Abstract
Objectives
Breastfeeding is important to infant health and survival in sub-Saharan Africa. To promote breastfeeding effectively, understanding of psychological factors associated with infant feeding choices is required. This study investigated breastfeeding attitudes and health locus of control (HLoC) in a Nigerian community sample.
Methods
Men and women (N = 400) (71% female; mean age 34.2 years/ range 18–86 years) were recruited through community groups in Nigeria. Self-report survey by questionnaire measured breastfeeding attitudes using the Iowa Infant Feeding Attitude Scale (IIFAS) and health locus of control using the Multidimensional Health Locus of Control Scale (MHLoCs).
Results Mean
IIFAS scores (mean = 57.7; sd = 7.8) became less favourable with increasing age (p = 0.02). Men had higher IIFAS scores (mean = 58.6; sd = 7.6) than women (mean = 56.6; sd = 8.0) indicating more favourable attitudes toward breastfeeding (p = 0.02). Women scored higher than men on external chance HLoC (ECHLoC) (p = 0.003) and external powerful others HLoC (EPHLoC) (p = 0.02). Increasing age was associated with higher scores on ECHLoC (p < 0.01) and EPHLoC (p < 0.01). Multiple linear regression analysis was significant (p < 0.001) and explained 7.8% of variance in breastfeeding attitude. Lower IIFAS scores, reflecting more negative attitudes to breastfeeding, were associated with higher ECHLoC (p < 0.01) and EPOHLoC (p < 0.05). Higher IIFAS scores, reflecting more positive attitudes to breastfeeding, were associated with greater IHLoC (p < 0.01). Neither age nor gender were associated with IIFAS scores in the final model.
Conclusions
This implies a need to explore health locus of control when promoting positive attitudes to breastfeeding and supporting families in breastfeeding advocacy.
Significance
What is already known? Infant feeding decisions are made in a social context and influenced by significant others. Yet, most studies of breastfeeding attitudes have exclusively considered women of childbearing age and mostly in Western cultures.
What this study adds? This study meets a need to understand societal attitudes to breastfeeding in diverse cultures. The research also tests the theory that health-related locus of control (H-RLoC) will be related to breastfeeding attitudes. Knowledge of societal attitudes toward breastfeeding and of HRLoC will help to inform effective breastfeeding promotions that are tailored to the specific needs of Nigerian people.
Similar content being viewed by others
Explore related subjects
Find the latest articles, discoveries, and news in related topics.Avoid common mistakes on your manuscript.
Introduction
Infant feeding attitude is an important predictor of infant feeding decisions (Lau et al., 2017; Scott et al., 2004), a determinant of adherence to infant feeding guidelines (Li Huang et al., 2021; Hamze et al., 2019; Alkusayer et al., 2018) and predictive of duration and exclusivity of breastfeeding (Dadzie et al., 2023; Li et al., 2021; Yu et al., 2020; Donnan et al., 2013). To promote breastfeeding effectively, therefore, it is imperative to understand attitudes toward breastfeeding. The Iowa Infant Feeding Attitude Scale (IIFAS) was developed by de la Mora et al. (1999) to measure breastfeeding attitudes for which it has since been employed in various countries (Jefferson, 2017; Karande & Peker, 2012; Ahmed & El Guindy, 2011; Ho & McGrath, 2011; Sittlington et al., 2007; Simmie, 2006; de la Mora, et al., 1999). Responses to the IOWA infant feeding attitude scale (IIFAS) have been shown to predict infant feeding intention (Alkusayer et al., 2018; Chang et al., 2012; Sittlington et al., 2007; Dungy et al., 1999), chosen infant feeding method (Chen et al., 2013) and duration of breastfeeding (Alkusayer et al., 2018; Holbrook et al., 2013; Niela-Vilen et al., 2016). Relatively few studies (e.g. Jefferson, 2017; Lau et al. 2017; van Wagenen et al., 2015; Mitchell-Box et al., 2013; Chang et al., 2012) appear to have surveyed breastfeeding attitudes in population samples that include both men and women of a range of age.
The locus of control concept originates from Rotter’s (1966) social learning theory which posits that reinforcement for a particular behaviour is dependent upon whether perceived control over that behaviour is internally or externally located. Internal reinforcement for a behaviour occurs when an individual believes that the behaviour is within their control (internal locus of control) and external reinforcement occurs when an individual believes their behaviour to be dependent on factors external to them such as fate or chance (external locus of control) (Ayan & Eser, 2016). Levenson (1973) extended the locus of control concept by proposing a three-factor model by expanding the external locus of control to include two dimensions, chance and powerful others. Health locus of control (HLoC) refers to an individual’s beliefs about control over their health (Walston et al. 1978). A high external health locus of control (EHLoC) is the belief that other people such as family members and health providers or chance/fate determine health outcomes. A high internal health locus of control (IHLoC) suggests that an individual believes that their own actions determine their health outcomes. The Multidimensional Health Locus of Control Scale (MHLC) (Wallston et al., 1978) was developed to assess health related locus of control in healthy and non-healthy populations. People high on IHLoC are more likely to take responsibility for their health and to engage in healthy behaviour (Davey et al., 2019). Previous studies are of the consensus that individuals with high IHLoC are more likely to actively engage in dietary health promoting behaviour (Jang and Beck, 2018; Poínhos et al., 2014; Rongen et al., 2014; Helmer et al., 2012; Grotz et al., 2011; Wallston 2005; Steptoe and Wardle 2001; Springer et al., 1994). The evidence appears inconsistent, however, in that two recent studies found no association between dimensions of HLoC and dietary quality (Stewart-Knox et al., 2021; Hildt-Ciupińska & Pawłowska-Cyprysiak, 2020). A survey in Nigeria (N = 291) reported that women with higher IHLoC were more confident about breastfeeding (Lawal & Idemudia, 2017).
