Volume 28, Issue 4 (Fall 2020)                   Avicenna J Nurs Midwifery Care 2020, 28(4): 84-91 | Back to browse issues page

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Aghababaei S, Khodakarami B, Farhadian M, Kamali M. Effectivness of Counseling on Mother's Breastfeeding Self-Efficacy. Avicenna J Nurs Midwifery Care 2020; 28 (4) :84-91
URL: http://nmj.umsha.ac.ir/article-1-2189-en.html
1- Maternal and Child Care Center, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
2- Department of Biostatistics, Faculty of Health, Hamadan University of Medical Sciences, Hamadan, Iran
3- Department of Midwifery and Maternal and Child Health, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran , m.kamali1396@yahoo.com
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✅ The results of the study showed that providing counseling has been very effective in increasing the self-efficacy of breastfeeding mothers and their performance.

Extended Abstract:   (1337 Views)

Breastfeeding improves the survival, health and growth of all children and helps develop human capital [1]. The World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) recommend breastfeeding for all infants from birth to six months, and support and continue breastfeeding by supplementation until infancy is two years old. [2]. Despite the obvious benefits and numerous public health activities to promote breastfeeding, the rate of exclusive breastfeeding is low. According to UNICEF, the global average of exclusive feeding in infants under six months is 41% [3]. Among the effective factors on increasing breastfeeding are the mother's knowledge, support systems, social and economic status and self-efficacy of the mother in breastfeeding [7, 8]. According to Bandura’s theory, with appropriate educational interventions, mothers' self-efficacy and ability to breastfeed can be increased [11]. The present study was conducted to investigate the effect of breastfeeding counseling on the self-efficacy of lactating mothers.


Materials and Methods

This study was conducted as a two-group clinical trial on 60 pregnant women referred to Malayer women's hospitals.
This number of samples was calculated by the following formula:

Pregnant women were selected by available sampling method. Sampling was performed in two groups by block random method and the size of the blocks was considered as a multiple of the number of groups. Data collection tools included a demographic and midwifery characteristics questionnaire and a Fox and Dennis breastfeeding self-efficacy questionnaire. The intervention was carried out in accordance with GATHER's advisory principles. Maternal breastfeeding self-efficacy was assessed before intervention and one month after delivery in both groups.
To analyze the data SPSS statistical software version 23 (SPSS Inc., Chicago, Ill., USA), was used as well as descriptive statistics such as frequency table, mean and standard deviation and inferential statistics such as Chi-square, independent t-test, paired t-test and Fisher's exact test. The level of significance was considered 5%.



The research units in the two control and test groups were homogeneous in terms of demographic characteristics. The change in mothers' breastfeeding self-efficacy score after intervention was significantly higher than before in test group (P<0.001).

Table 1. Comparison of the frequency distribution of demographic characteristics of primiparous women in the experimental and control groups in terms of demographic and midwifery variables
Variable Control group
Test group
Test P
Frequency (%) Frequency (%)
Education High school (20.0) 6 (26.6) 8 X2= 1.566
Diploma (33.3) 10 (30.0) 9
University (46.7) 14 (43.3)13
Job Employed (33.3) 10 (23.3) 7 X2= 0.739 0.390
Unemployed (66.7) 20 (76.7) 23
History of abortion Positive (43.3) 13 (36.7) 11 X2= 0.278 0.597
Negative (56.7) 17 (63.3) 19
Type of delivery Normal (53.3) 16 (66.7) 20 X2= 1.111 0.292
Cesarean section (46.7) 14 (33.3) 10
Satisfaction with the sex of the baby Positive (76.7) 23 (83.3) 25 X2= 0.089 0.766
Negative (23.3) 7 (16.7) 5
Spouse support has it (60.0) 18 (70.0) 21 X2= 3.750 0.157
does not have (40.0) 12 (30.0) 9
Family income (Tomans) Less than 1 million (6.6) 2 (3.33) 1 *5.245 0.851
1 to 2 million (16.6) 5 (23.3) 7
More than 2 million to 3 million (40.0)12 (33.3) 10
More than 3 million (36.6)11 (40.0)12
Table 2. Comparison of mean breastfeeding self-efficacy scores in primiparous women, before and after the intervention between the test and control groups
Variable / group Control group
Test group
Breastfeeding self-efficacy Before intervention 79.06 ± 8.13 83.43 ± 16.13 0.193 a
After the intervention 116.23 ± 13.02 86.40 ± 13.37 a 0.001 <
* Significance at the level of 0.05, a an independent t-test
Table 3. Comparison of mean breastfeeding self-efficacy scores in primiparous women, before and after intervention in each test and control group
Variable / group Before intervention After the intervention P
Breastfeeding self-efficacy
Test group
79.06 ± 8.13 116.23 ± 13.02 a 0.001 <
Control group
83.43 ± 16.13 86.40 ± 13.37 0.496 a
a an independent t-test


