Effectiveness of educational intervention on exclusive breast feeding in primipara women: application of planned behavior theory

Breast-feeding is the recommended method of infant feeding because it is clearly associated with health benefits for infants and their mothers. Yet, many women who initiate breast-feeding fail to meet their own personal goals or recommended standards for duration of breast-feeding. To refine a Theory of Planned Behavior (TPB) based on structural model for explaining variability in breast-feeding intention and duration. This study was aimed to assess the effectiveness of an educational intervention to continue breastfeeding among primiparas in Tonekabon city. This is a quasi-experimental study with 110 primiparas who were in their seventh and eighth months of pregnancy referred to two health centers in Tonekabon city. The subjects were randomly selected from health centers in Tonekabon city and assigned to either control (n=55) and experimental group (n=55). The research tool was a self constructed questionnaire with two sections; demographic questions and the TBP constructs i.e. knowledge, attitude, subjective norms, intention and breast feeding behavior. Face and content validity was appointed by an expert’s panel. Internal consistency and reliability was confirmed by Cronbach's alpha and test-retest coefficients. Mothers in the experimental group received an educational intervention based on the TBP constructs in terms of how proper feeding infants with breast milk, the benefits of exclusive breast feeding, nutritional characteristics for infants with low birth weight, frequency and duration of breastfeeding and how to store breast milk in mothers who work. The data were collected two months before delivery and four months after delivery. The chi-square, t-test and and two-way ANOVA were used for data analysis. The confidence level was 95%. the average age of the mothers who participated in the study in experimental and control groups were 23.84 and 23.59, respectively. More than 60% of the mothers were educated until diploma and had an intermediate family income. There were no differences between the groups before educational intervention. The educational intervention resulted in a significant increase in attitude, subjective norm, perceived behavioral control, self-efficacy, behavioral intentions and breast feeding behavior (p<0.001) while there was no significant change in the control group. Breastfeeding behavior had no significant difference between the two groups before the educational intervention. A significant change in feeding behavior was observed in the experimental group once the educational intervention was implemented. our results indicated that the theory of planned behavior is an appropriate theory to explain the impact of psychosocial factors for the design and implementation of educational programs to increase exclusive breast-feeding among primiparas.