LITERATURE REVIEW
Definition
Self-efficacy, rooted in Bandura’s Social Learning Theory, refers to an individual's confidence in their ability to manage their motivation, thoughts, emotions, and social interactions while performing specific behaviors (A Bandura, 1977) Research consistently demonstrates that self-efficacy is a strong predictor of health behaviors, supported by both correlational and causal evidence Consequently, self-efficacy scales have been created to assess individuals' levels of confidence, distinguishing between those with high and low self-efficacy.
Self-efficacy plays a crucial role in determining an individual's performance in specific behaviors, as it represents their perception of their abilities rather than their actual skills (Albert Bandura, 1986) These perceptions are tied to beliefs about the capacity to execute particular actions in specific contexts, highlighting that self-efficacy is not a fixed personality trait but is influenced by situational factors Consequently, self-efficacy expectations vary across different scenarios and are contextually diverse.
Self-efficacy in breastfeeding is influenced by four key sources: enactive mastery experiences, such as personal breastfeeding success; vicarious experiences, including observing others breastfeed and receiving peer support; social and verbal persuasion from friends, family, and lactation consultants; and the perception of emotional and physical reactions, like pain and stress These elements are critical in enhancing breastfeeding confidence, as highlighted in research by Dennis and Faux.
Enactive mastery experiences are acquired through personal involvement and practice Several factors influence these experiences, including prior knowledge and the difficulty of the task, along with the effort exerted by the individual.
Enactive mastery experiences, as outlined by A Bandura (1977), involve individuals evaluating their performance before, during, and after a task, which in this context refers to a woman breastfeeding her infant This process includes self-monitoring and reflective reconstruction of experiences to assess goal attainment The woman's effort in breastfeeding is influenced by her commitment level and prior knowledge of the task, as well as her assessment of its difficulty Throughout the breastfeeding process, she cognitively monitors her performance and evaluates whether the outcome meets her expectations, such as having a healthy and settled infant Her attainment trajectory reflects her ongoing evaluation of her breastfeeding experiences and her interpretation of success over time.
Enactive mastery experience necessitates active cognitive processing during each task, influenced by perception, memory, coping, motivation, and learning Various non-modifiable demographic factors, such as maternal age, education level, parity, and household income, significantly shape a mother's life experiences and, consequently, impact cognitive processing (R Blyth et al., 2002).
Self-efficacy can be significantly enhanced through the observation of others successfully performing a task, a process known as modeling Individuals often relate to models who share similar characteristics, and witnessing these peers achieve success fosters a sense of vicarious experience For instance, in the context of breastfeeding, women who observe other mothers with comparable traits succeeding in this endeavor are more likely to feel empowered and motivated to engage in breastfeeding themselves, as they can envision positive outcomes based on these observations.
The credibility and knowledge of breastfeeding models significantly impact the effectiveness of vicarious experiences in breastfeeding Additionally, verbal persuasion enhances the modeling process, as highlighted by A Bandura (1977) Recent literature emphasizes the importance of structured peer breastfeeding support in achieving improved breastfeeding outcomes (Battersby, 2008).
Social and verbal persuasion significantly impacts self-efficacy, particularly in tasks like breastfeeding Influences from partners, parents, friends, and health professionals can shape an individual's confidence However, unrealistic verbal encouragement may lead to inflated self-efficacy and subsequent disappointment In breastfeeding education, visual media serves as a crucial source of social persuasion and vicarious experience, enhancing understanding and confidence in the practice.
It has been established in the literature that women’s perception of breastfeeding advice or education can be positive or negative (Graffy & Taylor,
Professional support plays a crucial role in shaping the perception of breastfeeding as a cultural norm, as evidenced by a study involving ten countries that found an increase in breastfeeding duration with the availability of support services Additionally, breastfeeding education significantly enhances breastfeeding self-efficacy, with research indicating that targeted interventions can effectively raise self-efficacy levels.
The fourth source of self-efficacy involves physiological and affective states, where individuals may perceive stressful or demanding situations as overwhelming, leading to impaired performance and the manifestation of feared outcomes This perception of stress can trigger a range of emotions, including fear, anger, and sorrow, which further complicate the individual's response.
