Original Article

http://dx.doi.org/10.1590/0104-07072017004100015

COMPARISON OF BREASTFEEDING SELF-EFFICACY BETWEEN

ADOLESCENT AND ADULT MOTHERS AT A MATERNITY HOSPITAL IN
RIBEIRO PRETO, BRAZIL

Carolina Maria de S Guimares1, Raquel Germano Conde2, Bruna Cremasco de Brito3,

Flvia Azevedo Gomes-Sponholz4, Mnica Oliveira Batista Ori5, Juliana Cristina dos Santos Monteiro6

1
Masters student, Graduate Program in Public Health Nursing, Universidade de So Paulo (USP), Escola de Enfermagem de Ribero
Preto (EERP). Ribeiro Preto, So Paulo, Brazil. E-mail: [email protected]
2
Masters student, Graduate Program in Public Health Nursing, EERP/USP. Ribeiro Preto, So Paulo, Brazil. E-mail: raquel.
[email protected]
3
B.Sc. in Nursing from EERP/USP. Ribeiro Preto, So Paulo, Brazil. E-mail: [email protected]
4
Ph.D. in Public Health Nursing. Professor, Maternal-Infant and Public Health Nursing Department, EERP-USP. Ribeiro Preto,
So Paulo, Brazil. E-mail: [email protected]
5
Ph.D. in Nursing. Professor, Nursing Department, School of Pharmacy, Dentistry and Nursing, Universidade Federal do Cear.
Fortaleza, Cear, Brazil. E-mail: [email protected]
6
Ph.D in Public Health Nursing. Professor, Department of Maternal-Infant and Public Health Nursing, EERP/USP. Ribeiro
Preto, So Paulo, Brazil. E-mail: [email protected]

ABSTRACT
Objective: to measure and compare the breastfeeding self-efficacy between adolescents and adults mothers in the immediate postpartum.
Method: is an observational, cross-sectional and comparative study, developed at a maternity hospital in Ribeirao Preto, Brazil. Data were
collected between January and July 2014. The sample consisted of 306 adult mothers and 94 adolescent mothers. The breastfeeding self-
efficacy scores were obtained using the Brazilian version of the Breastfeeding Self-Efficacy Scale. Student t-test was used to compare the
values of breastfeeding self-efficacy between the groups of participants. We considered a 5% significance level (p=0.05).
Results: most adolescents and adults mothers (54%) presented high levels of breastfeeding self-efficacy and there was no statistically
significant difference between the scores of the two groups (p=0.3482).
Conclusion: health professionals need to be careful about breastfeeding self-efficacy in order to direct specific actions for each group of
mothers (adolescents and adult mothers) to improve the breastfeeding rates.
DESCRIPTORS: Breastfeeding. Self-efficacy. Confidence. Nursing. Maternal and child health.

COMPARAO DA AUTOEFICCIA NA AMAMENTAO ENTRE

PURPERAS ADOLESCENTES E ADULTAS EM UMA MATERNIDADE DE
RIBEIRO PRETO, BRASIL

RESUMO
Objetivo: verificar e comparar a autoeficcia na amamentao entre purperas adolescentes e adultas no ps-parto imediato.
Mtodo: estudo observacional, transversal e comparativo, realizado no alojamento conjunto em uma maternidade, no municpio de
Ribeiro Preto, So Paulo. A coleta de dados foi realizada de janeiro a julho de 2014. Participaram do estudo 306 purperas adultas e 94
purperas adolescentes. Para avaliar a autoeficcia na amamentao, foi utilizada a verso brasileira da Breastfeeding Self-Efficacy Scale.
O teste t de Student foi usado para comparar os valores de autoeficcia entre os grupos participantes. Foi considerado um nvel de
significncia de 5% (p=0,05).
Resultados: entre os dois grupos, a maioria (54%) apresentou autoeficcia elevada, e a diferena entre os escores no foi estatisticamente
significativa (p=0,3482).
Concluso: os profissionais devem estar atentos autoeficcia na amamentao, direcionando aes especficas aos grupos de mulheres
adolescentes e adultas, favorecendo assim o aumento dos ndices de aleitamento.
DESCRITORES: Aleitamento materno. Autoeficcia. Confiana. Enfermagem. Sade materno-infantil.

