Exclusive Breastfeeding Intention Research Articles

Breastfeeding Intentions among Pregnant Women Enrolled in a Healthy Start Program in Arkansas.

Exclusive breastfeeding is recognized as the optimal source of nutrition for infants. Although exclusive breastfeeding rates have increased overall in the United States, substantial inequities exist in breastfeeding among individuals of different socioeconomic statuses, races, and ethnicities. The purpose of this study was to examine characteristics associated with exclusive breastfeeding intentions among pregnant women in Arkansas enrolled in a Healthy Start program. The current study included a cross-sectional design, with a sample of 242 pregnant women in Arkansas enrolled in a Healthy Start program. The majority of the participants (56.6%) indicated their infant feeding intentions included a combination of breastfeeding and formula feeding. There were substantial differences in breastfeeding intentions among women of different races/ethnicities, with 18.5% of Marshallese women indicating they planned to exclusively breastfeed, compared to 42.1% of White women, 47.6% of Black women, and 31.8% of Hispanic women (p < 0.001). Women over the age of 18 and with higher educational attainment were more likely to intend on exclusively breastfeeding. This is the first study to examine characteristics associated with exclusive breastfeeding intentions among pregnant women in Arkansas enrolled in a Healthy Start program. The study found that race/ethnicity and age were most strongly associated with breastfeeding intentions. These findings are critical to identifying populations for resource allocation and to developing culturally-tailored interventions to help women in Arkansas achieve their desired infant feeding methods.

Intenção de amamentar entre gestantes e variáveis associadas: estudo transversal em uma comunidade brasileira

ABSTRACT Objective: To investigate exclusive breastfeeding (EBF) intention and associated variables among women in the third trimester of pregnancy. Methods: The data were collected with a questionnaire for the pregnant women (n=653), from December/2018 to November/2019. They answered the Infant Feeding Intentions (IFI) scale, translated and adapted to Brazilian Portuguese, and a questionnaire on sociodemographic, biological, family, pregnancy, breastfeeding, health care, and habits variables. Descriptive statistics and multiple logistic regression analyses were performed with a 5% significance level, following a multilevel hierarchical model that estimated the association between the dependent and independent variables. The outcome EBF intention measured by the IFI score was dichotomized by the median (&lt;16 or =16). Results: Mean±standard deviation score for the IFI scale was 14.4±2.6 (score 0: very strong intention to not breastfeed at all; score 16: very strong EBF intention up to six months). The results from the regression analysis showed that pregnant women who had no intention to bottle feed (OR=4.33; 95%CI 2.79-6.72) or did not know (OR=1.85; 95%CI 1.21–2.82), those who planned the pregnancy (OR=1.52; 95%CI 1.09–2.12), those who believed they would have help to care for the baby (OR=3.60; 95%CI 1.51–8.56) or did not know (OR=3.97; 95%CI 1.26–12.51), and those who reported knowing the World Health Organization recommendations on breastfeeding (OR=1.73; 95%CI 1.13–2.64) were more likely to show a very strong EBF intention. Conclusions: Pregnant women in the third trimester of pregnancy presented a strong EBF intention. The higher EBF intention score was significantly associated with the structural, setting, and individual determinants.

Psychometric testing of the breastfeeding self-efficacy scale to measure exclusive breastfeeding in African American women: a cross-sectional study.

