Effectiveness of information booklet about breastfeeding techniques on the knowledge of antenatal mothers in selected hospitals

Ms. Shinde Radha Waman*

Assistant Professor (Obstetrics & Gynecological Nursing), Tilak Maharashtra Vidyapeeth, Trust, Institute of Nursing Education and Research, Pune, Maharashtra, India

radhashinde1793@gmail.com

Abstract: Introduction: The birth of the baby is an important event in the family. It is therefore important for the mothers to have a healthy baby. Breast milk is the best food for the babies as breast fed babies are healthier than formula fed babies. The health and nutritional status of millions of infants which influence their subsequent growth and development throughout childhood is determined by the pattern of breastfeeding practices during infancy. Background: Breast milk is a natural, renewable food that serves as a complete source of infant nutrition for the first six months of life. It has the appropriate balance of nutrients provided in bio-available and easily digestible form, protecting both mothers and children against illness and disease with unparalleled immunological and anti-inflammatory properties. Advantages of breastfeeding Scientific evidence has proved beyond any doubt that breastfeeding is an ideal form of feeding the newborn. Research Design: A single group pre-test and post-test design was chosen for the study. Research Approach: The research methodology adopted for the study was an evaluative approach. A pre-experimental consisting of one group pre-test, post-test design was selected by the investigator. Setting of the study: The setting for the present study was selected hospitals of the city. Sampling size: In the present study,50 primigravida antenatal mothers were selected. Population: The target population for present study was primigravida antenatal mothers of city. Summary: An information booklet is effective in improving knowledge of antenatal mothers regarding breastfeeding techniques.

Keywords: Effectiveness, Primigravida, Breast feeding Techniques, Information Booklet, Antenatal Mothers.

INTRODUCTION

THERE IS NO SUBSTITUTE FOR MOTHER’S LOVE,

THERE IS NO SUBSTITUTE FOR MOTHERS MILK.”

William Gouge

The birth of the baby is an important event in the family. It is therefore important for the mothers to have a healthy baby. Breast milk is the best food for the babies as breast fed babies are healthier than formula fed babies.

Human milk is a remarkable and renewable resource. It cannot be duplicated. Human milk has no substitute and the breast is nature’s apparatus for feeding the baby. Breast feeding is an art. In recognition of the immense importance of breast feeding, the Baby Friendly Hospital Initiative (BFHI) was launched by UNICEF/WHO in 1991. Breast feeding results in decreased problems such as infections and other medical problems to the mother as well as the baby.

The health and nutritional status of millions of infants which influence their subsequent growth and development throughout childhood is determined by the pattern of breastfeeding practices during infancy. In the light of current scientific knowledge, there is a consensus about human milk as being the only food product that is capable of adequately attending to all physiological requirements of infant’s metabolism during first six months of their life.

Advantages of breastfeeding

Scientific evidence has proved beyond any doubt that breastfeeding is an ideal form of feeding the newborn. It is estimated that exclusive breastfeeding can reduce 13% of childhood deaths, large contribution in comparison to any other child survival intervention. Breastfeeding is advantageous for all- the baby, the mother and the society.

Background:

Breast milk is a natural, renewable food that serves as a complete source of infant nutrition for the first six months of life. It has the appropriate balance of nutrients provided in bio-available and easily digestible form, protecting both mothers and children against illness and disease with unparalleled immunological and anti-inflammatory properties.

The health and nutritional status of millions of infants which influence their subsequent growth and development throughout childhood is determined by the

pattern of breastfeeding practices during infancy. In the light of current scientific knowledge, there is a consensus about human milk as being the only food product that is capable of adequately attending to all physiological requirements of infant’s

metabolism during first six months of their life.

Need For The Study:

Breastfeeding is one of the first bonding experiences between the mother and the child. Breast milk is constantly available and it is the safest and the most secure source of nourishment for the babies. It protects the baby against illness and ensures warmth and comfort of the baby that is held close to the nursing mother.

Exclusive breastfeeding for first 6 months could reduce infant mortality rate by 13%. Hence, health education and baby friendly hospital policy are also initiating every mother to give exclusive breastfeed. Many mothers are unable to practice exclusive breastfeeding as advocated. Lack of confidence in mothers, ability to breastfeed, problems with the infant latching or suckling, breast pain or soreness, and lack of individualized encouragement from their clinicians.

In India, the health care provider during the antenatal visits is usually an obstetrician or an auxiliary nurse midwife (ANM). In the rural health set up, ANM is the health functionary closest to the community. ANM visits home in their allotted villages and provide basic health services and health education including motivation and accompany pregnant woman from home to sub center for initial check-ups and taking full course of iron and folic acid. Although opportunities exist during the antenatal visits, counseling mothers regarding breastfeeding is often not done.

