Psychosocial Determinants of Intention to Utilise Human Milk Bank Services among Mothers of Preterm Infants at Pumwani Maternity Hospital, Nairobi

Abstract

Kenya experiences a neonatal mortality rate of 21 deaths per 1,000 live births. Many of these deaths are preventable through exclusive access to human milk, yet mothers of preterm infants often struggle with insufficient supply. Donor human milk offers a safe alternative, but its use remains limited in Kenya. This study explored psychosocial factors influencing mothers' intentions to use human milk bank services at Pumwani Maternity Hospital, the country's only operational milk bank. The general objective was to assess psychosocial determinants of intention to utilize human milk bank services among mothers of preterm infants. Specific objectives included examining attitudes toward donating and using donor milk, evaluating perceived social norms surrounding milk donation, assessing perceived behavioral control over donor milk decisions, and identifying barriers and facilitators that influence willingness to donate and accept donor milk. Guided by the Theory of Planned Behavior and supported by the Health Belief Model and Self Efficacy Theory, this descriptive cross-sectional mixed-methods study investigated key psychosocial constructs. A sample of 85 mothers was recruited from Pumwani Maternity Hospital. Data collection involved structured questionnaires and interviews, with analysis conducted using descriptive statistics, chi-square tests, and regression models. Findings revealed a notable donation-acceptance paradox. While 75.3 percent of mothers were willing to donate breast milk, only 37.6 percent were willing to accept donor milk, a statistically significant difference. Attitudes toward donor milk were moderately favorable, with strong trust in healthcare providers but persistent safety concerns. Perceived social norms were mixed, showing support from healthcare workers but hesitation among household members. Perceived behavioral control was relatively high. Regression analysis identified prior experience, decision-making confidence, and safety perceptions as significant predictors of acceptance intentions. Key barriers included safety concerns, cultural stigma, and financial limitations. Facilitators included support from healthcare providers, altruistic motivations, and positive peer experiences. The study concludes that improving acceptance of donor human milk requires targeted interventions that address safety misconceptions, involve family decision-makers, and highlight peer testimonials.