Addressing the Gap Between Recommended Infant Care Practices and Reality Using the Ecological Framework

The Theory of Planned Behavior (TPB; Ajzen, 1991) has been applied to breastfeeding and infant safe sleep practices to understand why some parents do not follow the American Academy of Pediatrics recommendations. This theory has limited usefulness for these behaviors, however, because it does not account for the dynamic nature of these behaviors over time. The current study addressed this limitation by assessing the TPB constructs and then applying principles from the Ecological Framework (Trickett, Kelly, & Vincent, 1985) to the contexts in which women perform these behaviors over the first 3 months postpartum. Eight women who were pregnant with their first child were interviewed using qualitative semi-structured interview guides during their third trimester of pregnancy to assess their plans and intentions, and at 10-14 weeks postpartum to assess their behaviors over time. Women also completed up to five phone interviews between delivery and the follow-up interview to collect data on their current feeding and sleep practices. Results from the TPB analyses replicated several findings from previous research. Analyses also identified previously unreported factors that affect women’s attitudes and perceived behavioral control over the behaviors of interest, most notably how women’s behavioral intentions are influenced by considerations for the mother-infant dyad, and not just the needs of the infant. Results from the ecological assessment identified several contextual factors for which the TPB does not account, including accessibility and use of resources (e.g., medical advice or support, familial support, and products to support breastfeeding and infant sleep) and coping strategies and adaptive behaviors used to address challenges, and the interdependence of feeding and infant sleep behaviors over time. Findings from this study expand our understanding of dynamic and complex nature of breastfeeding and infant sleep during the early postpartum months. Future interventions, programs, and policy statements to promote breastfeeding and infant safe sleep will be more effective when they address the needs of the mother-infant dyad and consider contextual factors that help or hinder women’s ability to perform these behaviors.