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Aim: The aim of this study was to determine the factors associated with breastfeeding self-efficacy among postnatal women in Kampala, Uganda. Methods: This was a descriptive cross-sectional study that was conducted among women attending a postnatal clinic at a teaching hospital in Kampala. Three hundred and eighty-four postnatal women were randomly selected to respond to an interviewer-administered questionnaire. We used the Breastfeeding Self-Efficacy scale (BFSES) to assesses breastfeeding self-efficacy (BFSE). Descriptive statistics and percentages were used to summarize the findings. Bivariate and multivariate logistic regressions were used to determine predictors of BFSE. Results: Participants had a mean BFSE score of 48.65. The 14 item BFSES consistently measured breastfeeding confidence with a Cronbach’s alpha of 0.89. About six in 10 women (60.2%) had high BFSE, the rest (39.8%) had low BFSE. Having a partner (adjusted odds ratio (aOR): 13, 95% CI 3.46–15) and receiving breastfeeding support from health workers (aOR: 4.45, 95% CI: 1.95–6.12) were significantly associated with BFSE. Conclusion: A notable number of mothers had a low BFSE. Health workers should support breastfeeding mothers to achieve the desired exclusive breastfeeding levels. Relevance to clinical practice: The findings of the study provide a direction for midwives in maternity care in educating and supporting women about breastfeeding for the improvement of exclusive breastfeeding rates thus realization of benefits of exclusive breastfeeding.
This cross‐sectional study was conducted to determine factors associated with BFSE of postnatal mothers. The study was carried out on postnatal units in a teaching hospital in Kampala, Uganda. The facility is one of the largest hospitals in the country offering maternal and child health services including antenatal, postnatal and special care for new born babies. The hospital has an official bed capacity of 1,790 beds. The postnatal section of this Hospital admits an average 100 mothers per day. The study population included women who had delivered either normally or by caesarean birth. The study included women who voluntarily consented to participate in the study. Women who had birth complications and those who were too sick to participate in the study were excluded. We used Epi‐info version 7 to calculate the samples size based on a consideration of a two‐tailed significance level, an (alpha) of 0.05, an expected frequency of low BFSE of 50% and a 95% confidence level. Based on these considerations, we enrolled a total of 384 postnatal mothers. We conceptualized BFSE as the mother’s confidence in her ability to breastfeed her baby. This conceptualization was based on the theorization of Dennis in his BFSE theory (Dennis, 1999). Based on this theory, Dennis and Faux developed the BFSE (Dennis & Faux, 1999) which was tested among 130 Canadian women. The original 43 item version of BFSE has since been reduced to 14 items through rigorous methodological studies and found to be valid and reliable in China (Dai and Dennis, 2003), in Poland (Wutke & Dennis, 2007) and in Australia (Creedy et al., 2003). In the present study, BFSE was operationalized as a summated score on the 14‐item version. The scale is anchored on a 5‐point liker scale where 1 indicates not at all confident and 5 indicates very confident. The total score on this scale ranges from 14–70 and higher scores correspond to higher levels of breastfeeding confidence. The internal consistency of the BFSES in this study was 0.89, with a Median score of 52. Participants with scores equal to or more than 50 were considered to have higher BFSE, and those with scores below 50 were considered to have low BFSE (Wutke & Dennis, 2007. In addition, we solicited information about; age, marital status, tribe, level of education, employment status, average monthly income, parity, social support, previous breastfeeding experience and health facility related variables form each participant. We randomly selected the participants from the postnatal clinic by writing numbers corresponding to total number of mothers admitted on the ward on pieces of paper. The pieces of paper were then placed in the containers and mixed thoroughly. Twenty pieces of paper were then picked without replacement; mothers corresponding to the picked pieces of paper were then approached and asked to participate in the study. Mother who accepted to participate in the study were then provided with detailed information, those who consented were then asked to respond to questions about their breastfeeding practices, social demographics and BFSE. Data collection was conducted in one of the rooms at the ward by two trained research assistants. We conducted data analysis using SPSS version 23 statistical software. The levels of BFSE were computed by summing the 14 items of the BFSES. As proposed by (Wutke & Dennis, 2007), we categorized mothers with scores of 50 or more as having high BFSE and those with scores <50 as having low BFSE. We then conducted bivariate analysis and generated crude odds ratios with corresponding 95% confidence intervals (CI). Following bivariate analysis, variables with p‐values of 0.2 or more and those that we deemed plausible were considered for the multivariate binary logistic regression model. The significance level was set at 0.05 and all p‐values were two tailed. Research Ethics committee approval was sought and secured from Makerere University School of Health Sciences Ethics Review Committee (SHSREC REF 2015‐047) and administrative approval from the hospital. Permission was also obtained from the postnatal unit head nurses. Written informed consent was also obtained from the study participants after provision of information about the study. Participants were assured of confidentiality and privacy by assigning them with numbers instead of names, and it was indeed maintained throughout the study. Participants had the liberty to withdraw from the study at any time, and this did not affect their access to the services at the clinic.
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