Background to the Research

• Although promoted internationally as the preferred method of infant feeding, the prevalence of breastfeeding in the United Kingdom generally falls short of national targets. Whilst recent promotion efforts have brought progress, evidence suggests that breastfeeding promotion should be aimed at the entire population and should be undertaken in schools.
• The TPB, which works on the premise that the best way to target behaviour is to measure behavioural intention, is one theory which has the potential to shape such intervention programmes. Given the lack of such approaches in the field of infant feeding choices, this study aimed to develop and pilot a TPB-based questionnaire for subsequent use in a breastfeeding intervention with 13-14 year old girls.
  

Research Approach

• Six semi-structured focus groups were carried out with 48 young people to identify the modal salient beliefs underlying young peoples' motivations to breastfeed. The measurement instrument was then constructed, incorporating all the key theoretical constructs and both direct and belief-based measures. The questionnaire was then piloted on a sample of 121 female and male schoolchildren to identify and assess the relative importance of the determinants of breastfeeding intention.
  

Main Findings

Salient beliefs elicited from the participants about breastfeeding

• Although almost half of the young people were able to report that they were breastfed as babies, participants generally had limited exposure to breastfeeding, usually restricted to family members or family friends.
• Some of the benefits noted included prevention of childhood illnesses and strengthening of immune systems, IQ development, perceived benefits for the mother, enhanced bonding, convenience and the fact it is cheaper.
• The main disadvantages were noted to include embarrassment and culture, the physiological aspects, demands on time, limitations to social activities and excluding the father.
• The opinions of mums, partners, family, close friends and the medical profession were seen as most likely to influence the decision to breastfeed, although participants were almost unanimous in their belief that the final decision would be with the mother.
• Factors that might make it difficult to breastfeed included the mother's health following birth, the possible pain or tiredness, the exclusion of the father and social factors, such as other people's opinions and negative reactions, feeling uncomfortable/embarrassed, not being allowed to breastfeed in a public place and it not being fashionable to breastfeed.
• Participants frequently mentioned their lack of knowledge of breastfeeding and suggested it might be more likely if they knew more about it.
• Behavioural beliefs about breastfeeding: bonding with one's baby; providing health benefits for one's baby; a convenient method of infant feeding; regaining one's figure; helping to prevent breast cancer; saving money; a natural feeding method; a time-consuming feeding method; a feeling of embarrassment; limiting to social activity; excluding the involvement of others; and an uncomfortable and painful feeding method.
• Normative beliefs about breastfeeding: most people who are important to me would want me/encourage my partner to breastfeed; I think my mum would want me/encourage my partner to breastfeed; I think my family would want me/encourage my partner to breastfeed; I think my partner would want me/would welcome the encouragement to breastfeed; I think my close friends would want me/encourage my partner to breastfeed; and I think the medical profession would want me/encourage my partner to breastfeed.
• Control beliefs about breastfeeding: the support of others; knowledge about infant feeding; the intolerance of others to breastfeeding in public; embarrassment; physical problems; lack of public breastfeeding facilities; having to do all the feeding myself; the tiredness I think I/my partner would experience; and the change in the shape of my/my partner's breasts.

Main findings of the pilot study

• 86% of participants found the questionnaire layout easy to follow and 78% found the questions easy or mostly easy to understand. 31% of respondents though the questions were repetitive or too similar and 17% thought that the questionnaire in general was too long.
• 44% of participants were breastfed as children but only 26% of females (53% of males) had previously been exposed to a breastfeeding mother, of whom only 12.5% (9.4% of males) acknowledged that this had occurred in a public place. Although 72% of females reported that it was quite/extremely likely they would breastfeed a baby (60% of males would encourage their partner to do so), those who had previously been exposed to a breastfeeding mother were significantly more likely to intend to do so, as were those who were breastfed compared to those who were not.
• None of the participants had received breastfeeding education in school and knowledge of breastfeeding was restricted. Although many were aware that breast and bottle milk are not the same, that breastfeeding can enhance the bonding process and that breast milk contains antibodies that protect a baby from infection, the majority either answered incorrectly or did not know that bottle-fed babies are more susceptible to illness.
• Further analysis revealed that, consistent with the focus group findings, the naturalness of breastfeeding, the perceived bonding process and knowledge were important considerations. Males appeared to attach much more importance to the potential health benefits, while females, although also aware of these, were equally concerned about limitations to their social activity and the associated embarrassment.

Conclusions

• The questionnaire proved to be reliable and the analysis, although preliminary, provided strong support for the predictive power of the TPB.
• Although the key purpose of the study was to develop and pilot a questionnaire and not to generalize its findings, it is noted that only 26% of females had witnessed a mother breastfeeding her baby, and these pupils were significantly more likely to declare an intention to breastfeed. Together with the significant influence of social support within the TPB framework, this seems to strengthen the view that increasing young peoples' exposure to breastfeeding may encourage more positive attitudes and adds weight to the suggestion that breastfeeding education should form part of the secondary school curriculum.