Nutr Res Pract.  2016 Feb;10(1):49-55. 10.4162/nrp.2016.10.1.49.

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

• Tengku Ismail TA
• Wan Muda W
• Bakar MI

• KMID: 2313900
• DOI: http://doi.org/10.4162/nrp.2016.10.1.49

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.

Keyword

Exclusive breastfeeding; Theory of Planned Behavior; postpartum support; breastfeeding difficulty

MeSH Terms

Breast Feeding*
Cohort Studies
Female
Follow-Up Studies
Humans
Intention*
Malaysia*
Postpartum Period
Prospective Studies

Reference

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 SJr, 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; 15:11–18.

4. Tan KL. Factors associated with exclusive breastfeeding among infants under six months of age in Peninsular Malaysia. Int Breastfeed J. 2011; 6:2.

5. Fishbein M, Ajzen I. The reasoned action approach. Predicting and Changing Behavior: the Reasoned Action Approach. New York (NY): Psychology Press;2010. p. 21–23.

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.

8. Lewallen LP. A review of instruments used to predict early breastfeeding attrition. J Perinat Educ. 2006; 15:26–41.

9. Mutuli LA, Walingo MK. Applicability of theory of planned behavior in understanding breastfeeding intention of postpartum women. Int J Multidiscip Curr Res. 2014; 2:258–266.

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.

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; 32:208–226.

13. Dodgson JE, Henly SJ, Duckett L, Tarrant M. Theory of planned behavior-based models for breastfeeding duration among Hong Kong mothers. Nurs Res. 2003; 52:148–158.

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; 7:357–362.

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; 20:51–59.

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 Behav Nutr Phys Act. 2009; 6:35.

23. Giles M, Connor S, Mc Clenahan C, Mallett J, Stewart-Knox B, Wright M. Measuring young peoples attitudes to breastfeeding using the theory of planned behaviour. J Public Health (Oxf). 2007. 29:p. 17–26.

24. Mullan BA, Wong CL. Hygienic food handling behaviours. An application of the theory of planned behaviour. Appetite. 2009; 52:757–761.

25. de Bruijn GJ. Understanding college students' fruit consumption. Integrating habit strength in the theory of planned behaviour. Appetite. 2010; 54:16–22.

26. Sutton S. Predicting and explaining intentions and behavior: how well are we doing? J Appl Soc Psychol. 1998; 28:1317–1338.

27. Rempel LA. Factors influencing the breastfeeding decisions of long-term breastfeeders. J Hum Lact. 2004; 20:306–318.

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; 30:347–351.

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. Appl Nurs Res. 2008; 21:123–130.

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 Lact. 2004; 20:30–38.

31. Giugliani ER. Common problems during lactation and their management. J Pediatr (Rio J). 2004; 80:S147–S154.

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.

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; 12:167–180.

36. Göksen F. Normative vs. attitudinal considerations in breastfeeding behavior: multifaceted social influences in a developing country context. Soc Sci Med. 2002; 54:1743–1753.