The perception of physiological states, such as increased heart rate or blood pressure, significantly influences an individual's emotional and physical well-being Past negative experiences, particularly related to breastfeeding challenges like nipple pain, can lead to fear and anxiety during subsequent breastfeeding attempts Conversely, individuals who maintain a positive outlook and do not misinterpret their experiences may handle similar pain with less stress, remaining committed to breastfeeding The subjective experience of pain poses a significant challenge for new mothers, often resulting in the consideration of alternative feeding methods Research indicates that postpartum pain can have a lasting impact on new mothers, affecting their breastfeeding experience for weeks.
Exclusive breastfeeding refers to feeding an infant solely with breast milk for the first six months of life, without introducing any other liquids or solids, including water The only exceptions to this guideline are oral rehydration solutions and drops or syrups containing vitamins, minerals, or medications, as recommended by the World Health Organization (WHO).
Background of breastfeeding self-efficacy
Self-efficacy, a concept introduced by Albert Bandura, refers to an individual's belief in their ability to successfully execute a specific task or behavior (Bandura, 1977) Building on this theory, Dennis (1999) established the concept of breastfeeding self-efficacy, highlighting the importance of perceived competence in breastfeeding practices.
Breastfeeding self-efficacy is a crucial factor that reflects a mother's confidence in her ability to breastfeed her baby This confidence significantly influences breastfeeding outcomes, including the decision to initiate breastfeeding and the level of effort a mother is willing to invest in the process.
HUPH whether she will have self-enhancing or self-defeating thought patterns and how she will emotionally respond to breastfeeding difficulties (C.-L Dennis, 1999)
Several factors significantly impact a mother's decision to start and continue breastfeeding, including maternal age, education, and socioeconomic status (Demirtas, 2012) Additionally, smoking habits (C L Dennis, 2002; Peat et al., 2004; Wambach et al., 2005) and available support resources play crucial roles (C L Dennis, 2002; Peat et al., 2004; Taveras et al., 2003) Positive attitudes and beliefs towards breastfeeding, along with practices like rooming-in with the baby and supportive hospital policies such as early discharge, further influence breastfeeding initiation and duration (Demirtas, 2012) Moreover, breastfeeding self-efficacy is a key determinant of successful breastfeeding (R Blyth et al., 2002; Chezem, Friesen, & Boettcher, 2003; C L Dennis & Faux, 1999; Swanson et al., 2012).
Breastfeeding self-efficacy, often equated with confidence in breastfeeding, plays a crucial role in enhancing breastfeeding success and duration Mothers who experience low self-efficacy tend to stop breastfeeding earlier than recommended, while those with high self-efficacy encounter fewer challenges in initiating and continuing breastfeeding Importantly, negative factors affecting breastfeeding self-efficacy can be mitigated through educational support during the prenatal period.
Benefits of exclusive breastfeeding
Breastfeeding offers numerous benefits for both mothers and infants, encompassing economic, physiological, and emotional advantages It is well-established that breast milk provides all essential nutrients required by infants during their first six months of life Additionally, breastfeeding plays a crucial role in protecting infants from diarrhoea and various common childhood illnesses.
HUPH pneumonia can lead to long-term health advantages for both mothers and children, including a decreased likelihood of childhood and adolescent overweight and obesity (Horta, Loret de Mola, & Victora, 2015; Weng, Redsell, Swift, Yang).
Breast milk is recognized as the most beneficial source of nutrition for infants, with no artificial formula able to replicate its unique properties Extensive research supports breastfeeding as the healthiest and preferred method of feeding for children Additionally, breastfeeding offers numerous advantages, including nutritional, immunological, psychological, social, and economic benefits.
Factors related to self-efficacy in exclusive breastfeeding
Breastfeeding self-efficacy has been positively correlated with breastfeeding outcomes in the literature across various populations around the world
A study in England revealed a strong link between breastfeeding self-efficacy, as measured by the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), and Bristol Breastfeeding Assessment scores, which evaluate newborn behaviors such as position, sucking, swallowing, and attachment at the breast This indicates that mothers with better breastfeeding techniques tend to have higher self-efficacy scores (Ingram et al., 2015) Furthermore, research shows that women with high breastfeeding self-efficacy immediately after childbirth are significantly more likely to exclusively breastfeed at four weeks postpartum compared to those with lower self-efficacy scores (Gregory et al., 2008).
