Mothers' attitudes toward exclusive breastfeeding explored using a questionnaire based on the transtheoretical model in an observational study

: The WHO European Region has among the lowest rates of exclusive breastfeeding (EBF), with substantial variability across countries. In Italy, EBF rates remain below WHO targets, particularly in Southern regions. Several tools have been proposed to assess mothers' attitudes toward breastfeeding, although no gold standard has been established. This study aimed to explore mothers' attitudes toward breastfeeding using a questionnaire based on the Trans-Theoretical Model (TTM). An observational study was conducted in two Sicilian hospitals, where mothers were enrolled during postpartum hospitalization and interviewed using a structured questionnaire. The most frequently observed stage of change was action (39%, n = 123/318), followed by contemplation (22%, n = 70/318), pre-contemplation (21%, n = 67/318), and determination (18%, n = 58/318). A significant trend was observed across stages of change in relation to infant feeding patterns during hospitalization (p < 0.0001), with higher stages showing a greater proportion of exclusive breastfeeding. The TTM-based approach may provide preliminary insights into mothers' attitudes toward breastfeeding, particularly in the pre-contemplation and contemplation stages of change. However, given the exploratory design, further studies are needed to refine the questionnaire and to assess its performance in longitudinal settings.