Original Article

Enhancing Patient–Provider Breastfeeding Conversations: Breastfeeding Intention and Prenatal Breastfeeding Self-Efficacy among a Sample of Pregnant Women

Authors: Erin M. McKinley, PhD, RD, Linda L. Knol, PhD, RD, Lori W. Turner, PhD, RD, Joy J. Burnham, PhD, Kristine R. Graettinger, MD, Maria Hernandez-Reif, PhD, James D. Leeper, PhD

Abstract

Objectives: The purpose of this study was to investigate and identify which sociodemographic factors may be associated with breastfeeding intention and breastfeeding self-efficacy among pregnant women.

Methods: Pregnant women at a medical center in Alabama completed a cross-sectional survey. The Prenatal Rating of Efficacy in Preparation to Breastfeed Scale (PREP to BF) was used to assess prenatal breastfeeding self-efficacy. A valid 3-item breastfeeding intention scale and the Fetal Health Locus of Control Scale also were used. Nonparametric tests were used to assess differences in breastfeeding intention, locus of control subscales, and PREP to BF scores by history with breastfeeding, planned mode of delivery, and sociodemographic factors.

Results: The participants in the final analysis (N = 124) had a mean prenatal breastfeeding self-efficacy score of 299.5 (±92.33), with a range of 0 to 390. Significantly lower scores related to intention and PREP to BF were found among Black women (P ≤ 0.05), those with a high school education or less (P ≤ 0.019), single women (P ≤ 0.028), and those who had no breastfeeding experience (P ≤ 0.035).

Conclusions: Identifying pregnant women with low breastfeeding self-efficacy and intention and recognizing the effects of social and cultural influences on breastfeeding are vital. Healthcare providers can engage in meaningful dialog to address ways to increase social support, communication, goal-setting skills, and overcoming mental and emotional barriers.
Posted in: Pregnancy16