The World Health Organization (WHO) recommends that infants be exclusively breastfed for the first six months of life with continued breastfeeding up to 24 months (WHO, 2018). Exclusive breastfeeding rates in Nigeria, although improved in recent years, remain well below recommended levels (Agho et al., 2019; Ogbo et al., 2015; United Nations Children’s Fund (UNICEF), 2019; Balogun et al., 2017; National Bureau of Statistics (NBS), 2017; Adewuyi & Adefemi, 2016; Lawan et al., 2014). Instruments with established psychometric validity for measuring breastfeeding attitudes have originated in Western countries (McRae, 2019; Iliadou et al., 2019; Reyes et al., 2019). Findings from these locations may not be applicable to Nigeria, where breastfeeding is deeply enshrined in cultural and religious practices (Adepoju et al., 2019; Leshi et al., 2016; Akinremi & Samuel, 2015). Understanding factors driving breastfeeding attitudes is imperative so that families in Nigeria can be effectively supported in exclusively breastfeeding during the first six months postnatally. Breastfeeding occurs in a social context. To enable exclusive breastfeeding as recommended for the first six months of life (WHO 2018), therefore, it is important to understand attitudes to breastfeeding in the wider community with a view to promoting a breastfeeding friendly society. Previous research has suggested that decisions about breastfeeding are made prior to conception (Giles et al., 2015; Chang et al., 2012). Yet most studies on breastfeeding attitudes have been conducted exclusively on childbearing women. Existing literature implies that although breastfeeding attitudes tend to be more positive in women (Jefferson, 2017; Chang et al., 2012), that partners and other family members exert considerable influence over infant feeding decisions (Satilmis et al., 2022; Vazquez-Vazquez, et al., 2022; Joseph & Earland, 2019; Ogundele et al., 2019; Cox et al. 2015; Chezem 2012; Michell-Box et al. 2013; Reid et al. 2010; Shaker et al., 2004).
The few existing studies of breastfeeding conducted in Nigeria (Akinremi & Samuel, 2015) found that although most respondents reported positive attitudes to breastfeeding, more than half (63.8%) did not exclusively breastfeed for the first six months of life. There is also evidence that younger women in Nigeria are less likely than older women to breastfeed exclusively for six months (Odukoya et al., 2022; Ogundare et al., 2021; Olasinde et al., 2021; Emmanuel & Clow, 2020). Initiatives to improve breastfeeding attitudes have been shown to lengthen the duration of exclusive breastfeeding (Li et al., 2021). People are also likely to vary in the degree to which breastfeeding attitudes are influenced by others (Satilmis et al., 2022; Vazquez-Vazquez, et al., 2022) and/or attributed to chance (Springer et al., 1994). Health locus of control can be assumed to be related to the independence people exert over breastfeeding attitudes and practices (Davey et al., 2019). Understanding how an individual’s HLoC relates to breastfeeding attitudes in a Nigerian community sample hold potential for promotion of exclusive breastfeeding to be tailored to individual and societal health loci of control (Marton et al., 2020; Davey et al., 2019; Jang & Baek, 2018). The current study therefore surveyed breastfeeding attitudes and HLoC across gender, age and society. Given results from previous research, we predict that people who hold an IHLoC orientation will have more positive attitudes to breastfeeding and that people who hold an EHLoC will have less positive attitudes to breastfeeding.
Method
Sampling and Procedure
The study was conducted in Nigeria in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and later amendments made prior to the time of data collection. Ethical approval was granted by the University of Bradford Humanities, Social and Health Sciences Research Panel.
A survey design was employed for which a convenience sample (N = 427) of men and women was recruited from among the population through direct communication (n = 200), formal and informal community groups and artisan communities (n = 177) with subsequent snowballing (n = 50). Data were collected over a six-month period during 2018 in four major locations across Nigeria (Lagos, Kaduna, Abuja and Osun). These locations were chosen because they serve as administrative and commercial centres and owing to rural-urban drift, they constitute a ‘melting pot’ for people of different cultures residing in in Nigeria (Ajaero and Onokala, 2013). These locations, therefore, had potential to recruit participants across different socio-cultural and demographic characteristics. Inclusion criteria were being 18 years of age or above, with no history of a mental health condition and fluent in English. Given the objective was to obtain a societal sample derived from the broader community, both men and women of a range of age, and including parents and non-parents were recruited. Because the opinions and views of broader society were sought, no attempt was made to control for experience of breast feeding.
Potential participants were assured of confidentiality and that no identifying information would be collected. No incentives were offered. Following a 24-hour cancellation period between recruitment and participation 20 volunteers did not attend to participate. Prior to data collection, participants were encouraged to read an information sheet detailing the purpose of the study, explaining how data would be collected and used, and what would be required of them should they agree to participate. After receiving information and having provided written consent to take part, participants completed the questionnaire on paper in a location of their choosing and in the presence of the researcher. Upon completion, the researcher provided a full debrief.
Materials
The survey tool included sociodemographic questions that enquired of gender, age, education level, employment, relationship status and whether respondents had children.
Iowa Infant Feeding Attitude Scale
Attitudes towards breastfeeding were measured by the 17-item Iowa Infant Feeding Attitude Scale (IIFAS) developed by de la Mora at al. (1999). The IIFAS has been used to determine breastfeeding attitudes in various countries and cultures (Jefferson, 2017; Karande & Peker, 2012; Ahmed & El Guindy, 2011; Ho & McGrath, 2011; Sittlington et al., 2007; Simmie, 2006; de la Mora, et al., 1999). The scale measures breastfeeding attitudes as a single factor within which half of the items are worded in a manner favourable to breastfeeding and the other half favourable to formula feeding. Responses were on a Likert scale ranging from one (strong disagreement) to five (strong agreement). Items favouring formula feeding were reverse-scored before a total score was computed. Scores ranged from 17 to 85 with higher scores indicating more positive attitudes to breastfeeding.
