September-December 2022 UNIVERSA MEDICINA Vol.41- No.3 

 
pISSN: 1907-3062 / eISSN: 2407-2230 

 
 

Predictors of breastfeeding self-efficacy  

in pregnant adolescents 
 

Funda Özdemir1 , Seda Karaçay Yıkar2 , and Evşen Nazik2   

 
                                            

                                           ABSTRACT 
 

 

BACKGROUND 

Breastfeeding is critical for infant health and development globally. 

Current knowledge and attitude of future parents will significantly 

influence breastfeeding practices. The study was conducted to determine 

the levels and determinants of breastfeeding self-efficacy among 

primiparous and secundigravid adolescents.  

 

METHODS 

A cross-sectional study was performed involving 54 primiparous and 

secundigravid adolescents in antenatal clinics of hospitals affiliated to the 

Ministry of Health in Adana, Turkey. They were aged between 16 and 19 

years, had a single living fetus, did not have pregnancy complications, 

were in their third trimester of pregnancy, attended an antenatal clinic, and 

agreed to participate in the study. Data were collected using a Personal 

Information Form and the Antenatal Breastfeeding Self-Efficacy Short 

Form Scale (BSES-SF). Kruskal-Wallis variance analysis, Mann Whitney 

U and multiple linear regression analysis test were used to analyze the 

data.  

 

RESULTS 

Mean age of the pregnant adolescents was 18.28 ± 0.79 years, and 31.5% 

had primary education, 96.3% were not working, 55.6% lived in a nuclear 

family, and 51.9% had not received breastfeeding education. The total 

BSES-SF mean score was 55.37 ± 12.84. Breastfeeding education has a 

statistically significant effect on breastfeeding self-efficacy of pregnant 

adolescents (p<0.05). Regular antenatal care, breastfeeding training 

status, breastfeeding education source variables and breastfeeding self-

efficacy variable of women significantly predicted negatively (p<0.05).  

 

CONCLUSIONS 

Breastfeeding education source was the most influential predictor variable 

of BSES. There is a need for nursing initiatives to enhance the 

adolescents’ antenatal breastfeeding self-efficacy levels.  

 

Keywords: Breastfeeding, self-efficacy, pregnant, adolescents, nursing 

 

 

 

 

1Ankara University, Faculty of 

Nursing, Obstetrics and Gynecology 

Nursing Department, Ankara/ 

TURKEY 
2Çukurova University, Faculty of 

Health Sciences, Obstetrics and 

Gynecology Nursing Department, 

Adana/TURKEY  

 

*Correspondence: 

Seda Karaçay Yıkar 

Çukurova University, Faculty of 

Health Sciences, Obstetrics and 

Gynecology Nursing Department, 

Adana /TURKEY  

Phone:+903223386484, 

Fax:+903223386970 

E-mail: sedakrcyyikar@gmailcom 

 

Date of first submission, September 26, 

2022 

Date of final revised submission, 

December 8, 2022 

Date of acceptance, December 14, 

2022 

 

This open access article is distributed 

under a Creative Commons Attribution-

Non Commercial-Share Alike 4.0 

International License 

 

 

254 

 
DOI: http://dx.doi.org/10.18051/UnivMed.2022.v41.254-262  

    Copyright@Author(s) - https://univmed.org/ejurnal/index.php/medicina/article/view/1384 

 

 

 

 

 

 

ORIGINAL ARTICLE 

Cite this article as: Özdemir F, Yikar SK, 

Nazik E. Predictors of breastfeeding self-

efficacy in pregnant adolescents. Univ 

Med 2022;41:254-62. doi: 10.18051/ 

UnivMed.2022.v41:254-262 

http://dx.doi.org/10.18051/UnivMed.2022.v41.254-262
https://univmed.org/ejurnal/index.php/medicina/article/view/1384
https://orcid.org/0000-0002-7483-6690
https://orcid.org/0000-0002-8893-9391
https://orcid.org/0000-0003-1885-5376


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INTRODUCTION

Ad o le sc e nc e  i s t h e  t r a ns it i on  f r om
childhood to adolescence, and includes ages
between 10 to 19 years.(1) Every year, an
estimated 21 million girls aged between 15 and
19 years, and 2 million girls under the age of 15,
become pregnant in developing regions.(2,3) In
addition, approximately 16 million girls aged
between 15 to 19, and 2.5 million girls under the
age of 16, give birth in developing regions.(3)

