This descriptive-analytical cross-sectional study was conducted in 2022 on 320 primiparous mothers with children under three months of age who were covered by the comprehensive health centers of Urmia city, who were eligible for the research and consented to participate in the study. This study was approved by the Ethics Committee of Urmia Health and Fertility Research Center with code IR.UMSU.REC.1401.064. The sample size in this study was calculated based on Masman et al.'s study with 95% confidence and 90% test power and r=0.404 using the correlation coefficient formula for 320 people (23).
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)
The criteria for entering the study included Iranian nationality, living in Urmia city, primiparous mothers who had children under three months old, singleton mothers, full-term babies, mothers who did not have any contraindications for breastfeeding according to the country's guidelines, such as cleft palate in the baby, and mothers who prohibited the use of drugs during breastfeeding. The mothers’ lack of hospitalization during infancy, lack of mental disorders, need for treatment, and willingness to participate in the study. Questionnaires that were incompletely completed were excluded.
To carry out the sampling, after dividing the city into three levels—well-off, semilow-income, and low-income—two comprehensive health centers with the largest number of clients from each level were selected. In each center, the list of primiparous mothers with children under three months of age was extracted through the SIB system, and the people in the list were sorted by number and randomly selected using Randomizer software. Then, if they agreed and met the criteria for entering the study, after providing informed consent, the mothers were assured that their information would remain confidential. Finally, the questionnaires were prepared according to the mother's wishes in person at the health center or during a telephone call. You will be completed through an interview by the researcher. Data analysis was performed using SPSS software (version 21), descriptive statistics were used to determine the mean (standard deviation), percentage and frequency, and Pearson's correlation test and multivariate linear regression were used to measure the relationships between variables.
All the data were collected using four tools, including the researcher-made demographic and fertility questionnaire, Watson's PANAS-X standard questionnaire to measure maternal emotions, the Iowa Breastfeeding Attitude Questionnaire (IIFAS) and the Breastfeeding Self-Efficacy Questionnaire-Short Form (BSES-SF).
A demographic and fertility characteristics questionnaire was administered by a researcher, which, according to review studies, included age, level of education, economic status, ethnicity, level of satisfaction with emotional support, type of delivery, gender of the baby, type of breastfeeding, breastfeeding education, hug care and breast problems.
Watson's PANAS-X is a standard questionnaire for examining maternal emotions. This questionnaire has ten questions for examining positive emotions and ten questions for negative emotions and the frequency of occurrence of positive and negative emotions and feelings during the past 6 months in five levels: rare or never, low, moderate, high and severe (1-5 marks are assigned to each of them, respectively). Some examples are as follows: "I am worried and anxious", "I feel pride, pride and honor", and "I am irritable and fractious". The minimum acquired score for each field of the questionnaire was 10, and the maximum was 50. The validity of the questionnaire of positive and negative emotions in Jabri et al.'s study was obtained with Cronbach's alpha values of 0.88 and 0.89, respectively (30). In addition, the validity and reliability of the questionnaires used have been confirmed in different samples and with different cultures (33). The IIFAS-Iowa Breastfeeding Attitude Questionnaire was invented by Mora in 1998. Its validity and reliability have been confirmed in the mentioned study (34). For scoring this tool, statements 1 to 15 are considered to range from 1 to 5 points, respectively (1=completely disagree, 2=disagree, 3=disagree not agree, 4=agree, 5=completely agree). Except for statements 1, 2, 6, 8, 10, and 13, the scoring was reversed. Higher scores indicate more positive attitudes toward breastfeeding. Some examples are as follows: "feeding with formula is easier than feeding with breast milk", "breastfeeding is easier than formula", and "mothers should not breastfeed in public places such as restaurants". The reliability of this questionnaire was assessed in the study of Faridvand et al., with a Cronbach's alpha coefficient of 0.89 (35). In the study of Qaraei et al., the validity and reliability of the Persian version of the Short Breastfeeding Attitude Scale were confirmed (36).
The breastfeeding self-efficacy questionnaire-short form (BSES-SF) is a 14-item scale with a positive load with the prefixes "I can always" and self-reports. It is graded using a Likert scale, with a score of 1 being given to the option "I completely disagree" and a score of 5 being given to the option "Completely agree". The range of scores is from 14 to 70, and higher scores indicate a higher level of breastfeeding self-efficacy. The validity of this questionnaire was confirmed in Varaei et al.'s study (15). The reliability of this questionnaire was checked in the study of Bastani et al., and the Cronbach's alpha was 0.87 (37). Additionally, the validity and reliability of this questionnaire were confirmed in Dennis's study, with a Cronbach's alpha coefficient of 0.96(38).