Additive Effects of Interpersonal Counseling and Mass Media on Psychosocial Determinants of Exclusive Breastfeeding among Vietnamese Mothers

Abstract

The pathways through which behavior change interventions impact breastfeeding (BF) practices have not been well studied. This study aimed to 1) examine separate and interactive effects of mass media (MM) and interpersonal counseling (IPC) on BF‐related psychosocial factors; and 2) assess the pathways through which intervention exposure affects exclusive breastfeeding (EBF). Survey data from mothers with children < 2 y (n=2045) from the process evaluation of Alive & Thrive's programs in Viet Nam were used. Exposure to MM only, IPC only, both, or neither was 51%, 5%, 19%, and 25%, respectively. Multiple linear regression showed consistent additive effects of MM+IPC on BF knowledge (b= 2.8, 11.5, and 14.4 for MM, IPC, and both, respectively), intention (b= 6.2, 14.9, and 18.0 for MM, IPC, and both), beliefs (b= 5.3, 12.7, and 16.8 for MM, IPC, and both), social norms (b= 5.0, 13.6, and 16.5 for MM, IPC, and both) and self‐efficacy (4.3, 14.6, and 17.4 for MM, IPC, and both). Women who viewed TV spots more frequently, recalled more messages, and those who received the recommended number of IPC visits had a higher score on psychosocial factors. Compared to no exposure, IPC and MM+IPC exposure were associated with 23.5% and 31.2% higher EBF, respectively. Structural equation modeling revealed that 90% of the total effect of IPC only or MM+IPC on EBF practice was explained by the psychosocial factors. The findings suggest that combining different behavior change modalities can lead to greater changes in psychosocial factors, which in turn positively affects breastfeeding behaviors.Funding: Bill & Melinda Gates Foundation, through Alive & Thrive, managed by FHI360