| Abstract|| |
Background: Youth princess' knowledge, attitudes, and beliefs toward exclusive breastfeeding are still low. Aims: This research would like to develop exclusive breastfeeding modules for princess youth in rural and urban areas. Methodology: This research uses a quasi-experiment design and implemented in urban and rural areas. Each consisted of intervention and control groups with samples (n = 127 and n = 104), while in rural areas (n = 126 and n = 103). The intervention group received learning with the Module plus Lecture Method (MLM), while the control group received the Learning Methods Module (LMM). Intervention was given to each school for 90 min. Knowledge, attitudes, and beliefs on exclusive breastfeeding are measured before and after intervention by questionnaire. Data analysis was performed using paired samples t-test and Friedman test. Results: The participants were aged between 15 and 16 years (67.6%), the birth order in the family was the first to second (61.3%), whereas the number of siblings was three to four (60.9%) and the 74.8% were Bugis. Seen increased knowledge, attitudes, and beliefs on exclusive breastfeeding after the intervention (P < 0.05) in all study groups. There was no difference in the increase in group knowledge in urban areas after the intervention P = 0.738. While rural areas, there is a difference in the increase in knowledge of MLM and LMM group P = 0.000. In addition, there was no difference in the improvement of attitudes and beliefs in all groups in the study area P > 0.05. Conclusions: LMM plus lecture and module learning methods can improve the knowledge, attitude, and belief of adolescent girls to exclusive breastfeeding. There is no visible difference between group receiving modules plus lectures and modules alone in urban areas. For rural areas, the group received a module plus lecture well than the module group alone on knowledge (P < 0.05), while attitudes and beliefs did not differ all groups in the study area.
Keywords: Attitude, beliefs, knowledge, modules and exclusive breast feeding, princess youth
|How to cite this article:|
Aris M, Hadju V, Bahar B, Nyorong M. An influence of the exclusive breastfeeding education knowledge, attitude, and beliefs for the princess youth in urban and rural areas in North Kalimantan-Indonesia. Ann Trop Med Public Health 2018;11:52-7
|How to cite this URL:|
Aris M, Hadju V, Bahar B, Nyorong M. An influence of the exclusive breastfeeding education knowledge, attitude, and beliefs for the princess youth in urban and rural areas in North Kalimantan-Indonesia. Ann Trop Med Public Health [serial online] 2018 [cited 2020 Feb 29];11:52-7. Available from: http://www.atmph.org/text.asp?2018/11/2/52/272540
| Introduction|| |
Exclusive breastfeeding is still a public health problem in many countries worldwide. The prevalence of the exclusive breastfeeding worldwide is around 39%, whereas in developing countries, it does not exceed 30%. Indonesia's exclusive breastfeeding prevalence in accordance with Profile of the Indonesian Ministry of Health 2014 is 52%, and 2015 rises to 55.7%. This figure is still far from the national target of 80%. In North Kalimantan, in 2015, the exclusive breastfeeding prevalence rate was 56.2%.
Exclusive breastfeeding is closely associated with child mortality and mortality.,, The children do not get exclusive breastfeeding ranges exposed to diarrhea and pneumonia., On the other hand, more than 10 million children under 5 years of age are reported die from inadequate breastfeeding. This mortality, 41% occurs in sub-Saharan Africa and 34% in Asia. Other studies indicating that exclusive breastfeeding can protect the hands, feet, and mouth children from germs up to 28-month-old. In addition, breastfeeding will also increase the body's resistance from invention. Previous studies mentioned that breastfeeding will increase intelligence in children.
Several studies have been conducted to increase coverage of exclusive breastfeeding. The intervention research is educational antenatal care support of fellow pregnant and lactating women. In addition, studies of parental support in increasing coverage of exclusive breastfeeding., Other forms of interventions that have been made are the formation of pregnant women's classes as well include integrated Hospital and Toddler Management developed., The results of this study show that educational interventions have increased the knowledge, attitudes, and beliefs of mothers on the benefits and importance of exclusive breastfeeding.
Module development pregnant and breastfeeding women have been in Indonesia. However, no exclusive breastfeeding module has been developed for youth princess' learning. While the results of the study, show that educational interventions targeting adolescents in schools can increase knowledge, attitudes, and beliefs toward exclusive breastfeeding. This study would like to develop exclusive breastfeeding modules for princess youth in rural and urban areas.
| Methodology|| |
The research was conducted in two areas, namely urban and rural areas. Urban area is Tarakan city with an area of 20.80 km2. The city has a population of 226,470 inhabitants. Travel to the provincial city using Speed Board was taken ± 1.30 min. Secondary education facilities or equivalent are as many as 19 units. This research was conducted at the School of State Madrasah Aliah with 306 students and the school of SMA Muhammadyah with 246 princess youth.
