Running head: BREASTFEEDING SELF-EFFICACY
Breastfeeding Self-Efficacy
Christina M. Mellon
University of Central Florida
Author Note
This paper was prepared for NGR 5800, Theory for Advanced Practice Nursing, Section 0W63,
taught by Dr. Hix.
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BREASTFEEDING SELF-EFFICACY
Abstract
Adolescent mothers are reluctant to breastfeed their newborn infants in the clinical setting
due to multiple factors. As a result of these concerns, breastfeeding rates in adolescent mothers
have suffered. Bandura’s theory of self-efficacy is applicable to this prevalent clinical issue.
Interventions can be created and implemented in order to motivate adolescent mothers to
breastfeed and increase their self-confidence with respect to breastfeeding. Nurses and healthcare
professionals can play a vital role in aiding adolescent mothers to breastfeed so as to promote
better long-term health among that segment of the population as well as in newborn infants. At
the same time, this will also positively affect the economic issue associated with breastfeeding.
As a result of the leadership role of nurses and other healthcare professionals, breastfeeding
rates among adolescent mothers will continue to soar.
Keywords: adolescents, mothers, reluctance to breastfeed, self-efficacy, nurses role
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BREASTFEEDING SELF-EFFICACY
Breastfeeding Self-efficacy
Background
Adolescents’ reluctance to breastfeed their newborn infants is a problem that is seen too
often in the clinical setting. According to Pentecost and Grassley (2014), the Healthy People
2020’s breastfeeding goal is to increase the rate of newborn infants that have attempted to
breastfeed to 82% and to increase the rate of those who continue to exclusively breastfeed after
three months to 46%. However, adolescent mothers have not been able to meet this goal, as
studies show that sixty percent of adolescent mothers attempted to breastfeed their newborn
infants and only 18% continue to exclusively breastfeed after three months (Pentecost &
Grassley, 2014). Many factors and concerns of adolescent mothers contribute to low
breastfeeding rates. Adolescent mothers state that they have not received the proper teaching in
the clinical setting on how to breastfeed; furthermore, they feel they do not have the support
from their families, friends or even hospital staff. So, with this overwhelming evidence, nurses
need to take an active role in trying to be the support that these young moms need.
There are tremendous health and economic benefits associated with breastfeeding for
both infants and their adolescent mothers. Infants of adolescent mothers have a higher risk of low
birth weight, preterm delivery and neonatal mortality; therefore, breastfeeding can be beneficial
in order to remediate some of these medical issues and provide healthier outcomes for the abovementioned infants (Woods, Chesser, & Wipperman, 2013). Support from family as well as from
healthcare providers and nursing staff as well as educating adolescent mothers properly are all
vital in order to encourage breastfeeding among this population of mothers and maximize its
longevity and benefits.
Problem Statement
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BREASTFEEDING SELF-EFFICACY
Adolescent mothers are reluctant to breastfeed their newborn infants.
Significance
Each year, 425,000 adolescents give birth and only 43% of adolescent mothers have
attempted to breastfeed (Grassley & Sauls, 2012). This statistic is significantly lower than adults,
ages 20 to 30 that give birth each year. It is noted that, 65% of women ranging from ages 20 to
29 initiated breastfeeding while women 30 and older had 75% participation in initiating
breastfeeding (Grassley & Sauls, 2012). Ultimately, infants and mothers are affected by this
problem. Formula fed infants are at a higher risk of developing infectious morbidity within their
first year of age (Stuebe, 2009). Breast milk contains immune factors that protect the infant
against infection such as oligosaccharides, which prevent the binding of respiratory pathogens to
respiratory tissue (Stuebe, 2009). The glycoproteins in breast milk prevent the attachment of
intestinal pathogens as well, which protects against Vibrio cholera, Escherichia coli, and
rotavirus (Stuebe, 2009). Formula fed infants are twice as likely to develop otitis media in the
first year of life compared to infants who were exclusively breastfed for more than three months
(Stuebe, 2009). Research shows that formula fed infants or infants that were fed breast milk and
supplemented with formula, were 2.8 times more likely to have gastrointestinal infections
compared to those infants who were exclusively breastfed (Stuebe, 2009). Formula fed preterm
infants are at a 5% risk for developing Necrotizing Enterocolitis, a condition where, 15% of the
cases are fatal (Stuebe, 2009). Since adolescents have a 15.7% chance of having preterm infants,
this is an important statistic (Apostolakis-Kyrus, Valentine, & DeFranco, 2013).
Studies show that infants that are not breastfed are at a 32% higher risk of becoming
obese (Grassley & Sauls, 2012). It is evident through research that due to factors associated with
breastfeeding, Sudden Infant Death Syndrome (SIDS) is less prevalent in breastfed infants rather
BREASTFEEDING SELF-EFFICACY
5
than infants that are formula fed (Stuebe, 2009). Infant feedings are closely related to cognitive
development as well. It is noted in various studies that those infants that were exclusively
breastfed for 4 to 6 months crawled and walked sooner than those who were formula fed (Stuebe,
2009). Furthermore, infants at 6.5 years of age scored 7.5 points lower in verbal IQ scores when
compared to children that were breastfed (Stuebe, 2009). Hospitals that fully support
breastfeeding can have a positive impact on neurodevelopment in school age children as well as
their overall quality of life in terms of health and intelligence.
