The Mediating Role of Maternal Confidence in the Relationship Between Breastfeeding Promotion and Exclusive Breastfeeding Duration

The Mediating Role of Maternal Confidence in the Relationship Between Breastfeeding Promotion and Exclusive Breastfeeding Duration | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Mediating Role of Maternal Confidence in the Relationship Between Breastfeeding Promotion and Exclusive Breastfeeding Duration Mohammed Malih Radhi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7243503/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background For public health, exclusive breastfeeding is essential for a child's health. However, many mothers stop breastfeeding prematurely. This study aimed to investigate the influence of maternal confidence on the relationship between breastfeeding promotion activities and the duration of exclusive breastfeeding among mothers after childbirth in Thi Qar Governorate, Iraq. Methods A descriptive, cross-sectional correlational design was used. A 406 postpartum mothers were recruited from hospitals and primary health care centers using a systematic random sample. Data were collected through interview-conducted questionnaires, including the Breastfeeding Support Scale (BSS), the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), and measures of duration of exclusive breastfeeding. Mediation analysis was conducted using the PROCESS macro model (Model 4) with resampling (5000 samples). Results Breastfeeding promotion was significantly associated with both maternal confidence (r = 0.52; p < 0.001) and duration of exclusive breastfeeding (r = 0.47; p < 0.001). Mediation analysis confirmed that maternal confidence partially mediated the relationship between breastfeeding promotion and duration of exclusive breastfeeding (indirect effect = 0.36; 95% CI: 0.19–0.54). Conclusion Enhancing maternal confidence through breastfeeding promotion strategies can effectively prolong the duration of exclusive breastfeeding. Interventions should prioritize confidence-building approaches in postnatal care. Maternal Confidence Breastfeeding Promotion Exclusive Breastfeeding 1. Introduction Breastfeeding remains one of the most effective public health practices for promoting the health and survival of infants and young children worldwide [ 1 ]. The World Health Organization (WHO) recommends exclusive breastfeeding (EBF) for the first six months of life, accompanied by continued breastfeeding alongside suitable complementary meals for up to two years or beyond. [ 2 ] Despite this global advice, exclusive breastfeeding quotes remain suboptimal in many countries, including Iraq[ 3 ]. The 2018 Iraq Multiple Indicator Cluster Survey suggested that simplest 26% of infants under six months have been exclusively breastfed, indicating an urgent need for effective interventions to improve breastfeeding practices[ 4 , 5 ]. One of the important components that influence breastfeeding outcomes is the degree of support and promotion provided to mothers, particularly during the prenatal and immediate postnatal periods [ 6 ]. Breastfeeding merchandising activities—consisting of health training, counseling by nurses and midwives, and peer support—were associated with elevated initiation and period of exclusive breastfeeding[ 7 ]. In unique, community-based breastfeeding interventions delivered via the number one healthcare structure have been powerful in increasing maternal knowledge and encouraging high-quality feeding behaviors[ 8 ]. However, notwithstanding the availability of breastfeeding merchandising activities in many healthcare settings, the variability in exceptional breastfeeding rates shows that other psychosocial variables may mediate this dating[ 9 ]. Maternal confidence, frequently operationalized as breastfeeding self-efficacy, is a vast mental aspect related to both the initiation and continuation of distinctive breastfeeding. Breastfeeding self-efficacy refers to a mother's notion of her ability to successfully breastfeed her little one, and it has been shown to at once affect breastfeeding results[ 10 ]. Mothers with excessive breastfeeding self-efficacy are much more likely to conquer commonplace breastfeeding difficulties and persist in exclusive breastfeeding for the endorsed period[ 11 ]. Additionally, breastfeeding aid from healthcare experts, family, and friends has been shown to have an impact on maternal self-efficacy levels, which in turn affect breastfeeding behaviors[ 12 ]. Several studies have proposed that breastfeeding mothers exert their wonderful influence on different breastfeeding lengths partially by way of increasing maternal self-efficacy. For instance, it is reported that established breastfeeding support interventions are not most effective in accelerating rates of different breastfeeding at six months; however, they also led to extensive enhancements in maternal self-efficacy[ 13 ]. Similarly, a study conducted in Turkey pronounced that higher breastfeeding assistance ratings were associated with increased breastfeeding self-efficacy, which became notably associated with longer exclusive breastfeeding durations[ 14 ]. These findings suggest that maternal confidence may additionally act as a mediating element in the relationship between breastfeeding promotion efforts and actual breastfeeding practices. Although previous studies have diagnosed the importance of breastfeeding advertising and self-efficacy, confined studies in Iraq have examined how these elements interact to influence extraordinary breastfeeding behaviors. Moreover, there's a paucity of research exploring the mediating function of maternal confidence within the specific cultural and healthcare context of southern Iraq, especially in Thi Qar Governorate. Understanding these relationships is essential for designing targeted interventions that support each aspect of the structures and maternal mental readiness for breastfeeding. 2. Materials and Methods 2.1. Study Design This study employed a descriptive correlational cross-sectional design to study the mediating impact of maternal self-confidence on the relationship between breastfeeding advertising activities and the period of special breastfeeding. A cross-sectional design is appropriate to assess the relationships among a number of variables at a single point in time, which is appropriate for public health behavioral research concerning psychosocial constructs. The primary goal of the study was to determine whether or not the aid and promotion of breastfeeding furnished through health services ought to enhance maternal self-efficacy, which in turn would be related to longer durations of exclusive breastfeeding amongst postpartum moms in Thi Qar Governorate, Iraq. 2.2. Study Sample The study was performed between March and June 2024 across selected maternal and infant health departments inside Bint Al-Huda Teaching Hospital and Primary Health Care Centers in Thi Qar Governorate. These websites had been decided on for their accessibility and excessive consumer flow, mainly amongst women who had recently given birth and had been attending postnatal or immunization clinics. They take a look at population-protected moms who had introduced stay-at-home infants in the preceding six months. Using a scientific random sampling approach, participants have been selected based on health facility attendance statistics. The pattern length was determined using the unmarried population percentage system. With a 0.05 confidence degree (Z = 1.96), an estimated unique breastfeeding occurrence (p) of 40%, and a 0.05 margin of error (d = 0.05), the initial sample length was calculated to be 369. To account for a 10% non-reaction rate, the final required pattern size was adjusted to 406 participants. Inclusion standards had been as follows: mothers who were elderly, 18 years or older, having brought a single singleton little one within the last six months, who attended as a minimum one postpartum health training consultation, were able to study and understand Arabic, and supplied informed consent. Mothers of babies with congenital anomalies that affect feeding, those identified with psychiatric conditions, and people who stated they began blended feeding practices from the beginning had been excluded from the study. 