A study conducted in Spain revealed that BSES-SF scores can effectively predict exclusive breastfeeding at three weeks postpartum for women breastfeeding in-hospital Additionally, mothers who had more children, previous breastfeeding experience of six months or longer, and those who viewed their past breastfeeding experiences as "very positive" demonstrated significantly higher levels of breastfeeding self-efficacy (Oliver-Roig et al., 2012).
A study conducted in Brazil explored the relationship between sociodemographic and obstetrical factors and self-efficacy scores among urban populations, revealing several significant associations Key findings indicated that maternal breastfeeding self-efficacy was positively correlated with age, marital status, maternal and paternal education levels, household income, number of household members, and government assistance Additionally, obstetrical factors such as a lack of previous miscarriages, having two living children, multiparity, breastfeeding experience, multiple pregnancies, prior positive breastfeeding experiences, being breastfed as infants, and knowing other breastfeeding mothers were also linked to higher self-efficacy scores (Uchoa et al., 2014).
Australian researchers have established a significant link between maternal confidence, as measured by the Breastfeeding Self-Efficacy Scale (BSES), and breastfeeding outcomes at one week and four months postpartum Women exclusively breastfeeding were more likely to achieve high BSES scores during these periods (R Blyth et al., 2002) Further studies identified modifiable antenatal factors, particularly intended breastfeeding duration and breastfeeding self-efficacy, as key predictors of breastfeeding success (R J Blyth et al., 2004) Additionally, a study revealed that Australian women with higher BSES scores were more likely to exclusively breastfeed at 12 weeks postpartum compared to those with lower scores (Hauck et al., 2007) Moreover, research examining the impact of breastfeeding self-efficacy on breastfeeding duration found that various confounding variables, assessed through both BSES and BSES-SF, were independent predictors of breastfeeding duration, regardless of factors such as breastfeeding intention, education level, smoking status, housing, and delivery mode (Baghurst et al., 2007).
Research in China highlights the impact of breastfeeding self-efficacy on primiparous women, revealing that those with higher BSES-SF scores are more likely to exclusively breastfeed for at least six weeks postpartum Factors influencing breastfeeding self-efficacy include living with a mother-in-law, higher income, and experiencing pregnancy loss, while later decisions to breastfeed and older maternal age correlate with lower self-efficacy scores Additionally, a Cantonese survey in Hong Kong found a significant relationship between high breastfeeding self-efficacy and prolonged breastfeeding duration, with notable exclusivity rates at one and six months postpartum.
A study in Japan revealed that women with low breastfeeding self-efficacy scores, as measured by the Japanese version of the BSES-SF, were less likely to exclusively breastfeed The research found no correlation between self-efficacy scores and factors such as age, marital status, education, or household income However, significant correlations emerged, showing that multiparous women had higher self-efficacy scores than primiparous women, and women intending to exclusively breastfeed also scored higher Additionally, mothers with a history of exclusive breastfeeding for over three months exhibited higher self-efficacy scores, while those with low scores were more likely to report insufficient milk supply four weeks postpartum Furthermore, a subsequent study indicated that educational interventions on breastfeeding effectively increased self-efficacy, particularly in hospitals with a Baby-Friendly initiative in place.
Self-efficacy in breastfeeding is influenced by various socio-demographic factors, including maternal age, education level, training, number of pregnancies, employment status, family income, and prior breastfeeding experiences Additionally, obstetric factors such as the number of children, previous breastfeeding experiences, and the timing and type of birth also play a significant role Knowledge of breastfeeding and infant feeding practices, including learning how to breastfeed, returning to work, expectations for exclusive breastfeeding, and understanding breast milk expression and maintenance, further impact a mother's self-efficacy in breastfeeding.
Maternal age is determined to be positively associated with breastfeeding initiation and duration in western countries (R J Blyth et al., 2004; Meedya et al.,
Research indicates that maternal age plays a crucial role in breastfeeding outcomes Studies have shown that older maternal age is positively associated with longer breastfeeding duration (Bolton et al., 2009) and higher Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) scores (Dodt et al., 2012) In contrast, younger mothers, particularly those under 26 years, tend to experience poorer breastfeeding outcomes (Narayan et al., 2005).
