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Objective To explore the factors that influence expectant parents' infant feeding decisions in the antenatal period. Design Mixed method systematic review focussing on participant views data. Data sources CINAHL, Medline, Embase and PsychInfo databases were interrogated using initial keywords and then refined terms to elicit relevant studies. Reference lists were checked and hand-searching was undertaken for 2 journals (‘Midwifery' and ‘Social Science and Medicine') covering a 3 year time period (January 2011–March 2014). Key inclusion criteria: studies reflecting expectant parents' views of the factors influencing their infant feeding decisions in the antenatal period; Studies in the English language published after 1990, from developed countries and of qualitative, quantitative or mixed method design. Review methods A narrative interpretive synthesis of the views data from studies of qualitative, quantitative and mixed method design. Data were extracted on study characteristics and parents' views, using the Social Ecological Model to support data extraction and thematic synthesis. Synthesis was influenced by the Evidence for Policy and Practice Information and Co-Ordinating Centre approach to mixed method reviews. Results Of the 409 studies identified through search methods, 17 studies met the inclusion criteria for the review. Thematic synthesis identified 9 themes: Bonding/Attachment; Body Image; Self Esteem/Confidence; Female Role Models; Family and Support Network; Lifestyle; Formal Information Sources; Knowledge; and Feeding in front of others/Public. The review identified a significant bias in the data towards negative factors relating to the breastfeeding decision, suggesting that infant feeding was not a choice between two feeding options, but rather a process of weighing reasons for and against breastfeeding. Findings reflected the perception of the maternal role as intrinsic to the expectant mothers' infant feeding decisions. Cultural perceptions permeated personal, familial and social influences on the decision-making process. Expectant mothers were sensitive to the way professionals attempted to support and inform them about infant feeding choices. Conclusions By taking a Social Ecological perspective, we were able to explore and demonstrate the multiple influences impacting on expectant parents in the decision-making process. A better understanding of expectant parents' views and experiences in making infant feeding decisions in the prenatal and antenatal periods will inform public health policy and the coordination of service provision to support infant feeding activities.

The aims of this study were (a) to devise a set of prioritised criteria of consultation competence which primary care nurses need to acquire and (b) to determine the face and content validity of these criteria.The criteria of consultation competence as contained in the Leicester Assessment Package (LAP) were modified for use with primary care nurses and sent to a stratified sample of UK primary care nurses (n=1126) to determine their face and content validity.Support for the seven categories of consultation competence varied from 93-98% and for the 39 component competences from 88-98%. There was no consensus for alternative or additional categories or components. CONCLUSIONS; We have established the face and content validity of the derived competences. These are suitable for the teaching and assessment of consultation skills of primary care nurses, at all stages of their professional development, when incorporated within an educational package.

This paper reports the development of a questionnaire designed to assess whether patients' experiences of cancer services meet agreed standards as part of the process of accrediting cancer centres and units. Based on issues that patients and carers consider important, questions covered all stages of a patient's journey through the health service. 446 patients from five hospitals in Trent Region (UK) were recruited, 66% ( n =298) returned completed questionnaires. Patients generally rated their experiences of care positively. Areas of care receiving 10% or more negative responses included the manner and surroundings in which the diagnosis was given; information about treatment implications and side-effects; recognizing how anxious the patient was feeling during treatment and follow-up; written information about the illness and its treatment; and involvement in decisions about treatment. The questionnaire demonstrated satisfactory internal consistency as well as sufficient discriminatory power to detect differences in perceptions of good and poor care between the three geographical study sites. Criterion validity was satisfactory as measured by the level of association between overall care scores and the combined scores of the eight subsections. Further work needs to be undertaken in testing for construct validity and sensitivity to change.

This paper provides the reader with a step-by-step guide to the process of validation. It is argued that validation should provide a forum for the constructive discussion and rigorous scrutiny of all aspects of the proposed course. This is an essential part of any educational institution's quality assurance program.