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Guimares CMS, Conde RG, Brito BC, Gomes-Sponholz FA, Ori MO, Monteiro JCS 2/9

COMPARACIN DE LA AUTOEFICACIA DE LA LACTANCIA MATERNA

ENTRE MADRES ADOLESCENTES Y ADULTAS EN UNA MATERNIDAD DE
RIBEIRO PRETO, BRAZIL

RESUMEN
Objetivo: verificar y comparar la autoeficacia de la Lactancia Materna entre purperas adolescentes y adultas en el posparto inmediato.
Mtodo: estudio observacional, transversal y comparativo, realizado en el alojamiento conjunto de una maternidad, en la ciudad de
Ribeiro Preto, Brazil. La recoleccin de datos fue realizada en el perodo de enero a julio de 2014. La muestra fue constituida por 306
madres adultas y 94 adolescentes. La versin brasilea de la Breastfeeding Self-Efficacy Scale evalu la autoeficacia de la lactancia materna.
Para comparar los valores de autoeficacia entre los grupos participantes, los valores fueron sometidos al test de t-Student. Fue considerado
un nivel de significancia de 5% (p=0,05).
Resultados: entre los grupos participantes la mayora (54%) present niveles elevados de autoeficacia, y la diferencia entre los resultados
entre adolescentes y adultos no fue estadsticamente significativo (p=0,3482).
Conclusin: los profesionales deben de estar atentos a la autoeficacia en el amamantamiento, con el objetivo de direccionar acciones
especficas a los grupos de mujeres adolescentes y adultas, favoreciendo as, el aumento de los ndices de amamantamiento.
DESCRIPTORES: Lactancia materna. Autoeficacia. Confianza. Enfermera. Salud materno-infantil.

INTRODUCTION the condition of being an adolescent and having

an intimate partner increases the risk of early
The World Health Organization1 (WHO)
weaning for the adolescents in comparison with
recommends exclusive breastfeeding for infants
the adult mothers.12 On the other hand, there is a
up to the sixth month of life and complementary
higher prevalence of starting breastfeeding among
breastfeeding until two years or older. The Brazi-
adult women, who are also more prone to breast-
lian Ministry of Health also follows this recom-
feeding longer than the adolescents.10,13-16
mendation, due to the benefits for the health of the
children, their mothers and their families.2-3 Among adults as well as adolescents, it is ob-
served that some of the variables related to the du-
In the last three decades, breastfeeding rates
ration of the breastfeeding, such as the perception
have significantly improved in Brazil, which con-
of little milk, personal and professional support
tributed to reduce childhood mortality in the cou-
and the experiences lived involve the construction
ntry.4-5 Despite this finding, the breastfeeding rates
or maintenance of maternal trust in ones ability
remain inferior to the recommendation by WHO.1-2
to cope with a complex situation, which is the
Scientific evidence demonstrates that early case of maternal breastfeeding.17-18 Studies appoint
weaning is a complex phenomenon, which goes that the intention to breastfeed and the confidence
beyond biological determinism and is influenced strongly influence the breastfeeding behavior.17-18
by psychological, social and cultural factors, being Therefore, maternal trust has been identified as an
characterized by the introduction of other foods variable that influences the start and maintenance
into the diet of children under exclusive breast- of breastfeeding.19
feeding up to the age of six months.6 The mothers
Differently from the variables that are not or
are aware of the benefits of breast milk, but it is
hardly modifiable (such as marital status, educa-
observed that this knowledge is not sufficient to
tional level and socioeconomic conditions), mater-
maintain breastfeeding over a long period, as re-
nal trust can be modified and lies within the health
commended.7
professionals access. Its analysis permits identi-
The factors that can influence the duration of fying the women at greater risk for early weaning
breastfeeding include maternal age. and making individual interventions when neces-
Some studies involving adolescents demons- sary.20 Studies that analyzed this variable among
trate that the behavior towards breastfeeding is si- adult mothers identified that, the greater the wo-
milar to the behavior of adult mothers, with high mans trust, the greater the chance of maintaining
initial rates and an important drop up to the sixth breastfeeding longer.21-22 Nevertheless, the trust to
month of life.8-11 Some authors appoint, however, breastfeed among adolescent mothers has been
that the association between personal factors and hardly explored, although some studies have iden-

