JMIR Publications

ABSTRACT

Background:

Breastfeeding exclusively throughout the first six months of life is critical for all children to attain optimal growth, development, and health. World Health Organization (WHO) created a target of increasing breastfeeding rates to 50% by 2025 while in Malaysia there is an indicator to achieve at least 70% of babies exclusively breastfed by 2025. According to the 2016 National Health and Morbidity Survey (NHMS), Malaysia's exclusive breastfeeding prevalence recently reached 47.1% (CI 43.13-51.18); nonetheless, this remains below the global and national targets. Women who have a greater perceived self-efficacy for breastfeeding are more likely to begin and continue breastfeeding despite obstacles.

Objective:

To develop, implement and evaluate the effect of health education intervention using Social Cognitive Theory namely Self-efficacy Breastfeeding (SeBF) module on breastfeeding self-efficacy, knowledge and attitude among antenatal mothers in a district in Selangor state.

Methods:

This study is a two-arm, parallel, single-blind cluster randomized controlled field trial with an intervention and control group involving primigravida or multigravida mothers who did not breastfeed exclusively during their previous pregnancy and reside in a district in Malaysia. All twelve maternal child health clinics in the district were randomly allocated into six intervention and six control groups. A total of 172 pregnant mothers was randomly assigned to the intervention group (n=82) or control group (n=82). Social Cognitive Theory was applied in the health education module and delivered via face-to-face and WhatsApp applications. Standard routine care was given to the control group. Data collection were at four-time points; baseline, immediate post-intervention, four weeks-, and eight weeks postpartum. Generalized Mixed Model Analysis was applied to measure the effect of health education on breastfeeding self-efficacy, knowledge and attitude post-intervention. Level of significance was set at 0.05.

Results:

The overall response rate was 81%. Using intention-to-treat analysis, the intervention group had significant increase scores of breastfeeding self-efficacy (F(21, 601) = 111.728, p = <0.001) and scores of knowledge (F(21, 601) = 8.331, p = <0.001) compared to the control group at eight weeks postpartum. However, no significant difference was observed for the scores of breastfeeding attitude post-intervention (F(21, 602) = 5.502, p = 0.472).

Conclusions:

The SeBF intervention programme that applied Social Cognitive Theory and delivered via face-to-face and WhatsApp significantly increase breastfeeding self-efficacy and knowledge. Further research is needed to assess SeBF effectiveness to improve exclusive breastfeeding at six months postpartum. Innovative and effective strategies need to be tested to improve the breastfeeding attitude of the mothers. Clinical Trial: Thai Clinical Trial Registry with identification number TCTR20200213004.