Evidence map›Paper›PMID 40448088›Full record

SynthesisInternational breastfeeding journal2025

Applying the theory of planned behavior to examine breastfeeding determinants in countries of the Gulf Cooperation Council: a systematic review.

Ayoub Al-Jawaldeh, Dana Matbouli, Dima Itani, Sara Diab, Mandy Taktouk, Sally Naalbandian, Lara Nasreddine

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in International breastfeeding journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Ayoub Al-JawaldehRegional Office for the Eastern Mediterranean (EMRO), World Health Organization (WHO), Cairo, Egypt.
Dana MatbouliNutrition and Food Sciences Department, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon.
Dima ItaniFaculty of Medicine, American University of Beirut, Beirut, Lebanon.
Sara DiabNutrition and Food Sciences Department, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon.
Mandy TaktoukNutrition and Food Sciences Department, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon.
Sally NaalbandianUniversity Libraries, American University of Beirut, Beirut, Lebanon.
Lara NasreddineNutrition and Food Sciences Department, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon. ln10@aub.edu.lb.

Funding

World Health Organization 001
6 · The paper itself

Abstract

backgroundAppropriate and timely nutrition during infancy constitutes a critical window of opportunity to ensure proper growth and development. Despite the established benefits of breastfeeding (BF), the proportions of breastfed infants remain disappointingly low in countries of the Gulf Cooperation Council (GCC). Using the Theory of Planned Behavior (TPB), this systematic review aims at examining infant feeding intentions, attitudes, subjective norms, perceived behavioral control and beliefs towards BF amongst women in various countries of the GCC.

methodsPertinent data were obtained through a search of peer-reviewed studies published between 2012 and 2024. A total of 12 electronic databases have been searched.

resultsA total of 101 studies were retained. The largest number of studies was from the Kingdom of Saudi-Arabia (80 studies). The results were mapped across the five TPB constructs: intention, subjective norms, attitude, perceived behavioural control and beliefs. Findings showed that, although the intention to BF was high, the intention to exclusively BF was considerably lower. BF was found to align well with the religious norms and social expectations in countries of the GCC. However, factors such as shyness, embarrassment and reticence over BF in public and pumping at work were reported by various studies. There was a negative attitude towards the suitability of BF for working mothers and it was common for women to consider that formula feeding and BF provide equal benefits. Perceived behavior control towards exclusive BF and the sufficiency of breast milk supply was identified as low in several studies, particularly amongst primigravida women and mothers of twins. Women believed that BF in public may expose them to the "evil eye" and that BF may lead to breast sagging.

conclusionsBy identifying opportunities and gaps under each of the TPB constructs, the results of this review may assist in the development of future culture-specific interventions aimed at BF promotion in countries of the region. These include multi-level interventions encompassing the educational system, the media and social media, in addition to community and hospital-based interventions. The results also call for the development of policies tailored to the identified factors in each of the TPB constructs.

Indexed as

Breast FeedingHealth Knowledge, Attitudes, PracticeMothersAdultFemaleHumansInfantInfant, NewbornIntentionMiddle EastTheory of Planned BehaviorAttitudesBeliefsBreastfeedingGulf Cooperation CouncilIntentionsPerceived behavioral controlSubjective normsSystematic reviewTheory of planned behavior

Identifiers

PMID40448088
PMCPMC12125868

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.