Problem Statement:

‘Effectiveness of information booklet about breastfeeding techniques on the knowledge of antenatal mothers in selected hospitals’.

Objectives of the study:

1. To assess the knowledge of breastfeeding techniques among antenatal mothers before administration of information booklet in selected hospitals.

2. To compare the knowledge of breastfeeding techniques antenatal mothers after administration of information booklet in selected among hospitals.

3. To find out association between study findings and selected demographic variables among antenatal mothers on breastfeeding techniques in selected hospitals.

Operational Definitions:

Assess:

According to Oxford dictionary assess means, to evaluate the value or quality of particular subject. In this study, assess means to evaluate the knowledge regarding breast feeding techniques and positions.

Effectiveness:

According to Oxford Dictionary effectiveness refers to producing of intended effect.

In this research study effectiveness refers to change in knowledge level regarding breast feeding techniques and positions.

Breastfeeding:

According to WHO/UNICEF Breastfeeding is the child has received breast milk direct from the breast or expressed.

In this study meaning of breastfeeding remains same.

Antenatal:

According to Oxford Dictionary antenatal means before delivery.¹⁹

In this research study antenatal is primigravida pregnant woman.

Assumptions:

The study assumes that:

Antenatal mothers may have limited knowledge regarding breastfeeding techniques.

Information booklet on breast feeding techniques may be useful strategy for learning to enhance knowledge regarding breastfeeding techniques

Hypothesis:

H_o: There will be no significant difference in the knowledge regarding breastfeeding techniques among antenatal mothers after providing the information booklet.

H₁: There will be significant difference in the knowledge regarding breastfeeding techniques among antenatal mothers after providing the information booklet.

Conceptual frame work:

CONCEPTUAL FRAMEWORK BASED ON GENERAL SYSTEMMODEL.

REVIEW OF LITERATURE

“Review of literature is a written, analytical summary of research findings on a topic of interest. It is a comprehensive compilation of what is known about the phenomenon. The purpose of review of literature to assess the evidence regarding the research topic by identifying and synthesizing studies that examine the subjects of interest”.²¹

In view of the present study the related literature review has been made and described under following headings.

1. Review related to knowledge regarding breastfeeding.

2. Review related to factors affecting breast feeding.

3. Review related to breastfeeding techniques.

4. Review related to effect of information booklet.

Review related to knowledge regarding breast feeding:

Breast milk is the best feed for the baby till the baby is of six months old. Exclusive breast feeding can save many lives by preventing malnutrition and infections. It is very essential to impart this knowledge to mothers. Many researches had been conducted which highlights the importance of Exclusive breast feeding.

Review related to factors affecting breast feeding:

The World Health Organization & China Ministry of Health mentioned that only 29% of mothers exclusively breastfed their babies for six months, while more than half of the mothers failed to do so. Insufficient breast milk & having no time to continue exclusively breast feeding after returning to work were cited as two major reasons were mothers are unable to exclusively breast feed their babies up to six months.

Review related to breastfeeding techniques:

A descriptive study to assess the knowledge on practice regarding breastfeeding techniques among postnatal women seeking medical services in ShriVinoba Bhave civil hospital, silvassa. A study focused to assess the knowledge on breastfeeding techniques among postnatal women. Quantitative approach with descriptive survey design was used. By convenient sampling techniques 65 postnatal women were selected. Data collected by using checklist regarding knowledge on breastfeeding techniques and analyzed by using descriptive and inferential statistics. Socio-demographic variable of postnatal women shown that maximum women (69.23%) were in 21-25 years of age and most of the women (55.38%) were primary educated.

Most of the women (60%) were home maker. More than half of the husbands (60%) were private employee. Majority of women (41.53%) were having family monthly income of Rs. <5000. Most of the women (75.38%) were from tribal area and most of the women (83.07%) were got knowledge on breastfeeding techniques from health care professionals. Most of the postnatal women (59%) having good knowledge on breastfeeding techniques. The Chi square value showed that there was a no significant association between study findings and socio-demographic variables.

Review related to effect of information booklet:

Learning is the addition of new knowledge and experience interpreted in the light of past knowledge and experience. To impart knowledge, several methods are used. Training is one of them. Cost of training is rising, at the same time the need of training is increasing. One way of lowering the cost of training is to deliver it as self instruction. It allows a person to take knowledge at his or her own pace and whenever possible. For revision to instructions, at any future times, it can be made immediately available. For these reasons, the use of self instruction is increasing. It can be in the form of information booklets, cassettes, compact discs etc.

Rawa developed an information booklet on the care of low birth weight infants for mothers whose babies were admitted in NICU. She found out its increasing acceptability and utility of the booklet among mothers, as it provided significant knowledge.

In WHO technical report series have stated the positive implication of individual and small group learning system in medical education. Self instruction material like information booklet is very effective for imparting knowledge among groups.

