Journal of Education and Health Promotion

Abstract BACKGROUND: Recent findings show that a longer breastfeeding duration and proper dietary
management could lower the risk of postnatal diabetes. An excellent and interactive education
module on breastfeeding and diet may effectively improve breastfeeding practices and dietary
knowledge among women with gestational diabetes mellitus (GDM). Therefore, this study delves
into developing and validating the content of Breastfeeding and Dietary Education Package (BFDEP)
for women with GDM.
METHOD: The development of the module involved three phases: need assessment, module
development, and validation. Six experts deployed a content validity index (CVI) to evaluate three
areas of the module, including objectives, structure or presentation, and relevance. Sixteen women
with GDM were involved in the face validation process by assessing the “literacy presentation,”
“illustrations,” “material is sufficiently specific,” and “quality of information.”
RESULTS: Generally, I‑CVI, S‑CVI/Ave, and S‑CVI/UA of the objectives, structure or presentation,
and relevance revealed an excellent level of content validity. No alteration was needed for the
domains of objective and relevance (S‑CVI/Ave: 1.0, S‑CVI/UA: 1.0). However, a minor revision was
required in the structure or presentation domain (S‑CVI/Ave: 0.98, S‑CVI/UA: 0.90). The experts
also thought that some module pages were wordy, and a change of font color was needed. The
module was thus modified accordingly. For face validation, “literacy presentation” and “material is
sufficiently specific” had a 99% positive response, while “illustrations” and “quality of information”
had 100% positive feedback.
CONCLUSION: A BFDEP with excellent content validity was developed and can be implemented to
improve breastfeeding practices and dietary knowledge among women with GDM.

Abstract BACKGROUND: Addressing good breastfeeding practices among antenatal and postnatal mothers 
is important as it helps in bringing about a positive change in the behavior, attitude, and practice 
with appropriate health education. Hence, this study was done to determine the awareness level 
of antenatal and postnatal mothers about the breastfeeding practices and benefits and identify the 
factors associated with it in rural Chengalpattu, Tamil Nadu, India.
MATERIALS AND METHODS: We conducted this community‑based cross‑sectional study among 
377 antenatal and postnatal mothers in the selected rural villages of Chengalpattu between October 
2019 and September 2020. Details regarding the sociodemographic characteristics and awareness/
knowledge about the breastfeeding were collected using pretested semistructured questionnaire. 
Knowledge adequacy was summarized as proportion with 95% confidence interval (CI), and factors 
associated with knowledge were interpreted as adjusted prevalence ratio (aPR) with 95% CI using 
log‑binomial regression.
RESULTS: About 19.6% (95% CI: 15.7%–24.0%) mothers had inadequate knowledge about 
breastfeeding. Women who were unemployed (aPR = 1.60; 95% CI: 1.02–2.51), belonging to the lower 
socioeconomic status (aPR = 2.62; 95% CI: 1.80–3.82), belonging to Muslim religion (aPR = 1.63; 
95% CI: 1.14–2.35), and living in joint family (aPR = 1.58; 95% CI: 1.12–2.21) had significant higher 
risk of inadequate knowledge about breastfeeding practices compared to those who were employed, 
belonging to upper socioeconomic status, Hindu religion, and living in nuclear family.
CONCLUSION: We found that almost one‑fifth of the antenatal and/or postnatal mothers had 
inadequate knowledge about the breastfeeding benefits and practices. Health education sessions are 
required to promote the awareness about breastfeeding during antenatal and postnatal check‑ups.

Abstract BACKGROUND: Breastfeeding is beneficial for the health of infants and mothers. It is a complex
social behavior that may be influenced by social support. The study aimed to determine the relationship
between perceived social support of breastfeeding women and their breastfeeding patterns.
MATERIALS AND METHODS: The research was a cross‑sectional study on 300 mothers with
6‑month infants or younger who were selected randomly. The data collection tool consisted standard
social support and breastfeeding patterns questionnaires. We analyzed data using descriptive and
analytical tests and SPSS 18 at a significance level of < 0.05.
RESULTS: The results indicated that 85%, 82.2%, and 38% of the infants were exclusively
breastfed at 1 week, 4, and 6 months after delivery, respectively. The result of post hoc LSD test
indicated that the mean number of supporters for mothers, who were in the 6th month of delivery,
was significantly lower than other times (P = 0.001). The one‑way analysis of variance indicated
no significant difference between perceived satisfaction of social support at different periods after
delivery (P = 0.92). Despite the present results, which indicated that the number of supporters and
scores of satisfaction with support in exclusive breastfeeding were higher than other groups, the
differences were not statistically significant.
CONCLUSIONS: The mean number of supporters was less in women, who had 6‑month‑old infants,
than mothers who had just given birth. It seems mothers with supplements and formula feeding
patterns, such as breastfeeding mothers, may be supported to use these methods. Therefore, more
studies are suggested on this field.