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tified that the young maternal age is one of the cha- professionals working with mothers and infants
racteristics of the women who wean early.18,23 and can contribute to implement actions that favor
The womans trust in her ability to breastfeed, higher breastfeeding rates.
or the self-efficacy in breastfeeding, is explained by
the Theory of Self-Efficacy in Breastfeeding, deve- METHOD
loped by Dennis24 based on the construct of trust or
self-efficacy, which is part of Banduras Cognitive An observational, cross-sectional and com-
Social Theory.25 The self-efficacy construct refers to parative study was undertaken of breastfeeding
a factor that mediates the health behaviors, as indi- self-efficacy among adolescent and adult postpar-
tum women, developed at the rooming-in unit of
viduals need to be convinced that they are able to
a public maternity in Ribeiro Preto, State of So
successfully perform a given task or behavior, be-
Paulo. The study sample was calculated based on
lieving that they will achieve the expected health
the information from the Annual Nursing Report
outcome. Hence, it should be understood that it is
at the maternity where the study took place, and
not enough for the individual to believe that a cer-
an earlier study28 involving the maternal confi-
tain behavior can help him to achieve a specific ob-
dence to breastfeed among Brazilian women. It
jective. He needs to feel able to personally execute
was based on the comparison of means between
that behavior.25
two groups: adolescent postpartum women and
The choice to breastfeed is based on the ex- adult postpartum women. Considering a tolera-
pected result, which is influenced by four proces- ble sampling error of 5%, a 95% confidence level
ses: a) if the mother decided to breastfeed or not; and an expected 10% loss, the sample consisted of
b) how much effort is made; c) is she will have 400 postpartum women, being 94 adolescents and
self-encouraging or self-destructive patterns of 306 adults.
thinking; and d) how she will emotionally respond
These postpartum women were selected by
to the breastfeeding difficulties. The expected sel-
simple random sampling, through a draw at the
f-efficacy, which also interferes in the choice of the
rooming-in unit among the women who complied
breastfeeding behavior, is developed based on the
with the following inclusion criteria: postpartum
four information sources: a) personal experience;
women at least 24h after birth, literate, able to
b) vicarious experiences; c) verbal persuasion; and
breastfeed, without visual, auditory and/or cog-
d) psychological and affective condition.24,26
nitive impairment, without pathologies or pro-
To assess the level of self-efficacy in breast- blems after birth, at the rooming-in unit with their
feeding, Dennis and Faux27 developed and valida- infants, born with a gestational age >37 weeks,
ted the Breastfeeding Self-efficacy Scale (BSES), a without special care needs such as phototherapy.
Likert scale whose content was elaborated based The data were collected between January
on the problems related to the practice and dura- and July 2014, the period considered to reach the
tion of breastfeeding presented in the literature, calculated sample. The data were collected from
and has been adapted to different countries, inclu- Monday to Friday, in the afternoon, when few
ding Brazil.28 Evidence shows that the BSES is a va- care routines happened at the rooming-in unit.
lid and reliable tool that can be used to help health Two masters students and one scientific initia-
professionals working for breastfeeding, helping tion student collected the data through a structu-
to identify women at greater risk of early weaning, red interview, using a questionnaire and informa-
as well as the area in which the woman experien- tion collected from the participants files. A pilot
ces more difficulty.19,26 study was undertaken before the start of the data
Studies using the BSES prove that women collection to adapt the best period to contact the
with higher self-efficacy levels breastfeed longer postpartum women and the best approach. Two
when compared to women with a higher level of instruments were used to collect the data. The
confidence.26,29 Nevertheless, no studies were fou- first was developed specifically for this study and
nd that compared the self-efficacy between ado- considered the identification data and the socio-
lescent and adult women. Hence, the objective in demographic characteristics, such as age, self-re-
this study was to assess and compare maternal ferred color, education, religion, occupation, ma-
self-efficacy in breastfeeding skills between these rital status, type of housing, monthly income and
two groups. This study is intended to help health type of help during postpartum (mother, mother-

