{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T05:55:29Z","timestamp":1791266129339,"version":"4.1.0"},"reference-count":43,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth"],"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Despite significant public health efforts, exclusive breastfeeding (EBF) rates among Israeli women remain low. Using the Extended Theory of Planned Behavior, this study aimed to identify key predictors of EBF among pregnant and preconception women in Israel.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This cross\u2010sectional study used a two\u2010wave online survey conducted in 2022 and 2024. Women who were pregnant or planning a pregnancy (\n n<\/jats:italic>\n \u2009=\u2009209) completed a questionnaire evaluating knowledge and social\u2010cognitive perceptions of breastfeeding, previous breastfeeding duration, and personal characteristics. A hierarchical regression analysis was conducted to identify the factors predicting EBF intention.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Participants demonstrated a moderate level of knowledge, positive attitudes, and high levels of subjective norms, perceived behavioral control, and intentions to practice EBF. The hierarchical regression revealed that previous breastfeeding duration (\n \u03b2<\/jats:italic>\n \u2009=\u20090.32,\n p<\/jats:italic>\n \u2009<\u20090.001), knowledge level (\n \u03b2<\/jats:italic>\n \u2009=\u20090.18,\n p<\/jats:italic>\n \u2009<\u20090.010), attitudes (\n \u03b2<\/jats:italic>\n \u2009=\u20090.30,\n p<\/jats:italic>\n \u2009<\u20090.001), and subjective norms (\n \u03b2<\/jats:italic>\n \u2009=\u20090.12,\n p<\/jats:italic>\n \u2009=\u20090.050) were significant positive predictors of EBF intention. Perceived behavioral control was not significantly associated with EBF intention (\n \u03b2<\/jats:italic>\n \u2009=\u20090.07,\n p<\/jats:italic>\n \u2009=\u20090.190).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n There is a need to enhance knowledge about the benefits of breastfeeding, foster supportive environments, and target specific interventions for women whose initial breastfeeding experiences were not successful. We conclude with a series of specific actions that healthcare providers and policymakers can take to improve breastfeeding rates.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/birt.70128","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T05:44:51Z","timestamp":1791265491000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Explaining Intentions for Exclusive Breastfeeding Among Israeli Women: An Extension of the Theory of Planned Behavior"],"prefix":"10.1111","author":[{"given":"Hadad","family":"Reut","sequence":"first","affiliation":[{"name":"Faculty of Health Sciences, Department of Nursing, Recanati School for Community Health Professions Ben\u2010Gurion University of the Negev Beer\u2010Sheva Israel"},{"name":"Department of Public Health Ministry of Health Beer\u2010Sheva Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bar\u2010Tal","family":"Etti","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Department of Nursing, Recanati School for Community Health Professions Ben\u2010Gurion University of the Negev Beer\u2010Sheva Israel"},{"name":"Department of Public Health Ministry of Health Beer\u2010Sheva Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elias","family":"Rawan","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Department of Nursing, Recanati School for Community Health Professions Ben\u2010Gurion University of the Negev Beer\u2010Sheva Israel"},{"name":"Department of Public Health Ministry of Health Beer\u2010Sheva Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mordekhy","family":"Sarah","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Department of Nursing, Recanati School for Community Health Professions Ben\u2010Gurion University of the Negev Beer\u2010Sheva Israel"},{"name":"Department of Public Health Ministry of Health Beer\u2010Sheva Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aricha","family":"Michal","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Department of Nursing, Recanati School for Community Health Professions Ben\u2010Gurion University of the Negev Beer\u2010Sheva Israel"},{"name":"Maternity Department Meir Medical Center Kfar