There are several health risks for all mothers attributed to not breastfeeding as well. It is
noted that women that do not breastfeed have a higher chance of developing premenopausal
breast cancer as well as ovarian cancer (Stuebe, 2009). Breastfeeding may help to lose weight
gain throughout pregnancy (Stuebe, 2009). Mothers who breastfeed tend to have lower glucose
levels, lipid metabolism, and blood pressure (Stuebe, 2009).
This problem has a significant effect on medical costs for both mothers and the United
States government. It is discussed that if 90 percent of U.S. families would exclusively
breastfeed for six months, the U.S. would be able to save $13 billion each year due to lowered
direct and indirect costs as well as costs of premature deaths in infants (Grasley & Sauls, 2012).
The mothers would not incur hospital or doctors’ cost as often, due to decreased chances of
developing illnesses and other health conditions for both them and their infants. It is essential to
note that mothers who breastfeed save on average $1500 to $2500 per year (Kennedy, 2000).
Since socioeconomic stability is one of the reasons why adolescent mothers do not initiate
breastfeeding, it is important to explain to adolescent mothers the health advantages of
breastfeeding as well as its benefits associated with cost containment (Apostolakis-Kyrus,
Valentine, & DeFranco, 2013).
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BREASTFEEDING SELF-EFFICACY
Specific Aims
In the healthcare setting, it is necessary for nurses and healthcare professional to address
the current concerns of adolescent mothers when it comes to breastfeeding their newborn infants.
Many mothers lack confidence and motivation, which ultimately, affects their breastfeeding
duration and longevity. Implementation of several interventions in the clinical setting is essential
for breastfeeding rates in adolescent mothers to peak. Arming mothers with the knowledge,
support, encouragement, and resources that they need can help to motivate adolescent mothers to
successfully breastfeed.
Theory/Conceptual Framework/Model
Bandura explains that theory of self-efficacy refers to one’s judgment of their ability to
perform competently and effectively a given task in a given situation (Entwistle, Kenall, &
Mead, 2010). The purpose of this middle range theory is to describe how an individual acquires
the belief to change certain behaviors in order to achieve desired outcomes (Bandura, 2004).
According to Bandura (2004), self-efficacy is the basis of human motivation and action. If one
does not believe that they can change their behaviors and achieve desired effects by their actions,
they will not be encouraged or motivated to act when faced with challenges (Bandura, 2004).
The major concepts of the theory are clearly specified and are at the middle range level.
Furthermore, the concepts are sufficient enough to explain the phenomenon and the concepts as
well as the relationships between them are explained in a model (Smith, 2014). The two major
concepts of this theory are self-efficacy expectations and outcome expectations (Resnick, 2014).
Self-efficacy expectations are an individual’s beliefs about their capabilities to achieve a given
task while outcome expectations refer to the end result if the given task is achieved (Resnick,
2014).
BREASTFEEDING SELF-EFFICACY
7
Bandura suggests that there are four major factors that influence self-efficacy judgment.
Enactive attainment refers to the performance of the behavior (Resnick, 2014). Vicarious
experience is being able to see others perform the same task successfully (Resnick, 2014). Verbal
persuasion or encouragement can be influential because one needs to feel as if they have the
ability to master the given task effectively (Resnick, 2014). It is important to note that
physiological feedback, or how an individual feels during a behavior, may influence their
performance of a behavior (Resnick, 2014). Consequently, these four factors, which influence
self-efficacy judgment can be altered through education and intervention by healthcare providers
(Pollard & Guill, 2009). Furthermore, Bandura explains how there is a direct relationship
between an individual’s self-efficacy behavior and outcome expectations (Resnick, 2014).
However, there are other factors to consider when analyzing changes in behavior other than a
person’s expectations (Resnick, 2014). Ultimately, the theory of self-efficacy helps to understand
an individual’s behavior and aids in creating interventions in order to affect a behavior change
(Resnick, 2014). Bandura’s theory of self-efficacy has been used in nursing care in order to help
patient’ s participate in health promoting activities and maximize results (Resnick, 2014).
Application to the Theory to Clinical Problem
Studies have shown that there is a positive relationship between the theory of selfefficacy and breastfeeding success (Pollard & Guill, 2009). Performance attainment, in this case,
successful breastfeeding, is most influential on one’s self-efficacy beliefs (Entwistle, Kendall, &
Mead, 2010). Studies showed that mothers who scored higher on the Breastfeeding Self-Efficacy
Scale breastfed for a longer duration (Pollard & Guill, 2009). In order for adolescent mothers to
successfully breastfeed, it is necessary for nurses and other healthcare professionals to assist in
BREASTFEEDING SELF-EFFICACY
8
providing education and interventions to aid these young mothers (Mossman, Heaman, Dennis,
& Morris, 2008).