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-in-law, husband, others); and obstetric characte- tests, significance was set at 5% (=0.05). Results
ristics of participants, such as parity, pregnancy with p<0.05 and a 95% confidence interval were
planning, prenatal care, date and type of delivery, considered statistically significant.
sex and weight of infant at birth, breastfeeding Approval for the study was obtained from
in the first hour of life and type of feeding at the the Research Ethics Committee at the Universidade
time of the data collection. The second instrument de So Paulo, Escola de Enfermagem de Ribeiro Preto,
was the BSES, used to assessed the participants protocol 21346013.80000.5393.
self-efficacy in breastfeeding skills.
The BSES is a Likert scale with 33 questions, RESULTS
divided in two domains: Technical and Intraper-
sonal Thinking. Each question comes with five Four hundred postpartum women were part
alternative answers, with scores ranging from of this study, being 94 adolescents and 306 adults.
1 to 5, being 1-I totally disagree; 2-I disagree; As regards the adolescent womens sociode-
3-I sometimes agree; 4-I agree; 5-I totally agree. mographic characteristics, the participants were
Hence, the total scale scores range between 33 characterized with a mean age of 16.53 years
and 165 points.28 Self-efficacy in breastfeeding, (SD=1.44), 50% self-declared mulatto, 58% indica-
identified through the scale, is distributed accor- ted finished primary education, 46% declared ha-
ding to the scores obtained by adding up each ving a fixed partner and 52% mentioned living at
question: low self-efficacy (33 to 118 points), me- their own home. Most participants (87%) declared
having no paid job and gaining a mean monthly
dium self-efficacy (119 to 137 points), high sel-
income of 2.23 minimum wages. Concerning the
f-efficacy (138 to 165 points).30 This instrument
obstetric characteristics, most adolescents (93%)
has been tested in different phases of the preg-
were pregnant for the first time and 65% indica-
nancy-postpartum cycle, and results support its ted not having planned the pregnancy. As regards
use in any phase of the perinatal period.31 Being a prenatal care, 60% started the monitoring in the
self-applied instrument, the postpartum woman first trimester of pregnancy, the majority (85%)
directly answered the BSES without interference having participated in six or more consultations.
by the researchers. Hence, the women answered 86% had a normal birth, 57% breastfed during the
if and how intensely they agreed or disagreed first hour of life and 92% were in exclusive breast-
from each question. feeding at the time of the data collection.
The data were stored in a structured electro- Among the 306 adult participants, the mean
nic worksheet through double data entry, which age was 26.49 years (SD=5.02). Among them, 42%
permitted the validation of the data, so as to eli- self-declared mulatto, 48% concluded secondary
minate possible errors and guarantee the reliabi- education, 50% had a fixed partner and 41% lived
lity in the compilation of the data. To analyze the in their own home. Most adult participants (59%)
data, the statistical software Statistical Analysis indicated no paid job and the mean income was
System SAS 9.0 and R version 3.0 were used. 2.68 minimum wages. Concerning the obstetric
To characterize the sample, the data analysis data, 40% of the adults had multiple pregnancies,
35% having given birth multiple times and 76%
was based on descriptive statistics.
indicated at least one abortion, 51% did not plan
To compare the self-efficacy in breastfeeding the pregnancy and the majority started prenatal
between the study groups, the BSES scores were care while still in the first trimester of pregnancy
added up and the mean scores were calculated (71%), having six or more consultations during
for the global instruments, for the domains (Te- the pregnancy (87%). As regards the type of birth,
chnical and Intrapersonal Thinking) and for each 70% had normal birth. Fifty-nine percent breast-
postpartum group (adolescents and adults). The fed in the first hour of life and the majority (91%)
mean scores were submitted to Students t-test. were in exclusive breastfeeding at the time of the
To use the test, it should be tested whether the data collection.
variances between the two groups are statistically What self-efficacy in breastfeeding is con-
equal and whether the distribution of the data is cerned, in the total sample, 54% presented high
normal. For this procedure, the PROC TTEST pro- self-efficacy. Table 1 shows the distribution of
cedure was used in the software SAS 9.0. For all adolescents and adults in terms of self-efficacy.

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Table 1 - Distribution of adolescent and adult postpartum women in the classification of breastfeeding
self-efficacy. Ribeiro Preto-SP, 2014

Self-efficacy ranking
Postpartum women Low Moderate High
Frequency % Frequency % Frequency %
Adolescent 11 11.70 32 34.04 51 54.26
Adult 40 13.07 99 32.35 167 54.58
Total 51 12.75 131 32.75 218 54.50

Table 2 shows the mean global scores bet- illustrated in Figure 1 by the Boxplot distribution.
ween adolescents and adults and the comparison In the analysis of the Technical domain, the results
of means. No statistically significant difference of the comparison of means showed no statistically
(p=0.3482) was observed between the mean global significant difference between the groups studied,
scores of the adolescent and adult group, that is, as can be observed in Table 3. The p-value in the
between the groups studied, the self-efficacy level comparison of means showed p=0.2142. This re-
in breastfeeding was similar. This result has been sult demonstrated that, concerning the Technical
domain of breastfeeding, the level of self-efficacy
between the groups was similar.As regards the
Table 2 Comparison of means of global scores Intrapersonal Thinking domain, the comparison of
on Breastfeeding Self-efficacy Scale between means showed no statistically significant difference
adolescent and adult postpartum women. either, with p=0.7139, that is, the level of self-effica-
Ribeiro Preto-SP, 2014 cy for Intrapersonal Thinking aspects is similar bet-
ween adolescents and adults. Table 4 displays the
data for this analysis.
Postpartum Comparison
women 95% CI p
n Mean Difference
Adolescent 94 138.86 1.79 -1.96 5.54 0.3482 Table 3 Comparison of mean scores in the
Adult 306 137.07 Technical domain of the Breastfeeding Self-
efficacy Scale between adolescent and adult
postpartum women. Ribeiro Preto-SP, 2014
160
Postpartum Comparison
women 95% CI p
n Mean Difference
140
Adolescent 94 83.32 1.49 -0.87 3.85 0.2142
Adult 306 81.83
Total Escore

