MINISTRY OF HEALTH UNIVERSITY OF HEALTH SCIENCES, FACULTY OF PUBLIC HEALTH AND MINISTRY OF EDUCATION AND TRAINING - MINISTRY OF HEALTH HANOI UNIVERSITY OF PUBLIC HEALTH RATTANAXAY INTHILATH SELF-EFFICACY IN EXCLUSIVE BREASTFEEDING AMONG MOTHERS IN XAYTHANY DISTRICT, VIENTIANE CAPITAL, LAO PDR MASTER THESIS MASTER OF PUBLIC HEALTH CODE: 8720701 HANOI, 2019 MINISTRY OF HEALTH UNIVERSITY OF HEALTH SCIENCES, FACULTY OF PUBLIC HEALTH AND MINISTRY OF EDUCATION AND TRAINING - MINISTRY OF HEALTH HANOI UNIVERSITY OF PUBLIC HEALTH RATTANAXAY INTHILATH SELF-EFFICACY IN EXCLUSIVE BREASTFEEDING AMONG MOTHERS IN XAYTHANY DISTRICT, VIENTIANE CAPITAL, LAO PDR MASTER THESIS MASTER OF PUBLIC HEALTH CODE: 8720701 Assoc. Pham Viet Cuong, PhD Dr. Khampheng Phongluxa, MD, MSc, PhD HANOI, 2019 ii ACKNOWLEDGMENTS I wish to acknowledge the support of the Medical Committee, Netherlands and Vietnam, Hanoi University of Public Health, Lao Tropical Public Health Institute and the University of Health Sciences in producing this work. To my parents: You both are my first role models.
I love you and I hope that you are blessed with many more years of life. Your relentless belief in my capabilities has allowed me to dare to dream. You have shown me that hard work brings results. Thank you for being my never-ending supporters and for also helping me to believe in myself.
To my wife: Your support, kindness, friendship, and love have held me up in times of self-doubt. You always challenge me to do my best. Thank you for your trust and for your gift of sharing your life with me. I hope that this journey with you never ends and that we continue to grow together.
Finally, you are one of the most loving and caring people I have ever met. Thank you for always being so positive about my journey and for providing me with insight and support. I am forever in gratitude to you for this. Next, I would like to express my sincerest gratitude to my supervisors, Associate Professor Cuong Pham V and Dr.
Khampheng Phongluxa for their kindness in offering many useful suggestions throughout my research and thus helping me to complete this dissertation. Thank you for never letting me quit and for believing that I could obtain a Master’s degree. Your professional support and personal friendship have meant more than gold to me. Finally, I would like to acknowledge all of the women who participated in this study and made possible its findings.
May you face every challenge in raising your children with strength and achieve every wish that you have. I hope to eventually see a world where children are breastfed exclusively and supported in every area of their life and where equity plus equality exist for women and children. Thank you for all of you who supported me and gave me the inspiration in the pursuit of my research goal. iii ABBREVIATIONS ANC Antenatal Care AOR Adjusted Odds Ratio BSE Breastfeeding Self-Efficacy BSES Breastfeeding Self-Efficacy Scale BSES-SF Breastfeeding Self-Efficacy Scale-Short Form CI Confidence Interval COR Crude Odds Ratio HUPH Hanoi University of Public Health ID Identity Document IRB Institutional Ethical Review Board LAK Lao kip OR Odds Ratio PDR People’s Democratic Republic SD Standard Deviation UNICEF The United Nations Children's Fund US The United States USA The United States of America USD US dollar WHO World Health Organization iv TABLE OF CONTENTS ACKNOWLEDGMENTS.
vii LIST OF TABLES. 3 CHAPTER 1: LITERATURE REVIEW. Breastfeeding self-efficacy. Background of breastfeeding self-efficacy.
Benefits of exclusive breastfeeding. Factors related to self-efficacy in exclusive breastfeeding. Measurement of self-efficacy in exclusive breastfeeding. Study location and time.
Data collection procedure. Socio-demographic characteristics. Obstetric characteristics of the participants. Breastfeeding knowledge and infant feeding characteristics.
Exclusive breastfeeding self-efficacy. Level of exclusive breastfeeding self-efficacy. Association between self-efficacy in exclusive breastfeeding scores and socio-demographic characteristics. Association between exclusive breastfeeding self-efficacy and obstetric characteristics.
