Sample characteristics
The study sample consisted of 332 mothers of macrosomia (148 from breastfeeding group and 184 from non-breastfeeding group) (table 1), with a response rate of 100%. In breastfeeding group, the mean age is 30.92 ± 4.07, and mean age is 30.92 ± 4.07 in non-breastfeeding group, with no significant differences between the groups (Table 1). The samples delivery times are no significant differences between the groups (Table 1). However, compared with two or more deliveries patients, the breastfeeding rate of patients with single delivery was 44.04%, which shows that 10% higher than two or more deliveries patients. The education background are no significant differences between the groups (Table 1). Meanwhile, the breastfeeding rate of patients with bachelor degree or above was 41.67%, and that of patients with other education was 48.57%, which shows that the education level is inversely proportional to the breastfeeding rate. There was no significant difference in monthly income between the two groups (Table 1.).
Breastfeeding knowledge, attitude, self-efficacy and social support scores in the study
Knowledge scores ranged between 11 and 17 in the over-all sample, with the mean score (14.87 ± 1.59), and the midpoint of the knowledge scale is 36.75% (39.86% in breastfeeding group and 34.78% in Non-breastfeeding) (Table 2). The mean score of breastfeeding group was 15.11 ± 1.13, and that of non-breastfeeding group was 14.67 ± 1.84, which was significant difference between the two groups, P < 0.05. There was no difference in breastfeeding skills between the two groups, however, the advantages of breastfeeding shown a significant difference between the two groups (11.04 ± 0.91 in breastfeeding group and 10.36 ± 1.85 in Non-breastfeeding), P < 0.01. Most of the high-scoring items on the knowledge scale pertained to maternal breastfeeding benefits. For example, 98.65% and 94.57% of participants in breastfeeding group and non-breastfeeding group, respectively, were aware of the decreased risk of ovarian cancer or mammary gland diseases with breastfeeding. Similarly, more than 80% of the participants (90.54% in breastfeeding group and 80.43% non-breastfeeding group) believed that “breastfeeding can prevent infant rickets”. However, part of participants in non-breastfeeding group lacked knowledge of nutrition of breast milk, such as breast milk can fully meet the nutritional needs of 6-month-old babies without adding any food and beverages. In addition, only 69.57% of non-breastfeeding participants believed that “breastfeeding can prevent childhood obesity,” while 91.89% of breastfeeding participants convinced that.
Attitude scores ranged between 49 and 73 in the overall population, with a mean score of 62.25 ± 5.46 and with 47.89% of study participants scoring above the midpoint of the scale (43.24% in breastfeeding group and 44.57% in Non-breastfeeding) (Table 2). The Cronbach’s α reliability estimate was 0.63. The mean score of attitude scale in breastfeeding group was 63.35 ± 4.07, and that of non-breastfeeding group was 61.37 ± 6.25, which was no significant difference between the two groups, P > 0.05. The most majority of participants (71.4% and 73.2%, respectively) perceived breastfeeding could increase the intimacy of mother and infant (95.41% and 94.75%, respectively). However, over half participants (68.92% and 59.35%, respectively) perceived "Milk powder to facilitate breast milk recovery". Although most participants were aware of the long-term benefits of breastfeeding, approximately 36.49% of breastfeeding group and 22.83% of non-breastfeeding participants believed “Milk powder is more convenient”. Only less participants (6.76% and 9.78%, respectively) believed that women should not breastfeed in public. In addition, more than 90% of participants (96.37% in breastfeeding group and 97.12% in non-breastfeeding group) stated that drinking alcohol occasionally is not suitable for breastfeeding.
Scores pertinent to perceived self-efficacy ranged between 14 and 70 for the overall population. The Cronbach’s α reliability estimate was 0.50. The total mean score was 46.39 ± 10.72, with 50.00% of participants scoring above the midpoint (Table 2). On the self-efficacy scale, the mean score of breastfeeding group was 50.50 ± 10.60, and that of non-breastfeeding group was 46.91 ± 11.87, which was significant difference between the two groups, P < 0.05. Among the self-efficacy scale, the number of breast-feeding group with 56 ≤ score < 70 was 36.49%, which was significantly higher than that of non-breastfeeding group (23.91%). Most low-scoring items (which reflect a negative confidence toward breastfeeding) pertained to make sure the baby get enough breast milk. The minority of participants stated they could ensure breast milk supply is adequate (47.30% and 42.39%, respectively). Furthermore, only approximately 32.43% of non-breastfeeding participants stated that they could ensure the baby is getting enough breast milk. In addition, close to half of participants stated they always satisfied with breastfeeding situation (47.30% and 38.04%, respectively).
Social support scores ranged between 31 and 54 in the overall sample. The Cronbach’s α reliability estimate was 0.64. The total mean score (45.27 ± 4.53) exceeded the midpoint of the scale, with 45.18% of participants scoring above the midpoint (Table 2). Over half of participants (55.41% and 53.26%, respectively) stated that they “have more than 3 friends who can get support and help,” although up to 95% in both groups supported from family members. In addition, 52.70% of breastfeeding participants often ask for help from family members, friends and organizations when they are in trouble, while only 39.13% in non-breastfeeding participants always ask for help.
With respect to both group differences, the mean knowledge score (15.11 ± 1.13 in breastfeeding group and 14.67 ± 1.84 in non-breastfeeding group) and the proportion of subjects scoring above the midpoint of the knowledge scale (39.86% vs. 34.78%) were significantly higher among participants from breastfeeding group than among those from non-breastfeeding group. In contrast, mean attitude score (63.35 ± 4.07 in breastfeeding group vs. 61.37 ± 6.25 in non-breastfeeding group) and the proportion of subjects scoring above the midpoint of the scale (43.24% vs. 44.57%) were significantly higher among participants from breastfeeding group than among those from non-breastfeeding group (Table 2). No significant differences were noted with respect to self-efficacy and social support.
Association between knowledge, attitude, self-efficacy and social support
Significantly higher knowledge scores were observed among participants with young women (15.19 ± 0.99 vs. 14.67 ± 1.67, p < 0.05) (Table 3). And there was no significant difference in knowledge among respect of delivery times, educational background and monthly household income. Mean attitude scores were significantly higher among breastfeeding participants who have higher education background (64.13 ± 3.98 vs. 62.44 ± 4.00, p < 0.05) (Table 3), while there was no significant difference in attitude scale among respect of age, delivery times and monthly household income. Mean self-efficacy scores were significantly higher among breastfeeding participants who have delivery twice and above (43.88 ± 8.25 vs. 49.15 ± 9.77, p < 0.001) (Table 3), and there was no significant difference in self-efficacy scale among respect of age, educational background and monthly household income. No significant differences were noted in social support with respect to age, delivery times, educational background and monthly household income.
Correlation analysis showed that, the knowledge to breastfeed was significantly negatively correlated with age, whereas in other characters these associations did not reach statistical significance (Table 3). On the other hand, breastfeeding behavior was found to be significantly positively correlated with educational background, implying that a more positive breastfeeding with young women who have high educational background. In both groups, behavior to breastfeeding was not associated with social support to breastfeed, but a significant association was found between delivery times and self-efficacy in breastfeeding.