120

100 Table 4 Comparison of mean scores in

the Intrapersonal Thinking domain of the
80 Breastfeeding Self-efficacy Scale between adult
and adolescent postpartum women. Ribeiro
Preto-SP, 2014
Adolescent Adult
Postpartum Comparison
Figure 1 Distribution of mean total scores women 95% CI p
n Mean Difference
on Breastfeeding Self-efficacy Scale between
Adolescent 94 55.54 0.30 -1.30 1.89 0.7139
adolescent and adult postpartum women.
Ribeiro Preto-SP, 2014 Adult 306 55.25

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DISCUSSION tant role in the encouragement of breastfeeding,

and these governmental strategies have triggered
In this study, the data were collected 24h af-
the breastfeeding rates in Brazil; nevertheless, the
ter birth, with a view to discovering the self-effica-
rates remain inferior to the recommendations.2,4
cy level at the start of breastfeeding. Most partici-
Analyses in the course of the last years demons-
pants (54.50%) presented a high self-efficacy level.
trate that, around the world, the breastfeeding ra-
Among the adolescent postpartum women, tes have stagnated in developed and developing
the mean BSES score was 138.86, indicating high countries, evidencing the need to strengthen the
self-efficacy; among the adults, the mean score was successful programs and to develop new strategies
137.7, indicating moderate self-efficacy, but very that are sensitive to the situation of women who
close to the bottom limit of high self-efficacy. The breastfeed and their families.37-39
results support other studies26,30 that identified a
Identifying the self-efficacy levels in the im-
moderate self-efficacy level among adult partici-
mediate postpartum and the postpartum women at
pants. What the adolescents result is concerned,
greater risk for early weaning and who need greater
no studies were found that analyzed the levels of
support is an important strategy for health profes-
maternal self-efficacy in breastfeeding in this popu-
sionals, as women with difficulties to start and es-
lation using the BSES. In a study in Canada, howe-
tablish breastfeeding present low levels of self-effi-
ver, involving adolescent mothers and applying the
cacy and are particularly vulnerable to interrupting
short version of the BSES, it was demonstrated that,
breastfeeding in the first 72h after birth.40
among the adolescents who started breastfeeding,
57% presented high self-efficacy in prenatal care.32 The comparison of the self-efficacy results bet-
In independent studies developed in China during ween adult and adolescent postpartum women pre-
pregnancy and during the hospitalization among sented no statistically significant difference between
adult postpartum women, low self-efficacy33-34 was these two groups, which appoints that maternal age
found, differently from the Brazilian reality. as an isolated variable did not influence the level of
maternal self-efficacy in breastfeeding in the imme-
In the analysis of each BSES domain, what
diate postpartum. A study developed in Australia
the Technical domain is concerned, the mean score found no association either between maternal age
was 83.32 among the adolescents and 81.83 among and the level of self-efficacy in breastfeeding.29 In a
the adults; for the Intrapersonal Thinking domain, study developed in Canada,26 it was observed that
the mean score of the adolescents was 55.54 and of the maternal age interfered in the levels of self-effica-
the adults 55.55. These results also differ from a stu- cy in breastfeeding when associated with the educa-
dy33 in which a mean score of 63.94 was found for tional level and parity, concluding that older women
Intrapersonal Thinking and 52.74 for the Technical with a higher education level and more children pre-
domain. Pregnant women with lower self-efficacy sented higher self-efficacy scores. In another study
concerning breastfeeding techniques, having suffi- developed in China, however, it was demonstrated
cient milk production and family support were ob- that, the older the mother, the lower the level of
served in a study that concluded that the low self-ef- breastfeeding self-efficacy, showing an inverse as-
ficacy levels among them may be due to the limited sociation between maternal age and the level of sel-
orientation about breastfeeding received in prenatal f-efficacy.33 Despite these findings, it is highlighted
care and the inappropriate preparation for breastfee- that these studies only involved adult women and
ding.34 that no other study was found in which the results
The higher self-efficacy levels found in this were compared between adolescent and adult mo-
study can be justified by the fact that the maternity thers. In one study, whose sample included adoles-
hospital studied is accredited by the Baby-Frien- cent mothers as from 16 years of age, the mean BSES
dly Hospital Initiative (BFHI). Brazilian studies in score was 146.6 points, indicating a high self-efficacy
hospital not accredited by BFHI observed higher level;41 in that study, however, the adolescents and
levels of self-efficacy in the first 24h after birth, dif- adults were not analyzed separately, nor was the
fering from this study by the use of the BSES-short influence of (adolescent or adult) age on the scores.
version.35-36 The influence of the actions practiced at
the BFHI maternity hospital on the breastfeeding
self-efficacy levels should be further investigated.
CONCLUSION
In addition, it is important to highlight that, in Breastfeeding is of fundamental important for
Brazil, beyond the BFHI, other public policies and maternal-child health and for society. The moment
programs in favor of breastfeeding play an impor- of birth and the hospital practices in the immediate

