INTRODUCTION:

Breastfeeding plays a vital role in a child’s development due to its numerous benefits, which have been established and supported by strong evidence. Whether a mother breastfeeds, the duration, and the various factors associated with breastfeeding success have been major public health concerns over the years. Although various strategies have been introduced by WHO and UNICEF to improve breastfeeding rates worldwide, breastfeeding practices remain low in many countries, particularly in low- and middle-income countries^1,2.

The prevalence of breastfeeding is relatively low among Nigerian mothers. Although 83% of babies are breastfed for up to one year, the proportion of exclusive breastfeeding is only 29%, which is lower than the 60% minimum recommended by WHO^3,4.

The low rate of exclusive breastfeeding among Nigerian mothers can be associated with sociocultural beliefs and poor knowledge, both of which play a vital role in determining breastfeeding success^5,6. Validation of this instrument scale was part of a larger study assessing the effectiveness of a breastfeeding education intervention program in improving breastfeeding knowledge, beliefs, infant feeding practices, and maternal stress among Nigerian immigrant mothers living in Kuala Lumpur, Malaysia.

A qualitative study by Joseph and Earland (2019) exploring sociocultural determinants of exclusive breastfeeding among Nigerian mothers revealed that the use of prelacteal fluids and foods as protective measures for babies was one of the harmful sociocultural beliefs that delayed breastfeeding initiation and prevented exclusive breastfeeding. Such practices are potential predisposing factors for diarrhea among infants⁷.

Improving mothers’ sociocultural beliefs requires a reliable and valid breastfeeding belief evaluation scale to measure their beliefs and experiences. This is essential for promoting and implementing effective interventions aimed at improving the existing low breastfeeding rate among Nigerian mothers. Many breastfeeding studies either select items from multiple questionnaires or use individual items to assess women’s beliefs^8-10. Currently, one validated instrument—the Beliefs About Breastfeeding Questionnaire (BAB-Q)—exists; however, it only comprises 8 items, and challenging aspects of breastfeeding, such as breastfeeding discomfort and maternal infant feeding practices, were not included. Additionally, the predictive validity of this instrument for breastfeeding behaviour was inconclusive¹¹.

Currently, there is one validated instrument that measures the Belief About Breastfeeding Questionnaire (BAB-Q), however, the scale only comprises 8 items and challenging aspects of breastfeeding such as.

Since the measurement of attitude (IIFAS) has been used over time in infant feeding^8–10,12, there is a need for an instrument that can measure breastfeeding beliefs as a psychosocial predictor of behaviour. This study, therefore, aimed to carry out psychometric validation of the Breastfeeding Belief Evaluation Scale (BBES) and explore its predictive utility in breastfeeding experiences among Nigerian mothers.

METHODS:

This study was conducted and reported in accordance with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines for studies evaluating measurement properties of patient-reported outcome measures ¹³.

Study design:

A cohort instrument validation study was conducted to evaluate the psychometric properties of the Breastfeeding Belief Evaluation Scale (BBES), including content development, structural validity, internal consistency, and hypothesis testing for construct (predictive) validity, in line with COSMIN recommendations.

Participants and Setting:

The study was conducted among Nigerian immigrant mothers residing in Kuala Lumpur, Malaysia. Eligible participants were women aged 18–45 years who had delivered a single, term infant (≤ 6months old) and who were breastfeeding or had breastfed at the time of data collection. Mothers who had preterm deliveries, infants with feeding difficulties, or who did not intend to breastfeed were excluded.

Sample size

COSMIN recommends a minimum sample size of at least 5–10 participants per item for factor analysis, with an absolute minimum of 100 participants for structural validity assessment. With an initial pool of 16 items, a minimum sample of 160 participants was considered adequate. A total of 168 mothers were recruited, meeting COSMIN criteria for exploratory factor analysis. Eligible participants were recruited through convenient sampling via various WhatsApp groups consisting of Nigerian immigrants in Malaysia, the African market situated at Chow Kit Kuala Lumpur, Friday prayers at university Mosques (UM, IIUM) as well as through snowball invitations. Potential participants were approached and invited to take part in the study.

