Nutrition Research and Practice

The Korean Nutrition Society (한국영양학회)
권호 표지
DOI QR코드

DOI QR Code

The extended Theory of Planned Behavior in explaining exclusive breastfeeding intention and behavior among women in Kelantan, Malaysia

  • Received : 2014.09.07
  • Accepted : 2015.10.01
  • Published : 2016.02.01
Download PDF
⟨ Previous Next ⟩

Abstract

BACKGROUND/OBJECTIVES: The purpose of this study is to utilize an extended Theory of Planned Behavior in identifying predictors of exclusive breastfeeding intention and behavior among women in Kelantan, Malaysia. SUBJECTS/METHODS: A prospective cohort study was conducted, recruiting pregnant womenthrough two-stage cluster sampling. Their exclusive breastfeeding intention, attitude, perceived norm, perceived behavioral control and past behavior were obtained at baseline through interviewer-guided questionnaire. At one month after delivery, another interview was conducted to determine the two additional variables in the extended theory, which were their postpartum support and breastfeeding difficulty. The behavior, which was the actual duration of exclusive breastfeeding, was obtained from the second follow-up at six months. Pearson correlation and two hierarchical regression analyses were conducted. RESULTS: A total of 200 women completed the study follow-up. Their median intended exclusive breastfeeding duration was 4.0 (IQR 5) months, and the median actual duration was 1.0 (IQR 4) month. The Theory of Planned Behavior explained 51.0% of the variance in intention, with perceived behavioral control and attitude were the significant predictors. It also explained 10.0% of the variance in behavior, but the addition of postpartum support and breastfeeding difficulty increased the amount of explained variance in behavior by 6.0%. The significant predictors of exclusive breastfeeding behavior were intention, postpartum support and breastfeeding difficulty. CONCLUSION: The extended Theory of Planned Behaviorhad a good predictive ability in explaining exclusive breastfeedingintention and behavior. The women's intention to practice exclusive breastfeeding may be improved by improving their perceived behavioral control and attitude. Providing correct postpartum support and skills to handle breastfeeding difficulties after delivery will improve their exclusive breastfeeding behavior.