In United States, African American women are the least likely group to breastfeed exclusively compared with Hispanic and non-Hispanic white women. It is crucial to examine the perceived confidence of African American women towards practicing exclusive breastfeeding. Previous studies have examined breastfeeding self-efficacy and other factors influencing exclusive breastfeeding. However, there is no research on exclusive breastfeeding self-efficacy of this population. The purpose of this study was to examine the validity and reliability of the breastfeeding self-efficacy scale to measure exclusive breastfeeding, and the relationship between exclusive breastfeeding self-efficacy and general self-efficacy and demographic variables in African American women. Descriptive cross-sectional design was used. A convenience sample of 53 pregnant African American women completed an online survey. Construct and criterion-related validity were assessed and reliability of the breastfeeding self-efficacy scale to measure exclusive breastfeeding (BSES-EBF) was examined using Cronbach's reliability. The general self-efficacy scale measured general self-efficacy. Descriptive statistics, bivariate correlation and non-parametric analyses were performed using statistical package for social sciences (v.28). The breastfeeding self-efficacy to measure exclusive breastfeeding scale had a Cronbach's alpha score of 0.907. One principal component was extracted from the BSES-EBF scale, with an Eigenvalue of 5.271 and which explained 58.57% of the variance in the instrument. The mean prenatal exclusive breastfeeding self-efficacy of participants was 35.15 (±7.41) from a range of 9 to 45. Exclusive breastfeeding was significantly associated with general self-efficacy (r = 0.503, p ≤ 0.001) and exclusive breastfeeding intention (p = 0.034). Breastfeeding self-efficacy scale to measure exclusive breastfeeding is a valid and reliable tool to measure exclusive breastfeeding self-efficacy in African American women. African American women had high exclusive breastfeeding self-efficacy (internal motivation). Hence, there is a need to address breastfeeding barriers and provide access to culturally sensitive support (external motivation) to increase exclusive breastfeeding in African American women.

Associated Factors of Exclusive Breastfeeding Intention among Pregnant Women in Najran, Saudi Arabia.

The exclusive breastfeeding (EBF) intention conceived by pregnant women is the most important predictor of breastfeeding (BF) initiation, duration, and continuation. This study explores the associated factors of EBF intention among pregnant women. This was a descriptive cross-sectional study conducted from November 2022 to January 2023 with 382 pregnant women who came to the outpatient clinic in the Maternal and Children Hospital (MCH). Four instruments were used for data collection: the Infant Feeding Intention scale, the Gender-Friendly BF Knowledge scale (GFBKS), the Iowa Infant Feeding Attitude scale (IIFAS), and the basic data questionnaire. The study findings indicated that 51.8% and 75.9% of gravida women had adequate knowledge and a positive attitude regarding BF. Furthermore, 56.3% of the participants had a high intention for EBF. Binary logistic regression illustrated that occupational status, antenatal care, plan for the current pregnancy, BF practice, last child delivery mode, medical disorder during the current pregnancy, age, BF knowledge, and attitude are potential predictors. The goodness of fit test revealed that 46.8% of the EBF intention could be anticipated through the positive pre-mentioned factors. The low EBF intention is modifiable by addressing the previously positive predictors. BF educational interventions should be tailored based on EBF intention predictors in order to be effective and lead to behavior change.

Association of illness perceptions and exclusive breastfeeding intentions among pregnant women with chronic conditions: A community-based pregnancy cohort study

ObjectiveWe examined whether changes in illness perceptions from preconception to pregnancy were associated with intentions to exclusively breastfeed to 6 months postpartum among women with chronic physical health conditions. MethodsWe analyzed self-reported cross-sectional questionnaire data collected in the third trimester from 361 women with chronic conditions enrolled in a community-based cohort study (Alberta, Canada). For individual and total illness perceptions, measured with the Brief Illness Perception Questionnaire, women were classified using change scores (preconception minus pregnancy) into one of the following groups: “worsening,” “improving,” or “stable” in pregnancy. Intention to exclusively breastfeed was defined as plans to provide only breast milk for the recommended first 6 months after birth. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using multivariable logistic regression modelling, with the “stable” group as the reference and controlling for demographic factors, chronic condition duration and medication, prenatal class attendance, and social support. ResultsOverall, 61.8% of women planned to exclusively breastfeed to 6 months. Worsened total illness perceptions (adjusted OR 0.50, 95% CI 0.30–0.82) as well as perceptions of worsened identity (i.e., degree of symptoms; adjusted OR 0.49, 95% CI 0.28–0.85) or consequences (i.e., impact on functioning; adjusted OR 0.60, 95% CI 0.34–1.06) were associated with lower odds of intending to exclusively breastfeed to 6 months. ConclusionsWomen who perceive their illness experience to worsen during pregnancy are less likely to plan to exclusively breastfeed to 6 months in accordance with public health recommendations.