Multidimensional Health Locus of Control
Health locus of control (HLoC) was measured using The Multidimensional Health Locus of Control scale (MHLC-Form A) created by Wallston et al. (1978). The scale comprises 18 items and assesses three independent dimensions (each of which contains six items) of HLoC. The Internal Health Locus of Control (IHLoC) dimension measures the degree to which an individual’s health state is believed the result of their individual choices and behaviour (e.g. If I get sick, it is my own behaviour which determines how soon I will get well again). The MHLoC has been used to determine HLoC beliefs in a range of populations (Blondé et al., 2020; Gibek & Sacha, 2019; Güzel et al., 2020; Hildt-Ciupińska et al. 2020; Olagoke et al., 2021), including in Nigeria (Lawal & Idemudia, 2017). The External Chance Health Locus of Control (ECHLoC) dimension subscale measures the strength of an individual’s belief that that their health state is determined by external factors or chance (Wallston et al., 1978). Chance belief is the notion that an individual’s health state is influenced by chance or fate (e.g. My good health is largely a matter of good fortune). External Powerful Others Health Locus of Control (EPOHLoC) refers to the degree to which health is perceived as determined by ‘powerful others’ such as health professionals or other significant people (e.g. Whenever I recover from an illness, it’s usually because other people (for example, doctors, nurses, family, friends) have been taking good care of me). Responses were on a Likert scale ranging from one (strong disagreement) to five (strong agreement). The three subscales have been found to be independent of each other (Holroyd et al., 2017; Wallston et al., 1978). Scores on each of the three subscales were summed separately so that total scores ranged from 6 to 36 with higher scores reflecting stronger beliefs.
Data Analysis
Data were analyzed using IBM SPSS 22.0 (IBM Corporation, Armonk, New York, USA). The initial data set consisted of 427 cases. Criteria for removing a case were multiple non-response (multiple data missing on more than one measure) and unit non-response (no data on an entire measure). A total of 27 cases were removed leaving a sample of 400 for analysis. IIFAS and HloC scores were checked for normality using Shapiro-Wilk’s test and all were found to have a skew and kurtosis value of below p > 0.5. Outliers were checked using boxplots and taking Z scores above 3.29 (Field, 2013), and no outliers were identified. Differences in HLOC subscale scores and IIFAS total scores were calculated between gender using t-tests. Associations between age, IIFAS and HLoC scores were calculated using a Pearson’s correlation. Multiple linear regression analysis was then conducted to determine associations between breastfeeding attitude scores (IIFAS) (dependent variable) and each of the three HLoC subscales (continuous), age (continuous) and gender (independent variable). A second regression model was computed with age excluded since age was not associated with breastfeeding attitudes in the first model. Statistical significance was assumed at p < 0.05.
Results
Sample Description
Respondents (N = 400) were of a mean age of 34.2 years ranging between 18 and 86 years, of whom 71.3% identified as female. A majority (73.3%) had a university degree. Nearly half were employed (45.5%), self-employed (17%), unemployed (5.5%), students (23.8%) and retired (3.3%). Nearly half (47.5%) were married, 42.5% were single and 9.5% were in ‘other’ relationships. Respondents who identified as single held more positive attitudes to breastfeeding than those in the ‘other (cohabiting)’ category F (1, 392) = 2.65, p = 0.05, η2 = 0.01. Over half of the sample (53.6%) had one or more children, 95% of whom reported having breastfed. Of those who reported breastfeeding a majority (70%) had continued for more than six months with 21.23% having breastfed exclusively for six months. Breastfeeding attitudes did not differ across educational level, occupation, accommodation type or having children.
The Iowa Infant Feeding Attitude Scale (IIFAS)
Internal reliability of the IIFAS was moderate (α = 0.55). The mean IIFAS score for the entire sample ranged from 36 to 79 (M = 57.67, S.D.= 7.76) (Table 1). Men (M = 58.57, S.D = 7.58) had similar attitudes toward breastfeeding to women (M = 56.57, S.D = 8.06) (t (398) = 1.56, p = 0.03). Increasing age was associated with lower IIFAS scores (r= -0.12, n = 395, p = 0.02).
Multidimensional Health Locus of Control Scale (MHLoCs)
Internal reliability of the HLoC dimensions for the current sample was moderate on the IHLoC subscale (0.54), good on the EPHLoC subscale (0.75) and moderate on the ECHLoC subscale (0.59). Overall, internal reliability on all three dimensions was at a level deemed acceptable in health research (Streiner, Norman & Cairney, 2015) and similar to internal reliability values obtained in other studies (Konkolÿ Thege et al., 2014; Hewson & Charlton, 2005; Kuwahara et al., 2004). The mean scores on each subscale for the entire sample were: IHLoC (M = 24.98, S.D = 4.98); EPOLoC (M = 23.36, S.D = 5.46); and, ECHLoC (M = 20.61, S.D = 5.49) (Table 2). Cronbach’s alpha indicated moderate reliability on the IHLoC subscale (0.54), good on the EPHLoC subscale (0.75) and moderate on the ECHLoC subscale (0.59).
Gender differences were found on ECHLoC F(3, 396) = 3.49, p = 0.02; Wilk’s Λ = 0.97. Women scored higher than men on ECHLoC F(1, 398) = 9.10; p = 0.003; ƞ2= 0.02; and EPOHLoC F(1,398) = 5.36, p = 0.02; ƞ2= 0.013. No gender differences were found for IHLoC F(1, 398) = 2.59; p = 0.11; ƞ2= 0.001.
Increasing age was associated with higher ECHLoC scores (r = 0.12, n = 395, p = 0.01) and EPOHLoC (r = 0.19, n = 395, p = 0.01). No significant association was observed between age and IHLoC (IHLoC (r = 0.04, n = 395, p = 0.42).
