Effects of Social Cognitive Theory Based Health Education Intervention on Exclusive Breastfeeding Practice Among Antenatal Mothers: A Study Protocol
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Abstract
Despite the numerous benefits of breastfeeding to mothers and infants, the rate of exclusive breastfeeding (EBF) in Nigeria is still low. Aim: This study aims to evaluate the effectiveness of health education intervention to improve EBF among antenatal mothers in the Imo State Specialist Hospital in Nigeria, using the social cognitive theory. Methods: This study is a two parallel arm single blinded randomised controlled trial (RCT) that will involve women who come for antenatal check-up in the Imo State Specialist Hospital in Owerri, Nigeria. The primary outcome is EBF practice while secondary outcome is breastfeeding knowledge, breastfeeding attitude, breastfeeding outcome expectancy, breastfeeding social support and breastfeeding self-efficacy. Participants were randomly assigned to either intervention (Health education intervention) or control group. The health education intervention will be developed based on the Social Cognitive Theory and the World Health Organisation guidelines on exclusive breastfeeding. The Social Cognitive Theory in breastfeeding education programme (SCT-BFEP) will be a six-month intervention programme delivered in phases, including a health education session (4 weeks), followed by weekly follow-up WhatsApp messages until eight weeks post-natal. Concealment was determined by using sequentially numbered sealed opaque envelopes. The sample size is 204. In brief, 102 mothers will receive health education alongside standard care for four weeks, while another 102 participants (control group) will receive only standard care. Discussion: Studies reported that health education interventions and behaviour change outlines provide an effective basis to increase EBF rates. A health education intervention programme is also a feasible and effective method that may contribute to the national strategy on infant and child feeding practices. This is done through the health education empowerment of mothers and the support of frontline healthcare providers and health programme managers to reinforce the importance and benefits of breastfeeding from early antenatal visits. Data collection will be done at baseline, at three months, and six months post-natal. Conclusion: The SCT-BFEP will be effective in positively affecting the outcome variables such as EBF practice, breastfeeding knowledge, attitude, intention, outcome expectancy, social support and self-efficacy. Trial Registration: The study has been prospectively registered in the Pan African Clinical Trial Registry with identification number PACTR202307540188312.
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Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, Rollins NC. Breastfeeding in the 21st century: Epidemiology,mechanisms, and lifelong effect. The Lancet. 2016; 387(10017), 475–490. doi: 10.1016/0140-6736 (15) 01024-7.
World Health Organization. Indicators for assessing infant and young child feeding practices: Part 2-measurements. Geneva, Switzerland: World Health Organization 2010.
Eidelman AI, Schanler RJ, Johnston M, et al. Breastfeeding and the use of human milk. J of Pead. 2012; 129(3):e827–e41.doi.org/10.1542/peds.2011-3552.
WHO/UNICEF. Global nutrition targets 2025: breastfeeding policy brief Geneva: World Health Organization. 2014.
World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) 20. Rates of Breastfeeding Increase Around the World Through Improved Protection and Support: Global Breastfeeding Scorecard 2023.
Dotimi DA, Ikemike OD, Ugochukwu JC. Challenges of Implementing Exclusive Breast Feeding Among Working-Class Mothers in Brass Island, Bayelsa State, Nigeria. Med Clin Sci. 2022; 4(1):1:6, doi:10.33425/2690-5191.1049.
Okafor IP, Olatona FA, Olufemi OA. Breastfeeding Practices of Mothers of Young Children in Lagos, Nigeria. Niger J of Paed. 2014; 41, 43-47. doi.org/10.4314/njp.v41i1,8.
Adebayo AM. Ilesanmi OS, Falana DT, Olaniyan SO, Kareem AO, Amenkhienan I, Alele FO, Afolabi AA. Omotoso BA, Ayodeji OO. Prevalence and predictors of exclusive breastfeeding among mothers in a semi-urban Nigerian community: a cross-sectional study. Ann of Ib Postgra Med. 2021. 2024 Aug;Vol. 19 No. 1. 31-39. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8935673.
Ebirim CI, Dozie UW, Akor W, Dozie IJ, Ashiegbu OA. Exclusive Breastfeeding Practice and Associated Maternal Socio-Demographic Factors among Mothers Attending Imo State Specialist Hospital, Owerri, South-Eastern Nigeria. Arch Com Med Public Health, 2016. 2(1): 027-031. doi: 10.17352/2455-5479.000013,
National Population Commission (NPC) [Nigeria] and ICF International. Demographic and Health Survey. Abuja, Nigeria, and Rockville, Maryland, USA: June, 2014.
Chineke HN, Iwu AC, Diwe KC, Duru CB, Uwakwe KA. Emmanuel EE, Oluoha, UR, Madubueze UC, Ndukwu EU, Ohale I. The Practice of Exclusive Breastfeeding and Its Socio-demographic Determinants amongst Nursing Mothers at a Tertiary Health Care Institution in South East, Nigeria. Open J of Prev Med. 2017; 7, 63-73, doi: 10.4236/ojpm..74006.