Association between exclusive breastfeeding self-efficacy with breastfeeding knowledge and infant feeding characteristics. Factors associated with high self-efficacy in exclusive breastfeeding. Factors associated with self-efficacy in exclusive breastfeeding. Limitations of the study.
52 ANNEX 1: MEASUREMENT OF STUDY VARIABLES. 71 ANNEX 4: INFORMATION SHEET FOR PARTICIPANTS. 76 ANNEX 5: INFORMED CONSENT FORM FOR PARTICIPANTS. 77 ANNEX 6: ETHICAL APPROVAL.
78 vi ABSTRACT Exclusive breastfeeding is the most efficacious form of infant feeding for the first six months of life. Many mothers in diverse countries prematurely discontinue breastfeeding and Lao mothers are not the exception. Maternal breastfeeding self- efficacy has been highlighted as an important psychometric factor for improving breastfeeding outcomes. However, self-efficacy in exclusive breastfeeding has not been extensively studied in Laos.
As such, this study was carried out to assess self- efficacy and related factors on exclusive breastfeeding among mothers in Xaythany District, Lao PDR. A cross-sectional study was conducted from November 2018 to April 2019. A sample of 151 mothers who have children under 12 months and living in Xaythany district agreed to participate in this study. The data were collected through face-to-face interviews with the mothers using a structured questionnaire.
The data were analyzed using the STATA program. Descriptive statistics, univariate analysis, and multiple logistic regressions were used. The average total score from the "taken BSES-SF" was determined as 56. The multiple logistic regression model showed that the variance of the number of times attended ANC (p<0.05), mothers learning the benefits of exclusive breastfeeding (p<0.01) and the mothers’ expectation to breastfeed exclusively (p<0.05) had statistically significant relationships with breastfeeding self-efficacy.
Exclusive breastfeeding self-efficacy amongst a sample of women in Xaythany district, Vientiane Capital, Lao PDR was influenced by ANC services, antenatal exclusive breastfeeding education, mother’s working status and mother’s expectation to exclusively breastfeed. The findings of this study showed the need to support antenatal exclusive breastfeeding education for mothers during pregnancy, especially the benefits of exclusive breastfeeding in an opportunity to improve their knowledge, attitude, expectation and exclusive breastfeeding self- efficacy. vii LIST OF TABLES Table 3.1: Socio-demographic characteristics of mothers Table 3.2: Obstetric characteristics of mothers Table 3.3: Breastfeeding knowledge and infant feeding characteristics Table 3.4: Exclusive breastfeeding self-efficacy of mothers Table 3.5: Level of exclusive breastfeeding self-efficacy Table 3.6: Univariate analysis of exclusive breastfeeding self-efficacy with socio-demographic characteristics Table 3.7: Univariate analysis of exclusive breastfeeding self-efficacy with obstetric characteristics of mothers Table 3.8: Univariate analysis of exclusive breastfeeding self-efficacy with breastfeeding knowledge and infant feeding characteristics Table 3.9: Multiple logistic regression analysis of factors related to high self-efficacy in exclusive breastfeeding. viii INTRODUCTION Exclusive breastfeeding is the most efficacious form of infant feeding for the first six months of life.
If the baby has been breastfed exclusively for six months the baby will be healthier because breast milk provides all the energy and nutrients for infant needs. Moreover, breastmilk increases immunity to disease and nutrient resistance, prevents disease and does not cause malnutrition or obesity while breastfeeding establishes a strong physical and emotional link between mother and baby (WHO, 2009). Breastfeeding is expected to reduce child mortality from preventable diseases by 13%, especially in children under five (Darmstadt et al. It's well documented salutary effects have resulted in international and national organizations promoting the initiation of breastfeeding and continuation exclusively to at least six months postpartum (WHO, 2001).
According to evidence, it brings numerous benefits (Grummer‐Strawn & Rollins, 2015) and indicates that exclusive practice is the most important preventive intervention with potentially the single largest impact on reducing child mortality. Sadly, only 41% of children aged under six months worldwide are exclusively breastfed (WHO, 2018). In Lao PDR, the Government has launched several strategies and policies in an effort to improve exclusive breastfeeding since 2006. The Exclusive Breastfeeding Campaign was strongly promoted during 2009-2010 to improve child survival rates and enhance the development of children by increasing the proportion of mothers who exclusively breastfeed their new-borns for six months.
