Husband Knowledge and Attitude Towards Mother's Breastfeeding

Self-Efficacy

Retnayu Pradanie

, Rr Dian Tristiana

and Risma Dwi Lestari

Faculty of Nursing Universitas Airlangga, Kampus C Mulyorejo, Surabaya, Indonesia

Undergraduated Student, Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia

Keywords: Husband, Knowledge, Attitudes, Self-Efficacy, Exclusive Breastfeeding.

Abstract: Breast milk is an ideal source of nutrition for infants. However, the level of exclusive breastfeeding has not

reached government targets. This might be affected by internal factors such as breastfeeding self-efficacy or

external factors that may originate from the husband. The aim of this study was to identify the relationship

between the husband’s knowledge and attitude about exclusive breastfeeding with breastfeeding self-

efficacy in mothers with infants aged 0-6 months. This study used a correlation study design with a cross-

sectional approach. The sample consisted of 85 mothers and their husbands who had infants aged 0-6

months through a purposive sampling technique in Puskesmas Pucang Sewu Surabaya. Data was taken

using questionnaires and analyzed statistically using a Spearman Rank Correlation test. The results showed

that there was a significant relationship between the husband’s knowledge and breastfeeding self-efficacy (p

= 0.002 r = 0.338) and the husband’s attitude with breastfeeding self efficacy (p = 0.000 r = 0.723). The

relationship between knowledge and breastfeeding self-efficacy was weak. It could be influenced by other

factors such as education, occupation, age, and the mother’s breastfeeding experience. While the

relationship between the husband’s attitude and breastfeeding self-efficacy was strong. This shows that the

husband’s positive attitude will increase the level of breastfeeding self-efficacy.

1 BACKGROUND

Breastfeeding is an important concern because

breast milk is an ideal source of nutrition since its

composition meets the needs of growth and optimal

development for the baby. The World Health

Organization (WHO) and the United Nations

Children’s Fund (UNICEF) encourage mothers to

exclusively breastfeed until infants are aged 6

months, continuing until the age of 2 years with

additional complementary feeding (Kementerian

Kesehatan Republik Indonesia 2014). But, the

coverage of exclusive breastfeeding in Indonesia in

2015 was still at 55.7% (Kementerian Kesehatan

Republik Indonesia 2017), while in East Java

Province it was 74.1%. Based on a report from the

Surabaya City Health Office profile 2015, coverage

of exclusively breastfed infants in Surabaya is

64.99% and has not reached the target set by the

government at 80%.

Exclusive breastfeeding may be influenced by

internal and external factors. Internal factors that can

support exclusive breastfeeding include the mother's

breastfeeding self-efficacy, which is a sense of

confidence that mothers have in terms of

breastfeeding and can be a predictor of breastfeeding

decisions, major efforts to breastfeed, and how to

respond to problems and difficulties during

breastfeeding (Dennis 2011). Low self-efficacy in

breastfeeding can lead to negative perceptions and

poor motivation (Pradanie 2015).

Based on initial surveys through interviews with

health workers at the Puskesmas Pucang Sewu

Surabaya, 50% of mothers in their area were not

exclusively breastfeeding their babies under 6

months old. The condition of some working mothers

makes them less confident to breastfeed babies

exclusively for 6 months because of poor time

management. This illustrates that a mother's self-

efficacy is important to support exclusive

breastfeeding.

Health officers in Puskesmas Pucang Sewu said

that environmental factors in the family, especially

the husband, play an important role for mothers in

deciding on infant breastfeeding (Pertiwi 2012).

Lack of a husband's support during breastfeeding

Pradanie, R., Tristiana, R. and Lestari, R.

Husband Knowledge and Attitude Towards Mother’s Breastfeeding Self-Efﬁcacy.

DOI: 10.5220/0008324603190323

In Proceedings of the 9th International Nursing Conference (INC 2018), pages 319-323

ISBN: 978-989-758-336-0

319

can cause the mother to feel less attention so they

fail to exclusively breastfeed their baby, while good

psychological support from a husband for a mother

could improve the success of exclusive

breastfeeding (Bahiyatun 2009).

The antecedent factors of breastfeeding self-

efficacy include direct experience, indirect

experience, verbal persuasion, and emotional state

(Dennis 2011). The encouragement of family,

especially the husband, can be used as a source of

verbal persuasion that can influence a mother's

motivation to develop self-efficacy in exclusive

breastfeeding. The husband's encouragement can be

influenced by the attitude and knowledge of the

husband about exclusive breastfeeding (Suciati et al.