Saba Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3039-8892","authenticated-orcid":false,"given":"Avraham","family":"Rinat","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Department of Nursing, Recanati School for Community Health Professions Ben\u2010Gurion University of the Negev Beer\u2010Sheva Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"issue":"1","key":"e_1_2_14_2_1","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1177\/08903344221132253","article-title":"Reviewing the Updated 2\u2010Year Recommendation for Breastfeeding","volume":"39","author":"Shoge O.","year":"2023","journal-title":"Journal of Human Lactation"},{"issue":"1","key":"e_1_2_14_3_1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1177\/1010539515624964","article-title":"The Long\u2010Term Public Health Benefits of Breastfeeding","volume":"28","author":"Binns C.","year":"2016","journal-title":"Asia\u2010Pacific Journal of Public Health"},{"issue":"4","key":"e_1_2_14_4_1","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1177\/2332649215581664","article-title":"Good, Bad, and Extraordinary Mothers: Infant Feeding and Mothering in African American Mothers' Breastfeeding Narratives","volume":"1","author":"Carter S. K.","year":"2015","journal-title":"Sociology of Race and Ethnicity"},{"key":"e_1_2_14_5_1","unstructured":"H.BernardoandV.Cesar \u201cLong\u2010Term Effects of Breastfeeding: A Systematic Review 2013\u201d."},{"issue":"6","key":"e_1_2_14_6_1","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1089\/jwh.2021.0504","article-title":"The Effects of Breastfeeding on Maternal Mental Health: A Systematic Review","volume":"31","author":"Yuen M.","year":"2022","journal-title":"Journal of Women's Health"},{"issue":"3","key":"e_1_2_14_7_1","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1177\/1469540513485271","article-title":"Infant\u2010Feeding Consumerism in the Age of Intensive Mothering and Risk Society","volume":"13","author":"Afflerback S.","year":"2013","journal-title":"Journal of Consumer Culture"},{"key":"e_1_2_14_8_1","doi-asserted-by":"crossref","DOI":"10.1590\/2317-1782\/20232021163en","article-title":"Factors related to exclusive breastfeeding in the context of primary health care","volume":"35","author":"Faria E. R.","year":"2023","journal-title":"CoDAS"},{"issue":"1","key":"e_1_2_14_9_1","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1111\/apa.16460","article-title":"Systematic Review and Meta\u2010Analysis of Breastfeeding and Later Overweight or Obesity Expands on Previous Study for World Health Organization","volume":"112","author":"Horta B. L.","year":"2023","journal-title":"Acta Paediatrica"},{"key":"e_1_2_14_10_1","unstructured":"Israeli Ministry of Health \u201cNational survey of babies health and nutrition state 2025 \u201dhttps:\/\/www.gov.il\/en\/pages\/30032023\u201001."},{"key":"e_1_2_14_11_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13006-020-00256-1","article-title":"\u201cThe Sweet and the Bitter\u201d: Mothers' Experiences of Breastfeeding in the Early Postpartum Period: A Qualitative Exploratory Study in China","volume":"15","author":"Xiao X.","year":"2020","journal-title":"International Breastfeeding Journal"},{"issue":"10","key":"e_1_2_14_12_1","doi-asserted-by":"crossref","first-page":"2147","DOI":"10.1016\/j.socscimed.2007.06.015","article-title":"Being a \u2018Good Mother\u2019: Managing Breastfeeding and Merging Identities","volume":"65","author":"Marshall J. L.","year":"2007","journal-title":"Social Science & Medicine"},{"issue":"11","key":"e_1_2_14_13_1","doi-asserted-by":"crossref","first-page":"24","DOI":"10.15520\/ijnd.2017.vol7.iss11.264.24-31","article-title":"Factors That Influence Exclusive Breastfeeding: A Literature Review","volume":"7","author":"El\u2010Houfey A. A.","year":"2017","journal-title":"International Journal of Nursing Didactics"},{"key":"e_1_2_14_14_1","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1353\/mpq.2003.0020","article-title":"Breastfeeding, Bonding, and the Mother\u2010Infant Relationship","volume":"49","author":"Else\u2010Quest N. M.","year":"2003","journal-title":"Merrill\u2010Palmer Quarterly"},{"issue":"2","key":"e_1_2_14_15_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0293130","article-title":"Using the Theory of Planned Behavior to Determine COVID\u201019 Vaccination Intentions and Behavior Among International and Domestic College Students in the United States","volume":"19","author":"Liu C.","year":"2024","journal-title":"PLoS