Belief structure underlying attitude, subjective norm, and perceived behavioral control of the six-month exclusive breastfeeding behavior

Numerous benefits of breastfeeding are optimized by increased exclusivity and duration of breastfeeding. The American Academy of Pediatrics recommends exclusive breastfeeding (EBF) for the first 6 months of the baby's life. Currently, only 10% of mothers continue EBF for 6 months, though nearly 74% of mothers initiate breastfeeding at birth. To extend the EBF duration, it is important to understand mothers' decision making processes. The purpose of this study was to describe the belief structure underlying mothers' intention to continue EBF for 6 months using the Theory of Planned Behavior (TPB). A cross-sectional study was conducted in fall of 2008, where breastfeeding mothers who were less than 3 months postpartum were invited from Central New Jersey to complete a self-administered questionnaire that measured the direct constructs and beliefs that constitute three constructs of TPB. Demographics of women (N=184) were 44.6% White, 36.4% Black, 50.5% married, 59.8% WIC-eligible, and mean age of 29.1±6.4 years. Attitude (β=0.44, p<0.01), subjective norm (β=0.27, p<0.01), and perceived behavioral control (β=0.28, p<0.01) together explained 50.2% (R= 0.71, p<0.01) of the variance in mother's intention to continue EBF for 6 months. Behavioral beliefs regarding easiness and convenience of breastfeeding were significantly correlated with attitude (r=0.31, 0.20, p<0.01). Normative beliefs from husband, family, friends, and society (r=0.27, 0.30, 0.27, 0.26, p<0.01) were correlated with subjective norm. The control belief regarding pumping breast milk (r=0.25, p<0.01) was correlated with perceived behavioral control. Identification of the above specific beliefs underlying influential constructs of TPB provides guidelines for effective intervention programs.