Iowa Infant Feeding Attitudes Scale (IIFAS) and Multidimensional Health Locus of Control Scale (MHLoCs)
Simple correlations were computed between breastfeeding attitudes and external dimensions of HLoC and all relationships were found to be negative (ECHLoC (r= -0.21, n = 400, p = 0.001) and EPHLoC (r= -0.16, n = 400, p = 0.001). Correlations indicated no relationship between breastfeeding attitudes and IHLoC (r = 0.07, n = 400, p = 0.15).
Multiple linear regression analysis was initially conducted with age (continuous variable), and indices of health locus of control (internal; external powerful others; external chance) entered as explanatory (independent) variables and with breastfeeding attitude (IIFAS) score as the outcome variable. The model significantly explained breastfeeding attitudes (F (4,366) = 6.27, p = 0.001) with an R2 of 0.064. Higher scores on Internal HLoC were (positively) associated with higher IIFAS scores reflecting more favourable breastfeeding attitudes (p = 0.001). Higher scores on External ‘Chance’ HLoC were (negatively) associated with lower IIFAS scores reflecting less favourable breastfeeding attitudes (p = 0.001). External ‘Powerful Others’ was not associated with IIFAS scores (p = 0.062).
Because age was not significantly associated with HLoC in the initial model (p = 0.716), age was excluded from the subsequent multiple linear regression analysis. A second multiple linear regression model was performed to explain breastfeeding attitude (IIFAS) scores (dependent variable) with gender, Internal HLoC, External Chance HLoC and External Powerful Others HLoC as explanatory (independent) variables (Table 2). The revised model was significant (F(4,395) = 8.39, p = 0.0001) with an R2 of 0.078 and explained 7.8% of the variance in breastfeeding attitude (Table 3). Higher IHLoC was significantly (positively) associated with higher (more favourable attitudes to breastfeeding) IIFAS scores (β = 0.17, t (395) = 3.30, p = 0.001). Higher ECHLoC was associated with lower (reflecting less favourable attitudes to breastfeeding) IIFAS scores (β= -0.18, t (395) = -3.26, p = 0.01). Higher EPOHLoC was associated with lower (reflecting less favourable attitudes to breastfeeding) IIFAS scores (β= -0.12, t (395) = -2.16, p = 0.03). Gender was not associated with IIFAS scores (β= -0.09, t= (395) -1.755, p = 0.08).
Discussion
This analysis explored associations between breastfeeding attitudes, gender, age and health locus of control orientation in Nigerian society. As hypothesised, higher IHLoC was associated with more positive attitudes to breastfeeding. As IHLoC increased by one point, IIFAS scores increased 0.28. Also as predicted, higher ECHLoC and EPOHLoC scores were associated with lower (more negative) attitudes to breastfeeding, and according to the model. Health locus of control (HLoC) accounted for 7.8% of the variance in breastfeeding attitude.
That attitudes became more favourable to breastfeeding with increasing IHLoC is in keeping with previous research that has looked at IHLoC and other dietary health related behavior (Jang & Baek, 2018; Rongen et al., 2014; Steptoe & Wardle, 2001). Assuming breastfeeding attitudes are linked to behaviour, the findings are also consistent with other studies which have found that individuals with high IHLoC were more likely to intend to breastfeed (Haslam et al., 2003). People who are lower in IHLoC, therefore, may need specific intervention to motivate breastfeeding (Marton et al., 2020; Davey et al., 2019). Breastfeeding promotion messages should be conveyed in a way that engenders greater internal locus of control and seek to give people confidence in their ability to deal with problems encountered in exclusively breastfeeding.
Also as predicted, high EPHOLoC was associated with less favourable attitudes toward breastfeeding. With every point increase in EPHOLoC a 0.18 decrease in IIFAS score was observed. This finding agrees with other research (Steptoe & Wardle, 2001) indicating that EPOHLoC can be associated with less healthy dietary practices. A high EPOHLoC implies that individuals believe that health is determined by others perceived as powerful. The finding that less favourable attitudes to breastfeeding were associated with greater EPOHLoC may go some way towards understanding why initiatives to promote exclusive breastfeeding have achieved limited success in Nigeria (Agho et al., 2019). Breastfeeding promotion should identify and target these groups in breastfeeding awareness programs, possibly through intermediaries perceived to be ‘powerful’ with a view to engendering positive attitudes toward breastfeeding.
As expected, individuals who scored high on ECHLoC exhibited less favourable attitudes towards breastfeeding. This agrees with results of previous studies indicating that individuals who scored high on ECHLoC were less likely to engage in health promoting behaviour (Grotz et al., 2011) or eat healthily (Helmer et al., 2012). That individuals who scored high on ECHLoC had less favourable attitudes towards breastfeeding implies that infant health is perceived a function of chance rather than how they are fed. Breastfeeding promotion should seek to counter fatalist views by providing information on benefits of breastfeeding.
Contrary to prediction and previous surveys that report more positive attitudes to breastfeeding in women (Jefferson, 2017; Chang et al., 2012; Mitchell-Box et al., 2013), the regression model indicated that the association between breastfeeding attitudes and health locus of control did not differ by gender. Also, contrary to hypothesis, age did not contribute to the relationship between HLoC and breastfeeding attitudes, a finding that appears to contradict evidence that younger women in Nigeria are less likely than older women to breastfeed exclusively (Olasinde et al., 2021; Emmanuel & Clow, 2020). Evidence for age differences in breastfeeding attitudes, however, appears inconsistent. Although some previous studies have also reported null findings regarding age (Cotelo et al., 2018; Ishak et al., 2014), others found more favourable attitudes to breastfeeding in younger people (Charafeddine et al., 2016), or more positive attitudes towards breastfeeding with increasing age (Lau et al., 2017; 2016). These results imply that efforts to improve attitudes to breastfeeding in Nigeria should target men and women and different age groups similarly.
