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ObjectivesBreastfeeding confers important health benefits to both infants and their mothers, but rates are low in the United Kingdom 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 post‐natally.DesignA prospective questionnaire study of both first‐time mothers (n = 77) and experienced breastfeeders (n = 72) recruited at an antenatal clinic in South East England.MethodsParticipants completed a questionnaire at 32 weeks pregnant assessing personal and vicarious experience of infant feeding (breastfeeding, formula‐feeding, and maternal grandmother’s 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 post‐natally. 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.ResultsPrevious 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.ConclusionVicarious 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. Statement of contribution What is already known on this subject? Rates of breastfeeding in the United Kingdom are low and resistant to change.Self‐efficacy may be an important and modifiable factor for breastfeeding initiation and maintenance. What does this study add? Self‐efficacy may only be a relevant factor among mothers who already have personal experience of breastfeeding.Vicarious experience of formula‐feeding has been shown to be related to a lower rate of breastfeeding at 6 weeks.

Self-efficacy is an important determinant of health behaviour. Digital interventions are a potentially acceptable and cost-effective way of delivering programmes of health behaviour change at scale. Whether behaviour change interventions work to increase self-efficacy in this context is unknown. This systematic review and meta-analysis sought to identify whether automated digital interventions are associated with positive changes in self-efficacy amongst non-clinical populations for five major health behaviours, and which BCTs are associated with that change. A systematic literature search identified 20 studies (n=5624) that assessed changes in self-efficacy and were included in a random effects meta-analysis. Interventions targeted: healthy eating (k=4), physical activity (k=9), sexual behaviour (k=3), and smoking (k=4). No interventions targeting alcohol use were identified. Overall, interventions had a small, positive effect on self-efficacy ( ̅ = 0.190, CI [0.078; 0.303]). The effect of interventions on self-efficacy did not differ as a function of health behaviour type (Qbetween = 7.3704 p = 0.061, df = 3). Inclusion of the BCT 'information about social and environmental consequences' had a small, negative effect on self-efficacy (∆ ̅ = -0.297, Q=7.072, p=0.008). Whilst this review indicates that digital interventions can be used to change self-efficacy, which techniques work best in this context is not clear.

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