Predicting perceived exclusive breastfeeding behavior among higher education female students in Saudi Arabia: Application of the theory of planned behavior using structural equation modeling.

The decision for infant feeding behaviors is often made early in life, based on the socio-cultural context. Thus, exploring this issue and its influencing factors can create Exclusive Breastfeeding (EBF) culture among future mothers. This study aimed to predict EBF behavior among female higher education students in Saudi Arabia through the application of the Theory of Planned Behavior (TPB) using Structural Equation Modeling (SEM). This descriptive exploratory research was conducted on three university campuses in three cities (Dammam, Jeddah, and Abha). A multistage cluster random sampling was employed to select 600 female students using a digital survey containing three sections: Personal Data and Previous BF Exposure, EBF Knowledge Scale, and The TPB constructs for the EBF scale (attitude, Subjective Norms/SN, Perceived Behavioral Control/PBC, intention, and Perceived Behavior). The results showed that the highest percent of the participants had moderate BF exposure (63.8%) and knowledge (65.7%), positive attitude (85.8%), high SN (66.2%), moderate PBC (75.8%), high intention (55.2%), and positive perceived behavior (55.2%). The SEM had acceptable fit indices were χ2/df ratio=3.817, GFI=0.935, RMSEA=0.044, NFI=0.942, CFI=0.951, PCFI =0. 924. It showed that the EBF attitude (β=0.607), SN (β=0.123), and PBC (β=0.158) were significant positive and direct predictors of the EBF intention (P <0.001). Both intention (β=0.213) and PBC (β=0.226) were significant positive and direct predictors of the perceived behavior (P <0.001). It accounted for 49.5% of the variance in EBF intention and 70.0% for the behavior. The BF exposure and knowledge were significant positive predictors of EBF intention (β=0.158, β= 0.237) and behavior (β=0.140, β= 0.207) (P=0.000). Thus, the TPB has a good predictive ability for EBF intention and behavior among the studied Saudi female university students. Thus, it can be employed for efficient health promotion and the development of EBF-friendly policies.

Perinatal support for breastfeeding using mHealth: A mixed methods feasibility study of the My Baby Now app.

Despite the well-known benefits of breastfeeding, breastfeeding rates remain suboptimal, particularly for women with lower socioeconomic position. Although popular, breastfeeding apps are often poor quality; their impact on breastfeeding knowledge, attitudes, confidence and intentions is unknown. A mixed method pre-post feasibility study was conducted to: 1) explore the feasibility of the My Baby Now app in providing perinatal breastfeeding support; 2) examine the impact on breastfeeding knowledge, attitudes, confidence and intentions; 3) to examine any differences in acceptability and impact of the app according to maternal education. The My Baby Now app was offered to pregnant women 20-30 weeks gestation. Breastfeeding knowledge and intentions were collected at baseline (T1) and 36-38 weeks gestation (T2); attitudes and confidence were collected at baseline, T2 and T3 (8-12 weeks post-partum). App engagement was measured via app analytics. Qualitative interviews were conducted with a purposeful sample following T3. Of 266 participants recruited, 169 (64%) completed T2 and 157 (59%) completed T3. Mothers without university education rated the app to be higher quality, more useful and impactful than mothers with university education. From T1-T2, breastfeeding knowledge (59.6% vs. 66.5%, p < 0.001) and exclusive breastfeeding intentions (76.6% vs. 80.9%, p < 0.001) increased. Breastfeeding attitudes and confidence scores also increased significantly across T1-T2 and T1-T3. App engagement during pregnancy predicted changes in breastfeeding attitudes from T1-T2 among participants without university education. App engagement did not predict changes in breastfeeding knowledge, confidence or intentions. Future randomised controlled studies should examine the effectiveness of mHealth interventions on breastfeeding outcomes.