The rural area is Sebatik's Island with five districts and an area of 246.61 km2. The island has a population of 35,000 inhabitants. Travel to the provincial city by using the Speed Board can be taken ± 4.30 min. Education facilities or equivalent are six pieces. The research was conducted at SMA Negeri 1 Sebatik Induk District with 402 princess youth and SMA Negeri 1 Middle Sebatik District with 135 princess youth.
This research is quasi-experiment. The study was divided into two groups, i.e., the intervention group and the control group. The intervention group received the module and was provided with a lecturing methods module (LMM). The control group received the module without any lecture (MLM).
Sampling is based on the Slovin's formula. Sampling is calculated based on the number population of each research area. The results of the calculation where the large populations of each group multiplied by 55% and small are multiplied by 45%. The research samples in urban areas in the intervention group (n = 127) and control (n = 104), while the rural areas in the intervention group (n = 126) and control (n = 103) were obtained.
Implementation of research
This research is divided into two stages. The first phase is carried out in November 2015 and the second phase of May-December 2016. The first phase is a survey and made as the material of exclusive breastfeeding modules making. The contents of the module are made in the form of dialog between mother and daughter. The contents of the module are validated by an obstetrician and grammar corrected by an Indonesian teacher (as well as a novel writer). The module was tested at school of SMK Health of Kaltara with a total sample of 50 respondents. The second phase begins with teacher training. Teachers who have been trained by obstetricians serve as material bearers to the intervention group and divide the modules in the control group in each school.
Before the learning is given to the students in the form of lectures plus multichip modules (MCM) in the intervention group and the module learning method (MLM) in the control group was given pretest. The intervention was given in the class for 90 min. The posttest is given three repetitions with the same questionnaire at the time of pretest. The first posttest after 1 week, the second posttest after 1 month, and the third posttest after 3 months of intervention in all groups.
Measurement of variables and data analysis
Knowledge, attitudes, and beliefs are measured by using questionnaires. The questionnaire has been tested before. Questionnaires are divided into three parts. The first section measures knowledge by the number of 16 statements and uses the Guttman scale. The first part of the provision is if the answer is true point 1, and if the wrong point 0 with a total value of 16 points. The second section measures attitudes with statements using a Likert scale (modification). The second part is if the answer agrees to point 3, hesitate to point 2, and disagree 1 with a total score of 39 points. The third section measures confidence with 12 statements and uses a Likert scale (modification). The third part is if the answer is sure point 3, doubly point 2, and not sure point 1 with a total score of 36 points. Data were analyzed using a computer and statistic test with paired samples t-test and Friedman test where interpretation if P = 0.05.
| Results|| |
Characteristics of the subject
Characteristics of the samples are presented in [Table 1]. There are no differences in characteristics based on age, birth order, the number of sibling except in rural and urban areas. The age of the participants in all study groups was 15-16 years old. LMM group = 63.8%, MLM = 84.6% urban area, and LMM = 66.7%, MLM = 56.3% rural area. The birth order in the family is the first and second child in all study groups and regions. LMM group = 60.6%, MPL = 75.0% urban area and LMM = 57.1%, MLM = 53.4% rural area. The participants of this research area in all major groups and regions between 3 and 4 siblings. So seen the LMM group = 66.1%, MLM = 66.3% urban area, and LMM = 55.6%, MLM = 55.3% rural area. While based on the characteristics of the tribe in the urban and rural areas seen there is a difference (P < 0.05).
Knowledge of the participants to exclusive breastfeeding before intervention in all research groups and areas was low. [Table 2] shows that the average subjects' answers were brought in a score of 7, whereas a maximum score of 16 points. The subject's attitudes and beliefs are sufficient As shown in [Table 3], the subject's attitudes above score is 28 and the highest score is 39. [Table 4] shows the participants' answers about the confidence score of 27 and the highest 36 points. There was a difference in knowledge before the intervention in the LMM and MLM in urban and rural areas (P < 0.05). [Table 3] shows the differences in subject attitudes before the intervention in the LMM and MLM of the two research areas (P < 0.05), while the subject's belief is seen only difference in group (LMM) and (MLM) in rural area (P < 0.05).
|Table 2: Subject knowledge of exclusive breastfeeding after intervention|
Click here to view
|Table 3: Subject attitudes about exclusive breastfeeding before and after urban, and rural intervention in all groups|
Click here to view
|Table 4: Subjective beliefs about exclusive breastfeeding before and after urban, and rural intervention in all groups|
Click here to view
Subject knowledge after intervention
Patients' knowledge of exclusive breastfeeding in the urban and rural areas in the MCM and post-intervention group (MLM) is presented in [Table 2]. In the urban and rural areas seen a statistically significant increase of knowledge was all (P < 0.05). The magnitude of the increase in group is knowledge (LMM) and (MLM) in urban areas (4.98 ± 3.73 and 5.71 ± 3.53). In rural areas is the group (LMM), and (MLM) (8.90 ± 2.91 and 5.98 ± 3.02). In the third test, there was no difference in the increase of group knowledge (LMM) and (MLM) in urban areas. While in rural area groups (LMM) and (MLM), there is difference of knowledge improvement P = 0.05.
