ArticleFrontiers in public health2026
Decision-making process of exclusive breastfeeding at 6 months postpartum based on the COM-B model: a multicenter, cross-sectional study in Southeast China.
Article in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Exclusive breastfeeding (EBF) for the first 6 months is crucial for public health, yet EBF rates in China remain below the 50% target of "Healthy China 2030." In Southeast China, adequate maternal knowledge and healthcare access do not ensure sustained EBF practices, indicating a clear knowledge-behavior gap. Traditional education models often ignore the interaction between psychological capabilities and environmental opportunities. Grounded in the COM-B (Capability, Opportunity, Motivation-Behavior) model, this multicenter study investigates EBF decision-making among postpartum women in this region. By examining how Capability (knowledge) and Opportunity (social support) interact through Motivation (self-efficacy), this research provides an evidence-based framework for targeted EBF interventions. Methods: A multicenter, cross-sectional study was conducted. We used convenience sampling to recruit 400 women at 6 months postpartum from two public hospitals in Southeast China. Validated instruments, including the Breastfeeding Knowledge Questionnaire, Breastfeeding Family Support Scale, and Breastfeeding Self-Efficacy Scale (Short Form), were used for data collection. Data analysis involved descriptive statistics, independent t-tests, ANOVA, and Partial Least Squares Structural Equation Modeling (PLS-SEM) to test the hypothesized pathways. Results: The exclusive breastfeeding (EBF) rate at 6 months postpartum was 30.25%. The PLS-SEM model explained 35.7% of the variance in EBF behavior ( Conclusion: Based on the COM-B model, this study identifies maternal self-efficacy (Motivation) as a key mediator connecting breastfeeding knowledge (Capability) and family support (Opportunity) to EBF behavior. These findings suggest that knowledge-focused education alone is insufficient. Future public health interventions should adopt a family-centered approach. Clinical programs should integrate family support and prioritize building maternal confidence to effectively improve EBF rates.
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