Explaining Infant Feeding: The role of breastfeeding experience and vicarious experience of infant feeding on attitudes, subjective norms, self-efficacy and breastfeeding outcomes

Objectives: Breastfeeding confers important health benefits to both infants and their mothers, but rates are low in the UK and other developed countries despite widespread promotion. This study examined the relationships between personal and vicarious experience of infant feeding, self-efficacy, the Theory of Planned Behaviour variables of attitudes and subjective norm, and the likelihood of breastfeeding at 6-8 weeks postnatal.
Design: A prospective questionnaire study of both first time mothers (n=77) and experienced breastfeeders (n=72) recruited at an antenatal clinic in South East England.
Methods: Participants completed a questionnaire at 32 weeks pregnant assessing personal and vicarious experience of infant feeding (breastfeeding, formula-feeding and maternal grandmothers’ experience of breastfeeding), perceived control, self-efficacy, intentions, attitudes (to breastfeeding and formula-feeding), and subjective norm. Infant feeding behaviour was recorded at 6-8 weeks postnatal. Multiple linear regression modelled the influence of vicarious experience on attitudes, subjective norm and self-efficacy (but not perceived control), and modelled the influence of attitude, subjective norm, self-efficacy and past experience on intentions to breastfeed. Logistic regression modelled the likelihood of breastfeeding at 6-8 weeks.
Results: Previous experience (particularly personal experience of breastfeeding) explained a significant amount of variance in attitudes, subjective norm and self-efficacy. Intentions to breastfeed were predicted by subjective norm and attitude to formula-feeding and, in experienced mothers, self-efficacy. Breastfeeding at 6 weeks was predicted by intentions and vicarious experience of formula-feeding.
Conclusion: Vicarious experience, particularly of formula-feeding, has been shown to influence the behaviour of first time and experienced mothers both directly and indirectly via attitudes and subjective norm. Interventions that reduce exposure to formula-feeding (perhaps by limiting advertising) or cushion mothers from its effects may enable more mothers to meet their breastfeeding goals.