title: Promoting positive attitudes to breastfeeding: the development and evaluation of a theory-based intervention with school children involving a cluster randomised controlled trial.
abstract: The objective of this study was to design, implement and evaluate an intervention based on the theory of planned behaviour (TPB) to enhance young peoples' motivations to breastfeed/support a partner to breastfeed. Six semi-structured focus groups were first conducted with 48 13-14-year-olds from two schools in Northern Ireland. The salient beliefs elicited were subsequently used to design a TPB-based questionnaire that was then administered to 2021 13-14-year-old pupils (852 males; 1169 females) from 36 post-primary schools to identify the most important determinants of breastfeeding. The results were used to inform the design and implementation of an intervention package that was subsequently evaluated using a cluster randomised controlled trial involving 44 randomly selected schools across Northern Ireland. Questionnaires were administered to 18 intervention and 26 control schools at baseline and again at 1 and 6 months post-intervention to evaluate its effectiveness. Multi-level modelling was employed to analyse the data. The results revealed significant effects on women's intention to breastfeed, β = 0.208, t(1275) = 2.715, P = 0.007; attitudes, β = 0.223, t(1275) = 4.655, P < 0.001; moral attitudes, β = 0.231, t(1275) = 4.211, P < 0.001; subjective norm, β = 0.118, t(1275) = 2.521, P = 0.012; and knowledge, β = 0.109, d.f. (1275) = 7.843, P < 0.001. However, for men, the results revealed significant effects on only the construct of knowledge, β = 0.104, t(541) = 4.345, P < 0.001.The research has provided evidence to support the need for breastfeeding education in schools and has shown how a theoretical framework may be used to inform the design and evaluation of a health behaviour intervention.
authors.affiliation: School of Psychology, University of Ulster, Coleraine, UK.
authors.forename: Melanie
authors.initials: M
authors.lastname: Giles
authors.affiliation: UKCRC Centre of Excellence for Public Health NI, Institute of Clinical Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queens University, Belfast, UK.
authors.forename: Samantha
authors.initials: S
authors.lastname: Millar
authors.affiliation: School of Psychology, University of Ulster, Coleraine, UK.
authors.forename: Cherie
authors.initials: C
authors.lastname: Armour
authors.affiliation: School of Psychology, University of Ulster, Coleraine, UK.
authors.forename: Carol
authors.initials: C
authors.lastname: McClenahan
authors.affiliation: School of Psychology, University of Ulster, Coleraine, UK.
authors.forename: John
authors.initials: J
authors.lastname: Mallett
authors.affiliation: School of Biomedical Sciences, University of Ulster, Coleraine, UK.
authors.forename: Barbara
authors.initials: B
authors.lastname: Stewart-Knox
mesh_terms: D000293:Adolescent; D001942:Breast Feeding / Q000523:psychology*; D016000:Cluster Analysis; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009042:Motivation; D009660:Northern Ireland; D015397:Program Evaluation; D011795:Surveys and Questionnaires
keywords: breastfeeding; health intervention; theory of planned behaviour
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