Explaining infant feeding: The role of previous personal and vicarious experience on attitudes, subjective norms, self‐efficacy, and breastfeeding outcomes

Abstract

ObjectivesBreastfeeding confers important health benefits to both infants and their mothers, but rates are low in the United Kingdom and other developed countries despite widespread promotion. This study examined the relationships between personal and vicarious experience of infant feeding, self‐efficacy, the theory of planned behaviour variables of attitudes and subjective norm, and the likelihood of breastfeeding at 6–8 weeks post‐natally.DesignA prospective questionnaire study of both first‐time mothers (n = 77) and experienced breastfeeders (n = 72) recruited at an antenatal clinic in South East England.MethodsParticipants completed a questionnaire at 32 weeks pregnant assessing personal and vicarious experience of infant feeding (breastfeeding, formula‐feeding, and maternal grandmother’s experience of breastfeeding), perceived control, self‐efficacy, intentions, attitudes (to breastfeeding and formula‐feeding), and subjective norm. Infant feeding behaviour was recorded at 6–8 weeks post‐natally. Multiple linear regression modelled the influence of vicarious experience on attitudes, subjective norm, and self‐efficacy (but not perceived control) and modelled the influence of attitude, subjective norm, self‐efficacy, and past experience on intentions to breastfeed. Logistic regression modelled the likelihood of breastfeeding at 6–8 weeks.ResultsPrevious experience (particularly personal experience of breastfeeding) explained a significant amount of variance in attitudes, subjective norm, and self‐efficacy. Intentions to breastfeed were predicted by subjective norm and attitude to formula‐feeding and, in experienced mothers, self‐efficacy. Breastfeeding at 6 weeks was predicted by intentions and vicarious experience of formula‐feeding.ConclusionVicarious experience, particularly of formula‐feeding, has been shown to influence the behaviour of first‐time and experienced mothers both directly and indirectly via attitudes and subjective norm. Interventions that reduce exposure to formula‐feeding (perhaps by limiting advertising) or cushion mothers from its effects may enable more mothers to meet their breastfeeding goals. Statement of contribution What is already known on this subject? Rates of breastfeeding in the United Kingdom are low and resistant to change.Self‐efficacy may be an important and modifiable factor for breastfeeding initiation and maintenance. What does this study add? Self‐efficacy may only be a relevant factor among mothers who already have personal experience of breastfeeding.Vicarious experience of formula‐feeding has been shown to be related to a lower rate of breastfeeding at 6 weeks.

Efeitos de uma tecnologia educativa na autoeficácia para amamentar e na prática do aleitamento materno exclusivo

“…The mean scores of self-efficacy for breastfeeding was higher and statistically significant for the IG (p<0.001) from the 2 nd week postpartum, and this difference remained until the 8 th week postpartum. The relationship between EBF and high scores of maternal self-efficacy for breastfeeding is well documented in studies that analyzed this variable (8,10) . The study investigating the role of psychosocial factors in EBF up to children's 6 months of life demonstrated that self-efficacy for breastfeeding is a strong predictor for both the intent and duration of breastfeeding (4) .…”

“…However, studies indicate that maternal age has not always posed as a risk factor for early weaning (9,18) . Previous experience in breastfeeding is one of the sources of development of beliefs in maternal self-efficacy in breastfeeding (7) and an important factor for the practice of EBF (4,8) . This experiment was similar in both groups and supported the results of the intervention.…”

“…The baseline homogeneity was also found by comparing the mean scores of BSES-SF between groups. This observation is important because high self-efficacy scores for breastfeeding are associated with a higher chance of women initiating and maintaining exclusive breastfeeding (6,(8)(9) . Hence the conclusion that BSES-SF scores in pregnant women of the IG and CG at the beginning of the study did not interfere in the results.…”

“…Maternal trust in breastfeeding, or lack thereof, is an important variable not only to initiate breastfeeding but also to maintain exclusive breastfeeding (6)(7) . High self-efficacy scores for breastfeeding were positively associated with exclusive breastfeeding between 4 and 6 weeks postpartum (9)(10) , and women who report lack of confidence in breastfeeding have about two to three times more chances of weaning the child in that period (8) . Expectations or beliefs in self-efficacy constructed by women can influence judgment about their ability to initiate breastfeeding, overcome difficulties and continue the practice (7) .…”

“…Expectations or beliefs in self-efficacy constructed by women can influence judgment about their ability to initiate breastfeeding, overcome difficulties and continue the practice (7) . These are related to personal experience, model observation (understood as vicarious experience with breastfeeding), verbal persuasion of influential people for breastfeeding, and factors such as pain, anxiety and fatigue that may interfere with women's confidence in breastfeeding (7)(8) and consequently in the prevalence of EBF.…”