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postpartum interfere directly in the construction of 5. Victora CG, Aquino EML, Leal MC, Monteiro
maternal self-efficacy in breastfeeding skills. CA, Barros FC, Szwarcwald CL. Maternal and
The is a pioneer study in the analysis and child health in Brazil: progress and challenges.
comparison of breastfeeding self-efficacy between The Lancet [Internet] 2011 may [cited 2013 Aug
adolescent and adult postpartum women. Inde- 20]; 377(9780):1863-76. Available from: http://
pendently of the age, the women in these groups dx.doi.org/10.1016/S0140-6736(11)60138-4
did not present significant different with regard to 6. Moreira MA, Nascimento ER, Paiva MS. Social
the study variable. The participation of postpar- representations concerning the breastfeeding
tum women admitted to a maternity hospital ac- practices of women from three generations.
credited by the IHAC can be considered a study li- Texto Contexto Enferm [Internet]. 2013
mitation, as these institutions act strongly in favor [cited 2014 Oct 10]; 22(2):432-41. Available
of breastfeeding, which may have influenced the from: http://www.redalyc.org/articulo.
participants answers. oa?id=71427998020
Besides this study, few studies were found in 7. Issler H, Douek PC, Andrs LM, Goldstein SR,
the scientific literature that analyzed self-efficacy Issa LJ, Fujinami PI, et al. Fatores socioculturais
in breastfeeding in the immediate postpartum. In do desmame precoce: estudo qualitativo.
addition, although the IHAC is a strategy that can Pediatria. 2010; 32(2):113-20
strengthen maternal self-efficacy, no studies were 8. Filamingo BO, Lisboa, BCF, Basso, NAS. A
found that related the actions or indicators of the Ba- prtica do aleitamento materno entre mes
by-Friendly Institutions with self-efficacy in breast- adolescentes na cidade de dois crregos, Estado
feeding. Hence, also considering that the BSES can de So Paulo. Sci Med. 2012; 22(2):81-5.
be used at any time in the perinatal period, further
9. Frota DAL, Marcopito LF. Amamentao entre
research is suggested, so that the women can be
mes adolescentes e no adolescentes, Montes
monitored prospective and retrospectively, with a
Claros, MG. Rev Sade Pblica [Internet]. 2004
view to expanding the knowledge and monitoring
Fev [cited 2013 Dec 05]; 38(1):85-92. Available
of mother and infant with regard to breastfeeding.
from: http://dx.doi.org/10.1590/S0034-
As an implication for professional practice, it 89102004000100012
is highlighted that the assessment of self-efficacy
10. Glass TL, Tucker K, Stewart R, Baker TE,
in breastfeeding is an important variable and can
Kauffman RP. Infant feeding and contraceptive
be used to identify the women with low levels, fa-
practices among adolescents with a high teen
cilitating the practice of strategies that contribute
to increase the breastfeeding rates. pregnancy rate: a 3-year retrospective study. J
Womens Health [Internet]. 2010 Sep [cited 2013
Nov 12]; 19(9):1659-63. Available from: http://
REFERENCES online.liebertpub.com/doi/full/10.1089/
1. World Health Organization (WHO). Infant jwh.2009.1849
and young child feeding. Model chapter for 11. Horta BL, Victora C, Gigante DP, Santos J,
textbooks for medical students and allied health Barros FC. Durao da amamentao em duas
professionals. Geneva: WHO; 2009. geraes. Rev Sade Pblica [Internet]. 2007
2. Ministrio da Sade (BR). II Pesquisa de Fev [cited 2013 Nov 25]; 41(1):13-8. Available
prevalncia de aleitamento materno nas capitais from: http://dx.doi.org/10.1590/S0034-
brasileiras e Distrito Federal. Braslia (DF): MS; 89102007000100003.
2009. 12. Cruz MCC, Almeida JAG, Engstrom EM.
3. Ministrio da Sade (BR). Secretaria de Ateno Prticas alimentares no primeiro ano de vida
Sade. Departamento de Ateno Bsica. de filhos de adolescentes. Rev Nutr [Internet].
Sade da criana: nutrio infantil: aleitamento 2010 [cited 2013 dez 05]; 23(2):201-10. Available
materno e alimentao complementar. Braslia from: http://dx.doi.org/10.1590/S1415-
(DF): MS; 2009. 52732010000200003
4. Venancio SI, Escuder MM, Saldiva SR, Giugliani 13. Alexander A, ORiordan MA, Furman L. Do
ER. Breastfeeding practice in the Brazilian breastfeeding intentions of pregnant inner-city
capital cities and the Federal District: current teens and adult women differ? Breastfeed Med.
status and advances. J Pediatr (RJ). 2010; 2010 Dec; 5(6):289-96.Epub 2010 Jun 24
86(4):317-24. 14. Feldman-Winter L, Shaikh U. Optimizing