Instrument Development and Content Validity

The BBES was developed following qualitative interviews conducted among Nigerian immigrant mothers to explore breastfeeding experiences, beliefs, and perceived barriers. Items were generated directly from qualitative findings and informed by existing literature on breastfeeding beliefs and the Theory of Planned Behaviour. An expert panel comprising nursing and public health researchers reviewed the initial items for relevance, clarity, and theoretical alignment. To assess comprehensibility and acceptability, a small group of breastfeeding mothers (n=5) reviewed the questionnaire prior to field administration, with no modifications required.

Data Collection Procedure:

The BBES questionnaire was administered face to face by trained researchers to minimize missing data and reduce reporting bias. The questionnaire comprised three sections: socio-demographic characteristics (Age, level of education, employment status, no of children, years in Malaysia, mode of delivery, gestational age, if their pregnancy was planned, whether they were breastfed as a child and household monthly income), infant-feeding practices (breastfeeding initiation, Exclusive breastfeeding and Breastfeeding duration), and the BBES items. Responses to BBES items were recorded using a 5-point Likert scale ranging from strong disagreement to strong agreement.

Structural Validity

Descriptive characteristics and clinical features of the mothers are presented along with their breastfeeding practices – initiation, exclusivity and duration. Structural validity was evaluated using exploratory factor analysis (EFA), consistent with COSMIN guidance for newly developed instruments. Sampling adequacy was assessed using the Kaiser–Meyer–Olkin (KMO) statistic and Bartlett’s Test of Sphericity^13,14. Principal component extraction with varimax rotation was applied. Items with factor loadings below 0.50 were removed, and the analysis was re-run to confirm the final factor structure.

Internal Consistency

Internal consistency reliability of each identified subscale was evaluated using McDonald’s omega (ω), as recommended by COSMIN for ordinal data. Reliability coefficients of ≥0.60 were considered acceptable for newly developed scales^15,16.

Hypothesis Testing for Construct(Predictive) Validity

Construct validity was examined through hypothesis testing by assessing associations between BBES subscale scores and theoretically related variables, including maternal education, employment status, breastfeeding exclusivity, and intended breastfeeding duration. Welch’s analysis of variance (ANOVA) was used due to non-normal distribution of scores and unequal group variances¹⁷. The direction and magnitude of associations were interpreted in accordance with predefined theoretical expectations.

Ethical Consideration:

Ethical approval for this study was received from the medical research and ethics committee of the Universiti Sultan Zainal Abidin Terengganu Malaysia (Ref No: UniSZA/UHREC/2023474). A study information sheet clearly explaining the purpose of the study and participants’ rights was provided to the mothers. Written informed consent was obtained from all participants before the commencement of the study. Data collection was conducted over a two-month period, from May to July 2023.

RESULT:

All mothers (N = 168) who participated in the study were within the reproductive age range. Specifically, 41 (24.4%) were aged 17–25 years, nearly half, 81 (48.2%), were aged 26–35 years, and 46 (27.4%) were aged 36–45 years.

The mothers’ employment status was relatively evenly distributed across four categories. Approximately one-third of the mothers were students (n = 56, 33.3%), 44 (26.2%) were homemakers (stay-at-home mothers), 38 (22.6%) were employed full-time, and 30 (17.9%) worked part-time.

Regarding educational attainment, all mothers reported having at least secondary education, with two-thirds having attained higher education (bachelor’s, master’s, and/or PhD levels).

In terms of parity, nearly half of the mothers (44.1%) had between two and three children, while 37.5% were first-time mothers at the time of the study. This distribution is important for understanding differences in breastfeeding beliefs, as explored in subsequent analyses.

Finally, the majority of the mothers (65.5%) had vaginal deliveries. Table 1 presents the socio-demographic and clinical characteristics of the mothers.

Table 1: Socio-demographic and Clinical characteristics of Mothers

N = 168	%
Age -group
17-25 years	41 (24.40)
26-35 years	81 (48.21)
36-45 years	46 (27.38)
Employment Status
Working Full time	38 (22.62)
Working Part-time	30 (17.86)
Homemaker	44 (26.19)
Student	56 (33.33)
Education
Secondary	56 (33.33)
Higher	112 (66.67)
Number of Child(ren)
First child	63 (37.50)
2-3 children	74 (44.05)
4-5 children	31 (18.45)
Mode of Delivery
Virginal delivery	110 (65.48)
Caesarean Section	53 (31.55)
Unanswered	5 (2.98)

% Of frequencies in parentheses M = Mean, SD = Standard deviation

Breastfeeding Practices:

At birth, 42 mothers (25.0%) initiated breastfeeding within one hour of delivery. Forty-five mothers (26.8%) initiated breastfeeding within the first six hours, while 43 (25.6%) began breastfeeding more than six hours after birth. Additionally, 33 mothers (19.6%) initiated breastfeeding one day after delivery.

