UCD School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, D04 V1W8, Ireland.
UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin 2, D02 YH21, Ireland.
Int J Behav Nutr Phys Act. 2024 Sep 2;21(1):95. doi: 10.1186/s12966-024-01641-3.
Breastfeeding self-efficacy is a woman's self-belief and confidence in her perceived ability to breastfeed. This modifiable determinant is strongly associated with breastfeeding initiation, exclusivity, and duration. It is unclear how important the timing of breastfeeding self-efficacy measurement and interventions are. The prenatal period appears underexplored in the literature and yet a prenatal focus provides increased opportunity for breastfeeding self-efficacy enhancement and further potential improvement in breastfeeding outcomes. This scoping review aims to synthesise the evidence on prenatal breastfeeding self-efficacy, describing for the first time the theoretical frameworks, measurement tools, and interventions used in the prenatal period.
8 databases were searched using the PCC framework (Problem: breastfeeding, Concept: self-efficacy, Context: prenatal period). From 4,667 citations and 156 additional sources identified through grey literature and snowballing, data were extracted from 184 studies and 2 guidance documents. All were summarised descriptively and narratively.
Just over half (57%) of included studies stated their theoretical underpinning, with Bandura's Self-Efficacy Theory / Dennis' Breastfeeding Self-Efficacy Framework predominant. Only half of intervention studies incorporated theory in their design. More intervention studies were undertaken in the past decade than previously, but the level of theoretical underpinning has not improved. Prenatal interventions incorporating theory-led design and using components addressing the breadth of theory, more frequently reported improving breastfeeding self-efficacy and breastfeeding outcomes than those not theory-led. Intervention components used less frequently were vicarious or kinaesthetic learning (52.5%) and involvement of social circle support (26%). The Breastfeeding Self-Efficacy Scales were the most common measurement tool, despite being designed for postpartum use. Overall, issues were identified with the late prenatal timing of breastfeeding self-efficacy investigation and the design, content and phraseology of measurements and interventions used in the prenatal period.
This review provides novel insights for consideration in the design and conduct of breastfeeding self-efficacy studies in the prenatal period. Future research should aim to be theory-led, commence earlier in pregnancy, and embed the breadth of self-efficacy theory into the design of interventions and measurement tools. This would provide more robust data on prenatal breastfeeding self-efficacy's role in impacting breastfeeding outcomes.
母乳喂养自我效能感是指女性对自己母乳喂养能力的自我信念和信心。这个可改变的决定因素与母乳喂养的开始、排他性和持续时间密切相关。目前尚不清楚测量和干预母乳喂养自我效能感的时间点有多重要。产前阶段在文献中似乎研究不足，但关注产前阶段为增强母乳喂养自我效能感和进一步改善母乳喂养结果提供了更多机会。本范围综述旨在综合有关产前母乳喂养自我效能感的证据，首次描述了产前阶段使用的理论框架、测量工具和干预措施。
使用 PCC 框架（问题：母乳喂养，概念：自我效能感，背景：产前阶段）在 8 个数据库中进行搜索。从 4667 条引文和通过灰色文献和滚雪球法额外确定的 156 条来源中，从 184 项研究和 2 份指导文件中提取数据。所有数据均进行了描述性和叙述性总结。
超过一半（57%）的纳入研究陈述了其理论基础，其中班杜拉的自我效能理论/丹尼斯的母乳喂养自我效能框架占主导地位。只有一半的干预研究在设计中纳入了理论。过去十年中开展的干预研究比以往任何时候都多，但理论基础的水平并没有提高。纳入理论设计并使用涵盖理论广度的组成部分的产前干预措施，比非理论导向的干预措施更频繁地报告改善母乳喂养自我效能感和母乳喂养结果。使用较少的干预组成部分是替代性或动觉学习（52.5%）和社交圈支持的参与（26%）。母乳喂养自我效能量表是最常用的测量工具，尽管它是为产后使用而设计的。总体而言，在产前母乳喂养自我效能感调查的时间点、产前阶段使用的测量和干预措施的设计、内容和措辞方面都存在问题。
本综述为在产前阶段进行母乳喂养自我效能感研究的设计和实施提供了新的见解。未来的研究应旨在以理论为指导，在妊娠早期开始，并将自我效能理论的广度纳入干预措施和测量工具的设计中。这将为产前母乳喂养自我效能感对影响母乳喂养结果的作用提供更有力的数据。