The impact of antenatal depressive symptoms on exclusive breastfeeding intention: A moderating effect analysis

ObjectiveExclusive breastfeeding intention is an important predictor of exclusive breastfeeding behavior. Antenatal depressive symptoms are a potentially modifiable risk factor for exclusive breastfeeding intention. However, studies of the impact of antenatal depressive symptoms on exclusive breastfeeding intention are sparse and contradictory. Therefore, explorations that evaluate the effects of identical factors of exclusive breastfeeding intention and antenatal depressive symptoms in their relationship are urgently needed. This study aims to (1) investigate the impact of antenatal depressive symptoms on exclusive breastfeeding intention based on confounders related either to antenatal depressive symptoms and/or exclusive breastfeeding intention and (2) explore whether or not identical factors moderate the relationship between antenatal depressive symptoms and exclusive breastfeeding intention. Design and SettingA cross-sectional survey was conducted at a tertiary hospital in Hunan, China. ParticipantsA total of 393 pregnant women completed a self-administered questionnaire, a question on their breastfeeding intention, the Edinburgh Postnatal Depression Scale, and the Perceived Social Support Scale during their first-trimester hospital visit. Logistic regression was used to evaluate the impact of antenatal depressive symptoms on exclusive breastfeeding intention. Moderate analysis was employed to explore whether identical factors moderate the relationship between antenatal depressive symptoms and exclusive breastfeeding intention. ResultsAntenatal depressive symptoms negatively affect the exclusive breastfeeding intention after controlling as fully as possible for confounders (adjusted OR = 2.88, 95% CI: [1.06, 7.82]) and it was moderated by one of the identical factors (i.e., social support). The results of the simple slope test showed a negative relationship between antenatal depressive symptoms and exclusive breastfeeding intention among pregnant women with low levels of social support (b =−0.011, p < 0.05). Conclusion and implication for practiceSocial support moderates the negative effects of depressive symptoms on exclusive breastfeeding intention. Clinical care practices and future intervention research that focus on improving antenatal depressive symptoms and exclusive breastfeeding intention should consider the moderator.

Pre-pregnancy Obesity Associated With Lower Odds of Meeting Breastfeeding Recommendations When Controlling for Prenatal Intentions

ObjectivesThe American Academy of Pediatrics (AAP) recommends exclusive breastfeeding (EBF) to 6 months of age, with continued breastfeeding (any BF) for at least 1 year. Maternal obesity has been associated with reduced duration of any and exclusive BF. However, few studies have incorporated degree of obesity or controlled for prenatal BF intentions when comparing BF outcomes. We calculated odds of meeting AAP BF recommendations by pre-pregnancy BMI category while controlling for prenatal BF intentions and demographics in PREVAIL, a CDC-funded birth cohort in Cincinnati, OH.MethodsPrenatally, enrolled subjects completed a 3rd trimester questionnaire including demographics, pre-pregnancy weight and height, and EBF intention to 6 months. BMI (kg/m2) was categorized as healthy (18.5–24.9), overweight (25–29.9), obesity 1 (30–34.9), or obesity 2+ (≥35). Postnatally, mothers self-reported BF initiation, exclusivity, and duration via quarterly study questionnaires. Logistic regression compared EBF to 6 months and ABF to 1 year across BMI categories among those who initiated BF. All models were adjusted for maternal race, education, income and intention to EBF to 6 months.ResultsOf N = 245 enrolled subjects, the pre-pregnancy maternal obesity prevalence was 41% (n = 100), with 23% (n = 57) meeting Obesity 2 + criteria. There were no significant differences between BMI categories in intention to EBF to 6 months or BF initiation, with high (84–87%) initiation rates. Healthy BMI mothers reported the highest (40%) and mothers with obesity 2 + the lowest (4%), rates of EBF to 6 months (aOR 0.13 (CI 0.02–0.57)). Although only 26% of mothers provided any BF at the 1 year mark, healthy BMI mothers (49%) were more likely to achieve this recommendation than mothers with overweight (13%, aOR 0.11 (CI: 0.04, 0.34)), obesity 1 (16%, aOR 0.11 (CI 0.03, 0.33) and obesity 2+ (10%, aOR 0.15 (CI 0.04, 0.46)).ConclusionsDespite high BF initiation rates, increasing BMI category was associated with decreasing odds of meeting AAP BF recommendations after adjustment for demographics and prenatal EBF intention in the PREVAIL Cohort. Whether these findings can be explained by physiologic barriers associated with higher BMI merits further attention.Funding SourcesCenters for Disease Control and Prevention.