Keywords

References

  1. Ministry of Health Malaysia, Institute for Public Health. Ekslusif, Panduan Penyusuan SusuIbu, 6 Bulan Pertama Hanya SusuIbu. Kuala Lumpur: Ministry of Health Malaysia; 2005.
  2. Fatimah S Jr, Siti Saadiah HN, Tahir A, Hussain Imam MI, Ahmad Faudzi Y. Breastfeeding in Malaysia: results of the Third National Health and Morbidity Survey (NHMS III) 2006. Malays J Nutr 2010;16:195-206.
  3. Tan KL Jr. Factors associated with non-exclusive breastfeeding among 4-week postpartum mothers in Klang district, Peninsular Malaysia. Malays J Nutr 2009;15:11-8.
  4. Tan KL. Factors associated with exclusive breastfeeding among infants under six months of age in Peninsular Malaysia. Int Breastfeed J 2011;6:2. https://doi.org/10.1186/1746-4358-6-2
  5. Fishbein M, Ajzen I. The reasoned action approach. In: Predicting and Changing Behavior: the Reasoned Action Approach. New York (NY): Psychology Press; 2010. p.21-3.
  6. Conner M, Norman P. Predicting health behavior: a social cognition approach. In: Conner M, Norman P, editors. Predicting Health Behavior: Research and Practice with Social Cognition Models. 2nd ed. Maidenhead: Open University Press; 2005. p.1-27.
  7. Bai Y, Middlestadt SE, Peng CY, Fly AD. Predictors of continuation of exclusive breastfeeding for the first six months of life. J Hum Lact 2010;26:26-34. https://doi.org/10.1177/0890334409350168
  8. Lewallen LP. A review of instruments used to predict early breastfeeding attrition. J Perinat Educ 2006;15:26-41. https://doi.org/10.1624/105812406X92967
  9. Mutuli LA, Walingo MK. Applicability of theory of planned behavior in understanding breastfeeding intention of postpartum women. Int J MultidiscipCurr Res 2014;2:258-66.
  10. Cabieses B, Waiblinger D, Santorelli G, McEachan RR. What factors explain pregnant women's feeding intentions in Bradford, England: a multi-methods, multi-ethnic study. BMC Pregnancy Childbirth 2014;14:50. https://doi.org/10.1186/1471-2393-14-50
  11. Wan H, Tiansawad S, Yimyam S, Sriaporn P. Factors predicting exclusive breastfeeding among the first time Chinese mothers. Pac Rim Int J Nurs Res Thail 2015;19:32-44.
  12. DiGirolamo A, Thompson N, Martorell R, Fein S, Grummer-Strawn L. Intention or experience? Predictors of continued breastfeeding. Health Educ Behav 2005;32:208-26. https://doi.org/10.1177/1090198104271971
  13. Dodgson JE, Henly SJ, Duckett L, Tarrant M. Theory of planned behavior-based models for breastfeeding duration among Hong Kong mothers. Nurs Res2003;52:148-58. https://doi.org/10.1097/00006199-200305000-00004
  14. Kota Bharu Municipal Council (MY). Population Distribution Information: Table 4.1 Total population by ethnic group, local authority area and state, Malaysia, 2010 [Internet]. Kelantan: Kota Bharu Municipal Council; 2013 [cited 2015 November 15]. Available from: http://www.mpkbbri.gov.my/c/document_library/get_file?uuid=f069f86e-6738-4bac-b244-d4c6899c3c8d&groupId=20005
  15. Jabatan Kesihatan Negeri Kelantan (MY). Laporan Tahunan 2010. Kota Bharu: Jabatan Kesihatan Negeri Kelantan; 2010.
  16. Ajzen I. Constructing a TpB questionnaire: conceptual and methodological considerations[Internet]. Worcester (MA): University of Massachusetts; 2002 [revised 2006 January; cited 2010 March 10]. Available from: http://www.uni-bielefeld.de/ikg/zick/ajzen%20construction%20a%20tpb%20questionnaire.pdf.
  17. Francis J, Eccles MP, Johnston M, Walker AE, Grimshaw JM, Foy R, Kaner EF, Smith L, Bonetti D. Constructing questionnaires based on the theory of planned behaviour: a manual for health services researchers [Internet]. Newcastle upon Tyne: Centre for Health Services Research, University of Newcastle upon Tyne; 2004 [cited 2010 March 6]. Available from: http://openaccess.city.ac.uk/1735/1/TPB%20Manual%20FINAL%20May2004.pdf.
  18. World Health Organization (CH). Indicators for assessing infant and young child feeding practices:part 1.definitions[Internet]. Geneva: World Health Organization; 2008 [cited 2010 March 10]. Available from: http://whqlibdoc.who.int/publications/2008/9789241596664_eng.pdf.
  19. Hughes RB. The development of an instrument to measure perceived emotional, instrumental, and informational support in breastfeeding mothers. Issues Compr Pediatr Nurs 1984;7:357-62. https://doi.org/10.3109/01460868409009772
  20. Wambach KA. A test of a breastfeeding intention and outcome model [Ph. D. thesis]. Tucson (AZ): University of Arizona; 1993.
  21. Wambach KA. Breastfeeding intention and outcome: a test of the theory of planned behavior. Res Nurs Health 1997;20:51-9. https://doi.org/10.1002/(SICI)1098-240X(199702)20:1<51::AID-NUR6>3.0.CO;2-T
  22. Boudreau F, Godin G. Understanding physical activity intentions among French Canadians with type 2 diabetes: an extension of Ajzen's theory of planned behaviour. Int J BehavNutr Phys Act 2009;6:35. https://doi.org/10.1186/1479-5868-6-35
  23. Giles M, Connor S, Mc Clenahan C, Mallett J, Stewart-Knox B, Wright M. Measuring young people's attitudes to breastfeeding using the theory of planned behaviour. J Public Health (Oxf) 2007;29:17-26. https://doi.org/10.1093/pubmed/fdl083
  24. Mullan BA, Wong CL. Hygienic food handling behaviours. An application of the theory of planned behaviour. Appetite 2009; 52:757-61. https://doi.org/10.1016/j.appet.2009.01.007
  25. de Bruijn GJ. Understanding college students' fruit consumption. Integrating habit strength in the theory of planned behaviour. Appetite 2010;54:16-22. https://doi.org/10.1016/j.appet.2009.08.007
  26. Sutton S. Predicting and explaining intentions and behavior: how well are we doing? J Appl Soc Psychol 1998;28:1317-38. https://doi.org/10.1111/j.1559-1816.1998.tb01679.x
  27. Rempel LA. Factors influencing the breastfeeding decisions of long-term breastfeeders. J Hum Lact 2004;20:306-18. https://doi.org/10.1177/0890334404266969
  28. Everson ES, Daley AJ, Ussher M. Brief report: the theory of planned behaviour applied to physical activity in young people who smoke. J Adolesc 2007;30:347-51. https://doi.org/10.1016/j.adolescence.2006.11.001
  29. Wilhelm SL, Rodehorst TK, Stepans MB, Hertzog M, Berens C. Influence of intention and self-efficacy levels on duration of breastfeeding for midwest rural mothers. ApplNurs Res 2008;21:123-30.
  30. Blyth RJ, Creedy DK, Dennis CL, Moyle W, Pratt J, De Vries SM, Healy GN. Breastfeeding duration in an Australian population: the influence of modifiable antenatal factors. J Hum Lact2004;20:30-8. https://doi.org/10.1177/0890334403261109
  31. Giugliani ER. Common problems during lactation and their management. J Pediatr (Rio J) 2004;80:S147-54. https://doi.org/10.2223/1248
  32. World Health Organization (CH). Infant and young child feeding: model chapter for textbooks for medical students and allied health professionals[Internet]. Geneva: World Health Organization; 2009 [cited 2011 September 20]. Available from: http://whqlibdoc.who.int/publications/2009/9789241597494_eng.pdf.
  33. Lawrence RA, Lawrence RM. Breastfeeding: a Guide for the Medical Profession. 6th ed. Philadelphia (PA): Elsevier Mosby; 2005.
  34. Al-Sahab B, Lanes A, Feldman M, Tamim H. Prevalence and predictors of 6-month exclusive breastfeeding among Canadian women: a national survey. BMC Pediatr 2010;10:20. https://doi.org/10.1186/1471-2431-10-20
  35. Februhartanty J, Bardosono S, Septiari AM. Problems during lactation are associated with exclusive breastfeeding in DKI Jakarta Province: father's potential roles in helping to manage these problems. Malays J Nutr 2006;12:167-80.
  36. Goksen F. Normative vs. attitudinal considerations in breastfeeding behavior: multifaceted social influences in a developing country context. SocSci Med 2002;54:1743-53. https://doi.org/10.1016/S0277-9536(01)00145-9