Adolescent fertility rate represents children
born alive per 1000 women aged between 15 to
19. According to Turkish Statistical Institute’s
data from 2017, adolescent fertility rate was 21
in 1000. In other words, every 21 out of 1000
women aged between 15 and 19 years of age
had given birth.(4)

There are many p hysiologica l and
psychosocial changes during adolescence. In
addition to these changes, pregnant adolescents
are preparing to adapt to new and different
situations, and to take new responsibilities during
the pregnancy, childbirth and postnatal period.(5)

One of the most important responsibilities of
adolescents to take during the postpartum period
is related to the feeding of the baby. A major
sociodemographic factor regarding breastfeeding
is age.(6) Adolescent mothers are a group that
should be  considere d as a priority in
breastfeeding. A cross-sectional study involving
392 adolescents showed that 290 (74%) had poor
knowledge regarding breastfeeding and that there
was a statistically significant association between
high level of knowledge and positive attitude.(7)

Özsoy (8) found that adolescent mothers had more
ne gative behaviors and attitudes towards
breastfeeding and needed more information and
help than adult mothers.

One of the issues that needs to be addressed
first in support of breastfeeding in adolescents is
the perception of breastfeeding self-efficacy.
According to Dennis and Faux,(9) breastfeeding
self-efficacy perception affects the mother’s
ability to breastfeed, the effort she will make for
the baby, as well as her emotional thoughts and

feelings.(9) Yenal et al.(10) found a significant
positive relationship between breastfeeding self-
efficacy perception and breastfeeding success in
their studies. Tokat and Okumuş (11) found that
antenatal education was effective in improving
breastfeeding self-efficacy perception and
breastfeeding success. In a study developed in
China among adult postpartum women during
pregnancy and the associated hospitalization, low
self-efficacy was found. Nevertheless, the self-
confidence to breastfeed among adolescent
mothers has been hardly explored.(12) In the
present study, the aim was to determine the
breastf eeding self-e fficacy of pr egnant
adolescents in a province of the Mediterranean
region. Determining the perception of
breastfeeding self-efficacy of adolescents is
important in shaping the provided healthcare. This
study was carried o ut to determine the
breastfeeding self-efficacy perceptions in
pregnant adolescents.

METHODS

Research design
This study used a cross-sectional design and

was performed in antenatal clinics of hospitals
affiliated to the Ministry of Health in Adana,
Turkey, between February and June 2015. In the
study, all adolescent pregnant women who came
to the outpatient clinic and met the research
criteria in the determined time interval were
included in the study.

Research subjects
The study was conducted with 54 primiparous

and secundigravid adolescents, who were aged
between 16 to 19 years, had a single living
fetus, did not have pregnancy complications, were
in their third trimester of pregnancy, attended an
antenatal clinic, spoke Turkish, and agreed to
participate in the study.

Data collection
The data were collected using a personal

i nf or ma tio n f o r m a nd  th e  A nt e n a t a l



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Özdemir, Yikar, Nazik                                                       Breastfeeding self-efficacy in pregnant adolescents

Breastfeeding Self- Efficacy Scale Short Form
(BSES-SF). The personal information form was
prepared by the researchers and consisted of
questions re lated t o socio-demogr aphic
characteristics (age, age of marriage, educational
status, occupational status, social security, income
level, type of family, place of residence, age of
husband, occupational status of husband) and
obstetric characteristics (planned status of
pregnancy, regular antenatal care, having a health
problem during pregnancy, breastfeeding training
status).

The Antenatal Breastfeeding Self-Efficacy
Short Form scale was developed by Dennis et
al.(13)and is a 14-item self-report instrument to
measure breastfeeding confidence. All items are
measured on a 5-point Likert-type scale, with 1
representing no conf idence  at all, and 5
representing greatest confidence. All items are
presented positively, and scores are summed to
produce scores that range from 14 to 70, with
higher scores indicating higher levels of
breastfeeding self-efficacy. Dennis et al.(13) stated
that it is also possible to use it in the antenatal
period by using the expression “future time” in
the items of BSES-SF. The BSES-SF Turkish
reliability and validity study was made by Aluş
Tokat et al.,(14) who found that the Cronbach alpha
value was 0.86.

Statistical analysis
The statistical analysis were performed using

SPSS for Windows version 22.0. Descriptive
statistics, Kruskal-Wallis variance analysis, and
Mann-Whitney U test, and multiple linear
regression were applied for analyzing the data.
Significant variables (p<0.05) were included in
the multiple linear regressions to investigate the
predictors of the breastfeeding self-efficacy. The
statistical significance level was accepted as
p<0.05.

