Critical Review of Theory Use in Breastfeeding Interventions

Abstract

Background: Numerous efforts to promote breastfeeding resulted in a steady increase in the rates of breastfeeding initiation and duration. Increasing numbers of breastfeeding interventions are focused on breastfeeding maintenance and exclusivity and based on behavioral theories. Few studies critically analyzed the use of theories in breastfeeding intervention development and evaluation. Research aim: The aim of this critical review was to examine the existing literature about breastfeeding intervention, and investigate the role of theory in its development, implementation, and evaluation to provide future directions and implications for breastfeeding interventions. Methods: This critical review examined the existing breastfeeding intervention studies that used self-efficacy theories (SE), theory of planned behavior (TPB), and social cognitive theory (SCT) and were published during the past decade. Using five databases, studies in which researchers explicitly applied these three theories to frame the intervention were selected. Studies were critically reviewed for fidelity to theory in intervention design, delivery, and evaluation. Results: Eighteen studies were reviewed: nine SE-, five TPB-, and four SCT-based. Most interventions were focused on building mothers’ breastfeeding self-efficacy to improve breastfeeding exclusivity and duration. To achieve this goal, researchers who developed SE-based interventions used individual approaches, whereas other researchers who based studies on TPB incorporated social and environmental changes. SE-based studies were more likely to include theory-based instruments, but TPB- and SCT-based studies demonstrated less consistent choices of measurement. Researchers in most studies did not test the relationships between the proposed theoretical constructs and breastfeeding outcomes as guided by theories. Inconsistent outcomes resulted among the studies due to variations in study follow-ups. Conclusion: Sound applications of single or multiple theories demonstrate a great potential to help practitioners and researchers develop effective breastfeeding interventions and evaluate true impacts on positive breastfeeding outcomes.

Interventions to Improve Breastfeeding Outcomes from Six Weeks to Six Months: A Systematic Review

“…The 17 remaining studies included in this review did not implicitly describe any theoretical underpinnings. This leads us to recommend that researchers develop interventions based on theory and spend adequate time describing the theoretical underpinning of interventions, which is consistent with recommendations of Bai et al (2019).…”

“…In a recent review con ducted by Kim et al (2018), it was recommended that breastfeeding interventions in combination with the BFHI as well as occur from the prenatal to postpartum period are more effective. Bai et al (2019) completed a review that examined selfefficacy theory, theory of planned behavior, and social cognitive theory use in breastfeeding interven tions and identified that application of one or more theories in the development of interventions was associated with pos itive breastfeeding outcomes. Despite the various reviews that have been completed on breastfeeding interventions there are still gaps in the knowledge of what characteristics are efficacious.…”

Growth and Change in the Journal of Human Lactation: A Content Analysis 1985–2018

“…Major theoretical concepts/frameworks published in JHL fell into two categories, individual's personal psychology and population-based socio-behavioral frameworks. Most of the personal psychology theories trace their beginnings to the social cognitive work of Bandura (1977Bandura ( , 1986, which has had an immense impact on breastfeeding research (Bai, Lee, & Overgaard, 2019;Shepaherd, Walbey, & Lovell, 2017). The most commonly measured individually based concepts were knowledge level, social support, intention, attitudes, and beliefs.…”

The role of emotions and injunctive norms in breastfeeding: a systematic review and meta-analysis

“…In terms of examining breastfeeding behaviours as an outcome, research has examined different forms of behaviours, including intentions, initiation, and duration (Bai et al, 2019;Davie et al, 2019). Additionally, some studies focus on exclusive breastfeeding (i.e., only breast milk directly from breast or expressed) and some studies focus on any breastfeeding.…”