Breastfeedıng Attıtudes of Women in Postpartum Perıod And Affecting Factors

Abstract

Objective: This study aims to determine breastfeeding attitudes and affecting factors of women during postpartum period. Materials and Methods: This study was conducted analytical and cross-sectional in the gynecology and obstetrics clinic of a university hospital in Izmir. The sample of the study consisted of 218 volunteer women in the postpartum period. The data were collected with the “Individual Description Form” and “Breastfeeding Attitude Evaluation Scale”. The number and percentage distributions, means, standard deviation, t-test in independent groups, and one-way analysis of variance (ANOVA) were used to analyze the data. Results: The mean age of the women was 27.45±5.98 and the mean score of women Breastfeeding Attitude Evaluation Tool was 100.38±18.88 (Min-max=44-146). It was determined that there was a statistically significant difference between the mean of the total score of women Breastfeeding Attitude Evaluation Tool and family type,the gender of the baby, information about breastfeeding and breast milk, the time of first breastfeeding, the frequency of breastfeeding, the duration of planned breastfeeding and the use of a nipple or bottle (p< 0.05). Conclusion: As a result of the research, it was found that the breastfeeding attitudes of women were moderate. It was concluded that the breastfeeding attitudes of women were affected by some socio-demographic and breastfeeding characteristics. Training by nurses on the factors affecting breastfeeding attitudes from the preconception period to women will improve their breastfeeding attitudes positively.

Keywords

• Breastfeeding
• postpartum period
• lactation
• attitude
• female

Doğum Sonu Dönemdeki Kadınların Emzirme Tutumları ve Etkileyen Faktörler

Abstract

Amaç: Bu çalışmanın amacı doğum sonrası dönemdeki kadınların emzirmeye ilişkin tutumlarını incelemek ve etkileyen faktörleri belirlemektir. Gereç ve Yöntem: Bu araştırma analitik ve kesitsel olarak İzmir’de bir üniversite hastanesinin kadın hastalıkları ve doğum kliniğinde yürütülmüştür. Araştırmanın örneklemini doğum sonu dönemde olan 218 gönüllü kadın oluşturmuştur. Araştırma verileri; “Birey Tanıtım Formu” ve “Emzirme Tutumu Değerlendirme Ölçeği” ile toplanmıştır. İstatistiksel analizde; sayı, yüzdelik dağılımları, ortalama, standart sapma, bağımsız gruplarda t testi ve tek yönlü varyans analizi (ANOVA) kullanılmıştır. Bulgular: Araştırmada kadınların yaş ortalaması 27,45±5,98 olup Emzirme Tutumunu Değerlendirme Ölçeği toplam puan ortalaması 100,38±18,88’dir (Min-max=44-146). Araştırmada, aile tipi, bebeğin cinsiyeti, emzirme ve anne sütü ile ilgili bilgi alma durumu, ilk emzirme zamanı, emzirme sıklığı, planlanan emzirme süresi ve emzik ya da biberon kullanma durumu ile Emzirme Tutumunu Değerlendirme Ölçeği toplam puan ortalamaları arasında istatistiksel olarak anlamlı bir farkın olduğu saptanmıştır (p<0,05). Sonuç: Araştırma sonucunda kadınların emzirme tutumlarının orta düzeyde olduğu bulunmuştur. Kadınların emzirme tutumlarının bazı sosyo-demografik ve emzirme ile ilgili faktörlerden etkilendiği sonucuna varılmıştır. Kadınlara prekonsepsiyonel dönemden itibaren hemşireler tarafından emzirme tutumlarını etkileyen faktörlere ilişkin eğitim ve danışmanlık verilmesi emzirme tutumlarını olumlu yönde geliştirecektir.

Keywords

• Emzirme
• doğum sonu dönem
• laktasyon
• tutum
• kadın
• Breastfeeding
• postpartum period
• lactation
• attitude
• female