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References

1. Lessen R, Kavanagh K. Position of the academy of nutrition and dietetics: promoting and supporting breastfeeding. J Acad Nutr Diet 2015;115:444–449.   2. Eidelman AI, Schanler RJ, Johnston M, et al. Breastfeeding and the use of human milk. Pediatrics 2012;129:e827–e841.   3. American College of Obstetricians and Gynecologists, Committee on Obstetric Practice. Committee Opinion No. 658: optimizing support for breastfeeding as part of obstetric practice. Obstet Gynecol 2016;127:e86–e92.   4. Chantry CJ, Eglash A, Labbok M. ABM position on breastfeeding–revised. Breastfeed Med 2015;10:407–411.   5. US Breastfeeding Committee. Statement on exclusive breastfeeding. http://www.usbreastfeeding.org/d/do/710. Published 2015. Accessed February 14, 2021.   6. Centers for Disease Control and Prevention. Breastfeeding Report Card 2020. https://www.cdc.gov/breastfeeding/data/reportcard.htm. Published 2020. Accessed February 14, 2021.   7. US Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Healthy People 2030. Increase the proportion of infants who are breastfed exclusively through age 6 months — MICH-15. https://health.gov/healthypeople/objectives-and-data/browse-objectives/ infants/increase-proportion-infants-who-are-breastfed-exclusively-through-age6-months-mich-15. Published August 18, 2020. Accessed February 14, 2021.   8. Bartick MC, Schwarz EB, Green BD, et al. Suboptimal breastfeeding in the United States: maternal and pediatric health outcomes and costs. Matern Child Nutr 2017;13:e12366.   9. Caulfield LE, Gross SM, Bentley ME, et al. WIC-based interventions to promote breastfeeding among African-American Women in Baltimore: effects on breastfeeding initiation and continuation. J Hum Lact 1998;14:15–22.   10. Kessler LA, Gielen AC, Diener-West M, et al. The effect of a woman’s significant other on her breastfeeding decision. J Hum Lact 1995;11:103–109.   11. Losch M, Dungy CI, Russell D, et al. Impact of attitudes on maternal decisions regarding infant feeding. J Pediatr 1995;126:507–514.   12. Manstead ASR, Proffitt C, and Smart JL. Predicting and understanding mothers’ infant-feeding intentions and behavior: testing the theory of reasoned action. J Pers Soc Psychol 1983;44:657–671.   13. Quarles A, Williams PD, Hoyle DA, et al. Mothers’ intention, age, education and the duration and management of breastfeeding. Matern Child Nurs J 1994;22:102–108.   14. Robinson KM, VandeVusse L. African American women’s infant feeding choices: prenatal breast-feeding self-efficacy and narratives from a black feminist perspective. J Perinat Neonatal Nurs 2011;25:320–328.   15. Wells KJ, Thompson NJ, Kloeblen-Tarver AS. Development and psychometric testing of the Prenatal Breast-feeding Self-efficacy Scale. Am J Health Behav 2006;30:177–187.   16. Hoddinott P, Kroll T, Raja A, et al. Seeing other women breastfeed: how vicarious experience relates to breastfeeding intention and behaviour. Matern Child Nutr 2010;6:134–146.   17. Kloeblen-Tarver AS, Thompson NJ, Miner KR. Intent to breast-feed: the impact of attitudes, norms, parity, and experience. Am J Health Behav 2002;26:182–187.   18. Hayden J. Introduction to Health Behavior Theory. Burlington, MA: Jones & Bartlett Learning; 2009.   19. Haslam C, Lawrence W, Haefeli K. Intention to breastfeed and other important health-related behaviour and beliefs during pregnancy. Fam Pract 2003;20:528–530.   20. Bandura A. Self-efficacy. In: Encyclopedia of Human Behavior, Ramachaudran VS, ed. New York: Academic Press; 1994.   21. Bandura A, McClelland DC. Social Learning Theory. New York: General Learning Press; 1977.   22. Kohan S, Heidari Z, Keshvari M. Facilitators for empowering women in breastfeeding: a qualitative study. Int J Pediatr 2016;4:1287–1296.   23. Chan MY, Ip WY, Choi KC. The effect of a self-efficacy-based educational programme on maternal breastfeeding self-efficacy, breast-feeding duration and exclusive breastfeeding rates: a longitudinal study. Midwifery 2016;36:92–98.   24. Brandão S, Mendonça D, Dias CC, et al. The breastfeeding self-efficacy scale-short form: psychometric characteristics in Portuguese pregnant women. Midwifery 2018;66:49–55.   25. Weeler BJ, Dennis CL. Psychometric testing of the modified breastfeeding self-efficacy scale (short form) among mothers of ill or preterm infants. J Obstet Gynecol Neonatal Nurs 2013;42:70–80.   26. Alghamdi S, Horodynski M, Stommel M. Racial and ethnic differences in breastfeeding, maternal knowledge, and self-efficacy among low-income mothers. Appl Nurs Res 2017;37:24–27.   27. Danawi H, Estrada L, Hasbini T, et al. Health inequalities and breastfeeding in the United States of America. Int J Childbirth Educ 2016;31:35–39.   28. Alus Tokat M, Serçekuş P, Yenal K, et al. Early postpartum breast-feeding outcomes and breast-feeding self-efficacy in Turkish mothers undergoing vaginal birth or cesarean birth with different types of anesthesia. Int J Nurs Knowl 2015;26:73–79.   29. Bartle NC, Harvey K. Explaining infant feeding: the role of previous personal and vicarious experience on attitudes, subjective norms, self-efficacy, and breastfeeding outcomes. Br J Health Psychol 2017;22:763–785.   30. Jones KM, Power ML, Queenan JT, et al. Racial and ethnic disparities in breastfeeding. Breastfeed Med 2015;10:186–196.   31. McKinley EM, Knol LL, Turner LW, et al. The prenatal rating of efficacy in preparation to breastfeed scale: a new measurement instrument for prenatal breastfeeding self-efficacy. J Hum Lact 2019;35:21–31.   32. Wurtele SK. Fetal health locus of control scale: development and validation. J Consult Clin Psychol 1986;54:814.   33. Francis JJ, Eccles MP, Johnston M, et al. Constructing questionnaires based on the theory of planned behaviour. a manual for health services researchers. Newcastle upon Tyne, UK: Centre for Health Services Research, University of Newcastle upon Tyne; 2004.   34. Armitage CJ, Conner M. Efficacy of the theory of planned behaviour: a meta-analytic review. Br J Soc Psychol 2001;40:471–499.   35. Shapiro SS, Wilk MB. An analysis of variance test for normality (complete samples). Biometrika 1965;52:591–611.   36. McDonald JH. Handbook of Biological Statistics, 3rd ed. Baltimore, MD: Sparky House Publishing; 2014.   37. Chen C, Yan Y, Gao X, et al. Influences of cesarean delivery on breastfeeding practices and duration: a prospective cohort study. J Hum Lact 2018;34:526–534.   38. Zhang F, Cheng J, Yan S, et al. Early feeding behaviors and breastfeeding outcomes after cesarean section. Breastfeed Med 2019;14:325–333.   39. Srinivas GL, Benson M, Worley S, et al. A clinic-based breastfeeding peer counselor intervention in an urban, low-income population: interaction with breastfeeding attitude. J Hum Lact 2015;31:120–128.   40. Bai DL, Fong DY, Tarrant M. Previous breastfeeding experience and duration of any and exclusive breastfeeding among multiparous mothers. Birth 2015;42:70–77.   41. Baumgartner T, Bhamidipalli SS, Guise D, et al. Psychosocial and sociodemographic contributors to breastfeeding intention in first-time mothers. Matern Child Health J 2020;24:1047–1056.   42. Porta F, Mussa A, Baldassarre G, et al. Genealogy of breastfeeding. Eur J Pediatr 2016;175:105–112.   43. Habel C, Feeley N, Hayton B, et al. Causes of women’s postpartumn depression symptoms: men’s and women’s perceptions. Midwifery 2015;31:728–734.