2.3. Study Instruments Data were accrued using a base interviewer-administered questionnaire that consisted of 4 sections. The first segment captured socio-demographic and obstetric data, including the mothers age, training, employment status, parity, shipping kind, number of antenatal care visits, and the little one’s delivery weight and age. The second section assessed breastfeeding advertising, usage of the Breastfeeding Support Scale (BSS) advanced by using Ekström et al. This scale includes 11 gadgets that measure the level of guidance mothers acquire from healthcare companies, their own family, and network contributors. Each object is rated on a 5-factor Likert scale, starting from 1 (strongly disagree) to 5 (strongly agree), with higher ratings reflecting more perceived help. The BSS has been widely used and validated for its exact reliability, with Cronbach’s alpha mentioned at 0.86[ 15 ] The 1/3 section measured maternal confidence using the Breastfeeding Self-Efficacy Scale – Short Form (BSES-SF), developed by Dennis. This 14-items device evaluates a mother’s self-assurance in her potential to breastfeed, with every item rated on a 5-point Likert scale from 1 (on no account assured) to five (usually assured). The overall rating ranges from 14 to 70, with better rankings indicating extra self-efficacy. This scale has been proven in numerous worldwide contexts and suggests excellent inner consistency, with a Cronbach’s alpha of 0.89. The fourth section of the questionnaire captured special breastfeeding length and the usage of each direct and categorical question. The direct query was phrased as: “How many weeks/months did you exclusively breastfeed your infant without giving any system, water, or food?” In addition, participants have been requested to pick out from categorical alternatives: less than 1 month, 1–3 months, 4–5 months, or full 6 months. This approach aligns with widespread breastfeeding measurement protocols[ 16 ]. 2.4. Validity and Reliability To ensure validity and reliability, the questionnaire underwent content validation via a panel of 5 professionals in maternal and infant health, reproductive health, and public health nursing. Their remarks are used to revise ambiguous gadgets and improve cultural relevance. A pilot look was then conducted on 41 mothers (10% of the final sample) to evaluate the readability, drift, and internal consistency of the questionnaire. The pilot information was excluded from the final analysis. Reliability checking out yielded Cronbach’s alpha values of 0.86 for the BSS and 0.89 for the BSES-SF, indicating strong inner consistency. 2.5. Data Collection Data collection was completed through skilled girl community health nurses who conducted interviews in private rooms at the healthcare centers to ensure patient privacy and comfort. Each interview lasted about 30 to 40 minutes. Before information collection, informed written consent was obtained from all participants. Participants have been confident that their responses could stay private and that they might withdraw from the study at any point without affecting their access to care. Ethical approval was granted via the Research Ethics Committee at the College of Nursing, University of Thi Qar. 2.6. Statistical Analysis Statistical analysis was accomplished using SPSS version 28. Descriptive facts, including frequencies, possibilities, manner, and fashionable deviations, had been used to explain the sample traits and scale ratings. Bivariate institutions between the number one and the variables were analyzed using Pearson’s correlation coefficients. To examine whether maternal self-assurance mediated the connection between breastfeeding merchandising and exceptional breastfeeding duration, multiple regression analysis was performed. Mediation evaluation was performed using the PROCESS macro for SPSS (Model 4) as proposed by Hayes. Bootstrapping techniques with 5,000 resamples had been carried out to estimate the indirect effect and 95% bias-corrected self-confidence durations. A confidence level of 0 in a programming language that did not consist of 0 was interpreted as evidence of a statistically significant mediating effect. The degree of significance for all statistical checks was set at p 35 79 (19.5) Educational level Primary or less 93 (22.9) Secondary 158 (38.9) College or higher 155 (38.2) Employment status Employed 129 (31.8) Unemployed 277 (68.2) Parity Primiparous 144 (35.5) Multiparous 262 (64.5) Mode of delivery Vaginal 292 (71.9) Cesarean 114 (28.1) Number of ANC visits <4 visits 97 (23.9) ≥4 visits 309 (76.1) Infant birth weight <2500 g 58 (14.3) ≥2500 g 348 (85.7) Infant age (months) 0–2 months 81 (20.0) 3–4 months 149 (36.7) 5–6 months 176 (43.3) Table 1 gives the demographic and obstetric traits of the 406 moms who participated in the study. The majority of the members have been aged 26–35 years (52.9%), and over two-thirds have been unemployed (68.2%). In terms of schooling, 38.9% had completed secondary schooling, and 38.2% had university training or higher, suggesting an incredibly well-educated pattern. Multiparous women (64.5%) were more popular than primiparous (35.5%), and the bulk (71.9%) had vaginal deliveries. Most mothers attended 4 or more antenatal care visits (76.1%) and delivered infants with a birth weight of≥2500 grams (85.7%). Regarding infant age, a substantial element (43.3%) has been elderly 5–6 months. Table (2). Descriptive Statistics of Main Study Variables Variable Number of Items Range Mean ±SD Breastfeeding Promotion Activities (BSS) 11 11–55 41.84 ± 6.52 Maternal Confidence (BSES-SF) 14 14–70 53.76 ± 9.12 Exclusive Breastfeeding Duration (months) 1 0–6 4.12 ± 1.72 Table 2 summarizes the descriptive information for the examine's three number one variables: breastfeeding promotion sports (BSS), maternal confidence (BSES-SF), and distinct breastfeeding (EBF) duration. The suggested score for breastfeeding promotion sports changed to 41.84 (SD = 6.52), suggesting that moms generally obtained a slight to excessive degree of breastfeeding help. Maternal confidence, measured through the BSES-SF, had an average rating of 53.76 (SD = 9.12), reflecting a normally high stage of self-efficacy amongst individuals. The common length of extraordinary breastfeeding became 4.12 months (SD = 1.72), indicating that whilst many mothers sustained exclusive breastfeeding, a few discontinued before the endorsed six months. Table (3). Pearson Correlations Between Main Variables Variables BSS BSES-SF EBF Duration Breastfeeding Promotion Activities (BSS) - Maternal Confidence (BSES-SF) 0.548** - Exclusive Breastfeeding Duration 0.413** 0.497** - ** p < 0.01 (2-tailed). Table 3 reports the Pearson correlation coefficients among the study’s three foremost variables. Breastfeeding promoting sports showed a vast and wonderful correlation with maternal confidence (r = 0.548, p < 0.01) and with the special breastfeeding period (r = 0.413, p < 0.01). Furthermore, maternal confidence was additionally undoubtedly associated with the specific breastfeeding period (r = 0.497, p < 0.01). Table (4). Mediation Analysis Using PROCESS Macro (Model 4) Path B SE t p 95% CI Path a (BSS→ BSES-SF) 0.854 0.061 13.98 <0.001 [0.734,0.974] Path b (BSES-SF→ EBF) 0.037 0.006 6.17 <0.001 [0.025,0.049] Path c' (Direct effect: BSS→ EBF) 0.122 0.018 6.78 <0.001 [0.087,0.158] Path c (Total effect: BSS→ EBF) 0.154 0.018 8.56 <0.001 [0.119,0.189] Table 4 presents the mediation analysis effects using Hayes' PROCESS Macro Model 4. The analysis tested whether maternal self-confidence mediates the connection between breastfeeding-promoting activities and distinctive breastfeeding length. The course from breastfeeding promoting to maternal self-confidence (Path a) changed into widespread (B = 0.854, p < 0.001), as became the course from maternal self-confidence to exceptional breastfeeding period (Path b: B = 0.037, p < 0.001). The