Promoting positive attitudes to breastfeeding: the development and evaluation of a theory‐based intervention with school children involving a cluster randomised controlled trial

Abstract

The objective of this study was to design, implement and evaluate an intervention based on the theory of planned behaviour (TPB) to enhance young peoples' motivations to breastfeed/support a partner to breastfeed. Six semi-structured focus groups were first conducted with 48 13-14-year-olds from two schools in Northern Ireland. The salient beliefs elicited were subsequently used to design a TPB-based questionnaire that was then administered to 2021 13-14-year-old pupils (852 males; 1169 females) from 36 post-primary schools to identify the most important determinants of breastfeeding. The results were used to inform the design and implementation of an intervention package that was subsequently evaluated using a cluster randomised controlled trial involving 44 randomly selected schools across Northern Ireland. Questionnaires were administered to 18 intervention and 26 control schools at baseline and again at 1 and 6 months post-intervention to evaluate its effectiveness. Multi-level modelling was employed to analyse the data. The results revealed significant effects on women's intention to breastfeed, β = 0.208, t(1275) = 2.715, P = 0.007; attitudes, β = 0.223, t(1275) = 4.655, P < 0.001; moral attitudes, β = 0.231, t(1275) = 4.211, P < 0.001; subjective norm, β = 0.118, t(1275) = 2.521, P = 0.012; and knowledge, β = 0.109, d.f. (1275) = 7.843, P < 0.001. However, for men, the results revealed significant effects on only the construct of knowledge, β = 0.104, t(541) = 4.345, P < 0.001.The research has provided evidence to support the need for breastfeeding education in schools and has shown how a theoretical framework may be used to inform the design and evaluation of a health behaviour intervention.

Development of theory‐based knowledge translation interventions to facilitate the implementation of evidence‐based guidelines on the early management of adults with traumatic spinal cord injury

“…As achieved in the current study and in an increasing number of initiatives, they urged future implementation efforts to include a theoretical justification for selection of KT interventions in order to optimize outcomes. They also recommended using rigorous study methods for evaluating the effectiveness of theory‐based interventions, a procedure that has still minimally been undertook although associated with encouraging findings [72–77].…”

Exploring the latitude of attitude: Intentions to breastfeed among adolescents in Lebanese schools

“…Largely grounded in previous work, which used TPB as framework to better understand adolescent breastfeeding intentions in Ireland (Giles et al, ; Giles et al, ; Giles et al, ; Giles, Connor, McClenahan, & Mallet, ), the survey included five sections that assessed demographic characteristics, intention to breastfeed/support wife to breastfeed, TPB direct and indirect constructs, basic knowledge related to breastfeeding, views on breastfeeding in public, and views on breastfeeding education. Two versions of the survey were available such that the male's version rotated around “supporting wife to breastfeed in the future” rather than “breastfeeding in the future.” The term “wife” was chosen as it is the most culturally responsive term to describe a male's significant other within the Lebanese context.…”

“…A normative belief score , ranging between −21 and 21, for each of the five individual groups was calculated. Due to the complexity of comprehending a similar rating approach for indirect measures of perceived control, we based the indirect measures of control on single items consistent with others (Giles et al, ; Giles et al, ; Giles et al, ; Giles et al, ). Accordingly, students were asked to rate how much nine factors, including support of others, having more knowledge about infant feeding, and tolerance of others to public breastfeeding (Table S5), would make it easier or more difficult for them to breastfeed/support wife to breastfeed on a 7‐point scale where 1 corresponds to more difficult and 7 to much easier .…”

“…Limited SBBE is taking place in Lebanon as it is only mandatory to briefly teach the students about the infant and maternal benefits of breastfeeding in fifth grade and about breastfeeding duration recommendations and breastfeeding barriers in 10th grade (Moukarzel et al, ). There is also no focus on leveraging SBBE to change psychosocial constraints such as negative attitudes, which have been shown to be consequential on intent to breastfeed (Giles et al, ).…”

“…To address this aforementioned gap in the literature, the theory of planned behaviour (TPB) may be used as a guiding theoretical framework (Ajzen, ; Ajzen & Fishbein, ). TPB is one of the most commonly used psychosocial frameworks in designing health education interventions and more recently in designing one SBBE intervention in Ireland (Giles et al, ). According to the theory, intention is an important predictor of future behaviour and is influenced by three main direct constructs: attitude, subjective norm, and perceived control (Ajzen, ; Ajzen & Fishbein, ).…”