Predicting Breastfeeding Intentions: A Test and Extension of the Theory of Normative Social Behavior with African American Social Identity

ABSTRACT

Breastfeeding is a health promoting social behavior but statistics suggest a persistent disparity of lower rates among African American mothers. The Theory of Normative Social Behavior (TNSB) explains when and how norms influence behaviors, but has produced inconsistent results with respect to proposed moderators group identity and injunctive norms (IN), limiting its predictive value in diverse cultural groups. Cultural norms are one of many influences on breastfeeding behaviors, yet little is known about their mechanisms of influence. The TNSB has not been tested in the breastfeeding context or within an exclusively African American cultural group. Given this knowledge gap, a survey of 528 African American mothers in the Washington, D.C. area was conducted to test the moderating effects of IN and subjective norms (SN) and social identity on the descriptive norms (DN) to intentions relationship as predicted by the TNSB. Structural equation modeling was used to show that when controlling for education and breastfeeding history, norms significantly predicted 26.4% of the variance in breastfeeding intentions. SN and DN interacted negatively to enhance breastfeeding intentions. Latent profile analysis using ethnic pride, collectivism, and religiosity scales detected four profiles of African American social identity. Social identity profile membership was a significant moderator on the DN to intentions pathway in the structural equation model. Profiles with the highest ethnic pride were significantly influenced by DN to intend to breastfeed. Implications from this study for public health intervention and communication messaging are discussed.

Acknowledgments

This research was generously supported by the Clara Schiffer Fellowship for Women’s Health and a fellowship from the Sumner M. Redstone Global Center for Prevention and Wellness. The authors would like to acknowledge the 528 mothers who generously gave their time to answer our survey. We are also grateful to Xuejing Duan, PhD for statistical consultation and to Catasha Davis, PhD for advice on formative research methodology and interpretation.

Disclosure statement

The authors have no conflicts of interest to declare.

Data availability statement

The survey data set is available from the corresponding author upon request to researchers interested in collaborations.

Supplemental data

Supplemental data for this article can be accessed on the publisher’s website.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Notes

1. Racialized identity often serves as a demographic indicator to identify groups with health disparities to study more in-depth. Race should not be considered a risk factor. The authors recognize race is socially constructed. Shared experiences of racism and systemic discrimination based on racialized identity contribute to health inequities. In this article, we use the term African American to refer to People of Color with African heritage across the diaspora born and raised in the U.S., and as an adjective to remind the reader that individuals are always more than their racial or ethnic identity.

2. Breastfeeding initiation is typically defined as nursing an infant even once. Exclusive breastfeeding is considered providing only breast milk and no other food or drink, and duration is the measure of time an infant receives breast milk.

3. LPA was conducted across the different possible variance-covariance structures. The best solution came from the most constrained structure, which did not uniquely estimate variances or covariances. Therefore, respecting page limits, only the results from this variance-covariance structure are presented.

4. Supplemental Figure 1 illustrates the nature of the significant interaction.

5. See Supplemental Figure 2a,b for profile membership probability by participants’ religion and education.

6. See Supplemental Figure 3 for a depiction of the significant positive and linear relationships between DN and breastfeeding intentions for ethnically proud and agnostic mothers as well as devout collectivist and ethnically proud mothers.

Additional information

Funding

This work was supported by the George Washington University [NA].