direct impact of breastfeeding merchandising on exclusive breastfeeding (Path c') remained considerable (B = 0.122, p < 0.001), indicating partial mediation. The overall effect (Path c) was also sizable (B = 0.154, p < 0.001). Importantly, the bootstrapped self-confidence c language for the oblique impact (a*b = 0.032, 95% CI [0.021, 0.045]) did not include 0, confirming a statistically significant mediation effect. Table (5). Proportion Mediated and Model Summary Model Effect Estimate Total effect (c) 0.154 Direct effect (c’) 0.122 Indirect effect (a*b) 0.032 Proportion mediated (a*b/c) 20.8% Model R² 0.287 F-statistic (df = 2, 403) 81.07 Model p-value <0.001 Table five summarizes the full, direct, and indirect consequences of the mediation version and affords the proportion of the whole impact mediated by maternal self-assurance. The oblique effect accounted for 20.8% of the total impact, suggesting that maternal confidence plays a meaningful mediating role, even though different factors may additionally make contributions to the exclusive breastfeeding period. The usual version explained 28.7% of the variance in exceptional breastfeeding period (R²=0.287), and the regression version turned into extraordinarily enormous (F = 81.07, p < 0.001). 4. Discussion The findings of this study confirm the essential role of maternal self-confidence in mediating the relationship between breastfeeding promotion activities and the length of exclusive breastfeeding (EBF). First, the descriptive information found that mothers in the study commonly obtained slight-to-high ranges of breastfeeding assistance and demonstrated robust breastfeeding self-efficacy. Despite this, the suggested EBF length changed to approximately 4.12 months, which falls short of the WHO-encouraged six months of exceptional breastfeeding[ 17 ]. The tremendous correlation among breastfeeding merchandising, sports, and maternal self-confidence (r = 0.548, p < 0.01) aligns with the literature indicating that structured guidance enhances mothers’ perception of their potential to breastfeed efficaciously. Studies by Mulcahy et al. And Guo et al. have emphasised that publicity to regular, evidence-based breastfeeding education improves maternal confidence, particularly when introduced via skilled healthcare specialists[ 18 , 19 ]. These findings recommend that promoting breastfeeding is no longer the best approach; however, it additionally cultivates psychological readiness and motivation to breastfeed. Similarly, the good-sized affiliation between maternal self-confidence and EBF period (r = 0.497, p < 0.01) reinforces existing evidence that confidence is a sturdy predictor of sustained breastfeeding. For example, a study by Moraes et al. observed that higher ratings on the Breastfeeding Self-Efficacy Scale had been associated with longer intervals of exclusive breastfeeding[ 20 ]. Another study using Shiraishi et al. In Japan, it was confirmed that self-efficacy mediated the impact of peer help and prenatal education on breastfeeding effects, echoing the modern-day study’s findings[ 21 ]. The mediation evaluation presents deeper insight by confirming that maternal confidence partially mediates the impact of breastfeeding advertising on the EBF period. The indirect effect changed into statistically sizeable (a*b = 0.032, 95% CI [0.021, 0.045]), with 20.8% of the whole effect being mediated. This suggests that whilst breastfeeding promotion independently impacts EBF length, a part of this effect is channeled through increased maternal self-confidence. These results are consistent with the theoretical framework proposed by Bandura’s Social Cognitive Theory, which asserts that self-efficacy is a primary determinant of behavior change and endurance[ 22 ]. Furthermore, the finding that the direct impact of breastfeeding promotion on EBF length remained widespread after accounting for maternal self-confidence suggests partial mediation, no longer complete mediation. This means that, similarly to self-assurance, different elements—which include cultural ideals, social help, or workplace rules—may have an impact on the breastfeeding period. Studies by Bengough et al. and Tran et al. Spotlight how those additional contextual and structural barriers can restrict moms' capacity to sustain exclusive breastfeeding, notwithstanding receiving aid and having self-assurance [ 23 , 24 ]. Overall, those results underscore the significance of integrating maternal self-confidence-constructing strategies into breastfeeding promotion programs. Interventions that integrate factual education with emotional support and talent-building (e.g., hands-on demonstrations, peer mentorship, and counseling) can be particularly powerful. As validated using Hamm et al., multi-aspect programs appreciably increase both maternal self-confidence and breastfeeding duration as compared to single-aspect interventions[ 25 – 27 ]. Study Limitation This study has several obstacles. First, its go-sectional design limits the capacity to set up causal relationships between variables. Second, data were collected through self-reported questionnaires, which can be prone to social desirability and consider biases. Third, the look was conducted in a specific geographical place, which may also restrict the generalizability of the findings to broader populations. Finally, unmeasured factors, which include companion support or cultural confidences, were now not blanketed but might also affect each maternal self-confidence and different breastfeeding periods. 5. Conclusion The study highlights that maternal self-confidence significantly influences the relationship between breastfeeding and duration of exclusive breastfeeding. Enhancing maternal self-confidence through breastfeeding counseling can lead to longer and more consistent breastfeeding practices. Healthcare providers are recommended to incorporate confidence-building techniques—along with personal counseling, peer support, and practical breastfeeding counseling—into postpartum care services. Policymakers should also prioritize duration-of-exclusive breastfeeding programs that empower mothers, particularly in the early postpartum period. Declarations Acknowledgments: The authors would like to thank all the participants who permitted them to interview herm for close cooperation and participation. Ethical Permissions: The ethical approval was obtained from the Research Ethics Committee of the University of Thi-Qar (date: 06/03/2024, number: 711/3). Conflicts of Interests: Nothing declared by the authors. Authors’ Contribution: Mohammed Malih Radhi (First Author), Introduction Writer/Main Researcher (25%); Mohammed Malih Radhi, Support Researcher/Discussion Writer (25%); Mohammed Malih Radhi, Methodologist and Data Collection (25%); Mohammed Malih Radhi, Statistical Analyst (25%). Funding/Support: The present study was not financially supported. INFORMATION Contributions : All authors. Conflict of interest : The authors declared no conflicts of interest.. Funding : None. References Prentice AM. Breastfeeding in the modern world. Annals Nutr Metabolism. 2022;78(Suppl 2):29–38. 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Association between duration of exclusive breastfeeding and nursing mothers’ self-efficacy for breastfeeding. Revista da Escola de Enfermagem da USP. 2021;55:e03702. Shiraishi M, Matsuzaki M, Kurihara S, Iwamoto M, Shimada M. Post-breastfeeding stress response and breastfeeding self-efficacy as modifiable predictors of exclusive breastfeeding at 3 months postpartum: a prospective cohort study. BMC Pregnancy Childbirth. 2020;20(1):730. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191. Bengough T, Dawson S, Cheng HL, McFadden A, Gavine A, Rees R, Sacks E, Hannes K. Factors that influence women's engagement with breastfeeding support: A qualitative evidence synthesis. Matern Child Nutr. 2022;18(4):e13405. Tran V, Reese Masterson A, Frieson T, Douglass F, Pérez-Escamilla R, O'Connor Duffany K. Barriers and facilitators to exclusive breastfeeding among Black mothers: A qualitative study utilizing a modified Barrier Analysis approach. Matern Child Nutr. 2023;19(1):e13428. Hamm RF, Pattipati S, Levine LD, Parry S, Srinivas SK, Beidas RS. Audit and feedback is an effective implementation strategy to increase fidelity to a multi-component labor induction protocol designed to reduce obstetric inequities. Implement Sci Commun. 