Predicting breastfeeding in women living in areas of economic hardship: Explanatory role of the theory of planned behaviour

Abstract

This study employed the theory of planned behaviour (TPB) and additional variables (descriptive norm, moral norm, self-identity) to investigate the factors underlying breastfeeding intention and subsequent breastfeeding at four time points (during hospital stay, at hospital discharge, 10 days postpartum and 6 weeks postpartum) in a sample of women selected from defined areas of economic hardship (N = 248). A model containing the TPB, additional variables and demographic factors provided a good prediction of both intention (R ² = 0.72; attitude, perceived behavioural control, moral norm and self-identity significant predictors) and behaviour – breastfeeding at birth (88.6% correctly classified; household deprivation, intention, attitude significant), at discharge from hospital (87.3% correctly classified; intention, attitude significant), 10 days after discharge (83.1% correctly classified; education, intention, attitude, descriptive norm significant) and 6 weeks after discharge (78.0% correctly classified; age, household deprivation, ethnicity, moral norm significant). Implications for interventions are discussed, such as the potential usefulness of targeting descriptive norms, moral norms and perceived behavioural control (PBC) when attempting to increase breastfeeding uptake.

Keywords:

• Theory of planned behaviour
• breastfeeding
• economic deprivation
• beliefs

Acknowledgements

This work was undertaken by researchers from the University of Leeds who received funding from the Department of Health. The views expressed in the publication are those of the authors and not necessarily those of the Department of Health. We would like to thank Roger Thomas of the National Centre for Social Research for his advice regarding the Household Deprivation Index.

Notes

Notes

[1] Eligible participants were defined as those living in an area of high deprivation (Index of Local Deprivation scores ≥ 6; Robson et al., 1998). Eleven percent of all households in England and Wales are defined by this cut-off, in which 14% of first births occur.

[2] We only obtained hospital records of breastfeeding at 6 weeks from 95 participants, therefore self-report data were employed. The results for this time point were not substantively changed by using the hospital record data.

[3] In one site, a local coordinator was appointed to screen hospital maternity records to identify women who: (a) Were 20–36 weeks pregnant, (b) Had not had any previous live births and (c) Lived in an area with an eligible postcode. Midwives were informed if they had eligible women on their caseload and were provided with the details of these eligible women and the materials necessary to recruit them into the project.

[4] Any woman recruited into the project who had a stillbirth, an early neonatal death or whose baby had congenital malformations, was not contacted by project staff to collect infant feeding data. The placement of a sticker on a woman's notes when recruited into the project, combined with internal systems for notification of relevant staff in the event of severe problems, ensured the project was informed at the earliest possible opportunity of any such eventualities.