Factors associated with breastfeeding knowledge and attitudes among non-pregnant, nulliparous women of reproductive age: A scoping review

Problem and background: Although breastfeeding has well-established benefits for both mothers and infants, global rates remain suboptimal. Knowledge and attitudes are key factors associated with breastfeeding outcomes and identifying the factors that shape these before pregnancy can guide initiatives to improve breastfeeding rates. Aim: This scoping review aimed to map factors associated with breastfeeding knowledge and attitudes in nonpregnant, nulliparous women of reproductive age. Method: In line with PRISMA-ScR and the Joanna Briggs Institute methodology, the Population, Concept, and Context framework was applied to identify factors affecting breastfeeding knowledge and attitudes. A comprehensive search across SCOPUS, MEDLINE, Web of Science, Cochrane Library, CINAHL, and Embase was conducted. Data were extracted using a standardised form, and methodological quality was assessed. A narrative synthesis was performed to summarise the findings. Findings: The review included 37 studies from 22 countries, primarily focusing on university students. Breastfeeding knowledge varied, with some studies reporting moderate to high levels, while others reported lower levels. Most participants had positive attitudes, though a few were neutral or negative. Key associated factors included education, exposure to breastfeeding, age, cultural norms, and socioeconomic status. Higher education and exposure to breastfeeding information were associated with better knowledge and attitudes, while the relationship with socioeconomic status showed mixed results. Conclusion: This review highlights the multifactorial nature of breastfeeding knowledge and attitudes. Interventions before pregnancy are crucial to improving breastfeeding outcomes. Further research is needed, particularly in regions with low breastfeeding rates.