2025;6(1):2. Elywy GJ, Radhi MM, Tuama AM. Determination the causes of neonatal mortality during the last 3 years ago in Al-Kut City. Prof.(Dr) RK Sharma. 2020;20(3):195. Radhi MM, AL-Rubaey NK, AL-Jubori RH, Kadhim Hindi NK. Prevalence of viral hepatitis infections in Babylon province, Iraq, during the interval from 2014 to 2018. Ann Trop Med Public Health. 2019;22(9):S253. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Introduction","content":"\u003cp\u003eBreastfeeding remains one of the most effective public health practices for promoting the health and survival of infants and young children worldwide [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The World Health Organization (WHO) recommends exclusive breastfeeding (EBF) for the first six months of life, accompanied by continued breastfeeding alongside suitable complementary meals for up to two years or beyond. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] Despite this global advice, exclusive breastfeeding quotes remain suboptimal in many countries, including Iraq[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The 2018 Iraq Multiple Indicator Cluster Survey suggested that simplest 26% of infants under six months have been exclusively breastfed, indicating an urgent need for effective interventions to improve breastfeeding practices[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOne of the important components that influence breastfeeding outcomes is the degree of support and promotion provided to mothers, particularly during the prenatal and immediate postnatal periods [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Breastfeeding merchandising activities\u0026mdash;consisting of health training, counseling by nurses and midwives, and peer support\u0026mdash;were associated with elevated initiation and period of exclusive breastfeeding[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In unique, community-based breastfeeding interventions delivered via the number one healthcare structure have been powerful in increasing maternal knowledge and encouraging high-quality feeding behaviors[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, notwithstanding the availability of breastfeeding merchandising activities in many healthcare settings, the variability in exceptional breastfeeding rates shows that other psychosocial variables may mediate this dating[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMaternal confidence, frequently operationalized as breastfeeding self-efficacy, is a vast mental aspect related to both the initiation and continuation of distinctive breastfeeding. Breastfeeding self-efficacy refers to a mother's notion of her ability to successfully breastfeed her little one, and it has been shown to at once affect breastfeeding results[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Mothers with excessive breastfeeding self-efficacy are much more likely to conquer commonplace breastfeeding difficulties and persist in exclusive breastfeeding for the endorsed period[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Additionally, breastfeeding aid from healthcare experts, family, and friends has been shown to have an impact on maternal self-efficacy levels, which in turn affect breastfeeding behaviors[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSeveral studies have proposed that breastfeeding mothers exert their wonderful influence on different breastfeeding lengths partially by way of increasing maternal self-efficacy. For instance, it is reported that established breastfeeding support interventions are not most effective in accelerating rates of different breastfeeding at six months; however, they also led to extensive enhancements in maternal self-efficacy[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Similarly, a study conducted in Turkey pronounced that higher breastfeeding assistance ratings were associated with increased breastfeeding self-efficacy, which became notably associated with longer exclusive breastfeeding durations[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. These findings suggest that maternal confidence may additionally act as a mediating element in the relationship between breastfeeding promotion efforts and actual breastfeeding practices.\u003c/p\u003e\u003cp\u003eAlthough previous studies have diagnosed the importance of breastfeeding advertising and self-efficacy, confined studies in Iraq have examined how these elements interact to influence extraordinary breastfeeding behaviors. Moreover, there's a paucity of research exploring the mediating function of maternal confidence within the specific cultural and healthcare context of southern Iraq, especially in Thi Qar Governorate. Understanding these relationships is essential for designing targeted interventions that support each aspect of the structures and maternal mental readiness for breastfeeding.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1. Study Design\u003c/h2\u003e\u003cp\u003eThis study employed a descriptive correlational cross-sectional design to study the mediating impact of maternal self-confidence on the relationship between breastfeeding advertising activities and the period of special breastfeeding. A cross-sectional design is appropriate to assess the relationships among a number of variables at a single point in time, which is appropriate for public health behavioral research concerning psychosocial constructs. The primary goal of the study was to determine whether or not the aid and promotion of breastfeeding furnished through health services ought to enhance maternal self-efficacy, which in turn would be related to longer durations of exclusive breastfeeding amongst postpartum moms in Thi Qar Governorate, Iraq.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2. Study Sample\u003c/h2\u003e\u003cp\u003e The study was performed between March and June 2024 across selected maternal and infant health departments inside Bint Al-Huda Teaching Hospital and Primary Health Care Centers in Thi Qar Governorate. These websites had been decided on for their accessibility and excessive consumer flow, mainly amongst women who had recently given birth and had been attending postnatal or immunization clinics. They take a look at population-protected moms who had introduced stay-at-home infants in the preceding six months. Using a scientific random sampling approach, participants have been selected based on health facility attendance statistics.\u003c/p\u003e\u003cp\u003eThe pattern length was determined using the unmarried population percentage system. With a 0.05 confidence degree (Z\u0026thinsp;=\u0026thinsp;1.96), an estimated unique breastfeeding occurrence (p) of 40%, and a 0.05 margin of error (d\u0026thinsp;=\u0026thinsp;0.05), the initial sample length was calculated to be 369. To account for a 10% non-reaction rate, the final required pattern size was adjusted to 406 participants. Inclusion standards had been as follows: mothers who were elderly, 18 years or older, having brought a single singleton little one within the last six months, who attended as a minimum one postpartum health training consultation, were able to study and understand Arabic, and supplied informed consent. Mothers of babies with congenital anomalies that affect feeding, those identified with psychiatric conditions, and people who stated they began blended feeding practices from the beginning had been excluded from the study.