The attitude of the subject after the intervention
Subject attitudes toward exclusive breastfeeding in urban and rural areas in the LMM and postintervention group (MLM) are presented in [Table 3]. In urban and rural areas, statistically significant changes were observed (P < 0.05). The magnitude of the change in group attitudes (LMM) and (MLM) are in urban areas (5.74 ± 2.92 and 6.48 ± 4.15). While in rural areas is the group (LMM) and (MLM) (8.61 ± 4.15 and 5.89 ± 3.91). At the time of the third test, there was no noticeable difference in group attitude change (LMM) and (MLM) in urban and rural areas.
Subjective beliefs after intervention
Subcontinent confidence in exclusive breastfeeding in urban and rural areas in the MCM and postintervention group (MLM) is presented in [Table 4]. In urban and rural areas are visible statistically significant changes in belief (P < 0.05). The magnitude of group beliefs change (LMM) and (MLM) are in urban areas (2.25 ± 2.76 and 1.63 ± 2.98). While in rural areas is the group (MLM) and (MLM) (3.26 ± 2.17 and 2.43 ± 2.72). At the time of the third test was given no visible difference in group confidence (LMM) and (MLM) in urban and rural areas.
This research found that subject knowledge in rural and urban areas before intervention was lacking. Whereas after intervention, there was increased knowledge of participants in urban and rural areas in all groups after module learning with lectures and modules without lectures. Increased subject knowledge after intervention in all groups in the study area from the first posttest to the third posttest was statistically all meaningful P < 0.05. However, there is no difference in the increased knowledge of participants in groups (LMM) and (MLM) of urban areas. While in rural areas in the group (LMM) and (MLM), there is a difference in improvement after the intervention.
The methods (LMM) and (MLM) used in this study may increase the knowledge of princess youth on exclusive breastfeeding. Although it appears that reading only the exclusive breastfeeding module has been able to improve the subject's knowledge in the research area. Where seen before the intervention of knowledge of princess youth on exclusive breastfeeding is still low, the same previous research. Therefore, there is an increase in the knowledge of youth princess on exclusive breastfeeding after intervention in accordance with the results of the study.,, The knowledge of princess youth acquired during youth will have an effect on life. Hence that knowledge was gained during youth will affect the intention to breastfeed after having children.
The subject's attitudes in the study were seen before the intervention was sufficient. The learning (LMM) and (MLM) provided further enhances the attitude of young women to exclusive breastfeeding. Therefore, after the intervention, the attitude of all groups in the study area was statistically significant, P < 0.05. However, there is no difference in the increase in groups (LMM) and (MLM) in all groups in both urban and rural areas, and hence that (MLM) is enough to improve the attitude of princess youth to exclusive breastfeeding.
Human attitude is formed early on as in the school. Hence, the school is a means promoting exclusive breastfeeding in princess youth. It is said that breastfeeding should be promoted as a lifestyle. This is reinforced, that health education affects attitudes for primary school children against breastfeeding. In addition, in this study, it was found that participants wanting breastfeeding material to be included in the school curriculum in line with the results of the study that high school students have a positive attitude toward breastfeeding and support the promotion of breast milk in settings in formal education.
The results of this research found that before the subject beliefs intervention of exclusive breastfeeding is sufficient. It was seen from the subject's answer to the pretest before the intervention. Nevertheless, after being given intervention in all groups in the study area, there was a statistically significant increase of all P < 0.05. It also found no difference in the increase of confidence of the participants in all groups in the study area after the third post. So by reading the module can increase the beliefs of the subject to exclusive breastfeeding.
The breastfeeding education is given at the school will affect learners' beliefs. Breastfeeding education interventions targeting schoolchildren may influence beliefs on breastfeeding. The results of the study that the beliefs of princess youth before being given health education are seen as low as the results of this study and increased after intervening. Therefore, schools can promote breastfeeding as a lifestyle. So with the formation of belief in princess youth will affect the behavior of life in future.
| Conclusions|| |
There is no difference in module plus lecture learning with modules only to increase knowledge, attitudes, and beliefs in all groups in urban areas. Rural areas, there is no difference in the improvement of attitudes and beliefs in all groups. However, improved knowledge is better in the group receiving the module plus the lecture than the module alone.
The authors express their gratitude to the Education and Social Foundation of Kaltara, who has given permission and assistance of data information at the time of the author's research.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Teka B, Assefa H, Haileslassie K. Prevalence and determinant factors of exclusive breastfeeding practices among mothers in Enderta woreda, Tigray, North Ethiopia: A cross-sectional study. Int Breastfeed J 2015;10:2.
