A mixed method study to explore knowledge, attitudes, behaviour and experience of Breastfeeding

Abstract Background Breastfeeding is the optimal method of feeding in early infancy. EARLY START aims to build an intervention for reducing early life obesogenic behaviours. Using participatory action research, the exploratory phase examined mothers’ knowledge, attitudes, behavioral intentions, and experiences related to breastfeeding practices. Methods A mixed methods approach was employed to investigate maternal attitudes, intentions, and experiences related to breastfeeding using the Breastfeeding Self-Efficacy Scale (BFSE-SF) and the Comprehensive Breastfeeding Knowledge Scale (CBKS). A subgroup of mothers participated in a focus group to explore their experiences, beliefs, and attitudes toward breastfeeding. Data was analyzed using both descriptive and thematic content methods. Results Amongst 244 mothers, the mean self-efficacy score (BFSE-SF) was 51 (Range: 14-70), and the mean Child Feeding Knowledge and Beliefs Scale score (CBKS) was 75.85 (Range 28-84). Mothers exclusively breastfeeding (EBF) reported significantly higher levels of self-efficacy than those practicing mixed or formula feeding (p-value<0,001). EBF mothers demonstrated greater knowledge, more positive attitudes, and stronger capability in managing challenges, and correcting feeding difficulties (p-value<0,001). Qualitative data revealed that mothers’ experience significant breastfeeding challenges, some of which contribute to early cessation. Challenges are commonly associated with feelings of guilt, a heightened sense of personal responsibility, and prevailing social expectations. Mothers experiencing anxiety is related to unmet expectations and uncertainty about the breastfeeding journey. Conclusions Breastfeeding challenges require a supportive social environment to help mothers navigate fears, build self-efficacy, and meet their breastfeeding goals. New interventions should target mothers and their support networks to enhancing maternal confidence, resilience, and positive breastfeeding outcomes. Key messages • Maternal knowledge, self-efficacy and ability to cope with the challenges of breastfeeding positively affect breastfeeding outcomes and the breastfeeding journey. • New interventions should provide consistent and informed support to enhance maternal empowerment, beliefs and confidence about breastfeeding.