Factors influencing breastfeeding failure in mothers with hepatitis B infection: a qualitative study

To explore the factors contributing to breastfeeding failure among mothers infected with the hepatitis B virus (HBV) from the perspectives of stress and decision-making, with a specific focus on psychological factors.

A qualitative, descriptive design using semi-structured interviews.

Purposive sampling recruited 21 HBV-positive mothers at Shanghai First Maternity and Infant Hospital between February 1 and May 10, 2023. Data collection continued until thematic saturation. Interviews were audio-recorded, transcribed verbatim, and analyzed via thematic analysis with NVivo 12.6.1 software. Measures to ensure data trustworthiness included member checking, peer debriefing, and investigator triangulation.

Three participants withdrew before completion, resulting in 18 final interviews. Mean maternal age was 32.28 ± 4.80 years; 56% delivered by cesarean section, 67% had female infants. Five mothers were HBsAg-positive only, 13 were both HBsAg- and HBeAg-positive. Four mothers used partial breastfeeding, 13 formula feeding, only one practiced exclusive breastfeeding during hospitalization. Four core themes emerged: "Inadequate Knowledge of HBV Transmission Routes, Breastfeeding Benefits, and Resultant Decision-Making Uncertainty" (Cognitive Knowledge Deficits); Persistent Fear of Getting An Infant Infected With HBV, Despite Reassurance and Medical Information From Healthcare Providers (Emotional/psychological concerns); Practical Technical Difficulties in Breastfeeding, and Lactation-related Complications Compromising Feeding Sustainability (Persistent physiological and technical breastfeeding barriers); Family Members' Opposition to Breastfeeding that Increases Above the Maternal Feeding Intent and Directly Affects Infant Feeding Outcome (Family opposition and maternal intent deviate from infant feeding outcomes).

Breastfeeding among HBV-positive mothers is influenced by multiple factors including knowledge gaps, psychological concerns, physical challenges, and social pressures. Interventions should focus on improving knowledge, reducing psychological stress, enhancing technical support and engaging family members to promote breastfeeding continuation.

The study identifies HBV-positive mothers' breastfeeding barriers. It offers evidence for healthcare institutions' targeted strategies and helps improve breastfeeding rates and infant health.