Although Laos has made considerable progress toward improving the number of mothers who exclusively breastfeed their children up to six months of age, only 44.9% of babies receive this important good start in life (Lao Statistics Bureau, 2017), an increase of 4. In 2017, Khammuane Province showed the lowest number (14.4%) of infants exclusively breastfed for six months, followed by Savannakhet Province (16.8%) and Vientiane Capital (21%) (Lao Statistics Bureau, 2017). Additionally, the mortality rate for children under one year of age is still very high, almost 57 per 1,000 live births (Lao Statistics Bureau, 2017). 1 Many mothers in diverse countries prematurely discontinue breastfeeding (C.
Dennis, 2002; Mukuria, Kothari, & Abderrahim, 2006; Ryan, 1997), and Lao mothers are not the exception. Recently, maternal breastfeeding self-efficacy has been highlighted as an important psychometric factor for improving breastfeeding outcomes (Meedya, Fahy, & Kable, 2010). Self-efficacy in exclusive breastfeeding refers to maternal ability or confidence to breastfeed her newborn and influence her decisions regarding six months of breastfeeding or how she will tackle any breastfeeding issues (C. Maternal breastfeeding confidence or self-efficacy is a modifiable variable that has been shown to predict longer breastfeeding duration and increased exclusivity.
The variable of self-efficacy can be modified and enhanced through prenatal breastfeeding education (Eidman, 2011). Women discontinue breastfeeding exclusively not because of their intention to formula feed, but because they had low self-efficacy (C. In addition, researchers suggest that a lack of breastfeeding confidence is linked to discontinuing exclusive breastfeeding (Li, Fein, Chen, & Grummer-Strawn, 2008; Taveras et al., 2003; Taveras et al. However, few studies were found in this research of work conducted to investigate maternal self-efficacy in exclusive breastfeeding in Laos whereas there were many studies in different countries but with a different socio-economic context and culture to Laos.
This study aims to assess breastfeeding self-efficacy and the factors associated with exclusive breastfeeding self-efficacy among mothers in Xaythany District, Lao PDR. To assess self-efficacy in exclusive breastfeeding among mothers in Xaythany District, Lao PDR. To analyze factors related to self-efficacy in exclusive breastfeeding among mothers in Xaythany District, Lao PDR. 3 CHAPTER 1: LITERATURE REVIEW 1.
Breastfeeding self-efficacy Derived from Bandura’s Social Learning Theory, self-efficacy is a cognitive process of an individual’s confidence in their perceived ability to regulate their motivation, thought processes, emotional states, and social environment in performing a specific behavior (A. Self-efficacy has been shown repeatedly, through correlational and causal associations, to be predictive of health behaviors. Based on Bandura’s theory, self-efficacy scales have been developed to identify those with high or low confidence. Self-efficacy is a pivotal factor in the performance of a specific behavior since it reflects individuals’ perception of their abilities and not necessarily their true abilities (Albert Bandura, 1986).
These self-efficacy perceptions are related to beliefs about the abilities to perform specific behavior in particular situations and do not refer to a personality characteristic that operates independently of contextual factors. Thus, an individual’s self-efficacy expectations are situation-specific and diverse. There are four main sources of self-efficacy: enactive mastery experiences (e., breastfeeding experiences); vicarious experience (e., watching other women breastfeed, peer counselling); social and verbal persuasion (e., encouragement from others such as friends, family, and lactation consultants); and perception of emotional and physical (somatic) reactions (e., pain, fatigue, anxiety, stress) (A. These sources of self-efficacy have also been identified as important in breastfeeding research (C.
Enactive mastery experiences Enactive mastery experiences are those learned through personal experience. The interplay of several factors affects enactive mastery experiences. For example, pre-existing knowledge and task difficulty are two of these factors, with effort 4 expenditure and context also playing an important role (A. Other factors affecting enactive mastery experiences involve the individual assessing their own performance before, during, and after the task.
To do this, self-monitoring takes place, and reconstruction of enactive mastery experience by thoughtful reflection, allows the individual to assess the attainment of their goal. Attainment trajectories are the individual’s interpretation of their success over time (A. Enactive mastery experience in the context of this research is the woman actually undertaking the task of breastfeeding her infant.