Breastfeeding self-efficacy in mothers and its association with maternal functioning, maternal knowledge, and attitudes toward breastfeeding: a cross-sectional study

Abstract Breastfeeding constitutes a cornerstone intervention, delivering extensive benefits to children, women, and society. Although breastfeeding self-efficacy plays a crucial role in the initiation and continuation of breastfeeding, evidence regarding the factors associated with breastfeeding self-efficacy remains limited in Iran. This study aimed to examine breastfeeding Self-Efficacy in Mothers and Its Association with Maternal Functioning, Maternal Knowledge, and Attitudes Toward Breastfeeding. This cross-sectional study involved 245 breastfeeding mothers with infants under 6 months of age, recruited via multistage cluster sampling. Participants completed five assessment tools for evaluating demographic and obstetric characteristics, infant feeding attitudes, breastfeeding knowledge, maternal functioning, and breastfeeding self-efficacy (BES). Univariate and multiple linear regression analyses were conducted to identify predictors of breastfeeding self-efficacy. The mean (SD) scores of maternal functioning, breastfeeding self-efficacy, breastfeeding knowledge, and feeding attitude were 113.71 (13.83), 56.29 (7.38), 5.42 (1.45), and 52.91 (6.40), respectively. Pearson’s correlation analysis showed positive associations between breastfeeding self-efficacy and knowledge (r = 0.552, P < 0.001), feeding attitude (r = 0.413, P < 0.001), and maternal functioning (r = 0.308, P < 0.001). In the final adjusted regression model, which included previous breastfeeding experience, the model explained 32.4% of the variance in breastfeeding self-efficacy. Breastfeeding knowledge remained a significant independent predictor (β = 0.441, P < 0.001), as did previous breastfeeding experience (B = 1.628, P = 0.039), whereas feeding attitude and maternal functioning were not statistically significant after adjustment. Breastfeeding knowledge was the strongest independent predictor of breastfeeding self-efficacy, and previous breastfeeding experience was also independently associated with higher self-efficacy after adjustment. Although feeding attitude and maternal functioning were positively associated with breastfeeding self-efficacy in unadjusted analyses, their associations were not statistically significant in the final adjusted model. These findings highlight the potential importance of strengthening breastfeeding knowledge and building on mothers’ previous breastfeeding experiences in interventions aimed at improving breastfeeding self-efficacy.