A longitudinal study of the effect of psychosocial factors on exclusive breastfeeding duration.

OBJECTIVE: to examine the effect of psychosocial factors on exclusive breastfeeding duration to six months postpartum DESIGN: longitudinal, prospective questionnaire based study. SETTING: participants were recruited from a publically funded antenatal clinic located in the western metropolitan region of Melbourne, Victoria, Australia and asked to complete questionnaires at three time points; 32 weeks pregnancy, two months postpartum and six months postpartum. PARTICIPANTS: the participants were 125 pregnant women aged 22-44 years. MEASUREMENTS AND FINDINGS: psychosocial variables such as breastfeeding self-efficacy, body attitude, psychological adjustment, attitude towards pregnancy, intention, confidence and motivation to exclusively breastfeed and importance of exclusive breastfeeding were assessed using a range of psychometrically validated tools. Exclusive breastfeeding behaviour up to six months postpartum was also measured. At 32 weeks gestation a woman's confidence to achieve exclusive breastfeeding was a direct predictor of exclusive breastfeeding duration to six months postpartum. At two months postpartum, psychological adjustment and breastfeeding self-efficacy were predictive of exclusive breastfeeding duration. Finally, at six months postpartum, psychological adjustment, breastfeeding self-efficacy, confidence to maintain and feeling fat were directly predictive of exclusive breastfeeding duration. KEY CONCLUSIONS: psychosocial factors are significantly predictive of exclusive breastfeeding duration. Self-efficacy, psychological adjustment, body image, motivation and confidence are all important psychosocial factors implicated in a woman's ability to maintain exclusive breastfeeding over time. IMPLICATIONS FOR PRACTICE: Individualised antenatal breastfeeding education and support may be strengthened by strategies that build a woman's confidence to exclusive breastfeeding. Implementing psychosocial supports and methods providing positive feedback that increase a woman's self-efficacy to exclusively breastfeed to six months are also important two months postpartum.

The role of psychosocial factors in exclusive breastfeeding to six months postpartum.

OBJECTIVE: to investigate the psychosocial variables associated with the ability to exclusively breastfeed to six months postpartum. Additionally, to evaluate a conceptual model of psychosocial correlates of exclusive breastfeeding duration. DESIGN: online, retrospective questionnaire. SETTING: the questionnaire was placed online and participants accessed it through social networking sites including groups relating to breastfeeding, motherhood and parenting. Participants were also able to share the link with their own networks. This online setting facilitated recruitment of a wide range of Australian and international participants. PARTICIPANTS: 174 women aged 18 years and older who had given birth between six months to two years prior. Participants completed an online questionnaire, which asked them to report on three time points: pre-pregnancy, during pregnancy and during the first six months postpartum. Data were collected from June to December 2011. MEASUREMENTS: psychometrically validated tools such as the breastfeeding Self-Efficacy Scale, Body Attitude Questionnaire, Depression Anxiety and Stress Scale, Fetal Health Locus of Control Scale, and the brief COPE scale were used to measure psychosocial variables. Additional scales were developed by the researchers and met scale reliability criteria. FINDINGS: correlation analyses, t-tests and path analysis were used to statistically analyse the data. Results showed that women who exclusively breast fed to six months postpartum exhibited higher intention to exclusively breastfeed, breastfeeding self-efficacy, comfort breastfeeding in public, perceived physical strength and reported less perceived breastfeeding difficulties. Path analyses indicated that breastfeeding self-efficacy was a strong significant predictor of both exclusive breastfeeding intention and duration. Maternal attitude towards pregnancy (both during pregnancy and postpartum), psychological adjustment and early breastfeeding difficulties were also found to be significant predictors of exclusive breastfeeding intention and duration. KEY CONCLUSIONS: psychosocial factors are likely to play a significant role in the maintenance of exclusive breastfeeding for six months post-birth. Future research should adopt a prospective study design to examine the influence of psychosocial factors systematically and rigorously. IMPLICATIONS FOR PRACTICE: longitudinal, prospective studies are needed to further examine the role of psychosocial factors on exclusive breastfeeding outcomes. Interventions, which involve improving psychosocial factors such as breastfeeding self-efficacy, may improve exclusive breastfeeding outcomes.

Psychosocial correlates of exclusive breastfeeding: a systematic review.

BACKGROUND: the World Health Organization recommends that all infants worldwide are exclusively breastfed for the first 6 months of life for optimal health and development. However, very few women worldwide are meeting this recommendation. Psychosocial factors have been identified as potentially modifiable factors implicated in a woman's ability to successfully exclusively breastfeed, however there is very limited research examining these factors specifically for exclusive breastfeeding to 6 months duration. METHODS: a search of psychological, nursing and medical databases was conducted in June 2011 for studies published from 2000 to 2011 examining psychological correlates of exclusive breastfeeding to four to 6 months duration. RESULTS: nine papers from eight studies were found to be eligible for the review. Psychological factors have been reported to be highly predictive of exclusive breastfeeding outcomes. Research to date shows that psychosocial factors are not only importantly implicated in exclusive breastfeeding duration but they can also be changed through intervention and experiences. CONCLUSIONS: while there is a wealth of literature on the role of psychosocial factors in breastfeeding, there is very limited research specifically examining the role of psychosocial factors of exclusive breastfeeding to 6 months duration. Interpreting the results of the available literature is difficult due to the various methodologies and definitions of exclusive breastfeeding and small sample sizes. Further research, specifically, longitudinal cohort studies are needed which examine psychological determinants of exclusive breastfeeding and infant feeding methods from pregnancy through to 6 months postpartum.