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3. Study Instruments\u003c/h2\u003e\u003cp\u003eData were accrued using a base interviewer-administered questionnaire that consisted of 4 sections. The first segment captured socio-demographic and obstetric data, including the mothers age, training, employment status, parity, shipping kind, number of antenatal care visits, and the little one\u0026rsquo;s delivery weight and age. The second section assessed breastfeeding advertising, usage of the Breastfeeding Support Scale (BSS) advanced by using Ekstr\u0026ouml;m et al. This scale includes 11 gadgets that measure the level of guidance mothers acquire from healthcare companies, their own family, and network contributors. Each object is rated on a 5-factor Likert scale, starting from 1 (strongly disagree) to 5 (strongly agree), with higher ratings reflecting more perceived help. The BSS has been widely used and validated for its exact reliability, with Cronbach\u0026rsquo;s alpha mentioned at 0.86[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eThe 1/3 section measured maternal confidence using the Breastfeeding Self-Efficacy Scale \u0026ndash; Short Form (BSES-SF), developed by Dennis. This 14-items device evaluates a mother\u0026rsquo;s self-assurance in her potential to breastfeed, with every item rated on a 5-point Likert scale from 1 (on no account assured) to five (usually assured). The overall rating ranges from 14 to 70, with better rankings indicating extra self-efficacy. This scale has been proven in numerous worldwide contexts and suggests excellent inner consistency, with a Cronbach\u0026rsquo;s alpha of 0.89. The fourth section of the questionnaire captured special breastfeeding length and the usage of each direct and categorical question. The direct query was phrased as: \u0026ldquo;How many weeks/months did you exclusively breastfeed your infant without giving any system, water, or food?\u0026rdquo; In addition, participants have been requested to pick out from categorical alternatives: less than 1 month, 1\u0026ndash;3 months, 4\u0026ndash;5 months, or full 6 months. This approach aligns with widespread breastfeeding measurement protocols[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4. Validity and Reliability\u003c/h2\u003e\u003cp\u003eTo ensure validity and reliability, the questionnaire underwent content validation via a panel of 5 professionals in maternal and infant health, reproductive health, and public health nursing. Their remarks are used to revise ambiguous gadgets and improve cultural relevance. A pilot look was then conducted on 41 mothers (10% of the final sample) to evaluate the readability, drift, and internal consistency of the questionnaire. The pilot information was excluded from the final analysis. Reliability checking out yielded Cronbach\u0026rsquo;s alpha values of 0.86 for the BSS and 0.89 for the BSES-SF, indicating strong inner consistency.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.5. Data Collection\u003c/h2\u003e\u003cp\u003eData collection was completed through skilled girl community health nurses who conducted interviews in private rooms at the healthcare centers to ensure patient privacy and comfort. Each interview lasted about 30 to 40 minutes. Before information collection, informed written consent was obtained from all participants. Participants have been confident that their responses could stay private and that they might withdraw from the study at any point without affecting their access to care. Ethical approval was granted via the Research Ethics Committee at the College of Nursing, University of Thi Qar.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e2.6. Statistical Analysis\u003c/h2\u003e\u003cp\u003eStatistical analysis was accomplished using SPSS version 28. Descriptive facts, including frequencies, possibilities, manner, and fashionable deviations, had been used to explain the sample traits and scale ratings. Bivariate institutions between the number one and the variables were analyzed using Pearson\u0026rsquo;s correlation coefficients. To examine whether maternal self-assurance mediated the connection between breastfeeding merchandising and exceptional breastfeeding duration, multiple regression analysis was performed. Mediation evaluation was performed using the PROCESS macro for SPSS (Model 4) as proposed by Hayes. Bootstrapping techniques with 5,000 resamples had been carried out to estimate the indirect effect and 95% bias-corrected self-confidence durations. A confidence level of 0 in a programming language that did not consist of 0 was interpreted as evidence of a statistically significant mediating effect. The degree of significance for all statistical checks was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cstrong\u003eTable (1). Socio-Demographic and Obstetric Characteristics of the Respondents\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 236px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026le;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e112 (27.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e26\u0026ndash;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e215 (52.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026gt;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e79 (19.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 236px;\"\u003e\n \u003cp\u003eEducational level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003ePrimary or less\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e93 (22.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e158 (38.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eCollege or higher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e155 (38.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 236px;\"\u003e\n \u003cp\u003eEmployment status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e129 (31.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e277 (68.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 236px;\"\u003e\n \u003cp\u003eParity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003ePrimiparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e144 (35.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eMultiparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e262 (64.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 236px;\"\u003e\n \u003cp\u003eMode of delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eVaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e292 (71.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eCesarean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e114 (28.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 236px;\"\u003e\n \u003cp\u003eNumber of ANC visits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026lt;4 visits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e97 (23.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026ge;4 visits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e309 (76.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 236px;\"\u003e\n \u003cp\u003eInfant birth weight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026lt;2500 g\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e58 (14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026ge;2500 g\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e348 (85.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 236px;\"\u003e\n \u003cp\u003eInfant age (months)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e0\u0026ndash;2 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e81 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e3\u0026ndash;4 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e149 (36.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e5\u0026ndash;6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e176 (43.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 1 gives the demographic and obstetric traits of the 406 moms who participated in the study. The majority of the members have been aged 26\u0026ndash;35 years (52.9%), and over two-thirds have been unemployed (68.2%). In terms of schooling, 38.9% had completed secondary schooling, and 38.2% had university training or higher, suggesting an incredibly well-educated pattern. Multiparous women (64.5%) were more popular than primiparous (35.5%), and the bulk (71.9%) had vaginal deliveries. Most mothers attended 4 or more antenatal care visits (76.1%) and delivered infants with a birth weight of\u0026ge;2500 grams (85.7%). Regarding infant age, a substantial element (43.3%) has been elderly 5\u0026ndash;6 months.