Senghore T, Omotosho TA, Ceesay O, Williams DCH. Predictors of exclusive breastfeeding knowledge and intention to or practice of exclusive breastfeeding among antenatal and postnatal women receiving routine care: a cross-sectional study. Int Breastfeeding J. 2018; 13(9). doi.org/10.1186/s13006-018-0154-0.
Minas AG, Ganga-Limando M. Social-Cognitive Predictors of Exclusive
Breastfeeding among Primiparous Mothers in Addis Ababa, Ethiopia. PLoS ONE. 2016; 11(10): e0164128. doi:10.1371/.0164128.doi: 10.1371/journal.pone.0164128
Bandura A. Social Foundations of Thought and Action: A Social-Cognitive Theory. Prentice-Hall. Englewood Cliffs, NJ: Prentice-Hall. 1986; doi: 10.4236/aasoci.2023.138036.
Bandura A. Self-efficacy: The Exercise of Control. Encyclopedia of human behavior (Vol. 4). New York: WH Freeman and Co. 1997; doi.org/10.1002/9780470479216.corpsy0836.
Bandura A. Cultivate Self-Efficacy for Personal and Organizational Effectiveness. In: Locke, E. A. (ed.) Handbook of principles of organization behavior.UK: Blackwell Publishers 2000; doi: 10.4236/jssm.2015.83045
World Health Organization, UNICEF. Infant and young child feeding: Model Chapter for textbooks for medical students and allied health professionals. Geneva. 2009.
Prasitwattanaseree P, Sinsucksai N, Prasopkittikun, T, Viwatwongkasem. C. Effectiveness of Breastfeeding Skills Training and Support Program among First Time Mothers: A Randomized Control Trial. Pacific Rim Int J Nurs Res. 2019; Jan 2023 23(3)258-270.. Avaiable from https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/154845.
Wong KL Fong, DYT, Lee ILY, Chu S, Tarrant M. Antenatal Education to Increase Exclusive Breastfeeding. A Randomized Controlled Trial. Obstetrics & Gynecology 2014; vol. 124(5). doi: 10.1097/AOG.0000000000000481.
Lemeshow S,Ogston SA, Hosmer DW, Klar J, Lwanga SK. Adequacy of sample size in Health Studies. Biom, 1991; 47(1), 347.doi.org/102307/2532527.
Puharic, D, Malicki M,Borovac, J.A., Šparac, V., Poljak, B., Aracic,N., |Marinovic,N., Luetic, N.,Zakarija-Grkovic, I. (2019). The effect of a combined intervention on exclusive breastfeeding in primiparas: A randomised controlled trial. Matern Child Nutr. 2020; 16:e12948. https://doi.org/10.1111/mcn.12948.
Valentine JC, Cooper H. A systematic and transparent approach for assessing the methodological quality of intervention effectiveness research: The Study Design and Implementation Assessment Device (Study DIAD). Psycho meth, 2008; 13(2), 130-149; doi: 10.1037/1082-989X.13.2.130.
World Health Organization, Infant and young child feeding: Model Chapter for textbooks for medical students and allied health professionals. Geneva, 2009.
Dennis CL. The breastfeeding self-efficacy scale: psychometric assessment of the short form. Journal Obste Gyne Neo Nurs 2003; 32(6):734–44. doi: 10.1177/0884217503258459.
Mora ADL, Russell DW, Dungy CI, Losch M, Dusdieker L. The Iowa Infant Feeding Attitude Scale: Analysis of Reliability and Validity1. J Applied Soci Pyscho 1999; Nov;29(11):2362-2380. [doi: 10.1111/j.1559-1816. 1999.tb00115.
Wan H, Tiansawad S, Yimyam S, Sriarporn S. Effects of a Theory-based Breastfeeding Promotion Intervention on Exclusive Breastfeeding in China. CMU J. Nat. Sci. 2016;.C doi:10.12982/cmujns.2016.0005MU.
Nabulsi M, Tamim H, Shamsedine L, Charafeddine, L, Yehya, N, Kabakian-Khasholian T, et al. A multi-component intervention to support breastfeeding in Lebanon: A randomized clinical trial. PLos ONE. 2019; 14(6): e0218467. doi: 10.1371/journal.pone.0218467.
Huang P, Yao J, Liu X, Luo B. Antenatal education and postnatal support strategies for improving rates of exclusive breastfeeding: A randomised controlled trial. Med. 2019; 98:47(e17822). doi: 10.1097/MD.0000000000017822.
Efrat MW, Esparza S, Mendelson SG, Lane CJ. The effect of lactation educators implementing a telephone-based intervention among low-income Hispanics: A randomised trial. Health Educ J. 2015, 74(4): 424–441, doi: 10.1177/0017896914542666.
Ara G, Khanam M, Papri N, Nahar B. Haque, M. A., Kabir, I & Dibley, M.J. (2018). Peer counselling improves breastfeeding practices: A cluster randomized controlled trial in urban Bangladesh, Matern Child Nutr, 14:e12605.doi: 10.1111/mcn.12605