Regarding exclusive breastfeeding intentions, 73 mothers (43.5%) reported practicing or intending to practice exclusive breastfeeding for six months or longer, indicating that approximately four out of every ten mothers met the recommended duration. Among those who did not intend to exclusively breastfeed for six months, 25 (14.9%) reported plans to introduce supplementary feeding within the first week after birth, 26 (15.5%) within the first month, and 32 (19.0%) between two and five months after birth (Table 2).

The intended duration of breastfeeding among the mothers ranged from 9 to 24 months. Nearly half of the mothers (n = 77, 45.8%) intended to breastfeed for 13–18 months, while 54 (32.1%) planned to breastfeed for 9–12 months and 32 (19.0%) intended to continue breastfeeding for 19–24 months.

Table 2: Breastfeeding Practices of Mothers

Breastfeeding Practices	Frequency
Initiation (How soon after birth did you breastfeed your child?)
Within an Hour	42 (25.0)
1-6 hours	45 (26.8)
More than 6 hours	43 (25.6)
Next day	33 (19.6)
Exclusivity (How soon do you intend to complement your child's feeding?)
Less than a week	25 (14.9)
First month	26 (15.5)
2-5 months	32 (19.0)
6 months and above	73 (43.5)
Duration (How long do you intend to breastfeed your child?)
9-12 months	54 (32.1)
13-18 months	77 (45.8)
19-24 months	32 (19.0)

% Of frequencies in parentheses

Exploratory Factor Analysis:

Exploratory factor analysis (EFA) was conducted to examine the construct validity of the 16-item Breastfeeding Beliefs and Experiences Scale (BBES). EFA was selected in accordance with COSMIN recommendations for newly developed instruments where the underlying factor structure is not yet established. Principal component analysis with Varimax rotation was applied, and the solution converged after six iterations. The factor structure is presented in Table 3.

Sampling adequacy and item intercorrelations were assessed prior to factor extraction. The Kaiser–Meyer–Olkin (KMO) measure of sampling adequacy was 0.66, indicating acceptable adequacy, and Bartlett’s Test of Sphericity was statistically significant (χ² = 437.88, df = 91, p < 0.001), confirming that the data were suitable for factor analysis.

Two items with factor loadings below 0.50 were excluded, resulting in a final 14-item scale. Five components with eigenvalues greater than 1 were retained, accounting for 62.65% of the total variance. The extracted factors were labelled Breastfeeding deterrents (3 items; 14.48%), Non-exclusive breastfeeding (3 items; 14.19%), Associated discomfort (3 items; 13.45%), Breastfeeding benefits (3 items; 11.42%), and Formula feeding beliefs (2 items; 9.11%). All retained items demonstrated adequate factor loadings ranging from 0.60 to 0.82, supporting satisfactory construct validity.

Internal consistency reliability was evaluated using McDonald’s Omega (ω). The Breastfeeding deterrents subscale showed acceptable reliability (ω = 0.74). The Non-exclusive breastfeeding (ω = 0.67) and Associated discomfort (ω = 0.64) subscales demonstrated moderate reliability, while the Breastfeeding benefits subscale yielded a lower reliability estimate (ω = 0.54). Reliability estimation was not performed for the Formula feeding beliefs subscale due to the presence of fewer than three items. In line with COSMIN guidelines, exploratory factor analysis was used to assess structural validity given the novelty of the BBES. The use of McDonald’s Omega was preferred over Cronbach’s alpha due to its suitability for multidimensional scales. Although some subscales demonstrated omega values below the conventional 0.70 threshold which may reflect the exploratory nature of the scale and sample size limitations. COSMIN recognizes lower reliability estimates as acceptable in early-stage scale development, particularly for newly developed instruments and exploratory analyses¹³.

