Running Header: SELF-CONSCIOUS EMOTION BREASTFEEDING The role of social-cognitive and emotional factors on exclusive breastfeeding duration

Background: Previous research has suggested that exclusive breastfeeding is likely to be predicted by social-cognitive variables and fear. However, there is little research assessing the role of regret and self-conscious emotions (e.g., pride and guilt) in promoting exclusive breastfeeding. Research Aim: The primary aim of this research was to determine whether social-cognitive variables, fear, regret, and self-conscious emotions predict exclusive breastfeeding duration. The secondary aim of this research was to assess whether these factors predict infant feeding choice (i.e., exclusively breastfed, combination fed, or generally formula-fed). Methods: In this non-experimental one-group self-report survey, 375 mothers rated socialcognitive variables toward breastfeeding (attitude, subjective norm, perceived control and self-efficacy), their fear towards inadequate nutrition from breastfeeding and breastfeeding damaging their physical appearance, and the extent to which mothers may feel pride towards breastfeeding, and negative self-conscious emotions (guilt and shame) and regret for not breastfeeding their infant. Results: Exclusive breastfeeding duration was positively predicted by self-efficacy, pride, and regret, but negatively predicted by the fear towards inadequate nutrition. We also found that in contrast to exclusive breastfeeding, generally formula feeding an infant was associated with lower self-efficacy, pride, regret, but higher subjective norm and fear towards inadequate nutrition through breastfeeding. Conclusions: We argue that it is important to consider the role of self-conscious emotions and regret on exclusive breastfeeding. Background Given that human milk provides infants with the nutrients they need for healthy development, it is recommended that infants only receive human milk (i.e., are exclusively breastfed) from 0-6 months (World Health Organization, 2016). Despite this, many parents do not exclusively breastfeed their infant. Indeed, in the UK only 23% of mothers exclusively breastfeed their infant by 6 weeks and this drastically declined by 6 months (McAndrew, Thompson, Fellows, Large, Speed, & Renfrew, 2012). Similar rates are found in other European countries (World Health Organization, 2015). Therefore, it is important to assess the factors that promote and deter exclusive breastfeeding. Traditional theoretical models (e.g., Theory of Planned Behavior; Ajzen, 1991) suggest that health behaviors are likely to be determined by logical social-cognitive factors. However, it is also important to account for the role of emotions on health behaviors (Conner and Armitage, 1998; Hofmann, Friese, & Strack, 2009; Sniehotta, Presseau, & Araújo-Soares, 2013). Therefore, the aim of this research was to assess the extent to which exclusive breastfeeding is predicted by socialcognitive and emotional factors. Social cognitive and emotional factors Social cognitive factors are the individual’s cognitions and thoughts towards an action. The theory of planned behavior (Ajzen, 1991) suggests that behavior is predicted by three social cognitive factors: the attitude towards the action (attitude), the belief that others support the action (subjective norm), and the perceived control over undertaking the action (perceived control). Similarly, Armitage and Conner (1999) suggest another important socialcognitive variable is the perceived ability to undertake the action (i.e., self-efficacy). In line with this, breastfeeding is predicted by attitude (Manstead, Proffitt, & Smart, 1983), subjective norm (Bai, Wunderlich, & Fly, 2011), perceived control (Dodgson, Henly, Duckett, & Tarrant, 2003; McMillan et al., 2008), and self-efficacy (Blyth, Creedy, Dennis, Moyle, Pratt, & De Vries, 2002; de Jager, Broadbent, Fuller-Tyszkiewicz, Nagle, McPhie, & Skouteris, 2015; de Jager, Broadbent, Fuller-Tyszkiewicz, & Skouteris, 2014). Moreover, interventions based on these social-cognitive factors have been found to increase breastfeeding intentions (Giles et al., 2014). This suggests that the social-cognitive factors proposed by the theory of planned behavior and extensions of this model (i.e., self-efficacy) are likely to predict exclusive breastfeeding. As such, these four variables (henceforth referred to as social-cognitive variables) were assessed in this research. Although these social-cognitive variables are important, breastfeeding is closely associated with emotions (Faircloth, 2013; Lawton, Ashley, Dawson, Waiblinger, & Conner, 2012). Researchers often focus on the role of emotions in deterring beneficial health behaviors. Indeed, research has found that women may be unlikely to breastfeed if they fear that the infant may not receive adequate nutrition (Brown, Raynor, & Lee, 2011; Williamson, Leeming, Lyttle, & Johnson, 2012) or that breastfeeding may damage their physical appearance (Hannon, Willis, Bishop-Townsend, Martinez, & Scrimshaw, 2000; Nabulsi, 2011). However, research has suggested that some, more complex, emotions (e.g., pride, regret, guilt, and shame) may serve a self-regulatory role and thus promote beneficial behaviors (Giner-Sorolla, 2001; Van der Schalk, Bruder, & Manstead, 2012). As such, it is important also to consider the role of these emotions on health behaviors, such as exclusive breastfeeding. Pride, guilt and shame are felt following an evaluation of the self-concept and are thus regarded as self-conscious emotions (Lewis, 1995). People are likely to feel pride when they evaluate themselves positively and negative self-conscious emotions (e.g., guilt and shame) when they evaluate themselves negatively (Tangney & Dearing, 2002; Tracy & Robins, 2004). Regret is felt when people think that they would be in a better situation if they had acted differently (Zeelenberg & Pieters, 2007). Regret is often felt for intrapersonal rather than interpersonal harm (Berndsen, van der Pligt, Doosje, & Manstead, 2004), and is therefore not generally regarded as a self-conscious emotion. Importantly, research has found that mothers may feel pride for breastfeeding their child (Diaz Meneses, 2013; Swanson, Nicol, McInnes, Cheyne, Mactier, & Callander, 2012; Tarrant, Dodgson, & Choi, 2004), but feel regret and negative self-conscious emotions if they do not breastfeed (Guyer, Millward, & Berger, 2012; Ryan, Bissell, & Alexander, 2010; Ryan, Todres, & Alexander, 2011; Thomson, Ebisch-Burton, & Flacking, 2015). These emotions are likely to self-regulate behavior (Giner-Sorolla, 2001; Van der Schalk, Kuppens, Bruder, & Manstead, 2015). The desire to feel positive (e.g., pride) and avoid negative emotions (e.g., guilt, shame and regret) is likely to motivate people to maintain long-term goals (Baumeister, Vohs, DeWall, & Zhang, 2007; Zeelenberg & Pieters, 2007), such as exclusive breastfeeding. Indeed, these emotions are likely to predict a variety of health behaviors, such as fruit consumption (Onwezen, Bartels, & Antonides, 2014), screening (Sandberg & Conner, 2009), and exercising (Mack, Kouali, Gilchrist, & Sabiston, 2015). However, there has been little quantitative research assessing the extent to which these emotions predict exclusive breastfeeding.