Document Type : Original Article


Department of Health Education, Faculty of Health, Lorestan University of Medical Science, Lorestan, Iran


Background: Breastfeeding is the most natural and essential way for feeding newborn babies. This
is an ideal approach for physical and emotional development of babies, as well as for the recovery
of mothers. This study was aimed to determine the effect of breastfeeding education based on the
health belief model (HBM) toward primiparous women. Materials and Methods: In a case–control
group, quasi‑experimental study, 88 subjects were allocated in control and experimental groups.
Subjects who were assigned to the experimental group were provided a program consisting of
group education based on HBM during their prenatal period. Instrument for data gathering was
made by the researchers and standard questionnaire from Dennis and Faux for Breastfeeding
Self‑efficacy Scale (BSES). Baseline interviews were conducted before delivery and follow‑up
visits were conducted after 30 days and at the fourth month after delivery. Data were analyzed
using SPSS (version 16) with c2
, independent sample t‑tests, and paired t‑test. Results: Mean
age of pregnant women who participated in the study was 22 ± 3.29 years. After the program,
the experimental group had significantly better scores in terms of self‑efficacy, knowledge, and
attitude scores statistically. In the fourth month, the mean of child weight in the experimental group
was significantly higher than that of the control group (P=0.001) and exclusive breastfeeding
was significantly higher than in the control group (P=0.007). Conclusion: Prenatal education
in this study based on HBM was successful, and knowledge, attitude, self‑efficacy, and related
indicators improved. The necessity of producing standard education package and education
of pregnant mothers, especially in their first pregnancy, by health professionals is perceived.