Intention to Exclusively Breastfeed Is Associated with Lower Rates of Cesarean Section for Nonmedical Reasons in a Cohort of Mothers in Vietnam.

Background: Breastfeeding brings benefits to both mothers and children in the short term and long term. Unnecessary cesarean sections can bring risks to both parties. This study was undertaken to examine the relationship between exclusive breastfeeding intention and cesarean delivery. Methods: We analyzed data collected from 554 single mothers who delivered in Dong Anh General District Hospital or Hanoi Obstetrics and Gynecology Hospital, Vietnam, in 2020–2021. The relationship between exclusive breastfeeding intention and cesarean delivery for nonmedical reasons was adjusted for maternal education, maternal age, parity, history of fetal loss, having at least eight antenatal contacts, hospital of delivery, child sex, and birth weight. Results: Antenatally, 34.8% (184/529) of mothers intended to breastfeed exclusively until 6 months and 30.8% (84/274) underwent cesarean section for a nonmedical reason. After adjusting for other factors, mothers who intended to breastfeed exclusively until 6 months were less likely to undergo cesarean delivery for nonmedical reasons (OR = 0.55, 95% CI: 0.31–0.96, p = 0.034). Conclusions: This study adds to the growing evidence related to unnecessary cesarean sections and routine over-medicalization of normal birth in the urban areas of Vietnam. The association between breastfeeding intentions and a lower rate of cesarean section suggests that education on breastfeeding could be a useful intervention for reducing the rate of cesarean sections and improving maternal and child health.

Exploring determinants of exclusive breastfeeding intention in nulliparous pregnant women: A cross-sectional path analysis

Background: One of the most important ways to improve neonatal health is Exclusive Breastfeeding (EBF). Objective: In this study, the determinants of EBF intention were investigated through Structural Equation Modeling (SEM) in nulliparous pregnant women. Materials &amp; Methods: This cross-sectional study was conducted among 249 pregnant women in Kerman in 2020. Data was collected using a questionnaire, including, questions related to knowledge, attitude, self-efficacy, and the intention of EBF. SEM in Amos statistical software version 20 was used to examine the relationships between the studied variables. Results: The mean age of participants was 26.98±6.16 years and the majority of them were housewife. There was significant correlation between the intention of EBF and self-efficacy (r=0.597, P&lt;0.001) knowledge (r=0.337, P&lt;0.001) and attitude (r=0.344, P&lt;0.001). Breastfeeding self-efficacy was the strongest predictor of intention to EBF (β=0.352, P&lt;0.001). Conclusion: This study revealed that mothers’ breastfeeding self-efficacy was the most important predictor of the EBF intention.

Promoting six-month exclusive breastfeeding: an examination of social norms messaging and outcome expectations

ABSTRACT Breast milk and breastfeeding bring considerable benefits to infants. A caveat in breastfeeding promotion efforts is the lack of emphasis on exclusive breastfeeding (EBF) for the first six months of a baby’s life. This research examined the relative effectiveness of descriptive and injunctive messaging on promoting 6-month EBF by employing a 3 (norms: descriptive norms vs. injunctive norms vs. no norms) X 2 (positive outcome recipient: baby vs. mother) factorial design and tested hypotheses with expecting women. Participants showed strong intention to exclusively breastfeed across experimental conditions. The results revealed that the descriptive normative message was more effective in promoting EBF than the control condition, whereas the injunctive normative message had no advantage over the control condition. Moreover, perceived outcome expectations for the baby and the mother attenuated the relationship between perceived descriptive norms and EBF intention. Theoretical and practical implications regarding how norms messaging can promote EBF are discussed.

