EXPLORING THE SOCIO-COGNITIVE CORRELATES OF BREASTFEEDING IN A GROUP OF ROMANIAN MOTHERS
Keywords:breastfeeding, informative intervention, self-efficiency, social norms, outcome expectancies, intention to breastfeed, Theory of Planned Behaviour
AbstractThe aim of our study was to develop and test the efficiency of a short informative intervention meant to increase mothers' adherence to breastfeeding while investigating potential associations between several social-cognitive variables and breastfeeding behaviour. Enhancing the rates of breastfeeding continuation is currently considered a very important objective for health educators due to its extensively documented benefits for newborns' health (Giles et al., 2014). Self-report questionnaires were administered to 74 women both two-three months before giving birth and when the child was three-six months old. Only 70 women participated to both stages of our study, 35 of which participated in our intervention, while the other 35 were assigned to the control condition. Results showed that mothers' perceived breastfeeding self-efficacy, their intention to breastfeed, their social norms and their outcome expectancies regarding breastfeeding were all associated with breastfeeding their child at three-six months after giving birth. Moreover, the mothers who participated in our short informative intervention were more likely to continue their breastfeeding behaviour at three-six months after giving birth as compared to mothers in the control group. Our results are discussed in the light of their contribution to previous research in this field and of their applicability for field practice.
Ajzen, I. (1991). The Theory of Planned Behavior. Organizational Behavior and Human Decision Processes, 50(2), 179-211.
Bandura, A. (1977). Self-efficacy: Toward a Unifying Theory of Behavioral Change. Psychological Review, 84(2), 191.
Baranowski, T., Sprague, D., Baranowski, J. H., and Harrison, J. A. (1991). Accuracy of Maternal Dietary Recall for Preschool Children.Journal of the American Dietetic
Association, 91(6), 669-674.
Blyth, R., Creedy, D. K., Dennis, C. L., Moyle, W., Pratt, J., and De Vries, S. M. (2002). Effect of Maternal Confidence on Breastfeeding Duration: An Application of Breastfeeding Self-efficacy Theory.Birth, 29(4), 278-284.
Britton, J. R., Britton, H. L., and Gronwaldt, V. (2006). Breastfeeding, Sensitivity, and Attachment.Pediatrics, 118(5), e1436-e1443.
Chapman, D. J., Damio, G., and Pérez-Escamilla, R. (2004). Differential Response to Breastfeeding Peer Counseling within a Low-income, Predominantly Latina Population.Journal of Human Lactation, 20(4), 389-396.
Chapman, D. J., Damio, G., Young, S., and Perez-Escamilla, R. (2004b). Effectiveness of Breastfeeding Peer Counseling in a Low-income, Predominantly Latina Population: a Randomized Controlled Trial.Archives of Pediatrics and Adolescent Medicine, 158(9), 897-902.
Chapman, D., Damio, G., Young, S., and Perez-Escamilla, R. (2004a). Association of Degree and Timing of Exposure to Breastfeeding Peer Counseling Services with Breastfeeding Duration. In Protecting Infants through Human Milk (pp. 303-306). Springer US.
Dennis, C. L. (1999). Theoretical Underpinnings of Breastfeeding Confidence: A Selfefficacy Framework. Journal of Human Lactation, 15(3), 195-201.
Dennis, C. L. (2002). Breastfeeding Initiation and Duration: A 1990-2000 Literature Review. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 31(1), 12-32.
Dennis, C. L. (2003). The Breastfeeding Self-efficacy Scale: Psychometric Assessment of the Short Form.Journal of Obstetrics Gynecology and Neonatal Nursing, 32(6), 734-744.
Donath, S. M. and Amir, L. H. (2003). Relationship between Prenatal Infant Feeding Intention and Initiation and Duration of Breastfeeding: a Cohort Study.Acta Paediatrica, 92(3), 352-356.