Ethical consideration
Before conductin g the  study, the

investigators obtained written approval from the

Ethics Board of School of Medicine, Cukurova
University (28.10.2014/24/2), written approvals
from the institutions in which the study was to be
performed, and verb al consent from the
participants. To obtain the adolescents’ verbal
consent, all participants were informed of the
purpose of the study and were assured that the
collected information would be used solely for
scientific purposes, be kept confidential and not
be shared by others than the researchers. A face-
to-face interview method was used by the
researchers to administer the questionnaires. The
interviews lasted approximately 15 minutes.

RESULTS

The demographic characteristics of the
subjects are shown in Table 1. The results showed
that 83.3 % of the pregnant adolescents were
18- 19 years old, and 55.6 % were married at the
age of 18- 19 years. Furthermore, 50.0% of the
adolescents had completed secondary school,
88.9% had socia l se cur ity, 96.3% were
unemployed, 68.5% reported that their income
equaled their expenditure, 55.6% lived in nuclear
families, and 51.9% lived in the city center. The
results also showed that 50.0% of the husbands
were at least 25 years old, 90.7% of the husbands
were employed, and 68.5% of the adolescents
chose their partner through love. The average
total score of BSES-SF was 55.37 ± 12.84 (Table
1).

No significant difference in mean BSES-SF
scores between subgroups of age, age of
marriage, educational status, having social
security, occupational status, economic status,
type of family, age of husband, occupational status
of husband and type of marriage (p>0.05) (Table
2).

A statistically significant difference was
found in mean BSES-SF between subgroups of
attending regular antenatal care, attending
breastfeeding education, and receiving the
education from a healthcare personnel (p<0.05)
(Table 3).



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Characteristics n (%) 
Age (years) 
 Mean ± SD 

 16-17 
 18-19 

Age of marriage (years) 
 15-17 
 18-19 

Education 
 Primary school  
 Secondary school  
 High school  

Having social security  
 Yes  
 No 

Occupational status 
 Employed  
 Unemployed  

Economical level 
 Income ≥expenditure  
 Income=expenditure  
 Income<expenditure  

Family type 
 Nuclear  
 Large  

Place of residence 
 Village  
 Town  
 City  

Age of husband (years) 
 Mean ± SD 
 18 – 24  
 ≥25 

Occupational status of husband 
 Employed  
 Unemployed 

Type of Marriage 
 Arranged 
 Love  

Planned status of pregnancy 
 Yes  
 No 

Regular antenatal care 
 Yes  
 No 

Breastfeeding training status 
 Yes  
 No 

Breastfeeding education source (n=27) 
 Healthcare personnel 
 Family/relative 
 Book/magazine/internet 
 Did not receive  

BSES-SF (Mean ± SD)  

 
18.28 ± 0.78 

9 
45 

 
24 
30 

 
17 
27 
10 

 
48 
6 
 

2 
52 

 
10 
37 
7 
 

30 
24 

 
5 

21 
28 

 
24.56±3.16 

27 
27 

 
49 
5 
 

17 
37 

 
45 
9 
 

48 
6 
 

27 
27 

 
22 
4 
1 

27 
55.37 ± 12.84 

 
 

16.7 
83.3 

 
44.4 
55.6 

 
31.5 
50.0 
18.5 

 
89.9 
11.1 

 
3.7 

96.3 
 

18.5 
68.5 
13 

 
55.6 
44.4 

 
9.3 

38.9 
51.9 

 
 

50 
50 

 
90.7 
9.3 

 
31.5 
68.5 

 
83.3 
16.7 

 
88.9 
11.1 

 
50.0 
50.0 

 
 

40.7 
7.5 
1.8 

50.0 

Table 1. The sociodemographic and obstetrics characteristics of the participant women (n=54)

Note ; BESE-SF : breastfeeding self-efficacy scale short form



258

Sociodemographic characteristics Mean scores of breastfeeding self-efficacy scale Test and p value 
Age 

 
 

KW=1.446 
p=0.229 

 16-17 49.88 ±0.00 
 18-19 49.00±15.91 

Age of marriage 
 

 
KW=0.478 

p=0.489 
 15-17  54.00±14.18 
 18-19 56.46±11.79 

Education 
 

 
KW=0.542 

p=0.763 
Primary school  57.11±12.75 
Secondary school  54.77±13.47 
High school  54.00±12.19 