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (2). Descriptive Statistics of Main Study Variables\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"633\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of Items\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRange\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn;SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 246px;\"\u003e\n \u003cp\u003eBreastfeeding Promotion Activities (BSS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e11\u0026ndash;55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e41.84 \u0026plusmn; 6.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 246px;\"\u003e\n \u003cp\u003eMaternal Confidence (BSES-SF)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e14\u0026ndash;70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e53.76 \u0026plusmn; 9.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 246px;\"\u003e\n \u003cp\u003eExclusive Breastfeeding Duration (months)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e0\u0026ndash;6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e4.12 \u0026plusmn; 1.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2 summarizes the descriptive information for the examine\u0026apos;s three number one variables: breastfeeding promotion sports (BSS), maternal confidence (BSES-SF), and distinct breastfeeding (EBF) duration. The suggested score for breastfeeding promotion sports changed to 41.84 (SD = 6.52), suggesting that moms generally obtained a slight to excessive degree of breastfeeding help. Maternal confidence, measured through the BSES-SF, had an average rating of 53.76 (SD = 9.12), reflecting a normally high stage of self-efficacy amongst individuals. The common length of extraordinary breastfeeding became 4.12 months (SD = 1.72), indicating that whilst many mothers sustained exclusive breastfeeding, a few discontinued before the endorsed six months.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (3). Pearson Correlations Between Main Variables\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"633\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBSS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBSES-SF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEBF Duration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eBreastfeeding Promotion Activities (BSS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eMaternal Confidence (BSES-SF)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.548**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eExclusive Breastfeeding Duration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.413**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.497**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e** p \u0026lt; 0.01 (2-tailed).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 reports the Pearson correlation coefficients among the study\u0026rsquo;s three foremost variables. Breastfeeding promoting sports showed a vast and wonderful correlation with maternal confidence (r = 0.548, p \u0026lt; 0.01) and with the special breastfeeding period (r = 0.413, p \u0026lt; 0.01). Furthermore, maternal confidence was additionally undoubtedly associated with the specific breastfeeding period (r = 0.497, p \u0026lt; 0.01).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (4). Mediation Analysis Using PROCESS Macro (Model 4)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"633\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePath\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003et\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePath a\u003c/strong\u003e(BSS\u0026rarr; BSES-SF)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.854\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e13.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e[0.734,0.974]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePath b\u003c/strong\u003e(BSES-SF\u0026rarr; EBF)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e6.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e[0.025,0.049]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePath c\u0026apos;\u003c/strong\u003e(Direct effect: BSS\u0026rarr; EBF)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e6.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e[0.087,0.158]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePath c\u003c/strong\u003e(Total effect: BSS\u0026rarr; EBF)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e8.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e[0.119,0.189]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 4 presents the mediation analysis effects using Hayes\u0026apos; PROCESS Macro Model 4. The analysis tested whether maternal self-confidence mediates the connection between breastfeeding-promoting activities and distinctive breastfeeding length. The course from breastfeeding promoting to maternal self-confidence (Path a) changed into widespread (B = 0.854, p \u0026lt; 0.001), as became the course from maternal self-confidence to exceptional breastfeeding period (Path b: B = 0.037, p \u0026lt; 0.001). The direct impact of breastfeeding merchandising on exclusive breastfeeding (Path c\u0026apos;) remained considerable (B = 0.122, p \u0026lt; 0.001), indicating partial mediation. The overall effect (Path c) was also sizable (B = 0.154, p \u0026lt; 0.001). Importantly, the bootstrapped self-confidence c language for the oblique impact (a*b = 0.032, 95% CI [0.021, 0.045]) did not include 0, confirming a statistically significant mediation effect.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (5). Proportion Mediated and Model Summary\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"643\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 331px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel Effect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEstimate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 331px;\"\u003e\n \u003cp\u003eTotal effect (c)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003e0.154\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 331px;\"\u003e\n \u003cp\u003eDirect effect (c\u0026rsquo;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003e0.122\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 331px;\"\u003e\n \u003cp\u003eIndirect effect (a*b)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 331px;\"\u003e\n \u003cp\u003eProportion mediated (a*b/c)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003e20.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 331px;\"\u003e\n \u003cp\u003eModel R\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003e0.287\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 331px;\"\u003e\n \u003cp\u003eF-statistic (df = 2, 403)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003e81.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 331px;\"\u003e\n \u003cp\u003eModel p-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable five summarizes the full, direct, and indirect consequences of the mediation version and affords the proportion of the whole impact mediated by maternal self-assurance. The oblique effect accounted for 20.8% of the total impact, suggesting that maternal confidence plays a meaningful mediating role, even though different factors may additionally make contributions to the exclusive breastfeeding period. The usual version explained 28.7% of the variance in exceptional breastfeeding period (R\u0026sup2;=0.287), and the regression version turned into extraordinarily enormous (F = 81.07, p \u0026lt; 0.001).