A Path Analysis to Identify Factors Influencing the Provision of Water in Addition to Breast Milk by Mothers of Infants under Six Months of Age in Conakry and Kindia Regions, Republic of Guinea

Abstract

Water provision to infants under six months of age (IU6M) can hamper exclusive breastfeeding (EBF). Understanding factors and their relationships influencing this practice is needed to tailor EBF promotion programs. Using a validated questionnaire, this study aims to identify pathways in which individual factors and the environment interact to affect the provision of water in addition to breast milk among 300 mothers of IU6M. Our finding shows that 75% of mothers intended to provide water in addition to breast milk to their IU6M and that about 60% reported doing it. Results of the final path show that the subjective norm/SN (β = 0.432, p < 0.001), the attitude (β = 0.349, p < 0.001), and to a lesser extent the perceived control/PC (β = 0.141, p = 0.005) predict the intention of mothers to provide water in addition to breast milk to their IU6M. The environment scores predict the attitude (β = 0.210, p = 0.001) and the SN (β = 0.284, p < 0.001). Having the mother practicing early breastfeeding initiation at birth positively predicted the PC score (β = 0.157, p = 0.017) and predicted an increasing score of SN (β = 0.221, p = 0.003). Even though predicting the final behavior is complex, this research provides directions to nutrition education programs to tailor their content to the context and be more efficient in reducing the proportion of women providing water to their IU6M, hence contributing to the improvement of EBF.

A theory-based behavioural change communication intervention to decrease the provision of water to infants under 6 months of age in the Republic of Guinea

“…Beforehand, the path analysis results were used to define the intervention. (20) Results indicate that the subjective norm, the attitude, and to a lesser extent, the perceived control predict the intention of mothers to provide water in addition to breast milk to their IU6M, with the attitude being the most strongly associated with the intention. The intervention was thus designed to develop a more positive attitude among mothers towards the non-provision of water to their babies.…”

“…(14) Path analyses with version 1.6 of MPlus software (30) were performed to investigate pathways by which psychosocial and environmental factors influenced the provision of water in addition to breast milk among mothers of each group at the baseline and endline. Given that a specific pathway was identified at the baseline in the overall group (control and intervention together, n = 300), the same model (20) was tested in the current study. This model included the following variables of the extended TPB: the intention, direct measures of the attitude, the subjective norm, the perceived control, and the environment.…”

“…This research, which used a quasi-experimental design, was conducted in four health centers divided into the two previously mentioned regions. (20,21) Inclusion criteria for mothers of IU6M were the following: having a child aged below three months, being aged 20 years or older, having given birth through vaginal delivery and to a singleton child with a birth weight greater than 2•5 kg, and being willing to participate in the study, irrespective of whether the child is exclusively breastfed or not. Mothers of babies with severe medical conditions (e.g., AIDS, cancer), mental health issues, obstetric complications (e.g., c-section), babies with severe medical conditions (e.g., AIDS), or congenital malformations were excluded.…”

“…(14,22) Results of path analyses have shown that mothers' attitude and perception of the subjective norm were more associated with the intention of providing water. (20) In contrast, a positive environment was associated with a favorable attitude and the subjective norm. Specific behavioral, normative, and control beliefs were also identified.…”

“…In the Republic of Guinea, 33% of IU6M receive water in addition to breast milk. (19) To contribute to the improvement of the EBF rate, based on an extended version of the theory of planned behavior (TPB) (14) , formative research has been undertaken to identify psychosocial https://doi.org/10.1017/S1368980022001732 Published online by Cambridge University Press factors (attitude, subjective norm, and the perceived control) underlying the intention of mothers to provide water to babies (20) , so as to develop a behavior change intervention to reduce the provision of water among IU6M. Elements of the environment that could potentially influence psychosocial factors and the behavior itself have also been investigated.…”