The educational level of the mother
Maternal education is associated with improved childcare practices, with studies indicating that mothers with lower education levels often report higher self-efficacy scores Conversely, as maternal education increases, so do self-efficacy scores Additionally, higher levels of maternal education correlate with extended breastfeeding duration, highlighting the importance of education in enhancing maternal confidence and child-rearing outcomes.
A study in the USA revealed a significant association between education levels and breastfeeding self-efficacy, with an adjusted odds ratio (AOR) of 2.50 (Glassman et al., 2014) Similarly, research by Tokat et al (2010) showed statistically significant differences in breastfeeding self-efficacy scores among mothers with varying educational backgrounds, with those who completed elementary school scoring an average of 57.4 (SD 8.8) compared to 60.3 (SD 8.8) for high school graduates (F = 6.54, p = 0.002) These findings highlight the inconsistent impact of maternal education on breastfeeding self-efficacy across different studies.
A study conducted in Iran revealed that breastfeeding self-efficacy differs between working and non-working mothers, with housewives demonstrating significantly higher self-efficacy scores than employed mothers (p=0.008) six weeks postpartum This indicates that a mother's occupation plays a crucial role in her confidence to breastfeed, as housewives who can dedicate time to their infants tend to report increased breastfeeding self-efficacy (Poorshaban et al., 2017) Similarly, research by Brandão et al supports these findings.
A study by Brandão et al (2018) revealed notable variations in the BSES-SF scores based on occupational status, indicating that unemployed pregnant women had higher BSES-SF scores compared to their employed counterparts.
Ethnicity significantly influences nutrition and health outcomes through various mechanisms, including social, physical, behavioral, and biological factors (Cheng & Goodman, 2015) Research in the U.K revealed notable differences in breastfeeding self-efficacy scores between White and Southeast Asian mothers (Gregory et al., 2008) Additionally, McCarter‐Spaulding & Dennis (2010) identified ethnic variations in BSES-SF scores, further highlighting the impact of ethnicity on breastfeeding practices Studies focusing on Chinese populations also support these findings (Dai & Dennis).
2003) and Australian mothers (Creedy et al., 2003) have also demonstrated significant differences among the ethnicities
Religion often intertwines with spiritual well-being and practices, providing comfort through prayer, spiritual literature, and religious ceremonies during challenging times (Meraviglia, 1999) While some studies suggest that a mother's religion does not influence her self-efficacy in exclusive breastfeeding (Guimarães et al., 2017; Rashid et al., 2017), others indicate that religious beliefs significantly impact feeding methods (Mora et al., 1999) This study aims to explore the relationship between mothers' religious beliefs and their self-efficacy in breastfeeding.
A study conducted in Northern Iran revealed a positive correlation between the duration of breastfeeding and family size, indicating that longer breastfeeding is associated with larger families (Veghari, Mansourian, & Abdollahi, 2011) Additionally, research showed that women planning to breastfeed tend to have smaller family sizes compared to those who do not intend to breastfeed (Mitra, Khoury, Hinton, & Carothers).
Measurement of self-efficacy in exclusive breastfeeding
In 2003, Dennis reduced the Breastfeeding Self-Efficacy Scale (BSES) from
33 to 14 items and renamed it the BSES-Short Form (BSES-SF) (C L Dennis,
The Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), developed by Dennis, utilizes a 5-point Likert-type scale with scores ranging from 14 to 70, demonstrating its validity as a clinical research tool It not only identifies mothers at risk of early breastfeeding cessation but also assesses breastfeeding behaviors and perceptions The BSES-SF has been translated into multiple languages, with studies confirming its reliability and validity across various populations This straightforward tool is beneficial for both prenatal and postpartum mothers, serving to evaluate the effectiveness of prenatal interventions and assess a mother’s confidence in exclusive breastfeeding.