Cited by

  1. Factors influencing medical staff’s intentions to implement family-witnessed cardiopulmonary resuscitation: A cross-sectional, multihospital survey vol.16, pp.6, 2017, https://doi.org/10.1177/1474515117692663
  2. Belief factors associated with breastfeeding intentions of single women: Based on the theory of planned behavior vol.50, pp.3, 2017, https://doi.org/10.4163/jnh.2017.50.3.284
  3. Impact of an educational intervention on breastfeeding behaviour among pregnant women vol.27, pp.1, 2019, https://doi.org/10.12968/bjom.2019.27.1.33
  4. Extended Breastfeeding in Poland: Knowledge of Health Care Providers and Attitudes on Breastfeeding Beyond Infancy vol.35, pp.2, 2016, https://doi.org/10.1177/0890334418819448
  5. Factors affecting the behavior outcomes on post-partum intrauterine contraceptive device uptake and continuation in Nepal: a qualitative study vol.19, pp.None, 2016, https://doi.org/10.1186/s12884-019-2310-y
  6. To what extent does maternal body mass index predict intentions, attitudes, or practices of early infant feeding? vol.15, pp.4, 2016, https://doi.org/10.1111/mcn.12837
  7. Using the behaviour change wheel to explore infant feeding peer support provision; insights from a North West UK evaluation vol.14, pp.1, 2019, https://doi.org/10.1186/s13006-019-0236-7
  8. Predictors of Intention to Use Maternity Waiting Home Among Pregnant Women in Bench Maji Zone, Southwest Ethiopia Using the Theory of Planned Behavior vol.12, pp.None, 2016, https://doi.org/10.2147/ijwh.s267730
  9. Predictors of Intention to Use Maternity Waiting Home Among Pregnant Women in Bench Maji Zone, Southwest Ethiopia Using the Theory of Planned Behavior vol.12, pp.None, 2016, https://doi.org/10.2147/ijwh.s267730
  10. Effect of Education Based on Extended Theory of Planned Behavior on Exclusive Breastfeeding in Pregnant Women in Darmian in 2017 vol.9, pp.3, 2016, https://doi.org/10.5812/jhealthscope.100277
  11. Effectiveness of social-psychological interventions at promoting breastfeeding initiation, duration and exclusivity: a systematic review and meta-analysis vol.14, pp.4, 2016, https://doi.org/10.1080/17437199.2019.1630293
  12. Breastfeeding but not Exclusively: Exploration of Chinese American Mothers’ Infant Feeding Practices vol.37, pp.2, 2016, https://doi.org/10.1177/0890334420948451
  13. Breastfeeding Practice and Association between Characteristics and Experiences of Mothers Living in Bangkok vol.18, pp.15, 2016, https://doi.org/10.3390/ijerph18157889
  14. A qualitative exploration of mixed feeding intentions in first-time mothers vol.30, pp.1, 2016, https://doi.org/10.12968/bjom.2022.30.1.20