Duckett, L., Henly, S., Avery, M., Potter, S., Hills-Bonczyk, S., Hulden, R., and Savik, K. (1998). A Theory of Planned Behavior-based Structural Model for Breast-feeding. Nursing Research, 47(6), 325-336.
Duffy, E. P., Percival, P., and Kershaw, E. (1997). Positive Effects of an Antenatal Group Teaching Session on Postnatal Nipple Pain, Nipple Trauma and Breastfeeding Rates.Midwifery, 13(4), 189-196.
Ertem, I. O., Votto, N., and Leventhal, J. M. (2001). The Timing and Predictors of the Early Termination of Breastfeeding.Pediatrics, 107(3), 543-548.
Fishbein, M. and Ajzen, I. (2010).Predicting and Changing Behavior: The Reasoned Action Approach. Taylor and Francis.
Forster, D., McLachlan, H., Lumley, J., Beanland, C., Waldenström, U., and Amir, L.(2004). Two Mid-pregnancy Interventions to Increase the Initiation and Duration of Breastfeeding: A Randomized Controlled Trial.Birth, 31(3), 176-182.
Giles, M., McClenahan, C., Armour, C., Millar, S., Rae, G., Mallett, J., and Stewart-Knox, B. (2014). Evaluation of a Theory of Planned Behaviour-based Breastfeeding Intervention in Northern Irish Schools Using a Randomized Cluster Design.British Journal of Health Psychology, 19(1), 16-35.
Göksen, F. (2002). Normative vs. Attitudinal Considerations in Breastfeeding Behavior: Multifaceted Social Influences in a Developing Country Context.Social Science and Medicine, 54(12), 1743-1753.
Guise, J.M., Palda, V., Westhoff, C., Chan, B.K., Helfand, M., and Lieu T.A. (2003). The Effectiveness of Primary Care-based Interventions to Promote Breast-feeding: Systematic Evidence Review and Meta-analysis for the U.S. Preventive Services Task Force.The Annals of Family Medicine, 1(2), 70-78.
Hector, D. and King, L. (2005). Interventions to Encourage and Support Breastfeeding. New South Wales Public Health Bulletin, 16(4), 56-61.
Horta, B. L., and Victora, C. G. (2013).Long-term effects of breastfeeding. Geneva, Switzerland: World Health Organization.
Kistin, N., Benton, D., Rao, S., and Sullivan, M. (1990). Breast-feeding Rates among Black Urban Low-income Women: Effect of Prenatal Education.Pediatrics, 86(5), 741-746.
Kramer, M. S., and Kakuma, R. (2004). The optimal duration of exclusive breastfeeding. In Protecting Infants through Human Milk, vol 554 (pp. 63-77). Springer US.
Luszczynska, A. and Schwarzer, R. (2003). Planning and Self-efficacy in the Adoption and Maintenance of Breast Self-examination: A Longitudinal Study on Self-regulatory Cognitions.Psychology and Health, 18, 93-108.
Luszczynska, A. and Schwarzer, R. (2005). Social-cognitive theory. In M. Conner and P. Norman (Eds.),Predicting Health Behavior(2nd ed. rev., pp. 127-169). Open University Press, Buckingham.
Marlatt, G. A., Baer, J. S., and Quigley, L. A. (1995). Self-efficacy and addictive behavior. In A. Bandura (Ed.),Self-efficacy in Changing Societies (pp. 289-315).Cambridge University Press,
McCarter-Spaulding, D. E. and Kearney, M. H. (2001). Parenting Self-Efficacy and Perception of Insufficient Breast Milk.Journal of Obstetric, Gynecologic, and Neonatal Nursing, 30(5), 515-522.
Miracle, D. J., Meier, P. P., and Bennett, P. A. (2004). Mothers' Decisions to Change From Formula to Mothers’ Milk for Very-Low-Birth-Weight Infants.Journal of Obstetric, Gynecologic, and Neonatal Nursing, 33(6), 692-703.
Palda, V.A., Guise, J.M., and Wathen, N. (2004). Interventions to Promote Breastfeeding: Applying the Evidence in Clinical Practice.Canadian Medical Association Journal, 170(6), 976–978.