Conceptual Framework
This conceptual framework, illustrated in the accompanying figure, is based on a comprehensive literature review of prior studies and encompasses key elements such as socio-demographic characteristics, obstetric profiles, breastfeeding knowledge, and infant feeding practices (Otsuka et al.).
2014) to predict self-efficacy in the exclusive breastfeeding levels of the mothers (C L Dennis, 2003)
Self-Efficacy in Exclusive Breastfeeding
- Learning benefits of exclusive breastfeeding
Knowledge on exclusive breastfeeding and infant feeding practice:
METHODS
Study subjects
In this study, the subjects were mothers who had children aged less than 12 months and in accordance with the inclusion and exclusion criteria as follows:
- Mothers who were 18 years old or older with under 12-month old healthy children
- Mothers with no maternal and child complications that interfere with breastfeeding
- Mothers willing to participate in this study and who could read and write the Lao language
- Mothers with children under 12 months but who were born before 37 weeks or after 42 weeks of gestation
- Mothers whose infants had a birth weight of less than 2.500 grams or greater than 5.000 grams
Study location and time
Xaythany District, located in the north-north-east of Vientiane Capital, comprises 104 villages, including 48 suburban areas With a population of 196,565 residents, the district has 23,964 households averaging 5 to 6 members each Notably, the population includes 98,350 women and approximately 4,325 children under one year old, based on data from 2017 reflecting the Crude Birth Rate.
22 births per 1,000 people recorded in Vientiane Capital (Lao Statistics Bureau,
2016) According to data obtained from Xaythany District Hospital, there were 3,120 children under one-year-old in 2018
This study was conducted from November 2018 to April 2019 in Xaythany District, which has urban and rural areas located in Vientiane Capital of Laos
Study design
This study is a cross-sectional study with quantitative techniques used.
Sampling
The sample size was estimated using the following formula
n is a minimum sample size required
p is the expected proportion of mothers who have good self-efficacy in exclusive breastfeeding (Since we could not find any similar results in Laos, a p of 0.5 (50%) was used.)
z is the confidence level, with 95% confidence, thus z = 1.96
d is absolute precision (In this study, d=0.08 was used.)
Applying the formula, n1 eligible mothers needed for the study
In a study conducted in Xaythany District, three health centers—Dongbang, Xay, and Huaxieng—were randomly selected from a total of 13 community health centers Subsequently, 10 villages were chosen from a pool of 21 villages in the vicinity of these health centers, specifically including Nasala, Nontae, and Phonetong near Dongbang; Danxang, Xay, and Dontiw near Xay; and Huaxieng, Dongkuay, Phailom, and Sanghuabor near Huaxieng A total of 15 mothers were selected from nine villages, with an additional 16 mothers chosen from Sanghuabor village.
HUPH participants were recruited in February 2019 The 151 mothers who were eligible for the study were selected as in the following:
The lists of mothers who were eligible for the study were obtained from the community health centers’ logbooks and came to a total of 452 eligible mothers in ten villages
From these 452 eligible mothers, 151 mothers were selected using a simple random sampling technique.
Data collection
Participants were interviewed in person using a structured questionnaire that assessed their socio-demographic and obstetric profiles, breastfeeding knowledge, and infant feeding practices The final section included the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF).
A comprehensive questionnaire consisting of 40 questions was developed, covering socio-demographic and obstetric profiles, knowledge of exclusive breastfeeding, infant feeding practices, and the BSES-SF scale This questionnaire was translated into the Lao language and underwent a pretest for reliability with 30 mothers at Xaysettha District Hospital, achieving a high Cronbach's alpha score of 0.94 The Lao version effectively gathered specific data across five key areas, including 14 items from the BSES-SF scale, originally created by Cindy-Lee Dennis in 2003.
The participant information questionnaire was developed using insights from the literature review and included key areas such as socio-demographic factors, obstetrical information, knowledge of exclusive breastfeeding, and infant feeding practices Questions focused on maternal age, education level, occupation, ethnicity, religion, family size, and household income to gather comprehensive data from mothers.
The obstetric history questionnaire explored various factors, including the number of pregnancies, smoking habits, attendance at antenatal care sessions, awareness of exclusive breastfeeding benefits, pregnancy complications, delivery methods, delivery complications, and the baby's sex Additionally, it assessed knowledge regarding exclusive breastfeeding and infant feeding practices, covering topics such as breastfeeding experience, education on breastfeeding techniques, duration of infant care, expectations for exclusive breastfeeding, and understanding of how to express and store breast milk.
