title: Breastfeeding attitude, health-related quality of life and maternal obesity among multi-ethnic pregnant women: A multi-group structural equation approach.
abstract: BACKGROUND
  Identifying the factors influencing breastfeeding attitude is significant for the implementation of effective promotion policies and counselling activities. To our best knowledge, no previous studies have modelled the relationships among breastfeeding attitude, health-related quality of life and maternal obesity among multi-ethnic pregnant women; the current study attempts to fill this research gap.
  
  
  OBJECTIVE
  This study investigated the relationships among maternal characteristics, health-related quality of life and breastfeeding attitude amidst normal weight and overweight/obese pregnant women using a multi-group structural equation modelling approach.
  
  
  METHODS
  Exploratory cross-sectional design was used.
  
  
  METHODS
  Antenatal clinics of a university-affiliated hospital PARTICIPANTS: Pregnant women were invited to participate; 708 (78.8%) agreed to participate in the study.
  
  
  METHODS
  We examined a hypothetical model on the basis of integrating the concepts of a breastfeeding decision-making model, theory of planned behaviour-based model for breastfeeding and health-related quality of life model among 708 multi-ethnic pregnant women in Singapore. The Iowa Infant Feeding Attitude Scale and Medical Outcomes Study Short Form Health Survey were used to measure breastfeeding attitude and health-related quality of life, respectively.
  
  
  RESULTS
  Two structural equation models demonstrated that better health-related quality of life, higher monthly household income, planned pregnancy and previous exclusive breastfeeding experience were significantly associated with positive breastfeeding attitude among normal and overweight/obese pregnant women. Among normal weight pregnant women, those who were older with higher educational level were more likely to have positive breastfeeding attitude. Among overweight/obese pregnant women, Chinese women with confinement nanny plan were less likely to have positive breastfeeding attitude. No significant difference existed between normal weight and overweight/obese pregnant women concerning estimates of health-related quality of life on breastfeeding attitude (Critical Ratio=-0.193). The model satisfactorily fitted the data (Incremental Fit Index=0.924, Tucker-Lewis Index=0.905, Comparative Fit Index=0.921 and Root Means Square Error of Approximation=0.025). Health-related quality of life was found to affect breastfeeding attitude in multi-ethnic pregnant women.
  
  
  CONCLUSIONS
  This relationship implied the importance of early culturally specific interventions to enhance health-related quality of life for improving positive breastfeeding attitude among pregnant women across different ethnic groups.
authors.affiliation: Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Electronic address: nurly@nus.edu.sg.
authors.forename: Ying
authors.initials: Y
authors.lastname: Lau
authors.affiliation: Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Tha Pyai
authors.initials: TP
authors.lastname: Htun
authors.affiliation: Department of Obstetrics and Gynaecology, National University Hospital, Singapore.
authors.forename: Peng Im
authors.initials: PI
authors.lastname: Lim
authors.affiliation: Department of Obstetrics and Gynaecology, National University Hospital, Singapore.
authors.forename: Sarah Su Tin
authors.initials: SS
authors.lastname: Ho-Lim
authors.affiliation: Department of Obstetrics and Gynaecology, National University Hospital, Singapore.
authors.forename: Claudia
authors.initials: C
authors.lastname: Chi
authors.affiliation: Department of Rehabilitation, National University Hospital, Singapore.
authors.forename: Cammy
authors.initials: C
authors.lastname: Tsai
authors.affiliation: National University Hospital, Singapore.
authors.forename: Kai Wen
authors.initials: KW
authors.lastname: Ong
authors.affiliation: Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Piyanee
authors.initials: P
authors.lastname: Klainin-Yobas
mesh_terms: D000328:Adult; D001294:Attitude to Health; D001942:Breast Feeding / Q000523:psychology*; D005006:Ethnicity; D005260:Female; D006785:Hospitals, University; D006801:Humans; D009765:Obesity / Q000150:complications*; D011247:Pregnancy; D011248:Pregnancy Complications; D011788:Quality of Life
keywords: Breastfeeding attitude; Health-related quality of life; Multi-group structural equation modelling; Obesity; Overweight