Breastfeeding and the Theory of SelfEfficacy Christina Mellon

Breastfeeding and the Theory of Self-Efficacy Christina Mellon University of Central Florida

Background and Problem Statement • The Healthy People 2020’s breastfeeding goal is to increase the rate of newborn infants that have attempted to breastfeed to 82% and to increase the rate of those who continue to exclusively breastfeed after three months to 46% (Pentecost & Grassley, 2014). • Studies show that adolescent mothers have not been able to meet this goal, as only 60% of adolescent mothers attempted to breastfeed their newborn infants and only 18% continue to exclusively breastfeed after three months (Pentecost & Grassley, 2014). • Factors that contribute to low breastfeeding rates among adolescent mothers are: • • lack of proper teaching in the clinical setting • lack of support from family, friends, and hospital staff • lack of motivation or confidence Problem statement: Adolescent mothers are reluctant to breastfeed their newborn infants.

Significance • Infants of adolescent mothers have a higher risk of preterm delivery, low birth weight, and neonatal mortality (Woods, Chesser, & Wipperman, 2013). • Health risks attributed to not breastfeeding for both adolescent mothers and their newborn infants: • • Infants are at a higher risk for developing infectious morbidity, otitis media, respiratory infections, gastrointestinal infections, and Necrotizing Enterocolitis (Stuebe, 2009). • Mothers are at a higher risk for developing premenopausal breast cancer and ovarian cancer. Mothers who breastfeed have tend to have lower glucose levels, lipid metabolism and blood pressure (Stuebe, 2009) Economic benefits of breastfeeding for U. S. government and adolescent mothers: • If 90% of U. S. families would exclusively breastfeed for six months, the U. S. would be able to save $13 billion annually due to lowered direct and indirect costs as well as costs of premature deaths in infants (Grassley & Sauls, 2012). • Breastfeeding saves mothers $1500 to $2500 per year (Kennedy, 2000). • Less medical costs due to decreased chances of developing illness or other health conditions for both mom and baby.

Bandura’s Theory of Self-Efficacy • The theory describes how an individual acquires the belief to change certain behaviors in order to achieve desired outcomes (Bandura, 2004). • Two major concepts of theory: • Self-efficacy expectations: An individual’s beliefs about their capabilities to achieve a given task (Resnick, 2014). • Outcome expectations: An individual’s own judgments about what will be the end result if their given task once it has been successfully achieved (Resnick, 2014). • Sources of self-efficacy judgment: • Enactive attainment • Vicarious experience • Verbal persuasion • Physiological feedback (Resnick, 2014)

The Theory of Self-Efficacy and Adolescent Breastfeeding • Studies show that there is a positive correlation between theory of self efficacy and breastfeeding success (Pollard & Guill, 2009). • Research has shown that mothers that scored higher on the Breastfeeding Self- Efficacy Scale breastfed for a longer duration (Pollard & Guill, 2009). • In order for enactive attainment, in this case successful breastfeeding, to occur it is imperative for nurses and other healthcare professionals to assist in providing education and interventions to aid these young mothers (Mossman, Heaman, Dennis, & Morris, 2008).

Possible Nursing Interventions and Rationales • Nursing interventions that should be implemented in the clinical setting: • Make sure information and resources are of appropriate literacy level in order for adolescent mothers to use them for their benefit (Kennedy, 2000). • Provide teaching about benefits of breastfeeding, how to correctly position infant, and obtain a good latch. This will provide the mother with a more positive breastfeeding experience and less pain and discomfort (Sauls & Grassley, 2011). • Do not give free formula to breastfeeding mothers as it contributes to low breastfeeding rates (Woods, Chesser, & Wipperman, 2013). • Within the first hour place infant skin to skin and initiate breastfeeding which will help to create effective suckling and successful breastfeeding (Grassley & Sauls, 2012) • Praise and encourage adolescent mothers’ breastfeeding techniques by doing so, this will increase their self-confidence and promote longevity of breastfeeding (Pentecost & Grassley, 2013). • Include patient’s family and partner in breastfeeding teaching in order to promote support from loved ones.

Implementation Plan and Evaluation • • Implementation plan: • Have literature available regarding breastfeeding benefits and techniques. • Have necessary breastfeeding materials readily available such as breastfeeding pillows, breast pumps, nipple shields and breast pads. • Educate nurses on breastfeeding in order to teach and provide support for adolescent mothers. • Have lactation consultants available on hand via phone and outpatient classes for follow up. Evaluation plan: • Breastfeeding Self-Efficacy Scale could be used as a valuable assessment tool in the clinical setting to help to predict and assess an adolescent mother’s self-efficacy beliefs (Schlikau & Wilson, 2005). It may help to recognize those who may be at risk for early weaning (Pollard & Guill, 2009). • Follow up survey regarding the implementation of breastfeeding and its duration. • Have adolescent mothers come in for outpatient visit at 3 months and at 6 months to evaluate their progress and their needs.

Conclusion • Adolescent mothers’ unwillingness to breastfeed is a problem seen often in the clinical setting. • Nurses can play a vital role in providing the tools and resources necessary as well as help to instill the self confidence and motivation that adolescent mothers need in order to aid in successful breastfeeding and its longevity.

References • Bandura, A. (2004). Health promotion by social cognitive means. Health Education and Behavior, 31(2), 143 -164. doi: 10. 1177/1090198104263660 • Grassley, J. S. , & Sauls, D. J. (2012). Evaluation of the supportive needs of adolescents during childbirth intrapartum nursing intervention on adolescents' childbirth satisfaction and breastfeeding rates. JOGNN: Journal Of Obstetric, Gynecologic & Neonatal Nursing, 41(1), 33 -44. doi: 10. 1111/j. 1552 -6909. 2011. 01310. x • Kennedy, M. (2000). Teens and breastfeeding. International Journal of Childbirth Education, 15(2), 20 -22. • Mossman, M. , Heaman, M. , Dennis, C. , & Morris, M. (2008). The influence of adolescent mothers' breastfeeding confidence and attitudes on breastfeeding initiation and duration. Journal Of Human Lactation, 24(3), 268 -277. • Pentecost, R. , & Grassley, J. S. (2014). Adolescents' needs for nurses' support when initiating breastfeeding. Journal Of Human Lactation, 30(2), 224. doi: 10. 1177/0890334413510358 • Pollard, D. , & Guill, M. (2009). The relationship between baseline self-efficacy and breastfeeding duration. Southern Online Journal Of Nursing Research, 9(4). doi: 10. 1007/s 10995 -013 -1265 -2

References • Resnick, B. (2014). The theory of self-efficacy. In M. J. Smith and P. R. Liehr (eds). Middle range theory for nursing. (3 rd Ed) New York: Springer Publishing Company, Inc. • Sauls, D. J. , & Grassley, J. (2011). Development of the adolescent support model. Journal Of Theory Construction & Testing, 15(1), 24 -28. • Schlickau, J. M. , & Wilson, M. E. (2005). Breastfeeding as health-promoting behaviour for Hispanic women: literature review. Journal Of Advanced Nursing, 52(2), 200 -210. doi: 10. 1111/j. 1365 -2648. 2005. 03579. x • Stuebe, A. (2009). The risks of not breastfeeding for mothers and infants. Reviews of Obstetrics and Gynecology, 2(4), 222 -231. • Woods, N. , Chesser, A. K. , & Wipperman, J. (2013). Describing adolescent breastfeeding environments through focus groups in an urban community. Journal Of Primary Care & Community Health, 4(4), 307 -310. doi: 10. 1177/2150131913487380 •