The effect of an educational intervention based on the theory of planned behavior on breastfeeding behavior and self-efficacy in pregnant women in Iran: a quasi-experimental study

BACKGROUND: Breastfeeding is essential for the health and well-being of both infants and mothers. However, exclusive breastfeeding (EBF) rates remain low in many parts of Iran, especially in Zahedan. Several factors, including low self-efficacy, limited knowledge, negative attitudes, and socio-cultural barriers, contribute to the early discontinuation of breastfeeding. Educational interventions based on behavioral theories such as the Theory of Planned Behavior (TPB) can effectively promote positive breastfeeding behaviors and strengthen maternal self-efficacy. Therefore, this study was conducted to determine the effect of a TPB-based educational intervention on breastfeeding behavior and self-efficacy among pregnant women in Zahedan, Iran. METHODS: This quasi-experimental study used a pretest-posttest design and included 70 primiparous pregnant women attending health centers in Zahedan. Participants were purposively selected from five health centers and then assigned to intervention and control groups using simple random sampling. The intervention group received four educational sessions based on the TPB and self-efficacy concepts, while the control group received only routine care. Data were collected using demographic questionnaires, a behavioral intention questionnaire, and the Dennis Breastfeeding Self-Efficacy Scale. Data were analyzed using SPSS software, employing independent t-tests, paired t-tests, and chi-square tests. FINDINGS: The majority of participants (71.4%) were homemakers, and most mothers (72.8%) had a vaginal delivery. The mean age of mothers was 23.05 ± 2.56 years in the intervention group and 23.48 ± 3.69 years in the control group. After the intervention, mean scores for breastfeeding self-efficacy, attitude, subjective norms, perceived behavioral control, and behavioral intention increased significantly in the intervention group (p < 0.001), whereas no significant changes were observed in the control group. CONCLUSIONS: The TPB-based educational intervention was associated with improvements in pregnant women's breastfeeding intention, self-efficacy, and exclusive breastfeeding behavior. These findings suggest that integrating theory-driven educational programs into routine prenatal care may help strengthen maternal confidence and support sustained exclusive breastfeeding, particularly in socio-economically vulnerable regions.