The results showed that breastfeeding self-efficacy of mothers before the intervention in both test and control groups was moderate to poor, but after the intervention, a significant increase in breastfeeding self-efficacy was observed in the test group. It seems that the poor awareness of mothers at the beginning of the study is due to the lack of adequate and necessary training. Providing regular and planned education in the present study increased the level of mothers' self-efficacy towards breastfeeding. The results of a study by O'Campo et al., which was performed on 198 pregnant women, showed that breastfeeding self-efficacy is one of the most important and influential variables in the duration of breastfeeding that predicts its duration. Findings of their study showed that women with poor self-efficacy were 3.1 times more likely to stop breastfeeding [23].
Studies on breastfeeding self-efficacy in Iran are limited and few reports have been published in this field. The study of Parsa et al. showed the effect of educational intervention on increasing self-efficacy and continuity of breastfeeding, which is consistent with the findings of the present study [24]. The results of the study of Varaei et al. showed that breastfeeding self-efficacy was significantly associated with breastfeeding status [25]. In a study by McQueen et al. studies by Moafi et al. and Glassman et al. also showed the effect of educational intervention on increasing breastfeeding self-efficacy, which is consistent with the findings of the present study [28, 27]. The study of Saba et al. showed that face-to-face training is effective in increasing mothers' awareness and their performance in breastfeeding their children [29]. Also, in the study of Mete et al. breastfeeding self-efficacy should be considered as an important and effective factor in increasing the duration and level of breastfeeding and a criterion for assessing mothers at risk of early breastfeeding.
Holding educational classes can increase awareness and change the attitude of learners, which is consistent with the present study [32, 31]. Therefore, it is necessary for health care workers to teach mothers the correct information and training related to breastfeeding in breastfeeding promotion classes. It is recommended that educational programs for mothers begin in late pregnancy and continue for at least 6 months after the baby is born. One of the limitations of conducting research is the short time of the study and the loss of samples.



The results of the study showed that providing counseling has been very effective in increasing the self-efficacy of breastfeeding mothers and their performance.



The authors of this article express their gratitude to the Vice Chancellor for Research of Hamadan University of Medical Sciences, the staff of Dr. Gharazi and Mehr Malayer hospitals, and the mothers who participated in the study, who facilitated the research with their cooperation. This article is taken from the Master’s thesis of Counseling and Midwifery of the School of Nursing and Midwifery of Hamadan University of Medical Sciences with the code of ethics IR.UMSHA.REC.1397.483.


Conflicts of Interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.


Type of Study: Original Research | Subject: Midwifery
Received: 2020/05/17 | Accepted: 2020/05/26 | Published: 2020/11/23

1. Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016; 387(10017):475-90. [DOI:10.1016/S0140-6736(15)01024-7]
2. Qasem W, Fenton T, Friel J. Age of introduction of first complementary feeding for infants: a systematic review. BMC Pediat. 2015; 15(1):107. [DOI:10.1186/s12887-015-0409-5] [PMID] [PMCID]
3. Unicef. Improving child nutrition: the achievable imperative for global progress. New York: Unicef. 2013:1-14.
4. Olang B, Farivar K, Heidarzadeh A, Strandvik B, Yngve A. Breastfeeding in Iran: prevalence, duration and current recommendations. Int Breastfeed J. 2009; 4(1):8. [DOI:10.1186/1746-4358-4-8] [PMID] [PMCID]
5. Nayeri F, Shariat M, Dalili H, Raji F, Karimi A. The ministry of health IR of Iran, breastfeeding office. J Pediat. 2007; 5(2).
6. World Health Organization (WHO). Global nutrition targets 2025: Stunting policy brief. New York: World Health Organization; 2014.
7. Lawal AM, Idemudia ES. Examining maternal age, breastfeeding self-efficacy and health locus of control in psychological wellbeing of mothers. Psych Health Med. 2017; 22(10):1230-8. [DOI:10.1080/13548506.2017.1317824] [PMID]
8. Mirghafourvand M, Kamalifard M, Ranjbar F, Gordani N. Relationship of breastfeeding self-efficacy with quality of life in Iranian breastfeeding mothers. J Mat-Fet Neonat Med. 2018; 31(20):2721-8. [DOI:10.1080/14767058.2017.1354368] [PMID]
9. O'Brien M, Buikstra E, Hegney D. The influence of psychological factors on breastfeeding duration. J Adv Nurs. 2008; 63(4):397-408. [DOI:10.1111/j.1365-2648.2008.04722.x] [PMID]
10. Dennis CLE. Identifying predictors of breastfeeding self‐efficacy in the immediate postpartum period. Res Nurs Health. 2006; 29(4):256-68. [DOI:10.1002/nur.20140] [PMID]
11. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psych Rev. 1977; 84(2):191. [DOI:10.1037/0033-295X.84.2.191] [PMCID]
12. Aghababaei SRB, Bahmanzadeh M. Effects of breastfeeding education among primiparous women referring to Fathemieh hospital in Hamadan, Iran. Sci J Hamadan Nurs Midwifery Fac. 2009; 17(12):41-51.
13. Keramat A, Masoumi S, Shobeiri F, Raei M, Andarzgoo M, Babazadeh R. Effectiveness of educational program related to persuade women for breast feeding based on theory of planned behavior (TPB). Sci J Hamadan Nurs Midwifery Fac. 2013; 21(2):21-31.
14. Tol A, Majlesi F, Shojaeizadeh D, Esmaelee Shahmirzadi S, Mahmoudi Majdabadi M, Moradian M. Effect of the educational intervention based on the health belief model on the continuation of breastfeeding behavior. J Nurs Edu. 2013; 2(2):39-47.
15. Laanterä S, Pölkki T, Ekström A, Pietilä AM. Breastfeeding attitudes of Finnish parents during pregnancy. BMC Preg Childbirth. 2010; 10(1):79. [DOI:10.1186/1471-2393-10-79] [PMID] [PMCID]
16. Sherriff N, Hall V, Panton C. Engaging and supporting fathers to promote breast feeding: A concept analysis. Midwifery. 2014; 30(6):667-77. [DOI:10.1016/j.midw.2013.07.014] [PMID]
17. Dai X, Dennis CL. Translation and validation of the breastfeeding self‐efficacy scale into Chinese. J Midwifery Women Health. 2003; 48(5):350-6. [DOI:10.1016/S1526-9523(03)00283-6]
18. Tohotoa J, Maycock B, Hauck Y, Howat P, Burns S, Binns C. Supporting mothers to breastfeed: the development and process evaluation of a father inclusive perinatal education support program in Perth, Western Australia. Health Prom Int. 2010; 26(3):351-61. [DOI:10.1093/heapro/daq077] [PMID]
19. Bich T, Cuong N. Changes in knowledge, attitude and involvement of fathers in supporting exclusive breastfeeding: a community-based intervention study in a rural area of Vietnam. Int J Pub Health. 2016; 1(2):1-10.. [DOI:10.1007/s00038-016-0882-0] [PMID]
20. Kohan SH, Keshvari M, Dolati A. Promoting breastfeeding empowerment in primiparous women: effect of family centered education and support. Daneshvar (medicine) Shahed Univ. 2016; 125(1):51-9.
21. Dennis CL. Theoretical underpinnings of breastfeeding confidence: a self-efficacy framework. J Human Lact. 1999; 15(3):195-201. [DOI:10.1177/089033449901500303] [PMID]
22. Hasanpoor S, Bani S, Ansari S, Ebrahimi H. Measuring breastfeeding self-efficacy among pregnant women referred to health centers of Ahvaz. Nurs Midwifery J. 2010; 5(19):53-47.
23. O'Campo P, Faden RR, Gielen AC, Wang MC. Prenatal factors associated with breastfeeding duration: recommendations for prenatal interventions. Birth. 1992; 19(4):195-201. [DOI:10.1111/j.1523-536X.1992.tb00402.x] [PMID]
24. Parsa P, Boojar A, Roshanei G, Bakht R. The Effect Breastfeeding Counseling On Self-Efficacy And Continuation Breastfeeding Among Primiparous Mothers: A Randomized Clinical Trial. Scientific J Hamadan Nurs Midwifery Fac. 2016; 8(2):98-104.
25. Varaei S, Mehrdad N, Bahrani N. The Relationship between Self-efficacy and Breastfeeding, Tehran, Iran. Hayat. 2009; 15(3):31-8.
26. McQueen K, Sieswerda LE, Montelpare W, Dennis CL. Prevalence and factors affecting breastfeeding among Aboriginal women in Northwestern Ontario. J Obst Gynecol Neonat Nurs. 2015; 44(1):51-68. [DOI:10.1111/1552-6909.12526] [PMID]
27. Moafi F, Momeni M, Yeke Falah Z, Asgari S, Hajnasiri H. Assessment of Breastfeeding Self-Efficacy and Patterns and its Predictors in Mothers Living in Qazvin Province. J Urmia Nurs Midwifery Fac. 2018; 15(10):777-87.
28. Glassman ME, McKearney K, Saslaw M, Sirota DR. Impact of breastfeeding self-efficacy and sociocultural factors on early breastfeeding in an urban, predominantly Dominican community. Breastfeed Med. 2014; 9(6):301-7. [DOI:10.1089/bfm.2014.0015] [PMID] [PMCID]
29. Saba M, Bazm Amoun H, Razavi Z. Comparison of face to face education with other methods to pregnant mothers in increase exclusive breast feeding. Sci J Hamadan Univ Med Sci Health Serv. 2005; 12(3):42-7.
30. Mete S, Yenal K, Okumuş H. An Investigation into Breastfeeding Characteristics of Mothers Attending Childbirth Education Classes. Asia Nurs Res. 2010; 4(4):216-26. [DOI:10.1016/S1976-1317(11)60006-6]
31. Seighali F, Fallahi M, Farahani Z. The effect of breastfeeding workshop on attitude, knowledge and practice of participants. Razi J Med Sci. 2014; 21(118):92-101.
32. 32 Aghababaei S, Bakht R, Bahmanzadeh M. Effects of breastfeeding education among primiparous women referring to Fathemieh hospital in Hamadan, Iran. Sci J Hamadan Nurs Midwifery Fac. 2009; 17(12):41-51.

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