Having Social Security  
 

 
MW-U= 117.000 

p=0.475 
 Yes  55.89±12.84 
 No  51.16±13.21 

Occupational status 
 

 
MW-U= 45.000 

p=0.771 
 Employed  53.00±12.72 
 Unemployed  55.46±12.96 

Economical level 
 

 
KW= 2.594 

p=0.273 
Income≥expenditure  57.40±13.58 
Income=expenditure  55.94±12.62 
Income<expenditure  49.42±13.18 

Family type 
 

MW-U= 309.00 
p=0.372  Nuclear  57.06±11.73 

 Large  53.25±14.06 
Place of residence 

 
 

KW= 6.655 
p=003 

 Village  61.00±13.76 
 Town  49.57±14.39 
 City   58.71±9.93 

Age of husband 
 

MW-U= 282.000 
p=0.151  18 – 24  54.18±10.89 

 25 age and over  56.55±14.65 
Occupational status of husband 

 
 

MW-U= 110.000 
p=0.728 

 Employed  55.08±13.22 
 Unemployed  58.20±8.67 

Type of Marriage 
 

MW-U= 299.500 
p=0.779  Arranged 54.11±13.74 

 Love  55.94±12.56 

 

Table 2. Comparison of mean scores of breastfeeding self-efficacy scale of
pregnant adolescents according to their sociodemographic characteristics

Note : KW : Kruskal-Wallis; MW-U : Man Whitney-U

No statistically significant difference was
found between place of residence of indigenous
wo me n a nd br e a s t f e e d i ng e x tr a c t s . T he
variables consisting of regular antenatal care,
breastfeeding training status, breastfeeding
education source and breastfeeding self-efficacy
of women significantly predicted negatively
(p<0.05). Breastfeeding education source was
the most influential predictor of breastfeeding
self-efficacy (Beta=-0.541) (Table 4).

DISCUSSION

In this study, the BSES-SF mean scores of
pregnant adolescents was 55.37 ± 12.84. A study
by Alus Tokat et al.(14) showed that BSES-SF
mean scores of pregnant adolescents was 51.72
± 7.69. In another study conducted in Turkey, the
mean BSES-SF scores of pregnant adolescents
was 50.30 ± 9.30.(11) Otsuko et al.(15) found the
mean BSES-SF scores to be 42.4, and Brando et

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Obstetric characteristics 
Mean scores of breastfeeding 

self-efficacy scale 
Test and p value 

Planned status of pregnancy 
 

 
MW-U= 191.000 

p=0.788 
 Yes  55.80±12.66 
 No  53.22±14.28 

Regular antenatal care 
 

 
MW-U= 78.500 

p=0.07 
 Yes  56.70±11.88 
 No 44.66±16.28 

Breastfeeding training status 
 

MW-U= 141.500 
p=0.001  Yes 61.70±8.62 

 No  49.03±13.36 
Breastfeeding education source (n=27) 

 
 

KW= 19.736 
p=0.001 

 Healthcare personnel 63.86±6.14 
 Family/relative 53.00±13.85 
 Book/magazine/internet 53.00±0.00 
 Did not receive 48.88±13.33 

 

Table 3. Comparison of mean scores of breastfeeding self-efficacy scale according
to obstetric characteristics of pregnant adolescents

Note : KW : Kruskal-Wallis; MW-U : Man Whitney-U

Predictors Β Beta p value 
Place of residence 
Regular antenatal care 
Breastfeeding training status 
Breastfeeding education source 

0.072 
-0.074 
-0.201 
-0.824 

0.145 
-0.297 
-0.498 
-0.541 

0.294 
0.029 
0.000 
0.000 

 

Table 4. Predictors of breastfeeding self-efficacy among pregnant adolescents (n=54)

Note: β = regression coefficient; Beta = standardized regression coefficient

al.(16) obtained the figure of 57.51 ± 8.0 for the
BSES-SF mean scores of Portuguese pregnant
adolescents. In another study, the mean BSES-
SF scores of 306 adults and 94 adolescents who
were in the early postpartum period were
investigated, high self-efficacy levels were found
in both groups, and no statistically significant
difference was found between the groups.(17) No
significant difference was found between age,
age of marriage, educational status, having social
security, occupational status, economic status,
type of family versus BSES-SF mean scores of
pregnant adolescents. Gerçek et al.(18) studied
first day postpartum women and found no
statistically significant difference in the BSES-
SF mean scores between subgroups of age,
educational status, occupational status, economic
status, length of marriage. In the study by Ince
et al.,(19) where self-efficacy levels of mothers