Although the model strength was relatively weak, the results are consistent with the findings of other studies on HLoC (Cheng et al., 2016). Although mean scores on IHLoC and EPOHLoC were similar to figures originally reported by Wallston and colleagues (1978), ECHLoC scores were somewhat higher (23.36 in the present study vs. 16.2). This difference may be attributed to disparities in sampling and cultural background as Wallston and colleagues (1978) sample were students and air passengers recruited in the United States. That the questionnaire employed well validated scales and that the internal reliability of subscales was fairly good (Wallston, 2005) strengthens the results. Meanwhile, the results of the present study suggest that the sample are relatively higher in external HLoC which may render them difficult to reach through conventional breastfeeding promotion campaigns.
A potential limitation to consider when interpreting these data is that variables were self-reported and as such, subject to the constraints of memory. Convenience sampling resulted in a larger proportion of women in the sample and a bias toward people who spent longer in education. Given women who attain higher education levels are more likely to breastfeed (Alkusayer et al., 2018a; Wilkins et al., 2012), the outcomes of this study may not be generalizable to the general populace of Nigeria.
Conclusion
This study is novel in focusing upon societal attitudes to breastfeeding and health locus of control in Nigeria and indicates a need to adjust breastfeeding promotion interventions to account for individual and societal HLoC (Marton et al., 2020; Jang & Baek, 2018). Designing societal interventions to promote breastfeeding that take HLoC beliefs into account may hold the key to improving exclusive breastfeeding rates as advocated by the WHO (2018). HLoC may need to be considered in efforts to promote more positive attitudes to breastfeeding. That people who were lower in internal HLoC had more positive attitudes toward breastfeeding and people with higher external HLoC held more negative attitudes implies a need to target breastfeeding promotion toward HLoC orientation.
Data Availability
The data set is available on request and for publication.
References
Adepoju, O.T., Adesemoye, E.T., & Akinyele, I. (2019). Role of religion on knowledge, attitude and practices of lactatingmothers on infant feeding. International Journal of Nutrition, 4(2), 14–25.
Adewuyi, E. O., & Adefemi, K. (2016). Breastfeeding in Nigeria: a systematic review. International Journal of Community Medicine and Public Health, 3(2), 385–96.
Agho, K. E., Ezeh, O. K., Ghimire, P. R., Uchechukwu, O. L., Stevens, G. J., Tannous, W. K., et al. (2019). Exclusive breastfeeding rates and associated factors in 13 “Economic Community of West African States” (ECOWAS) Countries. Nutrients, 11(12), 3007.
Ahmed, A., & El Guindy, S. R. (2011). Breastfeeding knowledge and attitudes among Egyptian baccalaureate students. International Nursing Review, 58(3), 372–378.
Ajaero, C. K., & Onokala, P. C. (2013). The effects of rural-urban migration on rural communities of south-eastern Nigeria. International Journal of Population Research, 2013.
Akinremi, Z. O., & Samuel, F. O. (2015). Knowledge and attitude of exclusive breastfeeding among hairdresser apprentices in Ibadan, Nigeria. British Journal of Medicine and Medical Research, 5(3), 376.
AlKusayer, N. M., Midodzi, W. K., Newhook, L. A., Burrage, L., Gill, N., Halfyard, B., & Twells, L. K. (2018a). Psychometric assessment and precision remodeling of the Iowa infant feeding attitude scale to improve clinical use and efficacy among prenatal women in Canada. Journal of Human Lactation, 34(1), 20–29.
Alkusayer, N. M., Midodzi, W. K., Newhook, L. A., Gill, N., Halfyard, B., & Twells, L. K. (2018b). Determining clinically relevant cut off scores for the Iowa Infant Feeding Attitude Scale among prenatal women in Canada. Journal of Human Lactation, 34(4), 691–698.
Ayan, D., & Eser, G. (2016). The impact of employees’ internal control focuses, interactions with their leaders, and emotional attachment to the organization on the intention to quit: A study on public employees.Pamukkale University Journal of Institute of Social Sciences, 25, 35–51
Balogun, M. R., Okpalugo, O. A., Ogunyemi, A. O., & Sekoni, A. O. (2017). Knowledge, attitude, and practice of breastfeeding: A comparative study of mothers in urban and rural communities of Lagos, Southwest Nigeria. Nigerian Medical Journal: Journal of the Nigeria Medical Association, 58(4), 123.
Blondé, J., Desrichard, O., & Kaiser, B. (2020). Psychological predictors of the use of complementary and alternative medicines during pregnancy within a sample of Swiss women. Health Psychology Research, 8(1).
Chang, Y., Valliant, M., & Bomba, A. K. (2012). Gender differences in knowledge and attitude regarding breastfeeding. International Journal of Consumer Studies, 36(3), 342–351.
Charafeddine, L., Tamim, H., Soubra, M., de la Mora, A., & Nabulsi, M. (2016). Research and Advocacy Breastfeeding Team. Validation of the Arabic version of the Iowa Infant Feeding Attitude Scale among Lebanese women. Journal of Human Lactation, 32(2), 309–314.
Cheng, C., Cheung, M. W. L., & Lo, B. C. Y. (2016). Relationship of health locus of control with specific health behaviours and global health appraisal Golan a meta-analysis and effects of moderators. Health Psychology Review, 10(4), 460–477.
Chen, S., Binns, C., Liu, Y., Maycock, B., Zhao, Y., & Tang, L. (2013). Attitudes towards breastfeeding-the Iowa Infant Feeding Attitude Scale in Chinese mothers living in China and Australia. Asia Pacific Journal of Clinical Nutrition, 22(2), 266–269.
Chezem, J. C. (2012). Breastfeeding attitudes among couples planning exclusive breastfeeding or mixed feeding. Breastfeeding Medicine, 7(3), 155–162.