First, nurses need to ensure that the information and resources provided are of an
appropriate literacy level in order for the adolescent mothers to use the materials to their benefit
(Kennedy, 2000). For example, adolescent parenting programs or breastfeeding classes at the
hospital could be a valuable resource for breastfeeding help and encouragement (Tucker, Wilson,
& Samandari, 2011). In the clinical setting, nurses can talk about the benefits of breastfeeding as
well as teach these young mothers how to correctly position their infant and obtain a good latch
in order to avoid pain and discomfort; consequently, this will lead to a more positive
breastfeeding experience for the mother (Sauls & Grassley, 2011). Giving patients free formula
during their hospital stay has contributed to low breastfeeding rates; therefore, it is imperative for
nurses to eliminate this habit in order to support mothers who want be successful in
breastfeeding their newborn infants (Woods, Chesser, & Wipperman, 2013).
Studies have shown that adolescents have perceived a lack of support from their families,
friends, and healthcare professionals, throughout their breastfeeding process (Tucker, Wilson, &
Samandari, 2011). Intrapartum nurses play a crucial role in initiating breastfeeding as well as a
source of support throughout the process. Within the first hour, it is recommended for the infant
to be placed skin to skin with the mother and initiate breastfeeding (Grassley & Sauls, 2012).
This is a vital step in facilitating effective suckling and successful feeding patterns (Grassley &
Sauls, 2012). In addition, nurses can provide appraisal support. Praising and encouraging
adolescent mothers’ breastfeeding tactics and techniques can increase their self-confidence and
promote the longevity of breastfeeding (Pentecost & Grassley, 2013). Furthermore, including the
patients’ family and partner in the teaching of breastfeeding may be effective since most
BREASTFEEDING SELF-EFFICACY
9
adolescent mothers say that support from their families and partners is essential in their
breastfeeding success or failure.
The use of a breastfeeding self-efficacy workbook among mothers in Baby-Friendly and
non-Baby-Friendly hospitals showed an important clinical finding in regards to breastfeeding
self-efficacy (Otsuka, Taguri, Dennis, Wakutani, Awano, Yamaguchi, & Jimba, 2014). Despite
the fact that mothers in the non-Baby-Friendly hospital used the workbook more frequently and
thoroughly, this intervention did not significantly affect breastfeeding self-efficacy scores in nonBaby-Friendly hospitals (Otuska et. al, 2014). This shows the importance of knowledge and
support from nurses and healthcare staff and how the hospital routine can deter the development
of breast-feeding self-efficacy even if the mothers are willing and motivated to improve their
breastfeeding self-efficacy (Otuska et. al, 2014). The breastfeeding self-efficacy workbook
could be useful in helping to enhance breastfeeding self-efficacy and improve breastfeeding
exclusivity among adolescent mothers. Using the Breastfeeding Self-Efficacy Scale could be a
valuable assessment tool in the clinical setting as well as in helping to predict and assess a
mother’s self-efficacy beliefs (Schlickau & Wilson, 2005). It could also help to recognize those
who may be at risk for early weaning (Pollard & Guill, 2009). This tool could assist healthcare
professionals to further develop more interventions to help adolescent mothers successfully
breastfeed and increase their self-confidence (Entwistle, Kendall, & Mead, 2010).
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BREASTFEEDING SELF-EFFICACY
Summary and Conclusions
Adolescent mothers’ unwillingness to breastfeed their newborn infant is an extremely
prevalent problem seen often in clinical practice. Many times, these young mothers have several
concerns that shy them away from breastfeeding such as lack of knowledge on how to
breastfeed, discomfort, fatigue or lack of support from family, friends, and healthcare staff. It is
essential to note that breastmilk has several health benefits for both the mothers and their
newborn infants. Furthermore, there are several economic benefits associated with breastfeeding
as well. Adolescent mothers need to be educated on the importance of breastfeeding as well as
the tremendous benefits associated with this process. Ultimately, nurses and healthcare
professionals have the power and the necessary tools and resources, to instill the necessary selfconfidence and motivation these young mothers need to become successful in facilitating and
maintaining breastfeeding as well as nurturing its longevity.
Bandura’s theory of self-efficacy is extremely relevant and applicable to the issue of
breastfeeding and therefore, has been used in the clinical setting to help patients engage in health
promoting activities. At the same time, this theory allows for healthcare workers such as nurses
and other healthcare providers to gain a better understanding of an individual’s behavior and
perceptions regarding breastfeeding as well as to help pinpoint and create interventions, in order
to change adolescent mothers’ perceptions and behaviors so as to achieve the necessary desired
outcomes and optimize results. To further improve an adolescent mother’s self-efficacy in
breastfeeding, several interventions need to be put into place and actually implemented.
Ultimately, the use of these interventions can help to increase breastfeeding rates among
adolescent mothers; consequently, promoting infant health, improving adolescent mothers’ long
term health benefits and influencing the issue of economics.
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BREASTFEEDING SELF-EFFICACY
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