The study evaluated self-efficacy in exclusive breastfeeding using the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) developed by C L Dennis in 2003 Participants rated their confidence in different breastfeeding aspects on a Likert scale from 1 to 5, where a score of 1 indicated low confidence.
‘not at all confident’ response and 5 denoted a ‘very confident’ response When the
A total of 14 items were combined to assess breastfeeding self-efficacy, with a scoring range from a minimum of 14 to a maximum of 70 Scores exceeding the average indicate a high level of breastfeeding self-efficacy, as defined by C L Dennis in 2003.
Study variables
This study focused on self-efficacy in exclusive breastfeeding, assessed using the exclusive Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) After measuring and categorizing self-efficacy levels into two groups, we analyzed their relationship with socio-demographic factors, obstetric profiles, breastfeeding knowledge, and infant feeding characteristics to determine any associations with self-efficacy in exclusive breastfeeding.
Data analysis
Data entry was performed using Epidata software, followed by transferring the data to STATA software version 14 for cleaning and analysis The results were presented descriptively in Tables 3.1 to 3.5, focusing on socio-demographic information.
The obstetric profiles from HUPH highlighted the distribution of respondents across various descriptors, along with the statistical measures such as mean, median, minimum, and maximum for continuous numeric variables Self-efficacy in exclusive breastfeeding was analyzed using descriptive statistics, categorizing respondents into high and low self-efficacy groups based on their mean scores High self-efficacy was defined as a mean score above the overall mean, while low self-efficacy was indicated by a mean score at or below the overall mean To identify factors associated with self-efficacy in exclusive breastfeeding, a univariate analysis was conducted for each independent variable, incorporating those with a p-value below 0.25 into a multivariable model, following the purposeful selection theory.
W Hosmer & S Lemeshow, 2000; Paul, Pennell, & Lemeshow, 2013) The p-value of less than 0.05 was considered as significant association.
Ethical considerations
The study posed minimal to no risk to participants and received approval from the Ethical Committee of the University of Health Sciences Laos (ID: 111/19) and the Institutional Ethical Review Board of Hanoi University of Public Health (ID: 474/2018/YTCC-HD3) Mothers were interviewed in their homes regarding their socio-demographic and obstetric backgrounds, breastfeeding knowledge, and infant feeding practices Each participant was compensated with a small gift for their time, and they were informed of their right to withdraw from the study at any moment, although withdrawal would result in forfeiting the compensation.
All data and questionnaires would be kept in private files; all data and questionnaires would be destroyed after completion of the study
RESULTS
Socio-demographic characteristics
Table 3.1: Socio-demographic characteristics of mothers
Age (mean&.9, median&, min max C)
The study involved residents from ten villages across three community health centers in Xaythany District, with participants having a mean age of 26 years and an age range of 18 to 43 years Notably, 46.7% of the mothers were aged between 18 and 25 years, while 54.3% fell within the 26 to 43 age range.
The study found that 8.6% of participants identified as Hmong, all of whom were literate in Lao A significant majority, 91.4%, practiced Buddhism, and 71.5% reported family sizes ranging from 4 to 6 members Additionally, 66.9% of participants were housewives, with 22.5% earning an annual household income of less than 10,000,000 LAK (approximately 1,100 USD).
Obstetric characteristics of the participants
Table 3.2: Obstetric characteristics of the participants
Number of pregnancies (mean=2, min=1 max =9)
Attended ANC during last pregnancy
Learned about the benefits of exclusive breastfeeding during ANC
In a recent study, it was found that 43.7% of mothers with children under one year old were first-time mothers, while 14.6% had experienced four or more pregnancies Additionally, 4% of mothers reported smoking during pregnancy, and 29% indicated that family members smoked during this time Remarkably, about 95% of the mothers attended prenatal care.