\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe findings of this study confirm the essential role of maternal self-confidence in mediating the relationship between breastfeeding promotion activities and the length of exclusive breastfeeding (EBF). First, the descriptive information found that mothers in the study commonly obtained slight-to-high ranges of breastfeeding assistance and demonstrated robust breastfeeding self-efficacy. Despite this, the suggested EBF length changed to approximately 4.12 months, which falls short of the WHO-encouraged six months of exceptional breastfeeding[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe tremendous correlation among breastfeeding merchandising, sports, and maternal self-confidence (r\u0026thinsp;=\u0026thinsp;0.548, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) aligns with the literature indicating that structured guidance enhances mothers\u0026rsquo; perception of their potential to breastfeed efficaciously. Studies by Mulcahy et al. And Guo et al. have emphasised that publicity to regular, evidence-based breastfeeding education improves maternal confidence, particularly when introduced via skilled healthcare specialists[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. These findings recommend that promoting breastfeeding is no longer the best approach; however, it additionally cultivates psychological readiness and motivation to breastfeed.\u003c/p\u003e\u003cp\u003eSimilarly, the good-sized affiliation between maternal self-confidence and EBF period (r\u0026thinsp;=\u0026thinsp;0.497, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) reinforces existing evidence that confidence is a sturdy predictor of sustained breastfeeding. For example, a study by Moraes et al. observed that higher ratings on the Breastfeeding Self-Efficacy Scale had been associated with longer intervals of exclusive breastfeeding[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Another study using Shiraishi et al. In Japan, it was confirmed that self-efficacy mediated the impact of peer help and prenatal education on breastfeeding effects, echoing the modern-day study\u0026rsquo;s findings[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe mediation evaluation presents deeper insight by confirming that maternal confidence partially mediates the impact of breastfeeding advertising on the EBF period. The indirect effect changed into statistically sizeable (a*b\u0026thinsp;=\u0026thinsp;0.032, 95% CI [0.021, 0.045]), with 20.8% of the whole effect being mediated. This suggests that whilst breastfeeding promotion independently impacts EBF length, a part of this effect is channeled through increased maternal self-confidence. These results are consistent with the theoretical framework proposed by Bandura\u0026rsquo;s Social Cognitive Theory, which asserts that self-efficacy is a primary determinant of behavior change and endurance[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFurthermore, the finding that the direct impact of breastfeeding promotion on EBF length remained widespread after accounting for maternal self-confidence suggests partial mediation, no longer complete mediation. This means that, similarly to self-assurance, different elements\u0026mdash;which include cultural ideals, social help, or workplace rules\u0026mdash;may have an impact on the breastfeeding period. Studies by Bengough et al. and Tran et al. Spotlight how those additional contextual and structural barriers can restrict moms' capacity to sustain exclusive breastfeeding, notwithstanding receiving aid and having self-assurance [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOverall, those results underscore the significance of integrating maternal self-confidence-constructing strategies into breastfeeding promotion programs. Interventions that integrate factual education with emotional support and talent-building (e.g., hands-on demonstrations, peer mentorship, and counseling) can be particularly powerful. As validated using Hamm et al., multi-aspect programs appreciably increase both maternal self-confidence and breastfeeding duration as compared to single-aspect interventions[\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy Limitation\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study has several obstacles. First, its go-sectional design limits the capacity to set up causal relationships between variables. Second, data were collected through self-reported questionnaires, which can be prone to social desirability and consider biases. Third, the look was conducted in a specific geographical place, which may also restrict the generalizability of the findings to broader populations. Finally, unmeasured factors, which include companion support or cultural confidences, were now not blanketed but might also affect each maternal self-confidence and different breastfeeding periods.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThe study highlights that maternal self-confidence significantly influences the relationship between breastfeeding and duration of exclusive breastfeeding. Enhancing maternal self-confidence through breastfeeding counseling can lead to longer and more consistent breastfeeding practices. Healthcare providers are recommended to incorporate confidence-building techniques\u0026mdash;along with personal counseling, peer support, and practical breastfeeding counseling\u0026mdash;into postpartum care services. Policymakers should also prioritize duration-of-exclusive breastfeeding programs that empower mothers, particularly in the early postpartum period.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e The authors would like to thank all the participants who permitted them to interview herm for close cooperation and participation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Permissions:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe ethical approval was obtained from the Research Ethics Committee of the University of Thi-Qar (date: 06/03/2024, number: 711/3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interests:\u003c/strong\u003e Nothing declared by the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contribution:\u003c/strong\u003e Mohammed Malih Radhi (First Author), Introduction Writer/Main Researcher (25%); Mohammed Malih Radhi, Support Researcher/Discussion Writer (25%); Mohammed Malih Radhi, Methodologist and Data Collection (25%); Mohammed Malih Radhi, Statistical Analyst (25%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding/Support:\u003c/strong\u003e The present study was not financially supported.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eINFORMATION\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions\u003c/strong\u003e: All authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e: The authors declared no conflicts of interest..\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: None.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePrentice AM. Breastfeeding in the modern world. Annals Nutr Metabolism. 2022;78(Suppl 2):29\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJama A, Gebreyesus H, Wubayehu T, Gebregyorgis T, Teweldemedhin M, Berhe T, Berhe N. Exclusive breastfeeding for the first six months of life and its associated factors among children age 6\u0026ndash;24 months in Burao district. Somaliland Int Breastfeed J. 2020;15(1):5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNiazy SM, Al-Eqabi QA, Radhi MM, AL-Thabhawee GD. Nutritional Status in Community-Dwelling Older Adults and Geriatric Home. Iran J War Public Health. 2025;17(1):83\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNasser AA. Prevalence of Breastfeeding Indicators in Middle East and North African Countries: A Meta-Analysis of National Health Surveys (2010\u0026ndash;2020).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAl-Jawaldeh A, Abul-Fadl A. Trends in Infant Feeding in Countries of the Eastern Mediterranean region 1995 to 2020: Time for action. Egypt J Breastfeed. 2020;17:25\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBengough T, Dawson S, Cheng HL, McFadden A, Gavine A, Rees R, Sacks E, Hannes K. Factors that influence women's engagement with breastfeeding support: A qualitative evidence synthesis. Matern Child Nutr. 2022;18(4):e13405.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbdulahi M, Fretheim A, Argaw A, Magnus JH. Breastfeeding education and support to improve early initiation and exclusive breastfeeding practices and infant growth: a cluster randomized controlled trial from a rural Ethiopian setting. Nutrients. 