References

1. WHO. World Health Organızatıon Available from: https://www.who. int/health-topics/breastfeeding#tab=tab_1
2. WHO and UNICEF issue new guidance to promote breastfeeding in health facilities globally. Available from: https://www.who.int/ newsroom/ detail/11-04-2018-who-and-unicef-issue-new-guidance-topromote- breastfeeding-in-health-facilities-globally.
3. Gölbaşı Z, Koç G. Kadınların postpartum ilk 6 aylık süredeki emzirme davranışları ve prenatal dönemdeki emzirme tutumunun emzirme davranışları üzerindeki etkisi [Beastfeeding Behaviour of Women During Postpartum First Six Months and Effect of Prenatal Breastfeeding Attitude on Postpartum Breastfeeding]. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi. 2008 Mart 1;15(1):16- 31. Available from: https://dergipark.org.tr/en/download/article-file/88561.
4. Bilgin NÇ, Potur DC. Doğum sonu dönem kanıt temelli yaklaşımlar ve hemşirelik [Postpartum period evidence-based approaches and nursing]. Maltepe Üniversitesi Hemşirelik Bilim ve Sanatı Dergisi. 2010;3(3):80-87. Available from: https://www.academia.edu/1889201/ Do%C4%9Fum_Sonu_D%C3%B6nem_Kan%C4%B1t_Temelli_ Yakla%C5%9F%C4%B1mlar_Ve_Hem%C5%9Firelik.
5. Türkyılmaz C. Anne sütünün bebeğe ve anneye faydaları nelerdir?. [The Benefits of Mother’s Milk to the Infant and mother]. Türk Dünyası Uygulama ve Araştırma Merkezi Yenidoğan Dergisi. 2017;2(2):154-179. Available from: https://dergipark.org.tr/tr/download/article-file/751727.
6. Öztürk H, Demir Ü. Erken devrede emzirmenin anne-bebek sağlığı açısından yararları [Advantages of maternıty and newborn healty ın early suckllng]. Atatürk Üniversitesi Hemşirelik Yüksekokulu Dergisi. 2001;4(2):57-62. Available from: https://dergipark.org.tr/tr/download/ article-file/29156.
7. Beydağ KD. Doğum sonu dönemde anneliğe uyum ve hemşirenin rolü [Adaptation to motherhood in the postpartum period and the nurse’s role]. TSK Koruyucu Hekimlik Bülteni. 2007;6(6):479-484. Available from: https://www.bibliomed.org/mnsfulltext/1/khb_006_06- 479.pdf?1616139270.
8. Pınar G, Doğan N, Algıer L, Kaya N, Çakmak F. Annelerin doğum sonu konforunu etkileyen faktörler [Factors that affecting mothers’ postnatal comfort]. Dicle Tıp Dergisi. 2009 May 12;36(3):184-190. Available from: http://www.diclemedj.org/upload/sayi/20/Dicle%20Med%20J-01507. pdf.