Cotelo, M. D. C. S., Movilla-Fernández, M. J., Pita-García, P., & Novío, S. (2018). Infant feeding attitudes and practices of Spanish low-risk expectant women using the IIFAS (Iowa Infant Feeding Attitude Scale). Nutrients, 10(4), 520.
Cox, K. N., Giglia, R. C., & Binns, C. W. (2015). The influence of infant feeding attitudes on breastfeeding duration: Evidence from a cohort study in rural western Australia. International Breastfeeding Journal, 10(1), 25.
Dadzie, B., Bayor, F., Doat, A. R., Kappiah, J. B., Akayuure, C. A., Lamptey, A. A., & Kampo, S. (2023). Investigating factors that influence the practice of exclusive breastfeeding among mothers in an urban general hospital in Ghana: A cross-sectional study. BMC Women’s Health, 23(1), 1–12.
Davey, J., Herbst, J., Johns, R., Parkinson, J., Russel-Bennet, R., & Zainuddin, N. (2019). The role of health locus of control in value co-creation for standardized screening services. Journal of Service Theory and Practice, 30(1), S31–35.
de La Mora, A., Russell, D. W., Dungy, C. I., Losch, M., & Dusdieker, L. (1999). The Iowa Infant Feeding Attitude Scale: Analysis of reliability and validity 1. Journal of Applied Social Psychology, 29(11), 2362–2380.
Donnan, P. T., Dalzell, J., Symon, A., Rauchhaus, P., Monteith-Hodge, E., Kellett, G., et al. (2013). Prediction of initiation and cessation of breastfeeding from late pregnancy to 16 weeks: The feeding your baby (FYB) cohort study. British Medical Journal Open, 3(8), e003274. https://doi.org/10.1136/bmjopen-2013-003274.
Emmanuel, A., & Clow, S. E. (2020). Factors associated with timely initiation of breastfeeding and prelacteal feeding in North-Central Nigeria. International Journal of Childbirth, 10(2), 104–113.
Field, A. (2013). Discovering statistics using IBM SPSS statistics. Thousand Oaks: Sage.
Gibek, K., & Sacha, T. (2019). Comparison of health locus of control in oncological and non-oncological patients. Contemporary Oncology, 23(2), 115.
Giles, M., Millar, S., Armour, C., McClenahan, C., Mallett, J., & Stewart-Knox, B. (2015). Promoting positive attitudes to breastfeeding: The development and evaluation of a theory‐based intervention with school children involving a cluster randomised controlled trial. Maternal & Child Nutrition, 11(4), 656–672.
Grotz, M., Hapke, U., Lampert, T., & Baumeister, H. (2011). Health locus of control and health behaviour: Results from a nationally representative survey. Psychology Health & Medicine, 16(2), 129–140.
Güzel, A., Turan, S., & Üner, S. (2020). Turkish validity and reliability of multidimensional health locus of control scale form A. International Journal of Nursing Practice, 26(5), e12813.
Hamze, L., Mao, J., & Reifsnider, E. (2019). Knowledge and attitudes towards breastfeeding practices: A cross-sectional survey of postnatal mothers in China. Midwifery, 74, 68–75.
Haslam, C., Lawrence, W., & Haefeli, K. (2003). Intention to breastfeed and other important health-related behaviour and beliefs during pregnancy. Family Practice, 20(5), 528–530.
Helmer, S. M., Krämer, A., & Mikolajczyk, R. T. (2012). Health-related locus of control and health behaviour among university students in North Rhine Westphalia, Germany. BMC Research Notes, 5(1), 703.
Hewson, C., & Charlton, J. P. (2005). Measuring health beliefs on the Internet: A comparison of paper and Internet administrations of the Multidimensional Health Locus of Control Scale. Behavior Research Methods, 37(4), 691–702.
Hildt-Ciupińska, K., & Pawłowska-Cyprysiak, K. (2020). Positive health behaviors and their determinants among men active on the labor market in Poland. American Journal of Mens’ Health, 14(1), 1557988319899236.
Holbrook, K. E., White, M. C., Heyman, M. B., & Wojcicki, J. M. (2013). Maternal sociodemographic characteristics and the use of the Iowa Infant Attitude Feeding Scale to describe breastfeeding initiation and duration in a population of urban, Latina mothers: A prospective cohort study. International Breastfeeding Journal, 8(1), 7.
Holroyd, L. E., Anders, S., Robinson, J. R., & Jackson, G. P. (2017). Use of the Multidimensional Health Locus of Control Scale to predict information-seeking behaviors and health-related needs in pregnant women and caregivers. AMIA Annual Symposium Proceedings, 2017, p. 902. American Medical Informatics Association.
Ho, Y. J., & McGrath, J. M. (2011). A Chinese version of Iowa Infant Feeding Attitude Scale: reliability and validity assessment. International Journal of Nursing Studies, 48(4), 475–478.
Iliadou, M., Lykeridou, K., Prezerakos, P., Tzavara, C., & Tziaferi, S. G. (2019). Reliability and Validity of the Greek Version of the Iowa Infant Feeding Attitude Scale Among Pregnant Women. Materia Socio-Medica, 31(3), 160.
Ishak, S., Adzan, N. A. M., Quan, L. K., Shafie, M. H., Rani, N. A., & Ramli, K. G. (2014). Knowledge and beliefs about breastfeeding are not determinants for successful breastfeeding. Breastfeeding Medicine, 9(6), 308–312.
Jang, K., & Baek, Y. M. (2018). How to effectively design public health interventions: Implications from the interaction effects between socioeconomic status and health locus of control beliefs on healthy dietary behaviours among US adults. Health & Social Care in the Community, 26(5), 664–674.
