Examining Normative Influences on Breastfeeding Intentions among African American Women: Implications for Health Communication

Abstract

There is a persistent disparity in breastfeeding behaviors, particularly with duration, among African American mothers relative to other racial/ethnic groups. The Theory of Normative Social Behavior (TNSB) explains when and how social norms influence behaviors, but the TNSB has not been tested in breastfeeding or within an African American cultural context. The purpose of this dissertation was to reconceptualize and test the reconceptualized TNSB for breastfeeding among African American women in Washington, D.C. using a mixed methods approach.

Aim 1 was to describe normative referent groups and salient social identities related to breastfeeding social norms. Five focus groups were held with 30 African American mothers who had a child since 2016. Two coders conducted pragmatic thematic analysis. Participants perceived breastfeeding to be trending in popularity and acceptability in African American communities in D.C. They described different social identities relevant to making infant feeding decisions and their perceptions of norms depended on the referent.

Aim 2 was to assess the roles of descriptive norms (DN) in predicting breastfeeding intentions and examine the moderating roles of injunctive (IN) and subjective norms (SN) and social identity on the relationship between DN and intentions through a survey of 528 African American mothers. Structural equation modeling was employed to test predictions. Data were consistent with an interaction effect between SN and DN revealing that when SN are weak, the relationship between DN and intentions is positive and linear and when SN are strong, that relationship is less strong. Latent profile analysis using ethnic pride, collectivism, and religiosity scales detected four cultural clusters of African American identity, which was a significant moderator of the DN to intentions relationship. Two groups (with the highest ethnic pride) were significantly influenced by DN to intend to breastfeed.

Based on the results of this research, social marketing campaigns should emphasize pro-breastfeeding SN and messaging should be used to increase perceptions that breastfeeding is common in African American communities. Communicators should consider a positive deviance and trending norms approach, leveraging in-group community members who have successfully breastfed. Ethnic pride, religiosity/spirituality, and collectivism may be relevant concepts to consider for audience segmentation/group-level psychographic targeting of norms-based communication messages.