9. Beydağ KD. Doğum sonu dönemde anneliğe uyum ve hemşirenin rolü [Adaptation to motherhood in the postpartum period and the nurse’s role]. TSK Koruyucu Hekimlik Bülteni 2007;6(6):479- 484. Available from: https://www.bibliomed.org/mnsfulltext/1/ khb_006_06-479.pdf?1616139270.
10. Tengir T, Çetinkaya S. Yenidoğan beslenmesinde kullanılan yöntemler ve hemşirelik bakımı [Methods used in newborn nutrition and nursing care] . Fırat Sağlık Hizmetleri Dergisi 2008;3(9):119- 140. Available from: https://www.yumpu.com/tr/document/ read/19404293/yenidogan-beslenmesinde kullanlan-yontemler-frat-universitesi.
11. Açık Y, Deveci SE, Ulutaşdemir N, İpekçi N. Yenidoğan sarılığı ve aile eğitimi [Jaundice of nevvborn and family education]. Fırat Sağlık Hizmetleri Dergisi 2010;5(13):61-78. Available from: https://www.researchgate.net/profile/NilguenUlutasdemir/ publication/331811233_Yenidogan_Sariligi_ve_Aile_Egitimi/ links/5c8d173892851c1df9447d50/YenidoganSariligi-ve-Aile-Egitimi. pdf.
12. Shommo SA, Al-Shubrumi HA. Breastfeeding knowledge, attitude and practice among mothers in Hail district, northwestern Saudi Arabia. IOSR Journal of Nursing and Health Science 2014;3(1):49-56. Available from: https://iosrjournals.org/iosr-jnhs/papers/vol3-issue1/Version-5/ J03154956.pdf
13. Yanıkkerem E, Ay S, Göker A. Primipar ve multipar gebelerin emzirme tutumu ve yaşadıkları endişeler [Breastfeeding in primiparous and multiparous pregnants attitudes and concerns]. Van Tıp Dergisi 2014;21(1):6-16. Available from: https://jag.journalagent.com/vtd/pdfs/ VTD_21_1_6_16.pdf.
14. Luo J, Prince DCJ, Mungai KF, James N. Knowledge, Attitude, and Practice of Exclusive Breastfeeding Among Mothers Attending Masaka District Hospital Kigali/Rwanda: a Cross-section Study. Research square 2021. Available from: https://assets.researchsquare. com/files/rs-152011/v1/79ad3a8e-7372-4069-898b-451084d551cd. pdf?c=1631871851.
15. Dukuzumuremyi, JPC, Acheampong K, Abesig J, Luo J. Knowledge, attitude, and practice of exclusive breastfeeding among mothers in East Africa: a systematic review. International Breastfeeding Journal 2020;15(1):1-17. Available from: https://doi.org/10.1186/s13006-020- 00313-9.
16. Scott JA, Binns CW, Arnold RV. Attitudes toward breastfeeding in Perth, Australia: qualitative analysis. Journal of Nutrition Education 1997;29(5):244-249. Available from:https://www.sciencedirect.com/ science/article/pii/S0022318297702139#:~:text=https%3A//doi. org,Get
17. Hamid SBA, Yahya N. Knowledge, attitude, prior exposure and intention to breastfeed among undergraduate university students. Journal of Clinical and Health Sciences 2018;3(2):26-35. Available from: https://jchs-medicine.uitm.edu.my/images/manuscript/vol3issue2/ original-articles/p26 35/Knowledge-Attitude-Prior-Exposure-and- Intention-to-Breastfeed-among-Undergraduate-University-Students. pdf
18. Mortazavi F Mousavi SA, Chaman R, Khosravi A. Do Maternal Quality of Life and Breastfeeding Difficulties Influence the Continuation of Exclusive Breastfeeding? International Journal of Pediatrics 2014; Article ID 156049:7. Available from: http://dx.doi.org/10.1155/2014/156049. PMID: 24868209.
19. Alharbi1 AF, Almutairi1 AM, Alrasheedi AE, Aldukhayel A, Almutairi SM. Attitudes toward breastfeeding practices among breastfeeding women in Buraydah city, Saudi Arabia: A cross-sectional study. Int J Adv Med. 2020;7(8):1203-1210 Available from: http://dx.doi. org/10.18203/2349-3933.ijam20203119
20. Ünsür EK, Gündoğan BD, Ünsür MT, Okan FF. Emziren annelerin emzirme ile ilgili bilgi ve tutumlarının değerlendirilmesi [Evaluation of knowledge and attitude of the nursing mothers on breastfeeding]. Euras J Fam Med. 2014; 3(1): 33-40. Available from: http://ejfm.trakya. edu.tr/userfiles/2014/April/33-emziren-annelerin-emzirme-ile-ilgili-bilgi-ve-tutumlarinin-degerlendirilmesi.pdf.
21. TNSA 2018. URL: http://www.hips.hacettepe.edu.tr/tnsa2018/rapor/ TNSA2018_ana_Rapor.pdf.