Abstract BACKGROUND: Breastfeeding is not only a perfect food for the infant but also is a living fluid with
many features. It provides the infant’s physical growth and is responsive to its emotional needs.
Since determining the knowledge and attitude of girls in this period and promoting, it is considered
as the main principle in motivating them for choosing this method in future.
MATERIALS AND METHODS: This descriptive‑correlational study was conducted to determine
the knowledge and attitude of 630 high‑school students on breastfeeding at a selected public high
school in Tehran, Iran in 2018. A researcher‑made questionnaire was administered to collect the
data, to determine the validity of the tool; content validity was used and to determine its reliability,
a test re‑test method was applied. Data were analyzed by the nonparametric tests of Chi‑square,
multiple comparisons, and Spearman correlation coefficient.
RESULTS: The results showed that 80.3% had moderate knowledge. The mean score of knowledge
in the human sciences group was significantly higher than others. Furthermore, the attitude of
22.5% of girls was positive, 77.5% had no idea, none of them had negative attitudes. There was a
statistically significant difference between the mean score of attitude of the students in groups of
knowledge (good, moderate, and weak) (P < 0.01), and multiple comparison tests showed that the
positive attitude score in the moderate knowledge group was more than the attitude score in weak
and good knowledge.
CONCLUSION: The results indicate that there is an unbiased attitude about the moderate knowledge
of different aspects of breastfeeding among pre university students, although they have a moderate
knowledge on a complete and successful breast feeding.

Abstract BACKGROUND: The decrease in coverage of exclusive breastfeeding for mothers who work
in Pontianak has an impact on the decline of the baby’s immune system. Prevention efforts can
be done by increasing knowledge about exclusive breastfeeding tips for mothers who work by
providing health education. This study aims to examine the effectiveness of the use of health
education media in increasing maternal knowledge about exclusive breastfeeding tips for working
mothers.
MATERIALS AND METHODS: This is a quasi‑experiment study with a nonrandomized design
pretest and posttest control group design. The population of nursing mothers who have children
aged 0–6 months. The number of samples is 140, which is divided into four groups. Data collection
use direct interviews. Respondents filled out the pretest questionnaire to measure knowledge before
being given health education. Then, the first group was given treatment in the form of lectures, the
second group using leaflets, and the third group was given lectures first then given leaflets. After
that, his knowledge was measured again through a posttest. Data analysis were used to determine
the increase in the score of knowledge about exclusive breastfeeding tips for mothers who worked
on each media used repeated ANOVA and Kruskal–Wallis test, while one‑way ANOVA continued
with post hoc Bonferroni and Friedman followed by Mann–Whitney test used to compare score
differences knowledge on all three media.
RESULTS: there were significant differences in knowledge, before and after being given good health
education without media, with leaflets, electronic media, and electronic leaflets before. statistical
tests before and after used leaflets and electronic media without media 19.85 (P ≤ 0.001), leaflets
without media 8.42 (P ≤ 0.001). Electronic without media at 8.14 (P ≤ 0.001). In the pre‑ and
post‑test study, the experimental study was pseudo, 140 individuals with each group 35 individuals.
CONCLUSION: The most effective method in providing health education to increase the knowledge
of breastfeeding mothers about tips on exclusive breastfeeding for working mothers is electronic
leaflet media.

Abstract INTRODUCTION: Breast milk provides nutritional, immunological, behavioral, and economic benefits
and helps to build mother‑infant bonding. Antenatal mothers need to be sufficiently aware about the
benefits of breastfeeding.
OBJECTIVES: The aim of this study is to assess the awareness and perception of breastfeeding
among antenatal mothers and to find out any association between sociodemographic factors and
breastfeeding awareness.
METHODOLOGY: A cross‑sectional study was conducted among 250 antenatal women residing in the
urban slums of field‑practice area of urban health and training center; using a predesigned, pretested,
semi‑structured interview schedule. Antenatal checkup followed by one to one counseling for the
women regarding breastfeeding was provided. Data were represented by frequencies, proportions,
and associations using Chi‑square, and the P < 0.05 was considered statistically significant.
RESULTS: Most (55.6%) of the women were in the age group of 18–24 years. The mean age at
marriage was 19.2 ± 2.5 years. 81.2% of them were Hindus, 13.2% had adequate, 49.6% had
moderately adequate, whereas 37.2% women had inadequate awareness about breastfeeding.
About 100% intended to breastfeed their children, but only 64% said that they intended to exclusively
breastfeed. 66.4% knew about the importance of colostrum. Age‑group, religion, literacy, occupation,
type of family, gravida, and number of antenatal visits showed highly significant (P < 0.001) association
with awareness of breastfeeding.
CONCLUSION: Nearly one‑third of the antenatal mothers lacked awareness on breastfeeding
practices. Although all intended to breastfeed, still only 64% knew about exclusive breastfeeding.
These gaps need to be addressed by awareness generation activities during antenatal counseling.