and the factors affecting breastfeeding were
assessed, no significant difference in the BSES-
SF sc o r e s be t w e e n s ub gr ou p s of  a ge ,
educational level, occupational status, perceived
economic status. Adolescents with planned
pregnancies had higher total BSES-SF scores,
b ut  t h e  d if f e r e nc e  wa s  n ot  s t at i st i c a l l y
significant. Akkoyun and Arslan obtained similar
results in their study.(20) In a study by Aydyn and
Aba, adolescents with planned pregnancies had
higher levels of self-efficacy, but the difference
was not statistically significant.(21)

Pregnant adolescents who attended regular
antenatal care, had higher self-efficacy scores.
The results of a study by Yang et al.(22) were
similar to our findings. Tucker et al.(23) and
Wambach et al.(24) both found that women who
received antenatal support from healthcare
personnel had higher levels of self-efficacy.



260

Pregnant adoles cents receiving
breastfeeding education had higher mean BSES-
SF scores than adolescents who did not receive
any education, and the difference was statistically
significant. When investigating the source of the
education and the mean BSES-SF scores, the
highest mean score s were obta ined by
adolescents who received the education from
healthcare personnel. There are literature studies
suggesting that education is effective in improving
breastfeeding self-efficacy. Myzrak et al.(25)

investiga ted the e ffe cts of breastfeeding
education given to primipara women during
antenatal period, on the mothers’ breastfeeding
self-efficacy perceptions and success, and found
that the breastfeeding self-efficacy scores were
48.73 during the antenatal period prior to the
education, and 66.22 after the education, 8 weeks
postpartum. Tokat and Okumuş found that
antenatal education based on strengthening the
perception of breastfeeding self-efficacy was
effective in improving breastfeeding self-
efficacy.(11) In a study by Karagöz,(26) where the
effects of antenatal breastfeeding education on
breastfeeding success and self-efficacy were
investigated, repeated tests were conducted to
both the experiment and the control groups on
the first day and at one month, four, and six months
postpartum, and a statistically significant
difference was found between the postpartum
self-efficacy scores of the experimental and
control groups. Chan et al.(27) found that education
related to self-efficacy given during the antenatal
period affected the scores of the second week
postpartum, which were significantly higher than
the scores prior to education. Liu et al.(28)

investiga ted the e ffe cts of breastfeeding
education on breastfeeding self-efficacy four and
eight wee ks postpar tum and found that
breastfeeding self-efficacy was significantly
higher after this period. The findings of our study
are in accordance with the literature, and the
results indicate tha t education improves
breastfeeding self-efficacy positively.

This study has several limitations. First, this
study included 54 antenatal care women at a

single hospital in southern Turkey, limiting the
generalizability of the results, since breastfeeding
is a long process. The fact that breastfeeding was
not evaluated in the postpartum period is one of
the limitations of the study. Despite its limitations,
this study may be helpful in guiding further
research.

Adolescence is one of the importa nt
transition processes, which is one of the phases
of a wome n’s life.  Pregnancy is not
recommended during this period as it brings risks
to the mother and fetus. It is very important to
determine the self -efficacy of adolescent
pregnant women in or der to continue
breastfeeding effectively in the postpartum period,
as in every life period.

CONCLUSION

Adolescents who received education
regarding breastfeeding had higher levels of
breastf eeding self-e fficacy in our study.
Therefore, it is important that nurses and
midwives guide adolescents to pregnancy
education classes during the antenatal cares.
Pregnancy education classes should cover
subjects regarding breastfeeding in detail.

ACKNOWLEDGMENTS

The authors grateful to all the patients who
participated in this study.

CONFLICTS OF INTEREST

Nothing to declare.

CONTRIBUTORS

All authors have contributed significantly to
this article to design of the work; analysis, or
interpretation of data for the work and all authors
are in agreement with the content of the
manuscript. Authors’ contributions SKY collected
the data. FO and EN analyzed the data. FO, EN,
SKY drafted and finalized the manuscript. All

Özdemir, Yikar, Nazik                                                       Breastfeeding self-efficacy in pregnant adolescents



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authors contributed to the design of the study, and
reviewed the manuscript. All authors have read
and approved the final manuscript.

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Özdemir, Yikar, Nazik                                                       Breastfeeding self-efficacy in pregnant adolescents

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