title: Factors influencing first-time mothers' introduction of complementary foods: a qualitative exploration.
abstract: BACKGROUND
  Optimal infant nutrition comprises exclusive breastfeeding, with complementary foods introduced from six months of age. How parents make decisions regarding this is poorly studied. This study begins to address the dearth of research into the decision-making processes used by first-time mothers relating to the introduction of complementary foods.
  
  
  METHODS
  This qualitative explorative study was conducted using interviews (13) and focus groups (3). A semi-structured interview guide based on the Theory of Planned Behaviour (TPB). The TPB, a well-validated decision-making model, identifies the key determinants of a behaviour through behavioural beliefs, subjective norms, and perceived behavioural control over the behaviour. It is purported that these beliefs predict behavioural intention to perform the behaviour, and performing the behaviour. A purposive, convenience, sample of 21 metropolitan parents recruited through advertising at local playgroups and childcare centres, and electronically through the University community email list self-selected to participate. Data were analysed thematically within the theoretical constructs: behavioural beliefs, subjective norms and perceived behavioural control. Data relating to sources of information about the introduction of complementary foods were also collected.
  
  
  RESULTS
  Overall, first-time mothers found that waiting until six months was challenging despite knowledge of the WHO recommendations and an initial desire to comply with this guideline. Beliefs that complementary foods would assist the infants' weight gain, sleeping patterns and enjoyment at meal times were identified. Barriers preventing parents complying with the recommendations included subjective and group norms, peer influences, infant cues indicating early readiness and food labelling inconsistencies. The most valued information source was from peers who had recently introduced complementary foods.
  
  
  CONCLUSIONS
  First-time mothers in this study did not demonstrate a good understanding of the rationale behind the WHO recommendations, nor did they understand fully the signs of readiness of infants to commence solid foods. Factors that assisted waiting until six months were a trusting relationship with a health professional whose practice and advice was consistent with the recommendations and/or when their infant was developmentally ready for complementary foods at six months and accepted them with ease and enthusiasm. Barriers preventing parents complying with the recommendations included subjective and group norms, peer influences, infant cues indicating early readiness and food labelling inconsistencies.
authors.affiliation: School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology Kelvin Grove, Brisbane, 4059, Queensland, Australia. am.walsh@qut.edu.au.
authors.forename: Anne
authors.initials: A
authors.lastname: Walsh
authors.affiliation: School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs campus, Sippy Downs, 4556, Queensland, Australia. lkearney@usc.edu.au.
authors.forename: Lauren
authors.initials: L
authors.lastname: Kearney
authors.affiliation: School of Exercises and Nutrition Science, Institute of Health and Biomedical Innovation, Royal Children's Hospital Brisbane, Brisbane, Queensland, Australia. murray.nl@gmail.com.
authors.forename: Nicole
authors.initials: N
authors.lastname: Dennis
mesh_terms: D001942:Breast Feeding / Q000706:statistics & numerical data*; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D006801:Humans; D007223:Infant; D007225:Infant Food / Q000706:statistics & numerical data*; D033182:Intention; D007407:Interviews as Topic; D008297:Male; D009035:Mothers; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D036301:Qualitative Research