Table 3: EFA Factor Loading and Omega Reliability ω

BFB Item		Breastfeeding deterrents	Non-exclusive feeding	Associated discomfort	Breastfeeding Benefit	Formula Feeding	Mean (SD)	% variance	Omega ω
16	Breastfeeding makes mother sick	0.81					3.11(0.80)
13	Breasts are not meant for feeding.	0.78					3.05(0.73)	14.48	0.74
10	Breastfeeding is difficult to learn.	0.70					3.11(0.68)
7	Breastmilk and other food should be given to the baby during the first six months.		0.78				3.22(0.80)	14.19
3	Baby needs water/juice for the first six months of life		0.75				3.29(0.95)		0.67
9	Herbal drinks/mixtures and concoctions should be introduced to the baby before six months for a good immune system.		0.71				2.87(0.85)
14	Breastfeeding makes leaving the home difficult.			0.82			3.11(0.93)	13.45	0.64
11	Pumping breastmilk is too much effort.			0.77			3.40(1.13)
15	Breastfeeding can make breasts sag.			0.61			3.45(1.25)
4	Babies that are fed breast milk are less likely to get sick than formula-fed babies.				0.77		3.47(1.42)	11.42
12	Breastfeeding is convenient.				0.74		3.57(0.94)		0.54
6	Breastfeeding helps mothers’ bond with their babies more quickly than formula-feeding.				0.60		4.61(0.74)
5	Babies fed formula sleep longer than babies fed breast milk.					0.71	2.70(1.13)	9.11	NA
8	Formula is as healthy as breastmilk.					0.62	2.52(1.28)		NA

Extraction Method: Principal Component Analysis, Rotation Method: Varimax with Kaiser Normalization, Rotation converged in 6 iterations.

Kaiser-Meyer-Olkin Measure of Sampling Adequacy is 0.662

Bartlett’s Test of Sphericity Approx. x² 437.88, df 91, p<0.001

Table 4: Pearson Correlation of Breastfeeding Belief Constructs

	Inter-item correlation	Breastfeeding deterrents	Non-exclusive feeding	Associated discomfort	Breastfeeding Benefit	Formula Feeding
Breastfeeding deterrents	0.45^***	3.09 (0.56)	0.20^*	-0.28^**	-0.19^*	0.21^**
Non-exclusive feeding	0.40^***		3.12 (0.67)	0.03	-0.08	0.30^**
Associated discomfort	0.38^***			3.89 (0.76)	-0.01	-0.13^#
Breastfeeding Benefit	0.27^**				3.32 (0.84)	-0.01
Formula Feeding	0.14^*					2.61 (0.91)

Correlation is significant at ^***<0.001, ^**<0.01, ^{* <}0.05, ^#<0.1

Construct mean and standard deviation in matrix diagonal

Table 5: Welch Analysis of Variance of Breastfeeding Beliefs against Mothers’ Characteristics and Breastfeeding Practices

	Breastfeeding deterrents		Non-exclusive feeding		Associated Discomfort		Breastfeeding Benefit		Formula Feeding
	F	Sig	F	Sig	F	Sig	F	Sig	F	Sig
Education	-3.84	<0.001	20.66	<0.001	5.02	<0.001	-3.13	0.002	11.05	0.001
Employment	-	-	-	-	6.40	<0.001	-	-	3.90	0.012
No of Child(ren)	-	-	-	-	-	-	9.15	<0.001	-	-
Mode of delivery	-	-	-	-	7.84	0.006	6.40	0.013	-	-
Breastfeeding Practices
Exclusivity	9.45	<0.001	14.34	<0.001	5.26	0.003	6.63	<0.001	5.91	0.001
Duration	-	-	11.12	<0.001	3.50	0.036	8.59	<0.001	-	-

Notes: showing only significant associations at p <0.05

Figure 5: Mean plot of breastfeeding beliefs by breastfeeding practices (Duration)

Figure 2 shows that mothers working full-time scored significantly higher on breastfeeding deterrents compared with mothers in other employment categories. They also reported relatively higher scores for formula feeding beliefs, although these scores were lower than those observed among stay-at-home mothers. Stay-at-home mothers showed stronger agreement with beliefs that formula-fed infants sleep longer and that formula is as healthy as breast milk.

Regarding parity, differences were observed only for the breastfeeding benefits construct. As shown in Figure 3, first-time mothers scored higher on breastfeeding benefits, including beliefs that breastfeeding reduces infant illness, is convenient, and enhances mother–infant bonding.