2021;13(4):1204.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMalih Radhi M, Zair Balat K. Health literacy and its association with medication adherence in patients with hypertension: A mediating role of social support. Iran Rehabilitation J. 2024;22(1):117\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBalat KZ, Laftah SA, Radhi M. The relationship between psychological distress and quality of life among women undergoing mastectomy in Iraq: A descriptive correlational study. Natl J Community Med. 2025;16(1):20\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSanchez SS, Rodriguez-Gallego I, Leon-Larios F, Andina-Diaz E, Perez-Contreras R, Gonzalez-Sanz JD. Influence of perceived maternal Self-Efficacy on exclusive breastfeeding initiation and consolidation: A systematic review. InHealthcare 2024 Nov 24 (12, 23, p. 2347).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoraes GG, Christoffel MM, Toso BR, Viera CS. Association between duration of exclusive breastfeeding and nursing mothers\u0026rsquo; self-efficacy for breastfeeding. Revista da Escola de Enfermagem da USP. 2021;55:e03702.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBengough T, Dawson S, Cheng HL, McFadden A, Gavine A, Rees R, Sacks E, Hannes K. Factors that influence women's engagement with breastfeeding support: A qualitative evidence synthesis. Matern Child Nutr. 2022;18(4):e13405.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRodr\u0026iacute;guez-Gallego I, Corrales-Gutierrez I, Gomez-Baya D, Leon-Larios F. Effectiveness of a postpartum breastfeeding support group intervention in promoting exclusive breastfeeding and perceived self-efficacy: a multicentre randomized clinical trial. Nutrients. 2024;16(7):9884.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCan V, Bulduk M, Can EK, Ayşin N. Impact of social support and breastfeeding success on the self-efficacy levels of adolescent mothers during the postpartum period. Reproductive health. 2025;22(1):19.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEkstr\u0026ouml;m A, Widstr\u0026ouml;m AM, Nissen E. Process-oriented training in breastfeeding alters attitudes to breastfeeding in health professionals. Scand J Public Health. 2005;33(6):424\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLabbok M, Krasovec K. Toward consistency in breastfeeding definitions. Stud Fam Plann. 1990;21(4):226\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHussein D, Girma D, Oyato BT, Birhanu B, Teressa B, Bacha S, Geleta RE, Ibrahim SM, Lakew MS. Exclusive Breastfeeding Practice and Associated Factors among Mothers Having Infants (Aged 0\u0026ndash;6 Months) in the Pastoral Community of Sawena District. Ethiopia: Bale Zone Oromia; 2023.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMulcahy H, Philpott LF, O'Driscoll M, Bradley R, Leahy-Warren P. Breastfeeding skills training for health care professionals: A systematic review. Heliyon. 2022;8(11).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGuo K, Shang X, Deng X. The Effects of a Newborn Care Education Program on Mothers\u0026rsquo; Self-Confidence, Care Knowledge, and Breastfeeding Behavior: A Systematic Review and Meta‐Analysis. Public Health Nurs. 2025;42(1):395\u0026ndash;410.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoraes GG, Christoffel MM, Toso BR, Viera CS. Association between duration of exclusive breastfeeding and nursing mothers\u0026rsquo; self-efficacy for breastfeeding. Revista da Escola de Enfermagem da USP. 2021;55:e03702.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShiraishi M, Matsuzaki M, Kurihara S, Iwamoto M, Shimada M. Post-breastfeeding stress response and breastfeeding self-efficacy as modifiable predictors of exclusive breastfeeding at 3 months postpartum: a prospective cohort study. BMC Pregnancy Childbirth. 2020;20(1):730.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBengough T, Dawson S, Cheng HL, McFadden A, Gavine A, Rees R, Sacks E, Hannes K. Factors that influence women's engagement with breastfeeding support: A qualitative evidence synthesis. Matern Child Nutr. 2022;18(4):e13405.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTran V, Reese Masterson A, Frieson T, Douglass F, P\u0026eacute;rez-Escamilla R, O'Connor Duffany K. Barriers and facilitators to exclusive breastfeeding among Black mothers: A qualitative study utilizing a modified Barrier Analysis approach. Matern Child Nutr. 2023;19(1):e13428.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHamm RF, Pattipati S, Levine LD, Parry S, Srinivas SK, Beidas RS. Audit and feedback is an effective implementation strategy to increase fidelity to a multi-component labor induction protocol designed to reduce obstetric inequities. Implement Sci Commun. 2025;6(1):2.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eElywy GJ, Radhi MM, Tuama AM. Determination the causes of neonatal mortality during the last 3 years ago in Al-Kut City. Prof.(Dr) RK Sharma. 2020;20(3):195.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRadhi MM, AL-Rubaey NK, AL-Jubori RH, Kadhim Hindi NK. Prevalence of viral hepatitis infections in Babylon province, Iraq, during the interval from 2014 to 2018. Ann Trop Med Public Health. 2019;22(9):S253.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Maternal Confidence, Breastfeeding Promotion, Exclusive Breastfeeding","lastPublishedDoi":"10.21203/rs.3.rs-7243503/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7243503/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eFor public health, exclusive breastfeeding is essential for a child's health. However, many mothers stop breastfeeding prematurely. This study aimed to investigate the influence of maternal confidence on the relationship between breastfeeding promotion activities and the duration of exclusive breastfeeding among mothers after childbirth in Thi Qar Governorate, Iraq.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA descriptive, cross-sectional correlational design was used. A 406 postpartum mothers were recruited from hospitals and primary health care centers using a systematic random sample. Data were collected through interview-conducted questionnaires, including the Breastfeeding Support Scale (BSS), the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), and measures of duration of exclusive breastfeeding. Mediation analysis was conducted using the PROCESS macro model (Model 4) with resampling (5000 samples).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eBreastfeeding promotion was significantly associated with both maternal confidence (r\u0026thinsp;=\u0026thinsp;0.52; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and duration of exclusive breastfeeding (r\u0026thinsp;=\u0026thinsp;0.47; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Mediation analysis confirmed that maternal confidence partially mediated the relationship between breastfeeding promotion and duration of exclusive breastfeeding (indirect effect\u0026thinsp;=\u0026thinsp;0.36; 95% CI: 0.19\u0026ndash;0.54).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eEnhancing maternal confidence through breastfeeding promotion strategies can effectively prolong the duration of exclusive breastfeeding. Interventions should prioritize confidence-building approaches in postnatal care.\u003c/p\u003e","manuscriptTitle":"The Mediating Role of Maternal Confidence in the Relationship Between Breastfeeding Promotion and Exclusive Breastfeeding Duration","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-18 09:53:53","doi":"10.21203/rs.3.rs-7243503/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"385068f6-e86c-47b0-9c43-595fb2ff59a2","owner":[],"postedDate":"September 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-05T07:57:25+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-18 09:53:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7243503","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7243503","identity":"rs-7243503","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}