Using Knowledge, Attitude, And Practice Model And Theory Of Planned Behavior To Understand Pregnant Women's Colostrum Feeding

Background Colostrum feeding(CF)is the first critical period for breastfeeding.However,influenced by certain old concepts or customs and dairy products promotion,pregnant or parturient Chinese women have certain misconceptions on colostrum.CF rate is not high in certain regions of China.CF was even lower than 10% in some areas.Several studies on CF and their influencing factors are currently available.Factors associated with CF of pregnant women in China have not been clarified sufficiently and lack in-depth study of theoretical models.Objective This study explores the knowledge,attitudes,intentions to CF,first feeding,and influencing factors,such as sociodemographic factors,cognition,attitudes,important people(husband,mother,father,mother-in-law,father-in-law,friends,colleagues,and relatives).CF health education is conducted by organizations or institutions,sources of CF knowledge using knowledge,attitudes,and practices(KAP)model and theory of planned behavior(TPB)among pregnant women in China.Results reflect pregnant women's knowledge,attitudes,and intentions to CF,first feeding,and influencing factors in China.This study providesreference and theoretical basis for the future development of CF health education and improve CF rate.Method In 2015,a cross-sectional study using a questionnaire among pregnant women was carried out in 16 hospitals in five provinces of mainland China(Chongqing,Chengdu,Zunyi,Liaocheng,and Tianjin).The analysis included 2,245 pregnant women(aged 18–45 years old),among which 75.4% is of pregnant women in the first pregnancy and24.6% of second pregnancies.This study adopted a questionnaire based on KAP model and TPB.Participants' characteristics were summarized using either the means and standard deviations or frequencies and percentages,which were presented using descriptive analysis.Chi-square test or Fisher's exact test,Pearson correlation analysis,univariate logistic regression analysis,and multivariate logistic regression analysis were employed in this study.Results1.Knowledge of colostrumThe total score of colostrum knowledge among all pregnant women,women in their first and second pregnancies was 50.55 ± 24.15,50.75 ±24.13,and 49.95 ± 24.20,respectively.The score of basic colostrum knowledge among all pregnant women,women in their first and second pregnancies was 14.47 ± 9.32,14.54 ± 9.38,and 14.26 ± 9.12,respectively.The score of CF knowledge among all pregnant women,women in theirfirst and second pregnancies was 36.08 ± 17.46,36.21 ± 17.39,and 35.70 ±17.71,respectively.Regarding the knowledge level of colostrum among all participants,the excellent,good,and fail level rates of colostrum were10.5%,17.5%,13.1%,59.0%,respectively.A total of 980(57.9%)women in their first pregnancy and 344(62.2%)women in their second pregnancy belong to the fail level of colostrum knowledge.Among all participants,1,117(66.02%)women in the first and 378(68.35%)women in their second pregnancy are found in the fail level of basic colostrum knowledge.In the fail level of CF knowledge,833(49.2%)women in the first and 278(50.3%)women in the second pregnancy were found.Multivariate logistic regression analysis find pregnant women,who are the only child with high education level,actively learn knowledge about colostrum,participate in counseling training,including CF content,obtain colostrum knowledge through the Internet,newspapers,magazines or books in the third trimester.They are aware of CF health education through medical institutions,education and training institutions,and non-governmental organizations.Other organizations or institutions do not likely belong to the fail level.2.Source of CF knowledge and awareness of CF health education conducted by organizations or institutionsAmong all participants,sources of obtaining colostrum-related information were from the Internet(58.8%),family members or relatives orfriends(45.8%),medical staff(45.3%),newspapers or magazines or books(34.4%),training institutions(27.5%),television or radio(26.5%),and other sources(6.4%).Among all participants,the awareness rate of CF health education conducted by organizations or institutions was as follows: medical institutions(70.3%),training institutions(60.4%),non-governmental organizations(22.9%),other organizations or institutions(10.7%),and government health agencies(9.3%).3.CF beliefApproximately 55.7% of women in their first pregnancy and 62.2%women in the second pregnancy had confidence to conduct CF.By contrast,26.2% women in their first pregnancy and 37.5% women in the second pregnancy did not perceive colostrum insufficiency.Multivariate logistic regression analysis found pregnant women actively learned about colostrum knowledge,participated in counseling training,including colostrum content.Women with good support from important people had confidence to conduct CF.Multivariate logistic regression analysis found pregnant women who were uncertain about the method of delivery,had average or dissatisfactory self-evaluation of colostrum knowledge were not that confident to conduct CF.Multivariate logistic regression analysis found pregnant women in their second pregnancy with medium or high income,those who weremarried,and those with good support from important people did not perceive colostrum insufficiency.4.Pearson correlation analysisAdditional methods to acquire colostrum knowledge had a statistically significant correlation with high-level cognition of colostrum knowledge,basic colostrum knowledge,and CF knowledge.Further awareness of organizations or institutions that conduct CF health education had a statistically significant correlation with the high-level cognition of colostrum knowledge,basic colostrum knowledge,and