Prochaska, J. O., DiClemente, C. C., and Norcross, J. C. (1992). In search of the structure of change. In Y. Klar, J.D. Fisher, J.M. Chinsky, and A. Nadler (Eds.),Self Change: Social psychological and clinical perspectives (pp. 87-114). Springer-Verlag, New York.
Quigley, M. A., Kelly, Y. J., and Sacker, A. (2007). Breastfeeding and Hospitalization for Diarrheal and Respiratory Infection in the United Kingdom Millennium Cohort Study. Pediatrics, 119(4), e837-e842.
Ryser, F. G. (2004). Breastfeeding Attitudes, Intention, and Initiation in Low-income Women: the Effect of the Best Start Program.Journal of Human Lactation, 20(3), 300-305.
Schwarzer, R. (1992).Self-efficacy in the Adoption and Maintenance of Health Behaviors: Theoretical Approaches and a New Model. Hemisphere Publishing Corp.
Schwarzer, R. (2001). Social-cognitive Factors in Changing Health-Related Behaviors. Current Directions in Psychological Science, 10(2), 47-51.
Serwint, J. R., Wilson, M. E., Vogelhut, J. W., Repke, J. T., and Seidel, H. M. (1996). A Randomized Controlled Trial of Prenatal Pediatric Visits for Urban, Low-income Families.Pediatrics, 98(6), 1069-1075.
Shahla, M., Fahy, K., and Kable, A. (2010). Factors that Positively Influence Breastfeeding Duration to 6 months: a Literature Review.Women and Birth, 23(4), 135-145.
Sipsma, H. L., Divney, A. A., Magriples, U., Hansen, N., Gordon, D., and Kershaw, T.(2013). Breastfeeding Intentions among Pregnant Adolescents and Young Adults and Their Partners.Breastfeeding Medicine, 8(4), 374-380.
Strathearn, L., Mamun, A. A., Najman, J. M., and O'Callaghan, M. J. (2009). Does Breastfeeding Protect against Substantiated Child Abuse and Neglect? A 15-year cohort study.Pediatrics, 123(2), 483-493.
Stuebe, A. M. and Bonuck, K. (2011). What Predicts Intent to Breastfeed Exclusively? Breastfeeding Knowledge, Attitudes, and Beliefs in a Diverse Urban Population. Breastfeeding Medicine, 6(6), 413-420.
Swanson, V. and Power, K. G. (2005). Initiation and Continuation of Breastfeeding: Theory of Planned Behaviour.Journal of Advanced Nursing, 50(3), 272-282.
Swanson, V., Power, K., Kaur, B., Carter, H., and Shepherd, K. (2006). The Impact of Knowledge and Social Influences on Adolescents' Breast-feeding Beliefs and Intentions.Public Health Nutrition, 9(03), 297-305.
Torres, M. M., Torres, R. R. D., Rodríguez, A. M. P., and Dennis, C. L. (2003). Translation and Validation of the Breastfeeding Self-efficacy Scale into Spanish: Data from a Puerto Rican Population.Journal of Human Lactation, 19(1), 35-42.
United Nations Children's Fund. (n.d.). The Baby-Friendly Hospital Initiative. In UNICEF. Retrieved February 21, 2014, from
Victora, C. G. (2000). Effect of Breastfeeding on Infant and Child Mortality Due to Infectious Diseases in Less Developed Countries: a Pooled Analysis.Lancet (British edition), 355(9202), 451-455.
Wiemann, C. M., DuBois, J. C., and Berenson, A. B. (1998). Racial/Ethnic Differences in the Decision to Breastfeed among Adolescent Mothers.Pediatrics, 101(6), e11-e11.
World Health Organization (May 1, 2001). The World Health Organization's infant feeding recommendation. In World Health Organization. Retrieved February 21, 2014, from http://www.who.int/nutrition/topics/infantfeeding_recommendation/en/.