A mixed-methods longitudinal study of Marshallese infant feeding beliefs and experiences in the United States: a study protocol

BackgroundArkansas has the largest population of Marshallese Pacific Islanders residing in the continental United States. Marshallese are disproportionately burdened by poorer maternal and infant health outcomes. Exclusive breastfeeding can prevent or help mitigate maternal and infant health disparities. However, exclusive breastfeeding among United States Marshallese communities remains disproportionately low, and the reasons are not well documented. This paper describes the protocol of a mixed-methods concurrent triangulation longitudinal study designed to explore the beliefs and experiences that serve as barriers and/or facilitators to exclusive breastfeeding intention, initiation, and duration among Marshallese mothers in northwest Arkansas.MethodsThe mixed-methods design collects qualitative and quantitative data during simultaneous data collection events, at third trimester, six weeks postpartum, and six months postpartum. Quantitative and qualitative data will be analyzed separately and then synthesized during the interpretation phase. The research team will disseminate results to study participants, research stakeholders, the broader Marshallese community, and fellow researchers.DiscussionFindings and results will be presented in subsequent manuscripts upon completion of the study. This study will be an important first step to better understand beliefs and experiences to exclusive breastfeeding intention, initiation, and duration in this community and will inform tools and interventions to help improve health outcomes. The study will also aid in filling the gap in research and providing essential information on the infant feeding beliefs and barriers among a Marshallese community in Arkansas.

Determinants of Exclusive Breastfeeding Intention in Pregnant Women in Birjand in 2020: Application of Integrated Behavioral Model

Background: Exclusive breastfeeding (EBF) for the first six months of life is the best nutritional option for the growth and development of infants. EBF has a unique biological and emotional effect on the health of the infant and mother. Despite this, the prevalence of EBF is lower than the standard recommended by the World Health Organization (WHO). Objectives: The current study aimed to investigate the determinants of exclusive breastfeeding’ intention based on the Integrated Behavioral Model (IBM) in pregnant women living in Birjand. Methods: Following a descriptive-analytical design, 292 pregnant women referred to health centers of Birjand (Iran) in 2020 were recruited. Sampling was performed using the multistage cluster random technique. Data were collected using a researcher-made questionnaire based on the constructs of IBM. Analyses were conducted by SPSS-19 using Pearson correlation and regression analysis at the significance level of P &lt; 0.05. Results: There was a significant positive correlation between EBF intention and the mean value of different constructs of IBM (P &lt; 0.001). According to the results of regression analysis, perceived self-efficacy, experiential attitude, and injunctive norm could predict EBF intentions (R2 = 0.58). Conclusions: This study demonstrated that a considerable part of the changes relevant to EBF intention could be predicted by the constructs of the integrated behavioral model. Hence, using this model to analyze other health behaviors is a promising option.

A quantitative and qualitative study of exclusive breastfeeding intention by high-risk pregnant women

The scope of this research was to assess the breastfeeding intention among high-risk pregnant women and related factors. It is a cross-sectional, qualitative and quantitative study, with 1,118 high-risk pregnant women who attended the prenatal care unit at a specialized center of the Unified Health System. The dependent variables were exclusive breastfeeding intention, intended duration and conditions that might interfere with breastfeeding. The Epi Info 7.4.1, Bioestat 5.3 and IRAMUTEQ 0.7.2.0 programs were used for data processing. The results showed that 8.76% of the pregnant women had conditions that could affect lactation. Among the women, 93.83% affirmed having exclusive breastfeeding intention, of which 69.86% intended to breastfeed until the child was six months old, revealing an association with sociodemographic variables (p<0.05). The intended breastfeeding duration was related to the age (p=0.0041), marital status (p=0.0053) and level of education (p=0.0116). The main reasons reported for not providing exclusive breastfeeding were the following: HIV, use of medications, work and lack of information. This research concluded that a small cohort of high-risk pregnant women presented conditions that could interfere with breastfeeding. Most of them intended to breastfeed exclusively for six months.

