Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Nancy L McCain


Background: Breastfeeding is well established as the optimal method for ensuring healthy infant nutrition. However, many adolescents remain unaware of the role of breastfeeding. Adolescent mothers continue to have the lowest rate of breastfeeding in many countries including Thailand, with only 17% of Thai adolescent mothers continuing to breastfed at 6 months postpartum. Objective: Examine factors influencing breastfeeding behaviors in adolescent mothers, particularly those in Thailand. Methods: This dissertation project involved two research studies focusing on breastfeeding influencing factors in adolescent mothers. The first study was an integrative review of 22 articles published in 2000-2012. The findings revealed that personal factors appear to be the most important to the decision to initiate and maintain breastfeeding for adolescent mothers. Perceptions of cultural expectations also influence breastfeeding decisions and behaviors. Additionally, infant factors seem to be considerations in breastfeeding duration for the adolescent mother. The second study used a prospective cohort design to explore personal, social, cultural, and infant factors that explain and predict breastfeeding initiation and maintenance at 4 weeks postpartum in Thai adolescent mothers. The sample of 96 adolescent mothers was recruited at two prenatal clinics in Thailand. There were three time points for data collection; the initial visit was completed in the prenatal period, the second visit was within 48 hours postpartum, and the third was at 4 weeks postpartum. Instruments were the Iowa Infant feeding Attitude Scale (IIFAS), Breastfeeding Influencing Factor Assessment (BIFA), Hughes Breast-Feeding Support Scale (HBSS), Pictorial Assessment of Temperament (PAT), Vulnerable Baby Scale (VBS), and Parenting Sense of Competence Scale (PSOC), all of which were translated into the Thai language. Results: Personal, social, and cultural factors were significantly correlated with breastfeeding initiation and were significant positive predictors of exclusive breastfeeding duration. Infant temperament was a significant negative predictor of exclusive breastfeeding duration. Maternal competence was also positively correlated with duration of exclusive breastfeeding. Conclusion: Facilitating the support mothers receive from their personal support systems is important to breastfeeding duration and maternal competence in the postpartum period. Enhancing exclusive breastfeeding and maternal competence provides a supportive environment for new adolescent mothers to develop their maternal role.


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Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

August 2013

Included in

Nursing Commons