One"},{"issue":"1","key":"e_1_2_14_16_1","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1080\/10463283.2023.2225897","article-title":"Longitudinal Tests of the Theory of Planned Behaviour: A Meta\u2010Analysis","volume":"35","author":"Hagger M. S.","year":"2024","journal-title":"European Review of Social Psychology"},{"issue":"2","key":"e_1_2_14_17_1","doi-asserted-by":"crossref","DOI":"10.17533\/udea.iee.v40n2e04.","article-title":"Application of the Extended Theory of Planned Behavior to Predict Exclusive Breastfeeding Intention, in Pregnant Nulliparous Women. A Cross\u2010Sectional Study","volume":"40","author":"Yazdanpanah F.","year":"2022","journal-title":"Investigaci\u00f3n y Educaci\u00f3n en Enfermer\u00eda"},{"key":"e_1_2_14_18_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.jpeds.2018.08.008","article-title":"Factors Associated With Breastfeeding Initiation and Continuation: A Meta\u2010Analysis","volume":"203","author":"Cohen S. S.","year":"2018","journal-title":"Journal of Pediatrics"},{"issue":"1","key":"e_1_2_14_19_1","doi-asserted-by":"crossref","DOI":"10.1186\/s12966-024-01641-3","article-title":"An Exploration of Prenatal Breastfeeding Self\u2010Efficacy: A Scoping Review","volume":"21","author":"McGovern L. M.","year":"2024","journal-title":"International Journal of Behavioral Nutrition and Physical Activity"},{"issue":"4","key":"e_1_2_14_20_1","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.wombi.2010.02.002","article-title":"Factors That Positively Influence Breastfeeding Duration to 6 Months: A Literature Review","volume":"23","author":"Meedya S.","year":"2010","journal-title":"Women and Birth"},{"issue":"3","key":"e_1_2_14_21_1","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1177\/0890334417708187","article-title":"The Role of Social\u2010Cognitive and Emotional Factors on Exclusive Breastfeeding Duration","volume":"33","author":"Shepherd L.","year":"2017","journal-title":"Journal of Human Lactation"},{"issue":"1","key":"e_1_2_14_22_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/17437199.2013.869710","article-title":"Time to Retire the Theory of Planned Behaviour","volume":"8","author":"Sniehotta F. F.","year":"2014","journal-title":"Health Psychology Review"},{"issue":"4","key":"e_1_2_14_23_1","doi-asserted-by":"crossref","first-page":"955","DOI":"10.26574\/maedica.2022.17.4.955","article-title":"Main Biopsychosocial Factors Influencing Breastfeeding: A Systematic Review","volume":"17","author":"Asimaki E.","year":"2022","journal-title":"Maedica"},{"issue":"1","key":"e_1_2_14_24_1","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1186\/s12884-022-04628-9","article-title":"Explaining Variance in Breastfeeding Intentions and Behaviors Among a Cohort of Midwest Mothers Using a Theory of Planned Behavior\u2010Based Structural Model","volume":"22","author":"Esquerra\u2010Zwiers A.","year":"2022","journal-title":"BMC Pregnancy and Childbirth"},{"issue":"7","key":"e_1_2_14_25_1","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1080\/08870440701615260","article-title":"Predicting Breastfeeding in Women Living in Areas of Economic Hardship: Explanatory Role of the Theory of Planned Behaviour","volume":"23","author":"McMillan B.","year":"2008","journal-title":"Psychology & Health"},{"key":"e_1_2_14_26_1","doi-asserted-by":"publisher","DOI":"10.1590\/S1980\u2010220X2018004503433"},{"key":"e_1_2_14_27_1","unstructured":"Central Bureau of Statistics \u201cBirths and fertility in israel 2020 \u201dhttps:\/\/www.cbs.gov.il\/en\/mediarelease\/Pages\/2022\/Births\u2010and\u2010Fertility\u2010in\u2010Israel\u20102020.aspx."},{"issue":"3","key":"e_1_2_14_28_1","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1111\/birt.12230","article-title":"Paid Maternity Leave and Breastfeeding Outcomes","volume":"43","author":"Mirkovic K. R.","year":"2016","journal-title":"Birth"},{"key":"e_1_2_14_29_1","unstructured":"Israeli Ministry of Health \u201cThe significance of breastfeeding 2025 \u201dhttps:\/\/me.health.gov.il\/en\/parenting\/raising\u2010children\/baby\u2010nutrition\/nursing\/breastfeeding\u2010benefits\/."