The implementation and challenges of breastfeeding counselling program in Majene district, West Sulawesi: A qualitative study among health workers

  • Dyah Febriyanti Faculty of Medicine Universitas Indonesia – Dr. Cipto Mangunkusumo Hospital
  • Judhiastuty Februhartanty Faculty of Medicine, Universitas Indonesia – Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
  • Luh Ade Ari Wiradnyani Faculty of Medicine, Universitas Indonesia – Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Keywords: breastfeeding, counsellors, experiences, prespectives,, program management

Abstract

Background: Inadequate breastfeeding practices increase the risk of malnutrition, infant deaths, and other related developmental problems. Counselling on breastfeeding promotion is one of the most effective ways to improve breastfeeding practices. Nevertheless, challenges in implementing the counselling hinder its effectiveness. Using the logic model framework, this study examines the implementation and challenges of breastfeeding counselling programs in Majene District, West Sulawesi Objective: This study aims to gain an in-depth understanding of experiences and perspectives regarding the implementation of the breastfeeding counselling program using the Logic Model among health workers in Majene District. Methods: From January to June 2024, a qualitative phenomenological approach was employed. Data collection included in-depth interviews with 12 trained breastfeeding counsellors, eight key informants, and focus group discussions with 24 mothers. Thematic analysis using NVivo 12, guided by the Logic Model framework, which grouped breastfeeding counselling into input, process, outputs, and outcomes aspects. Results: Key challenges included a shortage of trained counsellors, limited infrastructure, and budget constraints. Health workers adapted by integrating counselling into maternal health services, conducting home visits, and collaborating with Posyandu cadres. Exclusive breastfeeding rates showed slight improvements but remained below national targets. Beneficiaries expressed satisfaction but highlighted the need for longer and more frequent counselling sessions. Conclusions: The program faced significant resource challenges, including a shortage of skilled counsellors, budget constraints, and limited facilities. However, adaptive strategies by health workers crucial for overcoming logistical and resource constraints resulted in beneficiaries’ satisfaction and positive developments in breastfeeding rates.

Downloads

Download data is not yet available.

Author Biographies

Dyah Febriyanti, Faculty of Medicine Universitas Indonesia – Dr. Cipto Mangunkusumo Hospital
Department of Nutrition Science
Judhiastuty Februhartanty, Faculty of Medicine, Universitas Indonesia – Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
1Department of Nutrition Science,  2Southeast Asian Ministers of Education Organization – Regional Centre for Food and Nutrition (SEAMEO RECFON)/ Pusat Kajian Gizi Regional (PKGR) Universitas Indonesia
Luh Ade Ari Wiradnyani, Faculty of Medicine, Universitas Indonesia – Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
1Department of Nutrition Science,  2Southeast Asian Ministers of Education Organization – Regional Centre for Food and Nutrition (SEAMEO RECFON)/ Pusat Kajian Gizi Regional (PKGR) Universitas Indonesia

References

Rollins NC, Bhandari N, Hajeebhoy N, et al. Why invest, and what it will take to improve breastfeeding practices? The Lancet. 2016;387(10017):491-504. doi:10.1016/S0140-6736(15)01044-2

UNICEF. Infant and young child feeding . 2022. Accessed November 7, 2023. https://data.unicef.org/topic/nutrition/infant-and-young-child-feeding/).

WHO, UNICEF. Global Breastfeeding Scorecard 2023 Rates of Breastfeeding Increase Around The World Through Improved Protection and Support.; 2023. Accessed February 11, 2025. https://www.who.int/publications/i/item/WHO-HEP-NFS-23.17.

Badan Kebijakan Pembangunan Kesehatan, Kementerian Kesehatan RI. Status Gizi SSGI 2022.; 2022. Accessed February 12, 2025. https://layanandata.kemkes.go.id/katalog-data/ssgi/ketersediaan-data/ssgi-2022.

Kemenkes, Badan Kebijakan Pembangunan Kesehatan. Survei Kesehatan Indonesia 2023 Dalam Angka.; 2023. Accessed February 11, 2025. https://www.badankebijakan.kemkes.go.id/ski-2023-dalam-angka/

Victora CG, Bahl R, Barros AJD, et al. Breastfeeding 1 Breastfeeding in the 21st Century: Epidemiology, Mechanisms, and Lifelong Eff Ect. Vol 387.; 2016. http://mics.

Pusdatin. Profil Kesehatan Indonesia Tahun 2022.; 2023. Accessed February 12, 2025. http://www.kemkes/go.id

Thepha T, Marais D, Bell J, Muangpin S. Facilitators and Barriers to Exclusive Breastfeeding in Thailand: A Narrative Review. J Community Public Health Nurs. 2017;03(01). doi:10.4172/2471-9846.1000160

Rhodes EC, Zahid M, Abuwala N, et al. Experiences of breastfeeding peer counseling among women with low incomes in the US: a qualitative evaluation. BMC Pregnancy Childbirth. 2024;24(1). doi:10.1186/s12884-023-06213-0

Kellogg WK. Using Logic Models to Bring Together Planning, Evaluation, and Action Logic Model Development Guide.; 2004. www.wkkf.org.

Daniels L, Du Plessis LM, Mbhenyane X. Support for exclusive breastfeeding in the workplace: Development of a practice model for designated workplaces in the Breede Valley sub-district, Western Cape Province, South Africa. Stellenbosch University Thesis Database. 2020;(figure 1). Accessed February 2025. http://hdl.handle.net/10019.1/108417.