Texto Contexto Enferm, 2017; 26(1):e4100015

Guimares CMS, Conde RG, Brito BC, Gomes-Sponholz FA, Ori MO, Monteiro JCS 8/9

breastfeeding promotion and support in 25. Bandura A. Self-efficacy: toward a unifying

adolescent mothers. J Hum Lact. 2007 Nov; theory of behavioral change. Psychol Rev
23(4):362-7. [Internet]. 1977 Mar [cited 2014 Jan 10];
15. Monteiro JCS, Dias FA, Stefanello J, Reis 84(2):191-215. Available from: http://www.uky.
MCG, Nakano MAS, Gomes-Sponholz FA. edu/~eushe2/Bandura/Bandura1977PR.pdf
Breastfeeding among Brazilian adolescents: 26. Dennis CL. Identifying predictors of
Practice and needs. Midwifery [Internet] 2014 breastfeeding self-efficacy in the immediate
Mar [cited 2014 Jan 05]; 30(3):359-63. Available postpartum period. Res Nurs Health. 2006 Aug;
from: http://www.sciencedirect.com/science/ 29(4):256-68
article/pii/S0266613813000995. 27. Dennis CL, Faux S. Development and
16. Tucker CM, Wilson EK, Samandari G. Infant psychometric testing of the Breastfeeding
feeding experiences among teen mothers in Self-Efficacy Scale. Res Nurs Health. 1999 Oct;
North Carolina: Findings from a mixed-methods 22(5):399-409.
study. Int Breastfeed J [Internet] 2011 Sep [cited 28. Ori MOB, Ximenes LB. Traduo e adaptao
2014 Jan 05]; 6: 14. Available from: http:// cultural da Breastfeeding Self-Efficacy Scale
www.internationalbreastfeedingjournal.com/ para o portugus. Acta Paul Enferm [Internet].
content/6/1/14 2010 [cited 2013 Dec 04]; 23(2): 230-8. Available
17. Kools EJ, Thijs C, De Vries H. The behavioral from: http://dx.doi.org/10.1590/S0103-
determinants of breast-feeding in The 21002010000200013
Netherlands: predictors for the initiation of 29. Blyth R, Creedy DK, Dennis CL, Moyle W, Pratt
breast-feeding. Health Educ Behave. 2005; J, De Vries SM. Effect of maternal confidence
32(6):809-24. on breastfeeding duration: an application of
18. Kronborg H, Vaeth M. The influence of breastfeeding self-efficacy theory. Birth. 2002
psychosocial factors on the duration of Dec; 29(4):278-84
breastfeeding. Scand J Public Health. 2004; 30. Blyth R, Creedy DK, Dennis CL, Moyle W, Pratt
32(3):210-6 J, De Vries SM, et al. Breastfeeding duration
19. Dennis CL, Heaman M, Mossman M. in an australian population: the influence of
Psychometric Testing of the Breastfeeding Self- modifiable antenatal factors. J Hum Lact. 2004;
Efficacy Scale-Short Form Among Adolescents. 20(8):30-8.
J Adolesc Health. 2011; 49(3):265-71. 31. Lewallen LP. A review of instruments used to
20. Ori MOB, Ximenes LB, Almeida PC, Glick predict early breastfeeding attrition. J. Perin.
DF, Dennis CL. Psychometric assessment of Educ. 2006; 15(1):26-41.
the Brazilian version of the Breastfeeding 32. Mossman M, Heaman M, Dennis CL, Morris
Self-Efficacy Scale. Public Health Nurs. 2009; M. The influence of adolescent mothers
26(6):574-83. breastfeeding confidence and attitudes on
21. Nichols J, Schutte NS, Brown RF, Dennis CD, breastfeeding initiation and duration. J Hum
Price I. The impact of a Self-Efficacy Intervention Lact. 2008 Aug; 24: 268-77
on Short-Term Breast-Feeding Outcomes. 33. Ku C-M, Chow SK. Factors influencing the
Health Educ Behavior. 2009; 36(2):250-9. practice of exclusive breastfeeding among
22. Zubaran C, Foresti K. The correlation between Hong Kong Chinese women: a questionnaire
breastfeeding and maternal quality of life in survey. J Clin Nurs. 2010 Sep; 19(17-18): 2434-45
southern Brazil. Breastfeeding Med. 2011; 34. Zhu J, Chan WCS, Zhou X, Ye B, He H-G.
6(1):25-30. Predictors of breastfeeding self-efficacy among
23. Meedya S, Fahy K, Kable A. Factors that Chinese mothers: A cross-sectional questionnaire
positively influence breastfeeding duration to survey. Midwifery. 2014; 30(6):705-11.
6 months: a literature review. Women Birth 35. Rodrigues AP, Padoin SMM, Guido LA, Lopes
[Internet]. 2010 [cited 2014 Jun 07]; 23(4):135- LFD. Fatores do pr-natal e do puerprio que
45. Available from: http://www.sciencedirect. interferem na autoeficcia em amamentao.
com/science/article/pii/S1871519210000211 Esc Anna Nery [Internet]. 2014 [cited 2014
24. Dennis CL. Theoretical underpinnings of Dec 05]; 18(2):257-61. Available from: http://
breastfeeding confidence: a self-efficacy www.scielo.br/scielo.php?script=sci_
framework. J Hum Lact. 1999; 15(3):195-201 arttext&pid=S1414-81452014000200257