Prevalence of alcohol use in late pregnancy

BackgroundPrenatal alcohol exposure (PAE) can result in detrimental developmental complications. The objective of this study was to estimate the most recent PAE prevalence data for the state of West Virginia (WV) and associated factors.MethodIn all, 1830 newborn residual dried blood spots (DBS) in the WV Newborn Screening Repository were analyzed for phosphatidylethanol (PETH). Data were matched with Project WATCH data (94% match, N = 1729).ResultsThe prevalence of late pregnancy PAE was 8.10% (95%CI: 6.81, 9.38) for all births, 7.61% (95%CI: 6.26, 8.97) for WV residents only, and ranged from 2.27 to 17.11% by region. The significant factors associated with PAE included smoking (OR: 2.03, 95% CI: 1.40, 2.94), preterm births (OR: 1.88; 95% CI: 1.23, 2.89), birth weight of ≤2000 g vs. >3000 g (OR: 2.62, 95%CI: 1.19, 5.79), no exclusive breastfeeding intention (OR: 1.45, 95% CI: 1.02, 2.04), and not exclusively breastfeeding before discharge (OR: 1.61; 95% CI: 1.09, 2.38).ConclusionThe prevalence of PAE is higher than previously shown for the state. Accurate and timely estimates are vital to inform public health workers, policymakers, researchers, and clinicians to develop and promote effective prevention strategies to lower PAE prevalence and provide targeted interventions and treatment services for infants affected by PAE.

Exclusive Breastfeeding Knowledge, Intention to Practice and Predictors among Primiparous Women in Enugu South-East, Nigeria.

Breastfeeding is considered as the most complete nutritional source for infants because breast milk contains the essential carbohydrates, fats, proteins, and immunological factors needed for infants to thrive and resist infection in the formative first year of life. Knowledge of exclusive breastfeeding (EBF) among women is essential when promoting optimal breastfeeding practices. This cross-sectional descriptive survey assessed knowledge and intention to practice EBF and its associated factors during pregnancy among primiparous women in selected communities in Enugu State, Nigeria. A total population study that applied inclusion criteria was used to recruit 201 primiparous mothers attending their third trimester antenatal care from selected health facilities in rural and urban communities in Enugu State. A researcher-developed questionnaire was used to collect data on participants' knowledge and intention to practice EBF. Descriptive statistics of frequency, percentage, mean, and standard deviation were used to summarize categorical and continuous variables while Chi-square and Wald statistic tests predicted demographic data associated with knowledge status and intention to practice EBF of the participants. More than half (58.7%) of primiparous mothers had inadequate knowledge of EBF and only 62.7% had intention to exclusively breastfeed for 4–6 months. The Chi-square test result showed significant difference in the participants' place of residence (p = 0.024), EBF knowledge sources (p = 0.001), and EBF knowledge. The Wald statistic in Logistic regression model indicated the coefficient of age (p = 0.026), educational attainment (p = 0.046), EBF knowledge (p = 0.016), and sources of information about EBF (p = 0.027) to be significant predictors of good intention to practise EBF. Poor EBF knowledge and intention to practice in this population may be improved by combining facility-based and in-house methods of breastfeeding counseling, education, and support especially to intending and expectant mothers. Further studies are needed to be done using the multiparous women as well as assessing the effects of in-house EBF supportive-educative intervention to improve breastfeeding outcomes.

Predicting Exclusive Breastfeeding among Iranian Mothers: Application of the Theory of Planned Behavior Using Structural Equation Modeling.

Background:Identifying the factors that lead to the beginning, continuing, or stopping the Exclusive Breastfeeding (EBF) by mothers can be of great assistance in the design of interventions to strengthen this behavior. The aim of this study was to predict EBF among mothers with Infants Less than Six Months of Age (ILSMA) according to the Theory of Planned Behavior (TPB).Materials and Methods:The study was a cross-sectional one that conducted among 304 mothers with ILSMA in Khorramabad-Iran in 2017 using Structural Equation Modeling (SEM). The sampling method was a combination of census, stratified random, and systematic random sampling. The data collection tool was a contextualized, valid, and reliable questionnaire according to the TPB. Data were collected by a trained interviewer. Data were analyzed using SPSS-16 and AMOS-20 software programs and SEM.Results:Perceived Behavioral Control (PBC) could explain 65% of mothers' EBF intention. Intention and PBC were able to predict 79% of the variance in EBF together. The fitness indices of EBF model in the current study were acceptable (RMSEA = 0.07, CMIN/DF = 2.58, NFI = 0.81, CFI = 0.87, and GFI = 0.83).Conclusions:TPB is an appropriate model for predicting the intention and behavior of EBF. Policy makers and health system managers are recommended for taking some measures to add a standardized questionnaire in the electronic health record to predict EBF according to TPB of pregnant women and mothers with ILSMA. In this way, they can empower primary healthcare providers to design and implement a theory-based interventional plan.

