{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T06:12:30Z","timestamp":1788502350625,"version":"build-2803163510"},"reference-count":56,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"\n Background<\/jats:title>\n Exclusive breastfeeding (EBF) for the first 6 months is crucial for public health, yet EBF rates in China remain below the 50% target of \u201cHealthy China 2030.\u201d In Southeast China, adequate maternal knowledge and healthcare access do not ensure sustained EBF practices, indicating a clear knowledge\u2013behavior gap. Traditional education models often ignore the interaction between psychological capabilities and environmental opportunities. Grounded in the COM-B (Capability, Opportunity, Motivation-Behavior) model, this multicenter study investigates EBF decision-making among postpartum women in this region. By examining how Capability (knowledge) and Opportunity (social support) interact through Motivation (self-efficacy), this research provides an evidence-based framework for targeted EBF interventions.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A multicenter, cross-sectional study was conducted. We used convenience sampling to recruit 400 women at 6 months postpartum from two public hospitals in Southeast China. Validated instruments, including the Breastfeeding Knowledge Questionnaire, Breastfeeding Family Support Scale, and Breastfeeding Self-Efficacy Scale (Short Form), were used for data collection. Data analysis involved descriptive statistics, independent t-tests, ANOVA, and Partial Least Squares Structural Equation Modeling (PLS-SEM) to test the hypothesized pathways.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The exclusive breastfeeding (EBF) rate at 6 months postpartum was 30.25%. The PLS-SEM model explained 35.7% of the variance in EBF behavior (\n R<\/jats:italic>\n 2<\/jats:sup>\n \u202f=\u202f0.357). Breastfeeding knowledge (Capability)did not directly predict EBF behavior (\n p<\/jats:italic>\n \u202f=\u202f0.534). However, it showed a significant indirect effect. Specifically, knowledge positively predicted self-efficacy (Motivation) (\n B<\/jats:italic>\n \u202f=\u202f0.136), which in turn predicted EBF (\n B<\/jats:italic>\n \u202f=\u202f0.201). Furthermore, family support (Opportunity) had a direct positive effect on EBF (\n B<\/jats:italic>\n \u202f=\u202f0.097). It also predicted self-efficacy (\n B<\/jats:italic>\n \u202f=\u202f0.528), demonstrating a significant indirect effect on EBF behavior.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Based on the COM-B model, this study identifies maternal self-efficacy (Motivation) as a key mediator connecting breastfeeding knowledge (Capability) and family support (Opportunity) to EBF behavior. These findings suggest that knowledge-focused education alone is insufficient. Future public health interventions should adopt a family-centered approach. Clinical programs should integrate family support and prioritize building maternal confidence to effectively improve EBF rates.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1859936","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T05:28:53Z","timestamp":1788499733000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Decision-making process of exclusive breastfeeding at 6 months postpartum based on the COM-B model: a multicenter, cross-sectional study in Southeast China"],"prefix":"10.3389","volume":"14","author":[{"given":"Wu-lan","family":"Wang","sequence":"first","affiliation":[{"name":"Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University","place":["Fujian Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bao-ling","family":"Gao","sequence":"additional","affiliation":[{"name":"Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University","place":["Fujian Province, China"]},{"name":"Fujian Obstetrics and Gynecology Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University","place":["Fuzhou, Fujian Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Zeng","sequence":"additional","affiliation":[{"name":"Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University","place":["Fujian Province, China"]},{"name":"Fujian Obstetrics and Gynecology Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University","place":["Fuzhou, Fujian Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gui-hua","family":"Liu","sequence":"additional","affiliation":[{"name":"Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University","place":["Fujian Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying-ping","family":"Huang","sequence":"additional","affiliation":[{"name":"Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University","place":["Fujian Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao-feng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University","place":["Fujian Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao-qiu","family":"Guo","sequence":"additional","affiliation":[{"name":"Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University","place":["Fujian Province, China"]},{"name":"Fujian Obstetrics and Gynecology Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University","place":["Fuzhou, Fujian Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng-bin","family":"Guo","sequence":"additional","affiliation":[{"name":"Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University","place":["Fujian Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"ref1","volume-title":"The 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