22. Kaya Z, Yılmaz B, Satılmış İG. Toplum içinde emzirmeye yönelik görüş ve tutumlar. [Views and attitudes toward breastfeeding in public places]. Sağlık Bilimleri ve Meslekleri Dergisi 2019;6(3):595-609. Available from: https://www.archhealthscires.org/Content/files/sayilar/3/hsp4.pdf
23. Akyüz A, Kaya T, Şenel N. Annenin emzirme davranışının ve emzirmeyi etkileyen durumların belirlenmesi [Determination of breastfeeding behaviors of mothers and influencing factors]. TSK Koruyucu Hekimlik Bülteni 2007;6(5):331-336. Available from: https:// app.trdizin.gov.tr/publication/paper/detail/TnpJd01USXk=.
24. Balogun OO, O’Sullivan, EJ, McFadden A, et al. Interventions for promoting the initiation of breastfeeding. Cochrane Database of Systematic Reviews. 2016 Nov 9;(11):1-89. Doi: 10.1002/14651858. CD001688.pub3. PMID: 27827515. Available from: https://www.ncbi. nlm.nih.gov/pmc/articles/PMC6464788/pdf/CD001688.pdf
25. Arslan H. Emzirme tutumunu değerlendirme ölçeği geliştirme [Breastfeeding Attitudes of The Evaluation Scale Developing]. Hemşirelik Forumu 1999;2(3):132-6. Available from: https:// toad.halileksi.net/sites/default/files/pdf/emzirme-tutumunu-degerlendirme olcegi-toad.pdf.
26. Arslan Özkan H. Emzirme tutumunu değerlendirme ölçeği [Breastfeeding Attitudes of The Evaluation Scale]. KASHED 2015;2(1):53-58. Available from: https://toad.halileksi.net/sites/ default/files/pdf/emzirme-tutumunu-degerlendirme-olcegi-toad.pdf.
27. Yiğitbaş Ç, Kahriman İ, Çalık KY, Bulut HK. Trabzon il merkezindeki hastanelerde doğum yapan annelerin emzirme tutumlarının değerlendirilmesi [About the breast-feedıng attitudes and behavıour of the mothers that gave bırt ın hospitals ın Trabzon]. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 2012;1(2):49-60. Available from: https://dergipark.org.tr/en/download/article-file/84327.
28. Akcay N, Uzşen H, Buldur E. Emzirme sürecinde olan annelerin emzirme davranışlarını yönlendiren tutumlarının incelenmesi. Adnan Menderes Üniversitesi Sağlık Bilimleri Fakültesi Dergisi 2021;5(1):84- 92. Available from: https://dergipark.org.tr/en/download/article-file/930360.
29. Cangöl E, Şahin N. Emzirmeyi etkileyen faktörler ve emzirme danışmanlığı [Factors affecting breastfeeding and breastfeeding counselling]. Zeynep Kamil Tıp Bülteni 2014;45(3):100-105. Available from: https://dergipark.org.tr/en/download/article-file/205295.
30. Türkyılmaz C. Emzirme danışmanlığı ve emzirmede karşılaşılan sorunlar [Lactational counseling and breastfeeding promlems]. Klinik Tıp Pediatri Dergisi 2016;8(2):19-33. Available from: https://dergipark. org.tr/tr/download/article-file/767644.
31. Onat G. Emzirmeyi kolaylaştırıcı uygulamalar ve laktasyonel bakım [Practices for facilitating breastfeeding and lactation care] . Turkiye Klinikleri J Obstet Womens Health Dis Nurs-Special Topics 2018;4(2):131-46. Available from: http://acikerisim.karatay.edu. tr:8080/xmlui/bitstream/handle/20.500.12498/784/emzirme. pdf?sequence=1&isAllowed=y
32. Çalık KY, Çetin FC, Erkaya R. Annelerin emzirme konusunda uygulamaları ve etkileyen faktörler [Breastfeeding practices of mothers and influencing practices]. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 2017;6(3):80-91. Available from: https://dergipark.org.tr/tr/ download/article-file/376221.
33. Cascone D, Tomassoni D, Napolitano F, Di Giuseppe G. Evaluation of knowledge, attitudes, and practices about exclusive breastfeeding among women in Italy. International Journal of Environmental Research and Public Health 2019;16(12):2118. doi:10.3390/ijerph16122118. PMID: 31207988. Available from: https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC6617343/
34. Alsaç SY, Polat S. Annelerin emzirmeyi sonlandırma sürecine ilişkin bilgi ve uygulamaları [Knowledge and attitudes related to the finalization of mothers breastfeeding]. Florence Nightingale Hemşirelik Dergisi 2018;26(1):11-20. doi: 10.26650/FNJN.387152. Available from: https://fnjn.org/Content/files/sayilar/112/Annelerin%20 Emzirmeyi%20Sonland__rma%20S__recine%20__li__kin%20 Bilgi%20ve%20Uygulamalar__%5B%23387152%5D-415394.pdf
