Self-efficacy in breastfeeding mothers of term and preterm born infants

Abstract: Breast milk is beneficial for all infants, but especially for infants born preterm and optimizing breastfeeding can enhance health outcomes. Despite this, breastfeeding duration has declined in more than twenty years in Sweden and even more among preterm infants. Mothers’ self-efficacy is a modifiable factor that can affect breastfeeding duration and Breastfeeding Self-efficacy Scale-Short Form (BSES-SF) has been tested in several countries in order to identify mothers with low self-efficacy in breastfeeding, however, the scale has not been validated for a Swedish sample. Moreover, there is a need for evidence-based breastfeeding support programs adapted for the healthcare professionals (HCPs) working with mothers of preterm infants.A first aim of the present thesis was to psychometrically test the BSES-SF among mothers to both term- and preterm infants and to examine whether self-efficacy predicts breastfeeding duration. A secondary aim was to evaluate a breastfeeding support program based on Baby-Friendly Hospital Initiative for Neonatal Intensive Care (Neo-BFHI) and to describe HCPs’ experiences of the program.Papers I and II show potential for BSES-SF to be used in research with the aim to identify mother’s self-efficacy in breastfeeding. In Paper III findings reveal that self-efficacy predicts the mother’s adaptation to the infant. This is an important finding as the mother's adaptation to the infant is closely related to the theories of bonding and attachment. Paper IV describes and evaluates a training program for neonatal intensive HCPs based on Neo-BFHI’s ten steps to successful breastfeeding, with main results indicating that the training program was appreciated by the HCPs. In Paper V, we constructed and evaluated an instrument that measures the attitudes to breastfeeding and skin-to-skin contact among neonatal intensive care units’ HCPs. Findings suggest that the instrument could be used to evaluate future Neo-BFHI interventions to improve breastfeeding duration as well as HCPs’ support and skills.The main conclusion of this thesis is that mothers’ low self-efficacy in the early phase can be an important predictor for shorter breastfeeding duration. The breastfeeding training program was regarded as relevant and useful according to different HCPs categories and was shown to increase the HCPs’ interest in breastfeeding and provide them with tools for improved breastfeeding support. The program is designed in a way that makes it easy to copy and spread to other neonatal intensive care units in Sweden and it can also be used for newly employed HCPs.