Jefferson, U. T. (2017). Breastfeeding exposure, attitudes, and intentions of African American and Caucasian college students. Journal of Human Lactation, 33(1), 149–156.
Joseph, F. I., & Earland, J. (2019). A qualitative exploration of the sociocultural determinants of exclusive breastfeeding practices among rural mothers, North West Nigeria. International Breastfeeding Journal, 14(1), 1–11.
Karande, S., & Perkar, S. (2012). Do fathers’ attitudes support breastfeeding? A cross-sectional questionnaire-based study in Mumbai, India. Indian Journal of Medical Sciences, 66(1/2), 30.
Konkolÿ Thege, B., Rafael, B., & Rohánszky, M. (2014). Psychometric properties of the multidimensional health locus of control scale form C in a non-Western culture. PLoS One, 9(9), e107108.
Kuwahara, A., Nishino, Y., Ohkubo, T., Tsuji, I., Hisamichi, S., & Hosokawa, T. (2004). Reliability and validity of the Multidimensional Health Locus of Control Scale in Japan: relationship with demographic factors and health-related behavior. The Tohoku Journal of Experimental Medicine, 203(1), 37–45.
Lau, Y., Htun, T. P., Im Lim, P., Ho-Lim, S. S. T., Chi, C., Tsai, C., et al. (2017). Breastfeeding attitude, health-related quality of life and maternal obesity among multi-ethnic pregnant women: A multi-group structural equation approach. International Journal of Nursing Studies, 67, 71–82.
Lau, Y., Htun, T. P., Lim, P. I., Ho-Lim, S. S. T., & Klainin-Yobas, P. (2016). Psychometric properties of the Iowa Infant Feeding Attitude Scale among a multi-ethnic population during pregnancy. Journal of Human Lactation, 32(2), 315–323.
Lawal, A. M., & Idemudia, E. S. (2017). Examining maternal age, breastfeeding self-efficacy and health locus of control in psychological wellbeing of mothers. Psychology Health & Medicine, 22(10), 1230–1238.
Lawan, U. M., Amole, G. T., Jahum, M. G., & Sani, A. (2014). Age-appropriate feeding practices and nutritional status of infants attending child welfare clinic at a Teaching Hospital in Nigeria. Journal of Family & Community Medicine, 21(1), 6.
Leshi, O., Samuel, F. O., & Ajakaye, M. O. (2016). Breastfeeding knowledge, attitude and intention among female young adults in Ibadan, Nigeria. Open Journal of Nursing, 6(1), 11–23.
Levenson, H. (1973). Multidimensional locus of control in psychiatric patients. Journal of Consulting and Clinical Psychology, 41(3), 397–404.
Li, J. Y., Huang, Y., Huang, Y. Y., Shen, Q., Zhou, W. B., Redding, S. R., et al. (2021). Experience predicts the duration of exclusive breastfeeding: The serial mediating roles of attitude and self-efficacy. Birth - Issues in Perinatal Care. 10.1111.birt.12549.
Marton, G., Pizzoli, S. F. M., Vergani, L., Mazzocco, K., Monzani, D., et al. (2020). Patients’ health locus of control and preferences about the role that they want to play in the medical decision-making process. Psychology Health & Medicine,10.1080?13548506.2020.1748211.
McRae, M. J. (2019). Exclusive Breastfeeding, 24-Hour Rooming-In, and the Importance of Women’s Informed Choices. Nursing for Women's Health, 23(4), 309–315.
Mitchell-Box, K., Braun, K. L., Hurwitz, E. L., & Hayes, D. K. (2013). Breastfeeding attitudes: Association between maternal and male partner attitudes and breastfeeding intent. Breastfeeding Medicine, 8(4), 368–373.
National Bureau of Statistics (2017). Demographic Statistics Bulletin. Abuja: Federal Republic of Nigeria.
Niela-Vilén, H., Melender, H. L., Axelin, A., Löyttyniemi, E., & Salanterä, S. (2016). Predictors of breastfeeding initiation and frequency for preterm infants in the NICU. Journal of Obstetric Gynecologic & Neonatal Nursing, 45(3), 346–358.
Odukoya, O. A., Titiloye, M. A., & Arulogun, O. S. (2022). Exclusive breastfeeding intentions among adolescents in urban communities. Ibadan, Nigeria (59 vol., p. 00469580221086914). INQUIRY: The Journal of Health Care Organization, Provision, and Financing.
Ogbo, F. A., Page, A., Idoko, J., Claudio, F., & Agho, K. E. (2015). Trends in complementary feeding indicators in Nigeria, 2003–2013. BMJ Open, 5(10), e008467.
Ogundare, E., Babatola, A., Omoyajowo, A., Ajite, A., Adeniyi, A., Fatunla, O., & Olatunya, O. (2021). Breastfeeding: Knowledge, perception, and intention to practice among female students of Tertiary Institutions in Ekiti, Southwest Nigeria. International Quarterly of Community Health Education p. 0272684X211034349.
Ogundele, T., Ogundele, O. A., & Adegoke, A. I. (2019). Determinants of prelacteal feeding practices among mothers of children aged less than 24 months in Ile-Ife Southwest Nigeria: a community cross-sectional study. The Pan African Medical Journal, 34.
Olagoke, A. A., Olagoke, O. O., & Hughes, A. M. (2021). Intention to vaccinate against the novel 2019 coronavirus disease: The role of health locus of control and religiosity. Journal of Religion and Health, 60(1), 65–80.
Olasinde, Y. T., Ibrahim, O. R., Idowu, A., Odeyemi, A. O., Olasinde, A., Agelebe, E., & Gbadero, D. A. (2021). Determinants of exclusive breastfeeding practices among mothers of infants less than six months attending an immunization clinic in Southwestern Nigeria. Cureus, 13(6).
