Exposure to mass media and interpersonal counseling has additive effects on exclusive breastfeeding and its psychosocial determinants among Vietnamese mothers.

Phuong H Nguyen,Rahul Rawat,Silvia Alayon,Marie T Ruel,Tuan T Nguyen,Edward A Frongillo,Purnima Menon,Lan M Tran,Sunny S Kim,Nemat Hajeebhoy

doi:10.1111/mcn.12330

Abstract

The pathways through which behavior change interventions impact breastfeeding practices have not been well studied. This study aimed to examine: (1) the effects of exposure to mass media and interpersonal counseling on exclusive breastfeeding (EBF) and hypothesized psychosocial determinants (i.e. knowledge, intention, beliefs, social norms, and self‐efficacy); and (2) the pathways through which exposure to mass media and interpersonal counseling are associated with EBF. We used survey data from mothers with children < 2 year (n = 2045) from the 2013 process evaluation of Alive & Thrive's program in Viet Nam. Multiple linear regression analyses and structural equation modeling were used to estimate effects. Exposure to mass media only, interpersonal counseling only, both or neither was 51%, 5%, 19% and 25%, respectively. Exposure to both mass media and interpersonal counseling had additive effects on EBF as well as on related psychosocial factors, compared with no exposure. For example, EBF prevalence was 26.1 percentage points (pp) higher in the group that received interpersonal counseling only, 3.9 pp higher in the mass media group and 31.8 pp higher in the group that received both interventions. As hypothesized, more than 90% of the total effect of the two interventions on EBF was explained by the psychosocial factors measured. Our findings suggest that combining different behavior change interventions leads to greater changes in psychosocial factors, which in turn positively affects breastfeeding behaviors.

Highlights

Exclusive breastfeeding (EBF) up to 6 months of age is recommended to assure optimal health, growth and development of children (Victora et al 2016) and reduce mortality (Sankar et al 2015)
Dependent variables Maternal knowledge on breastfeeding Feeding intention Perceived advantages/disadvantages of breastfeeding Social norms related to breastfeeding Self-efficacy related to breastfeeding Exclusive breastfeeding among infants
The associations between exposure and outcomes were highest among mothers exposed to both interventions, followed by those exposed to interpersonal counseling alone, and lowest among those exposed to mass media alone

Summary

Introduction

Exclusive breastfeeding (EBF) up to 6 months of age is recommended to assure optimal health, growth and development of children (Victora et al 2016) and reduce mortality (Sankar et al 2015). Reaching universal optimal breastfeeding could prevent 823 000 annual deaths in children younger than 5 years (Victora et al 2016) Despite these health benefits, the adoption of breastfeeding recommendations remains low in lowand middle-income countries where only 37% of infants are exclusively breastfed (Victora et al 2016). EBF prevalence has been stagnant since 2006, alongside increases in early introduction of semi-solid and solid foods, infant formula use and bottle feeding (Nguyen et al 2011; Gso & Unicef 2014). To reverse these negative trends and promote adoption and continued practice of EBF, effective behavior change interventions at scale are necessary

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