Predicting perceived exclusive breastfeeding behavior among higher education female students in Saudi Arabia: Application of the theory of planned behavior using structural equation modeling

Abstract

The decision for infant feeding behaviors is often made early in life, based on the socio-cultural context. Thus, exploring this issue and its influencing factors can create Exclusive Breastfeeding (EBF) culture among future mothers. This study aimed to predict EBF behavior among female higher education students in Saudi Arabia through the application of the Theory of Planned Behavior (TPB) using Structural Equation Modeling (SEM). This descriptive exploratory research was conducted on three university campuses in three cities (Dammam, Jeddah, and Abha). A multistage cluster random sampling was employed to select 600 female students using a digital survey containing three sections: Personal Data and Previous BF Exposure, EBF Knowledge Scale, and The TPB constructs for the EBF scale (attitude, Subjective Norms/SN, Perceived Behavioral Control/PBC, intention, and Perceived Behavior). The results showed that the highest percent of the participants had moderate BF exposure (63.8%) and knowledge (65.7%), positive attitude (85.8%), high SN (66.2%), moderate PBC (75.8%), high intention (55.2%), and positive perceived behavior (55.2%). The SEM had acceptable fit indices were χ2/df ratio=3.817, GFI=0.935, RMSEA=0.044, NFI=0.942, CFI=0.951, PCFI =0. 924. It showed that the EBF attitude (β=0.607), SN (β=0.123), and PBC (β=0.158) were significant positive and direct predictors of the EBF intention (P<0.001). Both intention (β=0.213) and PBC (β=0.226) were significant positive and direct predictors of the perceived behavior (P<0.001). It accounted for 49.5% of the variance in EBF intention and 70.0% for the behavior. The BF exposure and knowledge were significant positive predictors of EBF intention (β=0.158, β= 0.237) and behavior (β=0.140, β= 0.207) (P=0.000). Thus, the TPB has a good predictive ability for EBF intention and behavior among the studied Saudi female university students. Thus, it can be employed for efficient health promotion and the development of EBF-friendly policies.