CF knowledge.5.Intention to CF and first feeding colostrumApproximately 69.4% of participants(72.3% urban pregnant women vs.57.6% rural pregnant women)wanted to feed their babies with colostrum immediately after birth.Approximately 19.1% would provide boiled water,3.6% would give infant formulas,and 2.8% would feed sugar water as first feed of babies.Multivariate logistic regression analysis of KAP model on intention to CF found that pregnant women with high knowledge level of CF and strong level colostrum-related belief were willing to do CF.The same analysis was conducted for TPB on intention to CF.Results found pregnant women who have positive attitude toward CF and good support from important people on CF were willing to CF.Multivariate logistic regressionanalysis of KAP model on intention to first feeding colostrum found pregnant women with high knowledge level on the benefits of composition,properties of colostrum,and CF were willing to feed their babies with colostrum immediately after birth.Multivariate logistic regression analysis of TPB on intention to first feeding colostrum found that pregnant women with positive attitude toward CF and strong subjective norms on CF were willing to feed their babies with colostrum immediately after birth.6.Important people influencing CF behaviorImportant people who could influence pregnant women's CF behavior include husband(44.6%),mother(37.0%),mother-in-law(31.6%),father(30.3%),father-in-law(28.0%),friends(27.8%),relatives(24.8%),and colleagues(24.6%).Pregnant women's self-perception of important people who support CF behavior was as follows: husband(89.3%),mother(87.9%),father(85.1%),mother-in-law(84.6%),father-in-law(82.6%),friends(79.6%),relatives(78.8%),and colleagues(78.2%).7.Willingness to learn colostrum knowledge through medical staffPregnant women's willingness to learn colostrum knowledge through medical staff among all pregnant women,women in their first pregnancy and second pregnancy was 83.6%,85.9%,and 76.7%,respectively.Multivariate logistic regression analysis on willingness to learn colostrum knowledge through medical staff found that pregnant womenwho participated in counseling training,including colostrum content,had dissatisfactory self-evaluation of knowledge of colostrum,with good support from important people,awareness of CF health education conducted by medical institutions,and sources of obtaining colostrum-related knowledge through medical staff were willing to learn colostrum knowledge through medical staff.However,women in their second pregnancy were not willing to learn colostrum knowledge through medical staff.8.Willingness to learn colostrum knowledge through social media,such as Weibo and WeChatPregnant women's willingness to learn colostrum knowledge through social media,such as Weibo and WeChat among all pregnant women,women in the first and second pregnancy was 80.1%,81.7%,and 75.1%,respectively.Multivariate logistic regression analysis on willingness to learn colostrum knowledge through social media found that pregnant women from Level 3A hospital,mid-pregnancy,late-pregnancy,those who obtained colostrum knowledge through the Internet,with good support from important people,were willing to learn colostrum knowledge through social media,such as Weibo and WeChat.However,women in their second pregnancy with average self-evaluation of knowledge of colostrum were not very willing to learn colostrum knowledge through social media,suchas Weibo and WeChat.ConclusionBreastfeeding practices are well-known to mothers but basic colostrum knowledge and the benefits of colostrum feeding are still understood poorly in China.The main sources of obtaining colostrum-related knowledge among pregnant women were from the Internet,family members or relatives or friends,and medical staff.About half of pregnant women in the first pregnancy and 60% of pregnant women had confidence in CF.Approximately 20% of pregnant women in the first pregnancy and 30% of pregnant women in the second pregnancy did not perceive colostrum insufficiency.Approximately 90% of women in the first pregnancy and women in the second pregnancy had intentions to CF.Approximately 70% of pregnant women wanted to feed their babies with colostrum immediately after birth.Approximately 80% of pregnant women were willing to learn colostrum knowledge through medical staff and social media,such as Weibo and WeChat.Pregnant women with high level cognition of CF or colostrum-related beliefs agree to CF.Pregnant women with positive attitude toward CF and good support from important people on CF were willing to CF.Pregnant women with high knowledge level cognition on the benefits of composition and CF,as well as the properties of colostrum were willing to feed their babies with colostrum immediately after birth.Pregnant women withpositive attitude toward CF and strong subjective norms on CF were willing to feed their babies with colostrum immediately after birth.This study relied on certain references to set up the publicity and communication platform of colostrum feeding,such as traditional(newspapers or magazines or books)and new media(micro-blog and WeChat)to establish the information exchange platform for colostrum feeding and promote the communication between the medical staff and pregnant women.Health education of colostrum knowledge was also carried out for the important people in the lives of pregnant women(such as husband,mother,and mother-in-law)This study applied the KAP model and TPB theory to the study of colostrum feeding behavior to explain and interfere with colostrum feeding behavior to improve the feeding rate of colostrum.This study also promoted the construction of baby-friendly hospitals under the policy of new universal two-child policy and valuable reference for implementing the policy of breastfeeding.