Path Model Validation of Breastfeeding Intention Among Pregnant Women

J Obstet Gynecol Neonatal Nurs. 2021 Mar;50(2):167-180. doi: 10.1016/j.jogn.2020.10.007. Epub 2021 Jan 16.


Objective: To validate a blended health belief model and integrated behavioral model of selected modifiable psychosocial constructs during pregnancy to seek the best-fit path model for breastfeeding intention.

Design: A nonexperimental, cross-sectional study.

Setting: A virtual online market research sample aggregator.

Participants: Women (N = 300) between 18 and 45 years of age in their second or third trimesters of pregnancy participated in the study in February 2018.

Methods: Based on the health belief model and the integrated behavioral model, we proposed a theoretical framework, including self-efficacy for breastfeeding, knowledge, perceived benefits, perceived barriers, attitude toward breastfeeding, patient-provider interaction, and motivation to breastfeed, to predict breastfeeding intention. We administered a 98-item questionnaire modified from preexisting instruments. We conducted descriptive, bivariate, and regression analyses to help with the formation of the path model.

Results: The best-fit path model with all significant paths and effect directions showed that intention to breastfeed is directly influenced by motivation to breastfeed, attitudes toward breastfeeding, and self-efficacy for breastfeeding, which together accounted for 56% (R2) of the variance in intention. We also identified indirect effects from knowledge about breastfeeding, patient-provider interaction, perceived benefits, and perceived barriers and their interrelationships with effect directions.

Conclusion: Through our findings, we contribute to the emerging body of evidence that shows the significant variables and their effect directions for breastfeeding intention. Incorporating these findings may provide support and evidence for clinical and community interventions focusing on modifiable psychosocial constructs during pregnancy to promote breastfeeding and further investigations using health behavior theories.

Keywords: breastfeeding; health belief model; integrated behavioral model; intention; path modeling.

MeSH terms

  • Breast Feeding*
  • Cross-Sectional Studies
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Intention*
  • Pregnancy
  • Pregnant Women
  • Self Efficacy
  • Surveys and Questionnaires