Breastfeeding practices demonstrated a strong association with breastfeeding beliefs (Figure 4). Mothers who did not intend to exclusively breastfeed during the first six months scored higher on non-exclusive feeding, breastfeeding deterrents, and formula feeding beliefs. In contrast, mothers intending to exclusively breastfeed reported higher scores for breastfeeding benefits and associated discomfort, indicating that breastfeeding-related discomfort did not deter breastfeeding intentions.

Finally, breastfeeding duration was significantly associated with several belief constructs (Figure 5). Mothers who intended to breastfeed for up to two years scored lower on non-exclusive feeding and breastfeeding deterrents, and higher on breastfeeding benefits, particularly bonding-related beliefs.

DISCUSSION:

In line with COSMIN recommendations, this study provides initial evidence of structural validity, internal consistency, and construct (predictive) validity of the Breastfeeding Belief Evaluation Scale (BBES), supporting its applicability in breastfeeding-related research and its potential use in breastfeeding support interventions.

The majority of participants in this study had attained higher education, which showed a significant influence on breastfeeding knowledge, particularly regarding the benefits of breastfeeding. This may be explained by the immigrant context of the study population, as some mothers migrated to Malaysia for educational purposes or were dependents of spouses who were studying or working in the country, thereby contributing to the higher educational levels observed.

Exploratory factor analysis (EFA) of the initial 16-item BBES supported a five-factor structure. Two items were removed due to low factor loadings: one assessing the cost implication of breastfeeding (“Breastfeeding costs less money than formula feeding”) and another addressing exclusivity (“Breastfeeding alone should be given to a baby during the first six months of life”). Although breastfeeding is widely acknowledged to be cost-effective and culturally normative across settings, as supported by social cognitive theory^19–21, these perceptions may have reduced variability in responses and contributed to weaker correlations within the factor structure.

The low loading of the exclusivity item may also be attributed to conceptual overlap with similar items in the scale (e.g., “Baby needs water and juice for the six months of life”), resulting in cross-loadings within the same construct. Although both removed items have been used in previous infant feeding studies ^8-9,11, they did not demonstrate adequate reliability or validity within the BBES.

Re-analysis using the refined 14-item BBES confirmed satisfactory construct validity. The extracted factors demonstrated reliability estimates consistent with expectations for newly developed instruments. Breastfeeding deterrents, non-exclusive feeding, and formula feeding were negatively correlated with breastfeeding benefits and associated discomfort, supporting the theoretical coherence of the scale.

Associated discomfort was more frequently reported among mothers who practiced exclusive breastfeeding, which may reflect the physical and practical demands required to achieve effective breastfeeding^11,22. This finding suggests that breastfeeding-related discomfort does not necessarily deter breastfeeding, but rather coexists with sustained breastfeeding efforts ^23,24.

Beliefs related to non-exclusive feeding, formula feeding, and breastfeeding deterrents emerged as key influences on exclusive breastfeeding practices. Mothers who endorsed these beliefs were less likely to breastfeed exclusively and appeared less aware of breastfeeding benefits, which may predispose them to alternative feeding practices.

Conversely, mothers who intended to breastfeed for longer durations reported fewer breastfeeding deterrents and non-exclusive feeding beliefs, while demonstrating greater recognition of breastfeeding benefits such as bonding. This finding aligns with behavioural theory, which identifies intention as a central determinant of behaviour ²⁵, and is consistent with evidence showing that breastfeeding intention strongly predicts breastfeeding initiation and duration ²⁶.

The predictive function of the BBES was further supported through its associations with socio-demographic characteristics and breastfeeding practices. Welch’s ANOVA indicated that maternal literacy was a predominant factor across all BBES constructs. Mothers with higher educational attainment scored higher on breastfeeding benefits and associated discomfort, and lower on non-exclusive feeding, breastfeeding deterrents, and formula feeding beliefs, underscoring the importance of continuous breastfeeding education in addressing negative breastfeeding beliefs²⁷.

Mothers working full-time scored higher on the breastfeeding deterrents scale, possibly due to work-related constraints that limit opportunities for breastfeeding, despite the option of expressing breast milk²⁸. In contrast, stay-at-home mothers scored higher on formula feeding beliefs, possibly reflecting perceptions that formula-fed infants sleep longer or are as healthy as breastfed infants. These findings suggest that individual beliefs and perceptions may shape feeding choices, even among mothers who are otherwise inclined to breastfeed^29,30, supporting the notion that breastfeeding beliefs may precede and influence maternal experience^11,31.