35. Akın B, Demir E, Gürdal A, Yılmaz S. 0-6 aylık bebeği olan annelerin bebek beslenmesine ilişkin tutumları ve tamamlayıcı besine geçiş süreleri. [Attitudes of mothers with babies of 0-6 months of age regarding ınfant nutrition and transition times to complementary feeding]. Acıbadem Univ. Sağlık Bilim. Derg. 2021;12(2):472-478. Available from: https://doi.org/10.31067/acusaglik.849205
36. Dinç A, Dombaz İ, Dinç D. 6-18 ay arası bebeği olan annelerin emzirme ve anne sütüne ilişkin geleneksel uygulamaları [Tradıtıonal practıces related to breast mılk and breastfeedıng of mothers wıth babıes of 6-18 months]. Balıkesir Sağlık Bilimleri Dergisi 2015; 4(3):125- 130. doi: 10.5505/bsbd.2015.40316.
37. Karaçam Z, Sağlık M. Emzirme sorunları ve sorunlara ilişkin yapılan girişimler: Türkiye’de yapılan çalışmalara dayalı bir sistematik derleme [Breastfeeding problems and interventions performed on problems: systematic review based on studies made in Turkey]. Turkish Archives of Pediatrics 2018;53(3):134-148. doi: 10.5152/TurkPediatriArs.2018.6350.
38. Coentro VS, Lai CT, Rea A, Geddes DT, Perrella SL. Breast Milk Production in Women Who Use Nipple Shields for Persistent Nipple Pain. Journal of Obstetric, Gynecologic & Neonatal Nursing 2021. Available from: https://doi.org/10.1016/j.jogn.2021.09.005
39. Hahn-Holbrook J, Little EE, Abbott M. Mothers are more sensitive to infant cues after breastfeeding compared to bottle-feeding with human milk. Hormones and Behavior 2021;136:105047. Available from: https:// pubmed.ncbi.nlm.nih.gov/34710778/
40. Howard CR, Howard FM, Lanphear B, Eberly S, Oakes D, Lawrence RA. (2003). Randomized Clinical Trial of Pacifieruse and Bottle-Feeding or Cupfeeding and Their Effect on Breastfeeding. Pediatrics 2003;11:511- 518. Available from: https://pubmed.ncbi.nlm.nih.gov/12612229/
41. Sarı E, Akcaboy M, Özturk S, Çoban G, & Şenel S. Breastfeeding education in a newly organized lactation consultation clinic: an evaluation of its effects on the improvement of maternal attitudes to breastfeeding. Turkish Archives of Pediatrics 2022;57(3):290. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9131809/pdf/ tap-57-3-290.pdf
42. Güney E, Uçar T. Gebelikteki beden imajının emzirme tutumu ve doğum sonu emzirme sürecine etkisi [Breastfeeding attitude of body image in pregnancy and effect on breastfeeding process]. Zeynep Kamil Tıp Bülteni 2018;49(1):49-53. doi: http://dx.doi.org/10.16948/ zktipb.338783.
43. Altamimi E, Al Nsour R, Al Dalaen D, Almajali N. Knowledge, Attitude, and Practice of Breastfeeding Among Working Mothers in South Jordan. Workplace Health Saf. 2017;65(5):210-8. Available from: https://pubmed.ncbi.nlm.nih.gov/27794075/
44. Liu N, Zhang F, Wei C, Jia Y, Shang Z, Sun L, Wu L, Sun Z, Zhou Y, Wang Y, Liu W. Prevalence and predictors of PTSS during COVID-19 outbreak in China hardest-hit areas: Gender differences matter. Psychiatry Res. 2020;287:112921. DOI: 10.1016/j.psychres.2020.112921
45. Bendau A, Petzold MB, Pyrkosch L, Mascarell Maricic L, Betzler F, Rogoll J, Große J, Ströhle A, Plag J. Associations between COVID-19 related media consumption and symptoms of anxiety, depression and COVID-19 related fear in the general population in Germany. Eur Arch Psychiatry Clin Neurosci. 2021;271:283-291. DOI: 10.1007/s00406-020- 01171-6
46. Wise T, Zbozinek TD, Michelini G, Hagan CC, Mobbs D. Changes in risk perception and self-reported protective behaviour during the first week of the COVID-19 pandemic in the United States. R Soc Open Sci. 2020;7:200742. DOI: 10.1098/rsos.200742
47. Shafiei A, Maleksaeidi, H. Pro-environmental behavior of university students: Application of protection motivation theory. Global Ecology and Conservation. 2020; DOI: 10.1016/j.gecco.2020.e00908.
