Mediating Effect of Attitude Between Knowledge and Willingness to Donate and Accept Donor Breast Milk in Odisha, India

Introduction: Breast milk banking (BMB) serves as a vital intervention to support neonatal health, particularly for preterm and low-birth-weight infants. However, cultural, attitudinal, and knowledge-based barriers affect its acceptance. This study assessed mothers' knowledge, attitudes, and willingness regarding breast milk donation (BMD) and donor breast milk (DBM), exploring factors influencing these aspects and the mediating role of attitude. Methods: A cross-sectional analytical study was conducted from November 2021 to July 2022, involving 400 mothers selected through convenience sampling. Data were collected using validated questionnaires assessing demographic details, knowledge, attitudes, and willingness toward BMB. Descriptive statistics, correlation, chi-squared tests, prevalence ratios, and mediation analysis using SmartPLS (SmartPLS GmbH, Bönningstedt, Germany) were performed. Results: Most participants, 250 (62.5%), were unaware of BMB, though 259 (64.8%) showed a favorable attitude. Willingness to donate was reported by 313 (78.3%), while 279 (69.8%) were willing to accept DBM. Major barriers included family disapproval and fear of disease transmission. Knowledge positively correlated with willingness but negatively with attitude. Mediation analysis showed that while higher knowledge directly increased willingness, it also reduced favorable attitudes, which negatively impacted willingness. Socio-demographic factors such as education, income, residence, and family type significantly influenced knowledge, attitudes, and willingness. Conclusion: Although mothers with higher knowledge were more willing to donate and accept breast milk, this was paradoxically linked to less favorable attitudes. Addressing misconceptions and promoting community-based education may improve both attitudes and participation in BMB programs.