Texto Contexto Enferm, 2017; 26(1):e4100015

Comparison of breastfeeding self-efficacy between adolescent and adult mothers at... 9/9

36. Souza EF, Fernandes RAQ. Autoeficcia na 39. Centers for Disease Control and Prevention
amamentao: um estudo de coorte. Acta Paul (CDC) [Internet]. Departament of Health and
Enferm [Internet]. 2014 [cited 2015 Jan 05]; Human Service (USA). Breastfeeding Report
27(5):465-70. Available from: http://dx.doi. Card. 2010 [cited 2014 Dec 05]. Available from:
org/10.1590/1982-0194201400076. http://www.cdc.gov/breastfeeding/pdf/
37. Matanda DJ, Mittelmark MB, Kigaru DMD. breastfeedingreportcard2010.pdf
Breast-complementary and bottle-feeding 40. Wilhelm S, Rodehorst-Weber TK, Stepans
practices in Kenya: stagnant trends were MBF, Hertzog M. The relationship between
experienced from 1998 to 2009. Nutr Res. 2014; breastfeeding test weights and postpartum
34(6):507-7. breastfeeding rates. J Hum Lact. 2010 May;
38. United Nations Childrens fund (UNICEF). 26(2):168-74.
Breastfeeding on the worldwide agenda: 41. Linares AM, Rayens MK, Dozier A, Wiggins
findings from a landscape analysis on political A, Dignan MB. Factors influencing exclusive
commitment for programmes to protect, breastfeeding at 4 months postpartum in a sample
promote and support breastfeeding. Nova York of urban hispanic mothers in Kentucky. J Hum
(US): UNICEF; 2013. Lact. 2015 May; 31(2):307-14.

Correspondence: Carolina Maria de S Guimares

Rua Uberaba, 100 ap. 22
14027090 Jd. Nova Aliana Sul, Ribeiro Preto, SP, Brasil Received: September 08, 2015
E-mail: [email protected] Approved: May 05, 2016

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