• Ying Lau, Sarah Su Tin Ho-Lim, Peng Im Lim, and Claudia Chi.
• Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Electronic address: nurly@nus.edu.sg.
• Int J Nurs Stud. 2019 May 1; 93: 55-63.

BackgroundIdentifying and understanding the determinants of breastfeeding exclusivity during early postpartum period are crucial for sustainable breastfeeding. Few researchers have examined the association among prepregnancy body mass index, ethnicity and exclusive breastfeeding. As a result, whether or not these factors exhibit different relationship patterns across body mass index groups remains unclear.ObjectivesThis study was performed to: (1) test the relationships among prepregnancy body mass index, ethnicity, health-related quality of life, maternal and obstetric characteristics and exclusive breastfeeding; and (2) compare the relationships among these study variables for two body mass index groups.DesignExploratory cross-sectional research design.SettingTwo postnatal wards of a university-affiliated hospital.ParticipantsA total of 715 postpartum multi-ethnic women in Singapore.MethodsWe used structural equation modelling with multigroup analysis to examine our hypothetical model, which integrated the concepts of breastfeeding initiation and health-related quality of life conceptual models. A 12-item short form health survey was used to assess the health-related quality of life.ResultsThe structural equation modelling showed that women with following factors were significantly less likely to initiate exclusive breastfeeding: being Chinese (β = -0.10, p <  0.05), having high body mass index (β = -0.11, p <  0.01), living with low household income (β = -0.08, p <  0.05) and exhibiting poor health-related quality of life scores (β = 0.17, p <  0.001). Multigroup analysis showed no difference (critical ratio = 0.061) between the parameter estimates of health-related quality of life on exclusive breastfeeding in the two body mass index groups. Health-related quality of life (β = 0.17, p <  0.001) and monthly household incomes (β = -0.11, p < 0.05) were the only significant factors in the normal body mass index group. All structural equation modelling values satisfactorily fitted the data (Goodness of Fit Index = 0.937-0.954, Incremental Fit Index = 0.937-0.945, Tucker-Lewis Index = 0.906-0.917, Comparative Fit Index = 0.936-0.942 and Root Means Square Error of Approximation = 0.027-0.040).ConclusionsEnhancing postpartum health-related quality of life and prepregnancy weight management are crucial to initiate exclusive breastfeeding. Our findings can guide the development of promising health promotion strategies among Chinese women with low household income.Copyright © 2019 Elsevier Ltd. All rights reserved.

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