With respect to parity, first-time mothers demonstrated stronger endorsement of breastfeeding benefits, including beliefs that breastfeeding reduces infant illness, is convenient, and enhances mother–infant bonding. This may be partly explained by higher educational attainment among newer mothers or other unmeasured factors ³².

Overall, this study demonstrates that the BBES is a reliable and valid instrument for assessing breastfeeding beliefs among Nigerian mothers. The scale has potential utility for guiding healthcare professionals in identifying negative breastfeeding beliefs and delivering targeted education, support, and care to promote optimal breastfeeding practices.

STRENGTH AND LIMITATION:

In line with established measurement reporting standards, this study has several strengths and limitations. To the best of our knowledge, it is the first study to develop and validate an instrument that measures breastfeeding beliefs with predictive validity among Nigerian mothers in Malaysia. The scale validation questionnaire was administered face-to-face, which minimized reporting bias and allowed for direct assessment of mothers’ infant-feeding intentions. Predictive validity was evaluated by examining associations between maternal breastfeeding beliefs and infant-feeding practices.

A key limitation of this study is the relatively small sample size, which precluded the use of confirmatory factor analysis (CFA) for assessing structural validity. Replication with larger samples is therefore warranted to enable CFA and further strengthen evidence of construct validity. In addition, the relatively high educational level of participants may limit the generalizability of the findings. Future studies should include mothers with lower educational attainment to improve representativeness and external validity.

CONCLUSION:

Mothers’ beliefs play a critical role in shaping infant-feeding practices, underscoring the need for effective interventions that target these beliefs. This study provides evidence that the Breastfeeding Belief Evaluation Scale (BBES) is a psychometrically sound instrument, developed and evaluated using established measurement standards, with demonstrated reliability and predictive validity for assessing mothers’ breastfeeding beliefs. The 14-item BBES offers a practical tool to support hypothesis testing and to guide the development, implementation, and evaluation of breastfeeding interventions aimed at improving maternal and infant health outcomes across the lifespan. Further evaluation using confirmatory factor analysis and additional measurement properties is warranted to strengthen the overall evidence base.

ABBREVIATIONS:

BFB: Breastfeeding Belief, EFA: Exploratory Factor Analysis, CFA: confirmatory Factor Analysis, BBES: Breastfeeding Belief Scale, WHO: World Health Organization; UNICEF: United Nations Children’s Fund.

COMPETING INTERESTS:

We declare that the work submitted are entirely our own. All authors have contributed towards the article and have read and approved the final manuscript. We have no conflict of interest to declare.

ACKNOWLEDGEMENTS:

Special thanks to all mothers for their time and enthusiasm in taking part in this study.

AUTHORS’ CONTRIBUTIONS:

Study design: BBO, OSL, KLA, IMA

Data Collection: BBO

Data Analysis: BBO, ZUO, OSL

Manuscript writing: BBO, OSL, KLA ZUO, IMA

Critical revisions for important intellectual content: OSL, KLA, IMA, BBO, ZUO.

ETHICS APPROVAL AND CONSENT TO PARTICIPATE:

This study was approved by the Medical Research Ethics Committee of Universiti Sultan Zainal Abidin Terengganu Malaysia (Ref No: UniSZA/ UHREC/ 2023474). All potential participants were informed of the purpose, confidentiality and affiliation of the study. Written inform consent were obtained from all the participant before each interview.

CONSENT FOR PUBLICATION:

Consent for the use of the quantitative data for publication purpose was obtained from all the participants.

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Received on 16.10.2024 Revised on 12.05.2025

Accepted on 22.08.2025 Published on 23.02.2026

Available online from February 25, 2026

Int. J. Nursing Education and Research. 2026;14(1):1-10.

DOI: 10.52711/2454-2660.2026.00001

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.


Figure 1: Mean plot of breastfeeding belief constructs by mothers’ education level	Figure 2 Mean plot of breastfeeding beliefs construct by mothers’ employment status

Figure 3: Mean plot of breastfeeding beliefs by number of Child(ren)	Figure 4: Mean plot of breastfeeding beliefs by breastfeeding practices (Exclusivity)