Exclusive Breastfeeding Behavior Model in Rural Central Java, Indonesia: The Application of Theory of Planned Behavior

Exclusive breastfeeding’s coverage is low in Indonesia, because attitude, subjective norm and perceived behavioral control fail affecting exclusive breastfeeding intention and behavior. Objectives of research were to formulate exclusive breastfeeding behavior and to explore the relationship of attitude, subjective norm, and behavioral control to exclusive breastfeeding intention and behavior. Mixed method was conducted in rural areas of Karanganyar Regency, Indonesia. Firstly, this was a survey research with attitude, subjective norm, and perceived behavioral control being independent variables. Dependent variables were exclusive breastfeeding intention and behavior. Population of research consisted of 873 lactating mothers. Sampling technique employed was multistage random sampling, with 126 lactating mothers being the sample. Data was collected using questionnaire, data analysis using path analysis. Secondly, case study was conducted through in-depth interview, focus group discussion (FGD), document review, and observation. In-depth interview and FGD was conducted with 49 participants: 30 lactating mothers and 19 health workers. Data analysis was conducted content analysis. The result showed that attitude, affective norm, and perceived behavioral control correlated with exclusive breastfeeding intention (ß = 0.09; p = 0.084; ß = 0.09; p = 0.027; ß = 0.51; p &amp;lt;0.001, respectively). Perceived behavioral control and intention correlated with exclusive breastfeeding behavior (ß = 0.08; p = 0.059; ß = 0.09; p = 0.068, respectively). Exclusive breastfeeding behavior model included attitude, subjective norm, perceived behavioral control, and exclusive breastfeeding behavior. Attitude, subjective norm, and perceived behavioral control collectively correlated with intention; intention and perceived behavioral perception were direct determinants of exclusive breastfeeding behavior.

Workplace support and breastfeeding duration: The mediating effect of breastfeeding intention and self-efficacy.

Given the large proportion of mothers in the United States work force, understanding the implications of workplace support on breastfeeding outcomes is an important public health priority. The current study investigates if (a) workplace support directly influences the working mothers' breastfeeding intention, self-efficacy, and duration, and (b) workplace support indirectly influences breastfeeding duration through the mediating effect of breastfeeding intention and self-efficacy. Data from the longitudinal Infant Feeding Practices Survey II were analyzed. The main predictor variable, workplace support, was based on a Likert scale from "not at all supportive" to "very supportive." Both mediators, exclusive breastfeeding intention and self-efficacy, were dichotomized (yes; no) while the study outcome, breastfeeding duration, was continuous. Structural equation modeling was used to obtain direct and indirect effects of breastfeeding intention and confidence in attaining breastfeeding goals. After adjusting for confounders, there was a statistically significant direct effect between self-efficacy, breastfeeding intention, and breastfeeding duration. A statistically significant indirect effect of workplace support on breastfeeding duration through self-efficacy in attaining breastfeeding goals was also observed. The mediation ratios of the indirect effects showed that self-efficacy in attaining breastfeeding goals accounted for 40.8% (P-value=0.032) of the total effect; however, all other mediation ratios did not show statistical significance. Self-efficacy is an important predictor for breastfeeding duration. Workplaces may help bolster women's self-efficacy by providing environments that are supportive to breastfeeding working mothers. Future research is needed to identify breastfeeding policies that boost self-efficacy.