Marjan M. A Comparative Analysis of Two Qualitative Methods: Deciding Between Grounded Theory and Phenomenology for Your Research. Vocational Training: Research And Realities. 2017;28(1):23-40. doi:10.2478/vtrr-2017-0003.

Xu W, Pan Z, Li Z, Lu S, Zhang L. Job burnout among primary healthcare workers in rural china: A multilevel analysis. Int J Environ Res Public Health. 2020;17(3). doi:10.3390/ijerph17030727.

Correction: Who are the real community health workers in Tshopo Province, Democratic Republic of the Congo? (BMJ Global Health (2019) 4 (e001529) DOI: 10.1136/bmjgh-2019-001529). BMJ Glob Health. 2020;5(1). doi:10.1136/bmjgh-2019-001529corr1.

Manzi A, Hirschhorn LR, Sherr K, et al. Mentorship and coaching to support strengthening healthcare systems: Lessons learned across the five Population Health Implementation and Training partnership projects in sub-Saharan Africa. BMC Health Serv Res. 2017;17. doi:10.1186/s12913-017-2656-7.

Harris A, Jordan N, Carroll AJ, et al. A budget impact analysis of cost to implement a whole child health focused, family-based intervention in primary care for children with elevated BMI. Implement Sci Commun. 2023;4(1). doi:10.1186/s43058-023-00429-z.

Salam A, Wireko AA, Jiffry R, et al. The impact of natural disasters on healthcare and surgical services in low- and middle-income countries. Annals of Medicine & Surgery. 2023;85(8):3774-3777. doi:10.1097/ms9.0000000000001041.

Vakilian K, Tabarte Farahani O, Heidari T. Enhancing breastfeeding - Home-based education on self-efficacy: A preventive strategy. Int J Prev Med. 2020;11(1). doi:10.4103/ijpvm.IJPVM_494_17.

Rai R, Khatun R, Inamdar P, Patil R. Impact of educational intervention on breastfeeding practices of mother undergoing institutional delivery. Int J Contemp Pediatrics. 2023;10(10):1550-1557. doi:10.18203/2349-3291.ijcp20232883.

Sarsak HI, Morales E, Chockalingam M. Editorial: Environmental adaptation for accessibility: a global perspective in the field of disability, rehabilitation and inclusion. Frontiers in Rehabilitation Sciences. 2024;5. doi:10.3389/fresc.2024.1514744.

Centers for Medicare T, Services M. Improving Access to Maternal Health Care In Rural Communities: An Issue Brief.; 2019. Accessed February 12, 2025. https://www.cms.gov/About-CMS/Agency-Information/OMH/equity-initiatives/rural-health/09032019-Maternal-Health-Care-in-Rural-Communities.pdf.

Mane UR, Salunkhe JA, Kakade S. Family Support to Women During Pregnancy and Its Impact on Maternal and Fetal Outcomes. Cureus. Published online June 9, 2024. doi:10.7759/cureus.62002.

Kesehatan J, Sundary S, Faletehan U. The Role Of Family Support In Childbirth: Implications For Maternal And Infant Well-Being. doi:10.62872/gbna7b66.

Sadewa DMA. Enabling the Grass Root: Health Cadres Empowerment Program in Efforts to Prevent and Manage Hypertension in the Tanjung Sub-Village Community. Jurnal Pengabdian kepada Masyarakat (Indonesian Journal of Community Engagement). 2023;9(3):181. doi:10.22146/jpkm.86250.

O’Cathain A, Croot L, Duncan E, et al. Guidance on how to develop complex interventions to improve health and healthcare. BMJ Open. 2019;9(8). doi:10.1136/bmjopen-2019-029954.

Zulkifli SS, Hamzah H. The importance of supervisor support for the work outcomes and psychological well-being of Malaysian low-income working mothers. Psikohumaniora. 2024;9(1):159-178. doi:10.21580/pjpp.v9i1.20756.

Wang CJ, Chaovalit P, Pongnumkul S. A breastfeed-promoting mobile app intervention: Usability and usefulness study. JMIR Mhealth Uhealth. 2018;6(1). doi:10.2196/mhealth.8337.

Doan TTD, Binns C, Pham NM, et al. Improving breastfeeding by empowering mothers in Vietnam: A randomised controlled trial of a mobile app. Int J Environ Res Public Health. 2020;17(15). doi:10.3390/ijerph17155552.

Huang HH, Lee TY, Lin XT, Duan HY. Maternal Confidence and Parenting Stress of First-Time Mothers in Taiwan: The Impact of Sources and Types of Social Support. Healthcare (Switzerland). 2022;10(5). doi:10.3390/healthcare10050878.

Dias De Oliveira L, Justo Giugliani ER, Córdova Do Espírito Santo L, Meirelles Nunes L. Counselling sessions increased duration of exclusive breastfeeding: A randomized clinical trial with adolescent mothers and grandmothers. Nutr J. 2014;13(1). doi:10.1186/1475-2891-13-73.

De P, Pradhan MR. Effectiveness of mobile technology and utilization of maternal and neonatal healthcare in low and middle-income countries (LMICs): a systematic review. BMC Womens Health. 2023;23(1). doi:10.1186/s12905-023-02825-y.

Awaliyah SN, Rachmawati IN, Rahmah H. Breastfeeding self-efficacy as a dominant factor affecting maternal breastfeeding satisfaction. BMC Nurs. 2019;18. doi:10.1186/s12912-019-0359-6.

Vaithilingan S, Johnson A. Correlation of Breast Feeding Self Efficacy with Maternal Breastfeeding Satisfaction.; 2023. www.jchr.org

Submitted

2024-12-30
Accepted
2025-02-17
Published
2025-02-28