Over half (59.0%) of participants attended a class on the benefits of exclusive breastfeeding during antenatal care (ANC), with four or more ANC visits averaging a score of 6 on a scale of 0 to 10 Complications during pregnancy were reported by 9% of mothers, including hypertension, edema, and threatened miscarriage, while 15.0% experienced delivery complications such as prolonged labor and heavy bleeding Additionally, 14.0% of participants underwent cesarean sections The gender distribution of newborns was slightly skewed, with 53.0% being baby boys and 47% baby girls.
Breastfeeding knowledge and infant feeding characteristics
Table 3.3: Breastfeeding knowledge and infant feeding characteristics
Learned how to breastfeed during pregnancy
Those who returned to work and thought they could continue breastfeeding (n8)
How long mother expected to give breast milk to baby
Followed schedule proposed by medical staff 17 11.3
Don’t know when she needed to breastfeed 2 1.3
Know how to maintain breastmilk production when apart from baby
Table 3.3 illustrates the breastfeeding knowledge and infant feeding characteristics among respondents, revealing that 98.0% had breastfeeding experience, with 46.0% learning how to breastfeed during pregnancy Notably, 25% of mothers returned to work, but only 10.0% did so after their baby reached six months of age, while 71.0% believed they could continue exclusive breastfeeding upon returning to work Regarding their breastfeeding expectations, 20.0% aimed for exclusive breastfeeding, 29.0% were undecided, and 5.0% expressed concerns about their ability to achieve it Additionally, 62.0% of mothers were knowledgeable about maintaining breast milk production when separated from their infants.
Exclusive breastfeeding self-efficacy
Table 3.4: Exclusive breastfeeding self-efficacy of mothers (n1)
I could determine if my baby had enough breast milk 0 2 (1.4) 22 (14.6) 91 (60.0) 36 (24.0)
I could successfully cope with breastfeeding like other challenging tasks
I could breastfeed my baby without using formula or other liquids as a supplement
I could determine if my baby had a big open mouth for the whole feeding 1 (0.7) 10 (6.6) 44 (29.1) 70 (46.4) 26 (17.2)
I was satisfied with the breastfeeding situation 5 (3.3) 7 (4.6) 14 (9.3) 77 (51) 48 (31.8)
I could breastfeed even though my baby was crying 0 0 20 (13.3) 97 (64.2) 34 (22.5)
I could keep wanting to breastfeed my baby 3 (2) 11 (7.3) 12 (8) 82 (54.3) 43 (28.4)
I could feel comfortable breastfeeding in front of the family 0 1 (0.7) 1 (0.7) 79 (52.3) 70 (46.3)
I was satisfied with my breastfeeding experience 6 (4) 4 (2.7) 10 (6.6) 79 (52.3) 52 (34.4)
I could take time for breastfeeding 0 5 (3.3) 30 (19.9) 62 (41.1) 54 (35.7)
I could finish feeding my baby on one breast before going to the other breast 0 1 (0.7) 4 (2.7) 99 (65.5) 47 (31.1)
I could breastfeed my baby for every feeding 8 (5.3) 10 (6.6) 8 (5.3) 66 (43.7) 59 (39.1)
I could manage my baby’s breastfeeding demands 4 (2.7) 8 (5.3) 13 (8.6) 72 (47.7) 54 (35.7)
I could tell when my baby finished breastfeeding 0 1 (0.7) 32 (21.2) 68 (45) 50 (33.1)
BSES-SF mean: 56.52, mode: 66, SD: 8.22, range 31 to 70, potential range 14 to 70; Cronbach's alpha= 0.9107, N = 151
Table 3.4 highlights the self-efficacy of mothers regarding exclusive breastfeeding, with a Cronbach’s alpha coefficient of 0.91 indicating strong internal reliability The average score on the exclusive breastfeeding self-efficacy scale was 56.52, with a standard deviation of 8.22, and scores ranged from a minimum of 31 to a maximum of 70 Notably, 46.3% of participants expressed high confidence (rating '5') in their ability to breastfeed comfortably in front of family, while only 17.2% felt equally confident in determining if their baby had a big open mouth throughout the feeding session.
