Date of Award

Spring 2010

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Leona VandeVussee

Second Advisor

Lisa Hanson

Third Advisor

Sandra Millon-Underwood

Abstract

Breast milk is the optimal form of nutrition for infants up to six months of age. Commercial formula is unequal to breast milk nutritionally, economically, and psychologically. African American women (AAW) continue to breastfeed the least compared to other populations. Few researchers conducting research related AAW's infant feeding preferences have employed the Black Feminist philosophy or the theory of self-efficacy. This philosophy and theory may offer insight into factors that influence AAW's infant feeding choices.

The purpose of this mixed-method study was to examine prenatal breastfeeding self-efficacy (confidence) and actively listen to and analyze AAW's reports of factors influencing their infant feeding choice. Fifty-nine AAW in their 3rd trimester of pregnancy completed a Prenatal Self-Efficacy questionnaire. Three to four weeks postpartum, 17 women were re-contacted and participated in individual narrative interviews.

Prenatal self-efficacy scores for women who intended to breastfeed were significantly higher (M = 82.59, SD =12.53) than those intending to bottle-feed (M = 70, SD 15.45), p = .001. Prenatal self-efficacy was predictive of intended feeding method (p = .004). During the individual postpartum interviews, women disclosed various reasons and personal explanations of how they arrived at their infant feeding choices. Four of the themes from the narrative were parallel to Bandura's (1977) four sources of self efficacy: performance accomplishments, verbal persuasions, vicarious experiences, and physiological responses. Two additional themes were identified: social embarrassment and feelings of regret. Women's actual feeding method was not always reflective of their feeding intention. Of the 11 women interviewed planning to breastfeed, seven were actually breastfeeding at 3-4 weeks postpartum. The levels of breastfeeding varied among the women. Seventy-one percent of the breastfeeding mothers reported using < 1 bottle of formula per day. In previous studies, self-efficacy has been shown to have an effect on infant feeding initiation, and duration among AAW. The current studied examined prenatal self-efficacy during the prenatal period. The prenatal period is a favorable time for providers to evaluate breastfeeding self-efficacy. Then appropriate teaching may begin based on the mother's confidence. The Black Feminist perspective revealed there is more to learn from AAW regarding their infant feeding decisions.

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