Path analysis of determinants of attitude toward exclusive breastfeeding among non-health college female students in Saudi Arabia

Background: Exploring the determinants of unmarried women’s attitude towards Exclusive Breastfeeding (EBF) can help develop
context-specific interventions that create a safe EBF culture among future mothers.
Objectives: Investigating the determinants of attitude toward EBF among non-health college female students in Saudi Arabia using path
analysis.
Methods: A descriptive exploratory study was conducted at three randomly selected university campuses (Riyadh, Dammam, and Jeddah)
in Saudi Arabia. Using multistage cluster random sampling, 500 unmarried female students were enrolled in the study. Data were collected
from February to May 2022 using a digital survey of four sections: personal data and prior breastfeeding exposure, attitude toward EBF
scale, knowledge scale, and perceived social support scale. The data were analyzed using multiple linear regression analysis and path
analysis.
Results: The highest percentage of the participants had a positive attitude toward EBF (59.8%), average levels of knowledge (46.0%), prior
breastfeeding exposure (60.8%), and positive perceived social support (54.0%). The path model fits the data perfectly [χ2=0.000, DF=0,
CIMN=0.000, GFI=0.999, NFI=0.999, CFI=0.999, PCFI =0.999]. Knowledge (β=0.301) perceived social support (β=0.227), and prior
breastfeeding exposure (β=0.211) (P<0.001) directly and significantly predicted attitude toward EBF, with significant positive correlations
with each other (P<0.001). The linear regression model predicted a 3.8% variance in attitude toward EBF, where increasing age (β=0.139,
P=0.002) and income level (β=0.124, P=0.006) were significant predictors of positive attitude, however, the place of residence was not
(β=0.016, P=0.724).
Conclusion: Unmarried Saudi female university students' knowledge of EBF was the strongest determinant of their attitude toward EBF
followed by perceived social support, prior breastfeeding exposure, and increased age and income level. Thus, targeted educational
interventions and mass campaigns on EBF are crucial to promote EBF among future generations.