Level of exclusive breastfeeding self-efficacy
Table 3.5: Level of exclusive breastfeeding self-efficacy
Level of self-efficacy N Percentage
BSES-SF mean: 56.52, SD: 8.22, Range: 31 to 70, potential range 14 to 70; Cronbach's alpha = 0.9107, N = 151
Table 3.5 presents the level of exclusive breastfeeding self-efficacy The mean of exclusive breastfeeding self-efficacy was 56.52, SD: 8.22, minimum score
In a study measuring self-efficacy in exclusive breastfeeding, participants were classified based on their total scores, which ranged from 31 to 70 A mean score equal to or below the total mean indicated low self-efficacy, while a score above the mean signified high self-efficacy The findings revealed that 57% of the mothers exhibited high levels of self-efficacy regarding exclusive breastfeeding, indicating a greater confidence among these mothers compared to those with lower self-efficacy levels.
Association between self-efficacy in exclusive breastfeeding scores and socio-demographic
Table 3.6: Univariate analysis of exclusive breastfeeding self-efficacy with socio-demographic characteristics
Variables Low (%) High (%) COR p-value 95% CI
Table 3.6 presents a univariate analysis of the socio-demographic characteristics and self-efficacy in exclusive breastfeeding among study participants The comparison of self-efficacy in exclusive breastfeeding is based on the mean age of the participants.
A study by HUPH revealed that older mothers exhibited double the self-efficacy in exclusive breastfeeding compared to younger mothers (COR=2, p0.05) Hmong mothers reported half the self-efficacy in exclusive breastfeeding compared to Lao mothers (COR=0.5, p=0.05) Unemployed mothers had lower self-efficacy than civil servant mothers, while traders had a 10% higher self-efficacy than civil servants Additionally, mothers practicing Animism showed lower self-efficacy compared to Buddhist mothers Larger family sizes correlated with lower self-efficacy in exclusive breastfeeding than smaller families (COR=0.6, p>0.05) Lastly, families earning over 20 million LAK (approximately 2,500 USD) annually had lower self-efficacy in exclusive breastfeeding than those with incomes at or below that threshold (COR=0.7, p>0.05).
Association between exclusive breastfeeding self-efficacy and obstetric characteristics
Table 3.7: Univariate analysis of exclusive breastfeeding self-efficacy with obstetric characteristics of mothers
> 1 time 34(40.0) 51(60.0) 1.3 0.391 (0.69 - 2.54) Attended ANC during pregnancy
≥ 4 times 56(48.3) 60(51.7) 0.4 0.021 (0.15 - 0.85) Learned the benefits of exclusive breastfeeding during
Table 3.7 illustrates the Univariate Logistic regression analysis of the obstetric characteristics of the mothers and exclusive breastfeeding self-efficacy
The study reveals an unexpected outcome: mothers who attended antenatal care four or more times exhibited lower self-efficacy in exclusive breastfeeding compared to those with fewer visits (COR=0.4, p0.05) However, complications during delivery negatively impacted self-efficacy, with a COR of 0.6 (p>0.05) Interestingly, mothers who underwent caesarean births exhibited 1.6 times higher self-efficacy in exclusive breastfeeding than those who had natural births, reflected by a COR of 1.6 (p>0.05) Additionally, the sex of the baby did not show significant differences in self-efficacy scores, with a COR of 1.0 (p>0.05).
Association between exclusive breastfeeding self-efficacy with breastfeeding knowledge and
breastfeeding knowledge and infant feeding characteristics
Table 3.8: Univariate analysis of exclusive breastfeeding self-efficacy with breastfeeding knowledge and infant feeding characteristics of mothers
Variables Low (%) High (%) COR p-value 95% CI
Learned how to breastfeed during pregnancy
Before 6 months 10(45.5) 12(54.5) 0.7 0.516 (0.29 - 1.85) After 6 months 12(75.0) 4(25.0) 0.2 0.009 (0.06 - 0.67) How long mother expected to give breast milk to baby
Knew how to maintain breast milk production when apart from baby
Table 3.8 illustrates the Univariate analysis of breastfeeding knowledge and infant feeding characteristics of mothers and exclusive breastfeeding self-efficacy
A study on breastfeeding knowledge revealed that participants who learned about breastfeeding during pregnancy exhibited nearly double the self-efficacy compared to those who did not, with a COR of 1.9 (p