Effects of a theory of planned behavior-based intervention on breastfeeding behaviors after cesarean section: A randomized controlled trial

Objectives: To examine the efficacy of an intervention based on the theory of planned behavior (TPB) in improving breastfeeding behavior among women with cesarean sections (C-sections). Methods: This research was a randomized controlled trial. Women with planned elective C-sections were recruited to participate in a randomized controlled trial between June and September 2020. One hundred thirty-two women were divided randomly into the intervention (n = 66) and control group (n = 66) by systematic random sampling. In the intervention group, an intervention project was implemented after the C-section to establish positive breastfeeding attitudes, cultivate supportive subjective norms, enhance perceived behavioral control, and strengthen breastfeeding intention to change behaviors. Those in the control group received routine pre-and post-delivery care. Exclusive breastfeeding rate and breast problem were collected at 5 days, 2 weeks, and 1 month after C-section. The modified Breastfeeding Attrition Prediction Tool (BAPT) on the first day in the hospital, two weeks, and one month after C-section and Numerical Rating Scale (NRS) 24 h postoperatively were used to compare the intervention effect between the two groups. Results: After the intervention, the intervention group had significantly higher exclusive breastfeeding rates than the control group at five days (86.4% vs. 60.6%), two weeks (77.3% vs. 57.6%), and one month (74.2% vs. 50.0%) after the C-section. Besides, the intervention group was less likely to have sore nipples at five days (6.1% vs. 18.2% in the control group, P < 0.05) and two weeks (9.1% vs. 12.1% in the control group, P < 0.05). After two weeks of intervention, attitude scores (90.64 +/- 8.31 vs. 87.20 +/- 8.15, P < 0.05), subjective norm scores (88.07 +/- 24.65 vs. 79.42 +/- 19.47, P < 0.05)and behavior control scores in the intervention group were significantly higher than those in the control group. After one month of intervention, attitude scores (90.34 +/- 10.35 vs. 84.22 +/- 10.51, P < 0.05) and behavior control scores (43.13 +/- 5.02 vs. 39.15 +/- 4.69, P < 0.05)in the intervention group were significantly higher than those in the control group, which resulted in the higher breastfeeding intention in the intervention group. Conclusion: This study indicated that the TPB-based interventions effectively improved women's breastfeeding behaviors after C-sections. (c) 2021 The authors. Published by Elsevier B.V. on behalf of the Chinese Nursing Association. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).