Breastfeeding demand of mothers of preterm infants in China: a qualitative study informed by the Behaviour Change Wheel

Abstract

Background Breastfeeding has been recognized as the golden standard, but the breastfeeding rates of preterm infants remain low globally. Due to the lack of sound theoretical framework and the attention to maternal needs in breastfeeding, the overall evidence and effectiveness of intervention is limited. This study aimed to explore Chinese preterm mothers’ demands on breastfeeding using the Behaviour Change Wheel to provide insight into the future design of breastfeeding behavior-enhancing intervention. Method A qualitative descriptive design was conducted in Wuhan in 2022. Based on purposeful sampling, 14 preterm mothers were recruited from a NICU in a Grade Ⅲ Class A hospital in Wuhan, China. Face-to-face semi-structured interviews were conducted to collect data using the interview guide developed by the Theoretical Domains Framework. Theoretical Thematic Analysis was used to review the data in 6 steps to identify themes. Results Five major themes emerged: (1) capability: infants’ cues reading and abnormalities identification, coping knowledge accumulation, and skills training; (2) physical opportunity: cleanliness and peace in the home, privacy and breastfeeding aids in public places; (3) social opportunity: family co-parenting, peer support, authoritative advocacy; (4) reflective motivation: health outcome information; (5) automatic motivation: maternal-infant bonding, free of aversive stimulus. Conclusion Preterm mothers’ demands for breastfeeding were diverse including capability improvement, physical and social opportunities acquirement, as well as increase in reflective and automatic motivation. People, resources and environments associated with the demands should be engaged to enhance capability, create opportunities, and promote motivation. Future studies are needed to design effective interventions according to mothers’ specific demands.