Sutardjo. Exlusive Breastfeeding, in the Indonesian Health Profile. Jakarta: Kementerian Kesehatan RI; 2015. p. 113.
Sutardjo. Exlusive Breastfeeding, in the Indonesian Health Profile. Jakarta: Republic of Indonesia: 2016. p. 144.
Kramer MS, Kakuma R. The optimal duration of exclusive breastfeeding: A systematic review. Adv Exp Med Biol 2004;554:63-77.
Lamberti LM, Zakarija-Grković I, Fischer Walker CL, Theodoratou E, Nair H, Campbell H, et al
. Breastfeeding for reducing the risk of pneumonia morbidity and mortality in children under two: A systematic literature review and meta-analysis. BMC Public Health 2013;13 Suppl 3:S18.
Ericson J, Eriksson M, Hellström-Westas L, Hagberg L, Hoddinott P, Flacking R. The effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants: Study protocol for a randomized controlled trial. BMC Pediatr 2013;13:73.
Teka B, Assefa H, Haileslassie K. Prevalence and determinant factors of exclusive breastfeeding practices among mothers in Enderta Woreda, Tigray, North Ethiopia: A cross-sectional study. Int Breastfeed J 2015;10:1.
Lin H, Sun L, Lin J, He J, Deng A, Kang M, et al
. Protective effect of exclusive breastfeeding against hand, foot and mouth disease. BMC Infect Dis 2014;14:645.
Okanda JO, Borkowf CB, Girde S, Thomas TK, Lecher SL. Exclusive breastfeeding among women taking HAART for PMTCT of HIV-1 in the Kisumu Breastfeeding Study. BMC Pediatr 2014;14:280.
Pound CM, Moreau KA, Hart F, Ward N, Plint AC. The planning of a national breastfeeding educational intervention for medical residents. Med Educ Online 2015;20:26380.
Sim TF, Hattingh HL, Sherriff J, Tee LB. Perspectives and attitudes of breastfeeding women using herbal galactagogues during breastfeeding: A qualitative study. BMC Complement Altern Med 2014;14:216.
Mossman M, Heaman M, Dennis CL, Morris M. The influence of adolescent mothers' breastfeeding confidence and attitudes on breastfeeding initiation and duration. J Hum Lact 2008;24:268-77.
Prost A, Colbourn T, Seward N, Azad K, Coomarasamy A, Copas A, et al
. Women's groups practising participatory learning and action to improve maternal and newborn health in low-resource settings: A systematic review and meta-analysis. Lancet 2013;381:1736-46.
Haroon S, Das JK, Salam RA, Imdad A, Bhutta ZA. Breastfeeding promotion interventions and breastfeeding practices: A systematic review. BMC Public Health 2013;13 Suppl 3:S20.
Rahardian P. The importance of exclusive breastfeeding in IMD and exclusive breastfeeding 6 months. Jakarta: Ministry of Health Republic Indonesia; 2018. p. 37.
Zeller CL. Effects of a Breastfeeding Education Module on the Breastfeeding Knowledge and Attitudes of Middle School Students. Ann Arbor: Carlow University; 2014. p. 93.
Sugiyono. Educational Research Methods (Quantitative, Qualitative and R & D Approach), Bandung: CV Alfabeta; 2011.
Swanson V, Power K, Kaur B, Carter H, Shepherd K. The impact of knowledge and social influences on adolescents' breast-feeding beliefs and intentions. Public Health Nutr 2006;9:297-305.
Siddell E, Marinelli K, Froman RD, Burke G. Evaluation of an educational intervention on breastfeeding for NICU nurses. J Hum Lact 2003;19:293-302.
Fujimori M, Morais TC, França EL, de Toledo OR, Honório-França AC. The attitudes of primary school children to breastfeeding and the effect of health education lectures. J Pediatr (Rio J) 2008;84:224-31.
Leffler D. U.S. high school age girls may be receptive to breastfeeding promotion. J Hum Lact 2000;16:36-40.
Walsh A, Moseley J, Jackson W. The effects of an infant-feeding classroom activity on the breast-feeding knowledge and intentions of adolescents. J Sch Nurs 2008;24:164-9.
Breinbauer C. Youth: Choices and Change: Promoting Healthy Behaviors in Adolescents. Vol. 594. Pan American Health Organization; 2005.
Spear HJ. College students' experiences and attitudes regarding middle and high school-based breastfeeding education. J Sch Nurs 2007;23:276-82.
Costa MM, Diniz-Santos DR, Santana JS, Silva LR. The impact of an educational intervention on breastfeeding. Health Educ 2006;106:309-14.
Dr. Muh Aris
Kaltara Nursing Academy, Kalimantan Utara
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4]