},{"key":"e_1_2_14_30_1","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.midw.2015.11.013","article-title":"Women' s Intention to Exclusively Breast Feed: The Israeli Perspective","volume":"34","author":"Natan M. B.","year":"2016","journal-title":"Midwifery"},{"issue":"5","key":"e_1_2_14_31_1","doi-asserted-by":"crossref","DOI":"10.1177\/10901981231220668","article-title":"Effects of Prenatal Breastfeeding Education on Breastfeeding Duration Beyond 12\u2009Weeks: A Systematic Review","volume":"51","author":"Oggero M. K.","year":"2024","journal-title":"Health Education & Behavior"},{"key":"e_1_2_14_32_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12978\u2010023\u201001701\u20100"},{"key":"e_1_2_14_33_1","first-page":"1","article-title":"Breastfeeding and the Risk of Childhood Cancer: A Systematic Review and Dose\u2010Response Meta\u2010Analysis","volume":"19","author":"Su Q.","year":"2021","journal-title":"BMC Medicine"},{"issue":"2","key":"e_1_2_14_34_1","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.numecd.2013.10.028","article-title":"Breastfeeding and the Maternal Risk of Type 2 Diabetes: A Systematic Review and Dose\u2013Response Meta\u2010Analysis of Cohort Studies","volume":"24","author":"Aune D.","year":"2014","journal-title":"Nutrition, Metabolism, and Cardiovascular Diseases"},{"issue":"5","key":"e_1_2_14_35_1","doi-asserted-by":"crossref","first-page":"396","DOI":"10.3390\/jpm11050396","article-title":"Maintenance of Maternal Breastfeeding up to 6 Months: Predictive Models","volume":"11","author":"Santacruz\u2010Salas E.","year":"2021","journal-title":"Journal of Personalized Medicine"},{"key":"e_1_2_14_36_1","doi-asserted-by":"publisher","DOI":"10.1080\/08870446.2021.2025374"},{"key":"e_1_2_14_37_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.pec.2023.107678","article-title":"Systematic Review and Meta\u2010Analysis of Psychoeducation on the Psychological and Social Impact Among First\u2010Time Mothers","volume":"111","author":"Ong Q. O.","year":"2023","journal-title":"Patient Education and Counseling"},{"key":"e_1_2_14_38_1","unstructured":"World Health Organization \u201cScope and impact of digital marketing strategies for promoting breastmilk substitutes 2022 \u201dhttps:\/\/iris.who.int\/bitstream\/handle\/10665\/353604\/9789240046085\u2010eng.pdf?sequence=2."},{"key":"e_1_2_14_39_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.nepr.2021.103172","article-title":"A Qualitative Descriptive Study of New Graduate Nurses' Experiences Supporting Breastfeeding Women in Neonatal Settings","volume":"55","author":"Prokop N.","year":"2021","journal-title":"Nurse Education in Practice"},{"key":"e_1_2_14_40_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10900\u2010007\u20109068\u20102"},{"key":"e_1_2_14_41_1","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1007\/BF03403610","article-title":"Social Determinants of Initiation, Duration and Exclusivity of Breastfeeding at the Population Level: The Results of the Longitudinal Study of Child Development in Quebec (ELDEQ 1998\u20132002)","volume":"94","author":"Dubois L.","year":"2003","journal-title":"Canadian Journal of Public Health"},{"issue":"2","key":"e_1_2_14_42_1","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1177\/0890334420948451","article-title":"Breastfeeding but Not Exclusively: Exploration of Chinese American Mothers' Infant Feeding Practices","volume":"37","author":"Goldbort J.","year":"2021","journal-title":"Journal of Human Lactation"},{"key":"e_1_2_14_43_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2022.923464"},{"key":"e_1_2_14_44_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13006-021-00401-4","article-title":"Examining Supports and Barriers to Breastfeeding Through a Socio\u2010Ecological Lens: A Qualitative Study","volume":"16","author":"Snyder K.","year":"2021","journal-title":"International Breastfeeding Journal"}],"container-title":["Birth"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/birt.70128","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/birt.70128","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/birt.70128","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T05:44:57Z","timestamp":1791265497000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/birt.70128"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,5]]},"references-count":43,"alternative-id":["10.1111\/birt.70128"],"URL":"https:\/\/doi.org\/10.1111\/birt.70128","archive":["Portico"],"relation":{},"ISSN":["0730-7659","1523-536X"],"issn-type":[{"value":"0730-7659","type":"print"},{"value":"1523-536X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,5]]},"assertion":[{"value":"2025-05-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"birt.70128"}}