A mixed method study to explore knowledge, attitudes, behaviour and experience of introducing solids

BACKGROUND: Infancy is a critical time for establishing dietary habits. EARLY START aims to build an intervention for reducing early life obesogenic behaviours. Using participatory action research, the exploratory phase investigates mothers’ knowledge, attitudes, behavioural intent and experience of introducing to solids METHODS: A mixed methods approach was used. Knowledge, attitudes and behavioural intent about infant feeding were investigated amongst mothers using the Infant Feeding Education Questionnaire (IFEQ). A subgroup participated in a focus group discussion of their experience of introducing solids. Data were analyzed using Descriptive and Thematic Content methods. RESULTS: One hundred and three mothers participated (mean age 33 y.o., tertiary education 94.3%, in employment 98.9%). Advice from health care professionals (HCP) was the most influential factors for when to start solids. Despite a relatively high total IFEQ score (39, min -56, max 56), learning needs were identified in areas, such as putting baby to sleep with bottle and recommended size of food pieces and breastfeeding duration. Maternal characteristics did not influence the IFEQ score. Mother's confidence on when to wean was associated with higher IFEQ score (β coeff.: -2.9, CI -5.4, -0.4, per change to a lower confidence category). Qualitative analysis showed that mother consider introduction to solids a ritual process that is challenging, emotional and requires guidance. It is compared to a “dance” between mother and baby with HCPs positively influencing coordination. Mothers express the need for timely and continuous information beyond the weaning phase that takes into consideration baby's behavioural development and self-contained needs. CONCLUSIONS: Mother's confidence on weaning is influenced by knowledge, attitudes and behavioural intent. New interventions should build confidence by focusing on challenges and addressing mother's emotional and baby's developmental and specific needs. KEY MESSAGES: • Knowledge, attitudes and behavioural intent of introducing solids affects a mother's confidence whilst infant feeding is considered a complex and emotional process requiring guidance on evolving needs. • Future interventions should focus on building confidence by addressing mother's challenges and emotions whilst taking into consideration the baby's developmental and self-contained needs.