Journal of Social and Personal Relationships 12(4): 483-502. van Uden-Kraan CF, Drossaert CHC, Taal E, Lebrun CEI, Drossaers-Bakker KW, Smit WM, Seydel E, van de Laar M. (2008) Coping with somatic illnesses in online support groups: do the feared disadvantages actually occur? Computers in Human Behavior 24(2): 309-24. Walker LO, Avant KC. (2005) Strategies for theory construction in nursing (fourth edition). Pearson Prentice Hall: Upper Saddle River, NJ. Wasko MML, Faraj S. (2000) ‘It is what one does’: why people participate and help others in electronic communities of practice. The Journal of Strategic Information Systems 9(2): 155-73.

PY - 2017/2/5

Y1 - 2017/2/5

N2 - Background. The internet is widely used by women to guide infant-feeding decisions and practice, but there is no clearunderstanding of women’s self-directed use of the internet to support breastfeeding.Aim. To conceptualise online breastfeeding support.Methods. With ethical approval, a mixed methods triangulated study was undertaken based on a concept analysis that usedan eight-step framework. The study was designed in three phases – Phase 1: a concept analysis to identify components ofonline breastfeeding support; Phase 2: testing of tentative components arising from the concept analysis through observationof breastfeeding-related online discussions (based on 126 threads containing 1230 messages generated by 510 individuals);Phase 3: confirmation of the resultant model through online interviews with 12 women.Findings. In total, 16 components of online breastfeeding support emerged indicating that women who engaged in this practicehad antecedents of: a breastfeeding goal; a breastfeeding query or interest in discussion/debate; inadequate face-to-face supportor seeks additional/optional support; willingness to seek and offer support online. Attributes manifested as a tailored menu ofsupport or enablement of debate by more experienced others, in an accessible, responsive, optionally anonymous environmentsustained by indirect reciprocity. Confirmed consequences were: reconstruction of breastfeeding experience; impact onbreastfeeding outcomes and other aspects of parenting; becoming expert and enabling face-to-face support. Together, thesecomponents constitute an authentic presence of support created by a global community of breastfeeding women.Conclusion. To our knowledge, this study is unique and has potential to impact on strategies targeting maternal and childhealth at a national and international level. The study provides new theoretical knowledge about women’s behaviour and usageof online support to enable them to achieve desired breastfeeding goal(s). This study provides empirical evidence of ‘womangenerated’,sustainable, online breastfeeding support and opens the doors for targeted public health research investment.

AB - Background. The internet is widely used by women to guide infant-feeding decisions and practice, but there is no clearunderstanding of women’s self-directed use of the internet to support breastfeeding.Aim. To conceptualise online breastfeeding support.Methods. With ethical approval, a mixed methods triangulated study was undertaken based on a concept analysis that usedan eight-step framework. The study was designed in three phases – Phase 1: a concept analysis to identify components ofonline breastfeeding support; Phase 2: testing of tentative components arising from the concept analysis through observationof breastfeeding-related online discussions (based on 126 threads containing 1230 messages generated by 510 individuals);Phase 3: confirmation of the resultant model through online interviews with 12 women.Findings. In total, 16 components of online breastfeeding support emerged indicating that women who engaged in this practicehad antecedents of: a breastfeeding goal; a breastfeeding query or interest in discussion/debate; inadequate face-to-face supportor seeks additional/optional support; willingness to seek and offer support online. Attributes manifested as a tailored menu ofsupport or enablement of debate by more experienced others, in an accessible, responsive, optionally anonymous environmentsustained by indirect reciprocity. Confirmed consequences were: reconstruction of breastfeeding experience; impact onbreastfeeding outcomes and other aspects of parenting; becoming expert and enabling face-to-face support. Together, thesecomponents constitute an authentic presence of support created by a global community of breastfeeding women.Conclusion. To our knowledge, this study is unique and has potential to impact on strategies targeting maternal and childhealth at a national and international level. The study provides new theoretical knowledge about women’s behaviour and usageof online support to enable them to achieve desired breastfeeding goal(s). This study provides empirical evidence of ‘womangenerated’,sustainable, online breastfeeding support and opens the doors for targeted public health research investment.

KW - Key words: Breastfeeding

KW - support

KW - online

KW - mixed methods

KW - concept analysis

KW - antecedents

KW - attributes

KW - consequences

KW - indirect

KW - reciprocity

KW - evidence-based midwifery

M3 - Article

VL - 13

SP - 76

EP - 83

JO - Evidence Based Midwifery

T2 - Evidence Based Midwifery

JF - Evidence Based Midwifery

SN - 1479-4489

IS - 3

ER -