Degree Type


Date of Award


Degree Name

Doctor of Philosophy


Food Science and Human Nutrition

First Advisor

Grace S. Marquis


The purpose of this study was to examine the culturally sensitive information regarding the factors that permit Ghanaian pregnant women to make an informed decision on infant feeding methods, with special attention to prenatal voluntary human immunodeficiency virus (HIV) testing and infant feeding. Focus group discussions (n = 10), in-person interviews (n = 403), and a follow-up study (n = 41) were conducted based on an integrated model of the Theory of Reasoned Action/Planned Behavior and the Health Belief Model.;Ghanaian pregnant women's intention of prenatal voluntary testing of HIV was low, but their intention would have increased significantly with a health professional's recommendation. Their intention about voluntary testing was well predicted by high self-efficacy about the testing, followed by no history of previous HIV testing. Participants generally had a high knowledge about transmission modes of HIV including mother-to-child transmission (MTCT), but misconceptions were also common. Lack of knowledge about the prevention methods of MTCT was evident and this was strongly associated with a lower intention of having a prenatal voluntary testing.;Most women preferred exclusive breastfeeding to formula feeding at least during the first month due mainly to the protective property of breast milk for their infants. Almost all women intended to feed breast milk exclusively during the first month and the best predictor of exclusive breastfeeding intention was self-efficacy, followed by attitudes toward exclusive breastfeeding. Because of its recognized negative health consequences, only a small number of pregnant women intended to introduce formula within one month. If the distribution of subsidized formula for HIV-positive women were under-regulated, the spillover effects of formula feeding to children born to HIV-negative mothers or mothers of unknown status is likely to occur especially among those women who had favorable attitudes toward formula feeding.;An 'opt-out' approach of voluntary counseling and testing of HIV and a systematic nutrition education program including the risks and benefits of exclusive breastfeeding and formula feeding should be routinely offered to all pregnant women to enable them to make an informed infant feeding decision.



Digital Repository @ Iowa State University,

Copyright Owner

Yi-Kyoung Lee



Proquest ID


File Format


File Size

291 pages