Poínhos, R., van der Lans, I. A., Rankin, A., Fischer, A. R., Bunting, B. P., Kuznesof, S. (2010). Psychological determinants of consumer acceptance of personalised nutrition in 9 European countries. PloS One, 9, e110614.
Reid, J., Schmied, V., & Beale, B. (2010). I only give advice if I am asked’: Examining the grandmother’s potential to influence infant feeding decisions and parenting practices of new mothers. Women and Birth, 23(2), 74–80.
Reyes, C., Barakat-Haddad, C., Barber, W., & Abbass-Dick, J. (2019). Investigating the effectiveness of school-based breastfeeding education on breastfeeding knowledge, attitudes and intentions of adolescent females. Midwifery, 70, 64–70.
Rongen, A., Robroek, S. J. W., & Burdorf, A. (2014). The importance of internal health beliefs for employees’ participation in health promotion programmes. Preventative Medicine, 67, 330–334.
Rotter, J. B. (1966). Generalized expectancies for internal versus external control of reinforcement. Psychological Monographs: General and Applied, 80(1), 1–28.
Satilmis, I. G., Yilmaz, B., & Acar, Z. (2022). Attitudes and practices of postnatal mothers and their accompanying relatives to breastfeeding in public at a university hospital in Turkey. Eastern Mediterranean Health Journal, 28(10).
Scott, J. A., Shaker, I., & Reid, M. (2004). Parental attitudes toward breastfeeding: Their association with feeding outcome at hospital discharge. Birth, 31(2), 125–131.
Shaker, I., Scott, J. A., & Reid, M. (2004). Infant feeding attitudes of expectant parents: Breastfeeding and formula feeding. Journal of Advanced Nursing, 45(3), 260–268.
Simmie, E. (2006). Breastfeeding: Different ethnic background, different perceptions? British Journal of Midwifery, 14(1), 20–26.
Sittlington, J., Stewart-Knox, B., Wright, M., Bradbury, I., & Scott, J. A. (2007). Infant feeding attitudes of expectant mothers in Northern Ireland. Health Education Research, 22(4), 561–570.
Springer, N. S., Bogue, E. L., Arnold, M., Yankou, D., & Oakley, D. J. (1994). Nutrition locus of control and dietary behaviors of pregnant women. Applied Nursing Research, 7, 28–31.
Steptoe, A., & Wardle, J. (2001). Locus of control and health behaviour revisited: A multivariate analysis of young adults from 18 countries. British Journal of Psychology, 92(4), 659–672.
Stewart-Knox, B., Rankin, A., Bunting, B. P., Frewer, L., Celis-Morales, C., Livingstone, K. M., et al. (2021). Self-efficacy, habit strength, health locus of control and response to the personalised nutrition: Food4Me intervention study. British Food Journal https://doi.org/10.1108/BFJ-03-2021-0221.
Streiner, D. L., Norman, G. R., & Cairney, J. (2015). Health measurement scales: a practical guide to their development and use. Oxford University Press, USA.
United Nations Children’s Fund. (UNICEF) (2019). Maternal Mortality. https://data.unicef.org/topic/maternal-health/maternal-mortality/Accessed November 01, 2020.
van Wagenen, S. A., Magnusson, B. M., & Neiger, B. L. (2015). Attitudes toward breastfeeding among an internet panel of US males aged 2144. Maternal and Child Health Journal, 19(9), 2020–2028.
Vázquez-Vázquez, A. D. P., Fewtrell, M. S., Chan‐García, H., Batún‐Marrufo, C., Dickinson, F., & Wells, J. C. (2022). Do maternal grandmothers influence breastfeeding duration and infant nutrition? Evidence from Merida, Mexico. American Journal of Biological Anthropology, 179(3), 444–459.
Wallston, K. A. (2005). The validity of the multidimensional health locus of control scales. Journal of Health Psychology, 10(5), 623–631.
Wallston, K. A., Wallston, B. S., & DeVellis, R. (1978). Development of the Multidimensional Health Locus of Control (MHLC) scale. Health Education Monographs, 6(1), 160–170.
Wilkins, C., Ryan, K., Green, J., & Thomas, P. (2012). Infant feeding attitudes of women in the United Kingdom during pregnancy and after birth. Journal of Human Lactation, 28(4), 547–555.
World Health Organization (WHO) (2018). “Maternal Health in Nigeria: Generating Information for Action”. WHO. 2018. https://www.who.int/reproductivehealth/maternal-health-nigeria/en/ Accessed November 01, 2020.
Yu, J., Wei, Z., Lukoyanova, O., Borovik, T., & Fewtrell, M. S. (2020). Maternal infant feeding attitudes, infant eating behaviors, and maternal feeding choice at 3 and 6 months postpartum: A comparative multicenter international study. Breastfeeding Medicine, 15(8), 528–534.
Acknowledgements
Many thanks to the people of Nigeria who gave of their time to respond to this survey. The authors would also like to acknowledge the valuable contribution of Dr Sally Johnson to the inception and initial management of this project.
Funding
Not applicable, this research received no external funding.
Author information
Authors and Affiliations
Contributions
AA inputted to the design of the study, undertook data collection, data analysis and compiled the initial draft of the manuscript. AS oversaw data analyses. BS-K designed the study and redrafted the manuscript. VL commented on the reporting of the analysis and drafts of the manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors know of no conflict of interest that could affect the publication of this research.
Ethical Approval
This research was approved by the University of Bradford Humanities, Social and Health Sciences Ethical Committee and conducted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and later amendments made prior to the time of data collection.
Informed Consent
Informed consent for participation in the research and subsequent publication was obtained from all individual participants.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Adegbayi, A., Scally, A., Lesk, V. et al. A Survey of Breastfeeding Attitudes and Health Locus of Control in the Nigerian Population. Matern Child Health J 27, 1060–1069 (2023). https://doi.org/10.1007/s10995-023-03638-z
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-023-03638-z