RESEARCH METHODOLOGY

Research Design:

A single group pre-test and post-test design was chosen for the study.

Research Approach:

The research methodology adopted for the study was an evaluative approach. A pre-experimental consisting of one group pre-test, post-test design was selected by the investigator.

Variables:

Independent Variable: In the present study, the independent variable was information booklet regarding breastfeeding techniques.

Dependent Variable: In the present study, the dependent variable was knowledge regarding breastfeeding techniques.

Setting of the study:

The setting for the present study was selected hospitals of the city.

Target Population:

The target population for present study was primigravida antenatal mothers of city.

Accessible Population:

Accessible population for the present study was primigravida antenatal mothers attending OPD in selected hospitals of the city.

Sample: In this study samples were primigravida antenatal mothers attending OPD in selected hospitals of the city.

Sampling Technique: In the present study, the sampling technique used was non probability convenience sampling.

Sampling size:

In the present study,50 primigravida antenatal mothers were selected.

Inclusion Criteria:

· Antenatal mothers who will be willing to participate in the study.

· Antenatal mothers who are primigravida mothers.

· Antenatal mothers who can read & write Marathi or English.

· Antenatal mothers who will be present in the OPD during the study.

Exclusion Criteria:

· Antenatal mothers who are multigravida.

· Antenatal mothers those who don’t understand Marathi or English.

· Antenatal mothers who will not be willing to participate in the study.

· Antenatal mothers with high risk pregnancy.

Tool Preparation:

A self-structured questionnaire was developed to assess the effectiveness of information booklet regarding breastfeeding techniques.

Description of the tool, the self-structured questionnaire consist of two sections i.e.

section I and section II.

Section I: Consist of items on demographic data (age at present, educational qualification, residence, status of mother and previous knowledge of breastfeeding techniques, if yes then source of knowledge ).

Section II: Consist of structured questionnaire on the knowledge regarding breastfeeding techniques. A score of “one” was given for each correct answer for every item. The total score 20.No negative scoring was given. Technique: The technique used was self-structured questionnaire.

ANALYSIS AND INTERPRETATION OF DATA:

The analysis of the collected data was done with help of inferential and descriptive statistics. The data was first coded and entered into computer .The data was then processed by using Minitab14 statistical software. Frequency, percentage, means, Standard Deviation and Fisher’s exact test and Chi-square Test of independence of attributes was calculated to fulfill the objectives of the study.

Development of the tool:

Structured knowledge questionnaires were prepared for assessing the effectiveness of information booklet regarding breastfeeding techniques with the help of the following:

Review of research and non-research literature used in the area related to breastfeeding techniques. Opinions and suggestions from experts, helped in determining the important areas to be included.

Presentation of the data organized in four sections.

Section I – A. Description of sample’s characteristics in terms of frequency and percentage. And assessment of existing knowledge and sources of information.

Section II – Pre-test & post-test scores regarding knowledge of breastfeeding techniques among antenatal mothers.

Section III - Analysis of data related to knowledge of antenatal mothers and the effect of information booklet regarding breastfeeding techniques.

Section IV - Association of demographic variables with knowledge regarding breastfeeding techniques among antenatal mothers.

Major findings of the study:

The following interpretation can be drawn from the findings of the study were based on objectives of the study.

Findings of Section I -

· 32% of the antenatal mothers had age 20-25 years, 44% of them had age 26-30 years, 20% of them had age 31-35 years and 4% of them had age 36-40 years.

· 14% of them had primary education, 44% of them had secondary education, 20% of them had higher secondary education and 22% of them had graduation and above.

· 36% of them had previous knowledge about breastfeeding techniques.

· 4% of them had previous knowledge from mass media, 30% of them had knowledge form health worker, 2% of them had knowledge from friend.

· 8% of them had service, 82% of them were housewives, 8% of them had business and 2% of them had some other occupation.

· None of them had any bad habit.

· 62% of them were residing in urban area and 38% of them were residing in rural area.

Findings of Section II -

Findings of Section III -

Before administration of information booklet, Majority of 86% of the antenatal mothers had average knowledge (score 7-13) and 14% of them had poor knowledge (score 0-6) regarding breastfeeding techniques. In posttest, all antenatal mothers had good knowledge regarding breastfeeding techniques. This indicates that the knowledge of the antenatal mothers improved remarkably after implementation of information booklet about breastfeeding techniques.

Findings of Section IV –

Since all the p-values are large (greater than 0.05), none of the demographic variables was found to have significant association with the knowledge among the antenatal mothers regarding breastfeeding techniques. So the null hypothesis for this study will be accepted.

Recommendation:

1. A study may be replicated on large samples; thereby findings can be generalized for a large population.

2. A similar kind of studies can be undertaken in different settings and different target population.

3. A comparative study can be conducted to assess the effectiveness of information booklet versus video assisted learning.

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