1. Kang NM, Song Y, Hyun TH, Kim KN. Evaluation of the breastfeeding
intervention program in a Korean community health center. Int J
Nurs Stud 2005;42:409‑13.
2. American Academy of Pediatrics Work Group on Breastfeeding.
Breastfeeding and the use of human milk. Pediatrics 2005;115:496‑506.
3. Arenz S, Ruckerl R, Koletzko B, von Kries R. Breast‑feeding and
childhood obesity – a systematic review. Int J Obes Relat Metab
Disord 2004;28:1247‑56.
4. Grummer‑Strawn LM, Mei Z. Does breastfeeding protect against
pediatric overweight? Analysis of longitudinal data from the Centers
for Disease Control and Prevention Pediatric Nutrition Surveillance
System. Pediatrics 2004;113:81‑6.
5. Li C, Goran MI, Kaur H, Nollen N, Ahluwalia JS. Developmental
trajectories of overweight during childhood: Role of early life factors.
Obesity 2007;15:760‑71.
6. Hyun TS, Kang NM, Kim KN, Lim EY. The economics benefits of
breastfeeding. Korean J Community Nutr 2002;7:863‑71.
7. Labbok MH. Costs of not breastfeeding in the United States. ABM
news and views (Academy of Breastfeeding Medicine newsletter).
Vol. 1. 1995. p. 7.
8. Vieira GO, Silva LR, de O Vieira T. Child feeding and diarrhea
morbidity. J Pediatr (Rio J) 2003;79:449‑54.
9. Froozani MD, Permehzadeh K, Motlagh AR, Golestan B. Effect of
breastfeeding education on the feeding pattern and health of infants
in their first 4 months in the Islamic Republic of Iran. Bull World
Health Organ 1999;77:381-5. Available from: http://www.ncbi.nlm. [Last cited on 2012 April 06].
10. Hediger ML, Overpeck MD, Ruan WJ, Troendle JF. Early infant
feeding and growth status of US‑born infants and children aged
4–71 months: Analyses from the third National Health and Nutrition
Examination Survey, 1988–1994. Am J Clin Nutr 2000;72:159‑67.
11. Barton SJ. Infant feeding practices of low‑income rural mothers.
Am J Matern Child Nurs 2001;26:93‑7.
12. Centers for Disease Control and Prevention and Health Resources
and Services Administration. Maternal, infant and child health:
Breastfeeding, newborn screening, and service systems. Healthy
People 2010: Objectives for Improving Health. 2001. Available from:
htm#_Toc494699668 [Last cited on 2008 Sept 06].
13. Beheshteh O, Khalil F, Heidarzadeh A, Strandvik B, Yngve A.
Breastfeeding in Iran: Prevalence, duration and current
recommendations. Int Breastfeeding J 2009;4:8. Available from:
[last cited on 2012 April 06].
14. Khabazkhoob M, Fotouhi A, Majdi MR, Moradi A, JavaherforoshzadehA,
Haeri Kermani Z., et al. Prevalence of Exclusive Breastfeeding in Health
Center Mashhad, 2007. Iran J Epidemiol 2007;3:45‑53. Available from: [last cited on 2012 April 06].
15. Kang NM, Kim KN, Hyun TS. Breasting encouragement and support
of health professionals in the hospitals. Korean J Women Health
Nurs 2000;6:348‑57.
16. Chapman DJ, Damio G, Young S, Pérez‑Escamilla R. Effectiveness
of breastfeeding peer counseling in a low‑income, predominantly
Latina population: A randomized controlled trial. Arch Pediatr
Adolesc Med 2004;158:897‑902.
17. World Health Organization. 07. WHO/CDD/SER; 2007. Indicators for
assessing infant and young child feeding practices; p. 14.
18. Dennis CL, Faux S. Development and psychometric testing of the
Breastfeeding Self‑Efficacy Scale. Res Nurs Health 1999;22:399‑409.
19. Varaei Sh, Mehrda N, Bahrani N. The relationship between
self‑efficacy and breastfeeding, Tehran, Iran. HAYAT 2009;15:31‑8.
20. Weiser TM, Lin M, Garikapaty V, Feyerharm RW, Bensyl DM,
Zhu BP. Association of maternal Smoking Status With Breastfeeding
Practices: Missouri, 2005. Pediatrics 2009;124:1603‑10.
21. Jevitt C, Hernandez I, Groer M. Lactation complicated by overweight
and obesity: Supporting the mother and newborn. J Midwifery
Women’s Health 2007;52:606‑13.
22. Woldegebriel A. Mothers’ knowledge and belief on breast feeding.
Ethiop Med J 2002;40:365‑74. Available from: http://www.ncbi. [last cited on 2012 April 06].
23. Meei‑Ling Gau. Evaluation of a lactation intervention program to
encourage breastfeeding: A longitudinal study. Int J Nurs Stud
24. Owoaje ET, Oyemade A, Kolude OO. Previous BFHI training and
nurses’ knowledge, attitudes and practices regarding exclusive
breastfeeding. Afr J Med Med Sci 2002;31:137‑40.
25. Sharifirad GH, Golshiri P, Shahnazi H, Barati M, Hassanzadeh A. The
impact of educational program based on BASNEF model on breastfeeding
behavior of pregnant mothers in Arak. amuj. 2010;13:63‑70. Available
lang=enandsid=1 [last cited on 2012 April 06].
26. José M, Cernadas C, Noceda G, Barrera L, Martinez AM, Garsd
A. Maternal and perinatal factors influencing the duration of
exclusive breastfeeding during the first 6 months of life. J Hum
Lact 2003;19:136 44. Available from:
content/19/2/136.short [Last cited on 2012 April 06].
27. Martens PJ. Does breastfeeding education affect nursing staff
beliefs, exclusive breastfeeding rates, and baby‑friendly hospital
initiative compliance? The experience of a small, rural Canadian
hospital. J Human Lact 2000;16:309‑18.
28. Schlickau J, Wilson M. Development and testing of a Prenatal
Breastfeeding Education Intervention for Hispanic Women. J Perinat
Educ 2005;14:24‑35.
29. Dashti M, Scott JA, Edwards CA, Al‑Sughayer M. Determinants of
breastfeeding initiation among mothers in Kuwait. Int Breastfeed
J 2010;5:7. Available from:
pubmed/20667112 [last cited on 2012 April 06].
30. Blyth R, Creedy DK, Dennis CL, Moyle W, Pratt J, De Vries S. M. Effect
of maternal confidence on breastfeeding duration: An application
of breastfeeding self‑efficacy theory. Birth 2002;29:278‑84.
31. Torres MM, Torres RR, Rodriguez AM, Dennis CL. Translation and
validation of the breastfeeding self‑efficacy scale into Spanish: Data
from a Puerto Rican population. J Human Lact 2003;19:35‑42.
32. Sanín LH, González‑Cossío T, Romieu I, Peterson KE, Ruíz S, Palazuelos
E, et al. Effect of maternal lead burden on infant weight and weight
gain at one month of age among breastfed infants. Pediatrics
2001;107:1016‑23. Available from: http://www.pediatrics.aappublications.
org/content/107/5/1016.short [last cited on 2012 April 06].
33. Michael SK, Guo T, Platt RW, Shapiro S, Jean‑Paul Collet, Chalmers B,
et al. Breastfeeding and Infant Growth: Biology or Bias? Pediatrics
2002;110:343‑7. Available from:
content/110/2/343.short [Last cited on 2008 Sept 06].
34. Riordan JM. The cost of not breastfeeding: A commentary. J Hum
Lact 1997;13:93‑7.
35. Lamberti LM, Fischer Walker CL, Noiman A, Victora C, Black RE.
Breastfeeding and the risk for diarrhea morbidity and mortality.
BMC Public Health 2011;11(Suppl 3): S15. Available from: http://
[last cited on 2012 April 06].
36. Martin RM, Smith GD, Mangtani P, Frankel S, Gunnell D. Association
between breast feeding and growth: The Boyd‑Orr cohort study.
Arch Dis Child Fetal Neonatal Ed 2002;87: F193‑201.
37. Steinman L, Doescher M, Keppel GA, Gorstein SP, Graham E,
Haq A, et al. Understanding infant feeding beliefs, practices and
preferred nutrition education and health provider approaches: An
exploratory study with Somali mothers in the USA. Matern Child
Nutr 2010;6:67‑88. Available from:
pubmed/20055931 [last cited on 2012 April 06].
38. Chezem J, Friesen C, Boettcher J. Breastfeeding knowledge,
breastfeeding confidence and infant feeding plan: Effects on actual
feeding practices. J Obstet Gynecol Neonatal Nurs 2003;32:40‑6.
39. Dennis CL. Breastfeeding initiation and duration: A 1990-2000
literature review. J Obstet Gynecol Neonatal Nurs 2002;31:12-32.