Using an extended theory of planned behaviour to inform interventions aimed at increasing breastfeeding uptake in primiparas experiencing material deprivation

Objectives The theory of planned behaviour (TPB) was employed to investigate infant feeding intentions and subsequent behaviour in women from selected areas of economic hardship in the UK. Underlying beliefs were examined in order to inform future interventions aimed at increasing breastfeeding uptake among women living in such areas, which is associated with low rates of breastfeeding. Design Midwives recruited women from areas meeting study criteria. TPB measures were obtained from 303 primiparas via postal questionnaires completed during pregnancy, and feeding method was subsequently obtained from 286 of these women. Results A model containing age, education, deprivation, attitude, subjective norm (SN), and perceived behavioural control (PBC) predicted intention to breastfeed (R2=.44) and intention to formula feed (R2=.45). A model controlling for age, education and deprivation predicted ever having breastfed (86.1% correctly classified) and ever having formula fed (77.1% correctly classified). MANCOVAs differentiated those who intended to breastfeed and subsequently did (inclined actors), those who intended to breastfeed but did not (inclined abstainers), and those who did not intend to breastfeed and did not (disinclined abstainers). Differentiating outcome beliefs, normative beliefs, and control beliefs are presented. Conclusions The TPB provided a useful framework with which to examine the factors underlying breastfeeding intentions and behaviour amongst primiparas. A grouping system based on the congruence between intentions and subsequent behaviour revealed important differences between beliefs of the three groups. Further research might usefully test the effectiveness of interventions targeting the beliefs identified here in increasing breastfeeding uptake and duration.