48. Bashirian S, Jenabi E, Khazaei S, Barati M, Karimi-Shahanjarini A, Zareian S, Rezapur-Shahkolai F, Moeini B. Factors associated with preventive behaviours of COVID-19 among hospital staff in Iran in 2020: an application of the Protection Motivation Theory. J Hosp Infect. 2020;105(3):430-433. DOI: 10.1016/j.jhin.2020.04.035
49. Jørgensen F, Bor A, Petersen MB. Compliance without fear: Individual-level protective behaviour during the first wave of the COVID-19 pandemic. Br J Health Psychol. 2021;26:679-696. DOI: 10.1111/bjhp.12519 Dror AA, Eisenbach N, Taiber S, Morozov NG, Mizrachi M, Zigron A, Srouji S, Sela E. Vaccine hesitancy: the next challenge in the fight against COVID-19. Eur J Epidemiol. 2020;35:775-779. DOI: 10.1007/s10654-020- 00671-y
50. Detoc M, Bruel S, Frappe P, Tardy B, Botelho-Nevers E, Gagneux- Brunon A. Intention to participate in a COVID-19 vaccine clinical trial and to get vaccinated against COVID-19 in France during the pandemic. Vaccine. 2020;38(45):7002-7006. DOI: 10.1016/j.vaccine.2020.09.041
51. Du C, Zan MCH, Cho MJ, Fenton JI, Hsiao PY, Hsiao R, Keaver L, Lai CC, Lee H, Ludy MJ, Shen W, Swee WCS, Thrivikraman J, Tseng KW, Tseng WC, Almotwa J, Feldpausch CE, Folk SYL, Gadd S, Wang L, Wang W, Zhang X, Tucker RM. Health Behaviors of Higher Education Students from 7 Countries: Poorer Sleep Quality during the COVID-19 Pandemic Predicts Higher Dietary Risk. Clocks Sleep. 2021;3(1):12-30. DOI: 10.3390/ clockssleep3010002
52. Rahman MA, Hoque N, Alif SM, Salehin M, Islam SMS, Banik B, Sharif A, Nazim NB, Sultana F, Cross W. Factors associated with psychological distress, fear and coping strategies during the COVID-19 pandemic in Australia. Global Health. 2020;16(1):95.
53. Rehm J, Kilian C, Ferreira-Borges C, Jernigan D, Monteiro M, Parry CDH, Sanchez ZM, Manthey J. Alcohol use in times of the COVID 19: Implications for monitoring and policy. Drug Alcohol Rev. 2020;39(4):301-304. DOI: 10.1186/s12992-020-00624-w
54. Di Renzo L, Gualtieri P, Pivari F, Soldati L, Attinà A, Cinelli G, Leggeri C, Caparello G, Barrea L, Scerbo F, Esposito E, De Lorenzo A. Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey. J Transl Med. 2020;18:229. DOI: 10.1186/s12967-020-02399-5
55. Alkerwi A, Baydarlioglu B, Sauvageot N, Stranges S, Lemmens P, Shivappa N, Hébert JR. Smoking status is inversely associated with overall diet quality: Findings from the ORISCAV-LUX study. Clin Nutr. 2017;36:1275-1282. DOI: 10.1016/j.clnu.2016.08.013
56. Yıldız Ö. Ü. E. 13. Ünite: COVID-19 Pandemisinin Yaşam Tarzı ve Psikososyal Alandaki Etkileri. Yeni Koronavirüs hastalığının toplum üzerine etkileri. 2020;116-124.
57. Ercan Ş, Keklicek H. COVID-19 Pandemisi Nedeniyle Üniversite Öğrencilerinin Fiziksel Aktivite Düzeylerindeki Değişimin İncelenmesi. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi. 2020;5(2):69-74.
58. Romero-Blanco C, Rodríguez-Almagro J, Onieva-Zafra MD, Parra- Fernández ML, Prado-Laguna MDC, Hernández-Martínez A. Physical Activity and Sedentary Lifestyle in University Students: Changes during Confinement Due to the COVID-19 Pandemic. Int J Environ Res Public Health. 2020;17(18):6567. DOI: 10.3390/ijerph17186567
59. Al-Dmour H, Masa’deh R, Salman A, Abuhashesh M, Al-Dmour R. Influence of Social Media Platforms on Public Health Protection Against the COVID-19 Pandemic via the Mediating Effects of Public Health Awareness and Behavioral Changes: Integrated Model. J Med Internet Res. 2020;22(8):e19996. DOI: 10.2196/19996
60. Rachul C, Marcon AR, Collins B, Caulfield T. COVID-19 and ‘immune boosting’ on the internet: a content analysis of Google search results. BMJ Open. 2020;10(10):e040989. DOI: 10.1136/bmjopen-2020-040989
61. Hamulka J, Jeruszka-Bielak M, Górnicka M, Drywień ME, Zielinska- Pukos MA. Dietary Supplements during COVID-19 Outbreak. Results of Google Trends Analysis Supported by PLifeCOVID-19 Online Studies. Nutrients. 2020;13(1):54. DOI: 10.3390/nu13010054
62. Adams KK, Baker WL, Sobieraj DM. Myth Busters: Dietary Supplements and COVID-19. Ann Pharmacother. 2020; 54(8):820-826. DOI: 10.1177/1060028020928052