Abstract BACKGROUND: The positive effect of breastfeeding on health is globally accepted. However,
breastfeeding has not yet practiced at a favorite level. Empowerment of mothers is an important
factor for continuing breastfeeding. This study was conducted to explore women’s perception of
empowerment in breastfeeding.
METHODS: The present qualitative study was conducted in conventional content analysis method.
Thirty‑four semi‑structured deep interviews were conducted with 18 mothers, four key family members,
and 12 other personnel involved in breastfeeding counseling services.
RESULTS: Analysis of participants’ descriptions led to the emergence of five main categories: Enough
knowledge and skill for breastfeeding, feeling adequacy in breastfeeding, overcoming breastfeeding
problems, informed belief in the value of breastfeeding, and perceiving comprehensive support for
breastfeeding.
CONCLUSION: in participants’ point of view, empowerment in breastfeeding can be formed
through an acquisition of “Enough knowledge and skill for breastfeeding” as well as assurance
about the proper quality and quantity of mother’s milk. As well as overcoming breastfeeding
problems will lead to stabilization empowerment in breastfeeding. In addition, data analysis
showed that informed belief in the value of breastfeeding strengthens the empowerment in
breastfeeding and presence of perceived comprehensive support for breastfeeding facilitates
empowerment in breastfeeding continuance. Thus, comprehensive plans should be designing
for promoting breastfeeding.

Abstract Background: Breastfeeding depends on social and cultural conditions of societies. Behavior,Attitude,
Subjective Norms, Enabling Factors (BASNEF) model is one of the comprehensive models of
behavior study, especially in developing countries. This study was performed to investigate the
status of breastfeeding during the first two years of infants’ life and its risk factors through BASNEF
model structures. Materials and Methods: In this cross‑sectional descriptive‑analytical study, 406
mothers with 6-24‑month‑old babies were selected by multistage cluster sampling method. The data
were collected using a questionnaire with five sections based on the BASNEF model structures.
Demographic characteristics of the studied population were also recorded and analyzed using
Chi‑square tests and analysis of variance in SPSS18 statistical software. Results: The prevalence of
breastfeeding was 86.4% (351 mothers). Three hundred and thirty three mothers (82%) had good
knowledge and there was a significant relationship between knowledge and breastfeeding behavior
of mothers (P < 0.05). Two hundred and eighty five mothers (70.2%) had good and very good
attitude in this regard. There was no significant relationship between attitude and breastfeeding
behavior of mothers (P > 0.05). There was a significant relationship between breastfeeding behavior
of mothers and subjective norms of husbands, mother and mother‑in‑law (P < 0.05); however, no
significant relationship was found with regard to enabling factors (P > 0.05). Moreover, no significant
relationship was observed between type of children nutrition and variables of delivery mode,
maternal age and number of children (P > 0.05). Conclusion: In addition to knowledge of nursing
mothers, supports and encouragement of husbands, mothers and mother‑in‑laws, as subjective
norms of behavior, have a positive impact on
the breastfeeding behavior of mothers. Thus,
breastfeeding programs should pay more
attention to the role of these mentioned factors.

Abstract Background: Breastfeeding is the most natural and essential way for feeding newborn babies. This
is an ideal approach for physical and emotional development of babies, as well as for the recovery
of mothers. This study was aimed to determine the effect of breastfeeding education based on the
health belief model (HBM) toward primiparous women. Materials and Methods: In a case–control
group, quasi‑experimental study, 88 subjects were allocated in control and experimental groups.
Subjects who were assigned to the experimental group were provided a program consisting of
group education based on HBM during their prenatal period. Instrument for data gathering was
made by the researchers and standard questionnaire from Dennis and Faux for Breastfeeding
Self‑efficacy Scale (BSES). Baseline interviews were conducted before delivery and follow‑up
visits were conducted after 30 days and at the fourth month after delivery. Data were analyzed
using SPSS (version 16) with c2
, independent sample t‑tests, and paired t‑test. Results: Mean
age of pregnant women who participated in the study was 22 ± 3.29 years. After the program,
the experimental group had significantly better scores in terms of self‑efficacy, knowledge, and
attitude scores statistically. In the fourth month, the mean of child weight in the experimental group
was significantly higher than that of the control group (P=0.001) and exclusive breastfeeding
was significantly higher than in the control group (P=0.007). Conclusion: Prenatal education
in this study based on HBM was successful, and knowledge, attitude, self‑efficacy, and related
indicators improved. The necessity of producing standard education package and education
of pregnant mothers, especially in their first pregnancy, by health professionals is perceived.