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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 H P SELF-EFFICACY IN EXCLUSIVE BREASTFEEDING AMONG MOTHERS IN XAYTHANY DISTRICT, U VIENTIANE CAPITAL, LAO PDR H 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 H P SELF-EFFICACY IN EXCLUSIVE BREASTFEEDING AMONG MOTHERS IN XAYTHANY DISTRICT, VIENTIANE CAPITAL, LAO PDR U MASTER THESIS H MASTER OF PUBLIC HEALTH CODE: 8720701 Assoc Prof 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 H P To my wife: Your support, kindness, friendship, and love have held me up in times of self-doubt You always challenge me to 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 U gratitude to you for this Next, I would like to express my sincerest gratitude to my supervisors, H 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 H P U H iv TABLE OF CONTENTS ACKNOWLEDGMENTS iii ABBREVIATIONS iv ABSTRACT vii LIST OF TABLES viii INTRODUCTION RESEARCH OBJECTIVES CHAPTER 1: LITERATURE REVIEW 1.1 H P Definition 1.1.1 Breastfeeding self-efficacy 1.1.2 Exclusive breastfeeding 1.2 Background of breastfeeding self-efficacy 1.3 Benefits of exclusive breastfeeding 1.4 Factors related to self-efficacy in exclusive breastfeeding 1.5 Measurement of self-efficacy in exclusive breastfeeding 20 1.6 Conceptual Framework 21 U CHAPTER 2: METHODS 22 H 2.1 Study subjects 22 2.2 Study location and time 22 2.3 Study design 23 2.4 Sampling 23 2.4.1 Sample size 23 2.4.2 Sampling procedure 23 2.5 Data collection 24 2.5.1 Data collection procedure 24 2.5.2 Research instruments: 24 2.6 Study variables 25 2.7 Data analysis 25 2.8 Ethical considerations 26 CHAPTER 3: RESULTS 27 3.1 Socio-demographic characteristics 28 3.2 Obstetric characteristics of the participants 30 v 3.3 Breastfeeding knowledge and infant feeding characteristics 32 3.4 Exclusive breastfeeding self-efficacy 34 3.5 Level of exclusive breastfeeding self-efficacy 35 3.6 Association between self-efficacy in exclusive breastfeeding scores and socio-demographic characteristics 36 3.7 Association between exclusive breastfeeding self-efficacy and obstetric characteristics 38 3.8 Association between exclusive breastfeeding self-efficacy with breastfeeding knowledge and infant feeding characteristics 40 3.9 Factors associated with high self-efficacy in exclusive breastfeeding 42 CHAPTER 4: DISCUSSION 44 4.1 General information 44 4.2 Factors associated with self-efficacy in exclusive breastfeeding 45 H P 4.3 Limitations of the study 49 CONCLUSION 50 RECOMMENDATIONS 51 REFERENCES 52 ANNEX 1: MEASUREMENT OF STUDY VARIABLES 62 U ANNEX 2: QUESTIONNAIRE (ENGLISH VERSION) 66 ANNEX 3: QUESTIONNAIRE (LAO VERSION) 71 H 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 selfefficacy 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 selfefficacy and related factors on exclusive breastfeeding among mothers in Xaythany District, Lao PDR H P 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 U The average total score from the "taken BSES-SF" was determined as 56.52 ± 8.22, = 31, max = 70 The multiple logistic regression model showed that the H variance of the number of times attended ANC (p
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