title: The extended Theory of Planned Behavior in explaining exclusive breastfeeding intention and behavior among women in Kelantan, Malaysia.
abstract: OBJECTIVE
  The purpose of this study is to utilize an extended Theory of Planned Behavior in identifying predictors of exclusive breastfeeding intention and behavior among women in Kelantan, Malaysia.
  
  
  METHODS
  A prospective cohort study was conducted, recruiting pregnant womenthrough two-stage cluster sampling. Their exclusive breastfeeding intention, attitude, perceived norm, perceived behavioral control and past behavior were obtained at baseline through interviewer-guided questionnaire. At one month after delivery, another interview was conducted to determine the two additional variables in the extended theory, which were their postpartum support and breastfeeding difficulty. The behavior, which was the actual duration of exclusive breastfeeding, was obtained from the second follow-up at six months. Pearson correlation and two hierarchical regression analyses were conducted.
  
  
  RESULTS
  A total of 200 women completed the study follow-up. Their median intended exclusive breastfeeding duration was 4.0 (IQR 5) months, and the median actual duration was 1.0 (IQR 4) month. The Theory of Planned Behavior explained 51.0% of the variance in intention, with perceived behavioral control and attitude were the significant predictors. It also explained 10.0% of the variance in behavior, but the addition of postpartum support and breastfeeding difficulty increased the amount of explained variance in behavior by 6.0%. The significant predictors of exclusive breastfeeding behavior were intention, postpartum support and breastfeeding difficulty.
  
  
  CONCLUSIONS
  The extended Theory of Planned Behaviorhad a good predictive ability in explaining exclusive breastfeedingintention and behavior. The women's intention to practice exclusive breastfeeding may be improved by improving their perceived behavioral control and attitude. Providing correct postpartum support and skills to handle breastfeeding difficulties after delivery will improve their exclusive breastfeeding behavior.
authors: Department of Community Medicine, School of Medical Sciences, UniversitySains Malaysia, Health Campus, 16150 KubangKerian, Kelantan, Malaysia.
authors: Tengku Alina
authors: TA
authors: Tengku Ismail
authors: School of Health Sciences, UniversitySains Malaysia, Health Campus, 16150 KubangKerian, Kelantan, Malaysia.
authors: Wan Abdul Manan
authors: WA
authors: Wan Muda
authors: School of Health Sciences, UniversitySains Malaysia, Health Campus, 16150 KubangKerian, Kelantan, Malaysia.
authors: Mohd Isa
authors: MI
authors: Bakar
keywords: Exclusive breastfeeding; Theory of Planned Behavior; breastfeeding difficulty; postpartum support