2016). The husband's knowledge plays an important

role in encouraging, assisting and rewarding mothers

in the process of breastfeeding, sharing household

chores, and raising children (Rumaseuw et al. 2018).

A husband's negative attitude and poor knowledge

may cause the husband to be incapable of motivating

or encouraging the mother to exclusively breastfeed

(Sopiyani 2014).

Based on interviews conducted by researchers

with 6 breastfeeding mothers in Posyandu it was

stated that 3 fathers gave positive support and 3 were

negative. Researchers also found that the mother

with a positive husband still had low confidence

about being able to breastfeed her baby exclusively.

This phenomenon was interesting, and needs to be

explained by investigating the correlation between a

husband's knowledge and attitude with breastfeeding

self-efficacy. Many studies have been conducted on

breastfeeding self-efficacy, but most of them only

involved mothers as respondents. Whereas factors

derived from the husband, who can be seen as one

source of self-efficacy, also have an important role

in improving a mother's breastfeeding self-efficacy

and this is still rarely studied. Therefore, mothers

and family, especially husbands, together should

give attention to the breastfeeding process to achieve

exclusive breastfeeding (Bich & Cuong 2017).

2 METHODS

The design used in this research was correlational

with a cross-sectional approach. The population

were couples of mothers and fathers who have

babies under 6 months in the area of Puskesmas

Pucang Sewu Surabaya totalling 109 respondents.

By using purposive sampling, the sample in this

research numbered 85 respondents.

The variables in this research were the husband's

knowledge about exclusive breastfeeding, the

husband's attitude, and the mother's breastfeeding

self-efficacy. All data was measured using

questionnaires. The husband's knowledge

questionnaire about exclusive breastfeeding was

modified from Widjayanti (2010) which comprised

13 questions about the exclusive breastfeeding

concept. The husband's attitude was assessed using a

modified questionnaire from Purwaningrum (2009)

consisting of 19 questions with a Likert scale

containing favorable questions and unfavorable

questions. Breastfeeding self-efficacy was measured

using a Breastfeeding Self-Efficacy Short Form

(BSE-SF) questionnaire by Dennis (2003), which

comprised 14 questions with a Likert scale. All

questionnaires were tested for validity and reliability

with valid and reliable results.

This study has passed the ethical clearance from

the Health Research Ethics Committee, Faculty of

Nursing Universitas Airlangga with certificate

number 423-KEPK. This research was conducted in

the working area of Puskesmas Pucang Sewu

Surabaya during July 2017. Data was collected by

visiting the respondent's house. The collected data

was analyzed using a Spearman Rank Correlation

test with significance level of α ≤ 0.05.

3 RESULTS

General description of respondents (husbands) in

this study: 48 people (56.5%) aged 26-35 years old,

7 respondents (8.2%) aged 21-25 years old, 29

respondents (34.1%) aged 36-45 years old, and only

1 respondent (1.2%) aged > 45 years old. The

education level of husbands: 56 respondents (65.9%)

were graduated from senior high school, 5

respondents (5.9%) only finished elementary school,

15 people (17.6%) completed junior high school, 8

respondents (9.4%) graduated from university, and

there were still respondents who did not complete

elementary school – 1 person (1.2%). In terms of

occupation, most of the husbands work as

employees (67.8%), 16 people (18.8%) were self-

employed, and only 1 respondent (1.2%) worked as

a civil servant (government staff) and teachers.

For mothers as respondents, the majority were

aged 26-35 years old, as many as 46 respondents

(54.1%), 22 respondents (25.9%) were aged 21-25

years old, and 17 respondents (20%) were aged 36-

45 years old. In terms of education, 56 respondents

(65.9%) of the mothers were graduates from high

school, 15 people (17.6%) were graduates of junior

high school, 10 respondents (11.8%) were graduated

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

320

from university, and still there were respondents

who did not complete primary school, 2 people

(2.4%). Most of the mothers (61 people or 71.7%)

were housewives, 20 mothers (23.5%) were

employees, and only 2 respondents (2.4%) worked

as self-employed and teachers.

In this research 42 (49.4%) respondents have 2

children, with the age of the last child 6 month (24

respondents or 28.2%). The respondents who had 1

child totalled 22 people (25.9%), the respondents

who had 3 children totalled 18 people (21.2%), and

those respondents who had more than 3 children

numbered 3 people (3.5%). Based on breastfeeding

experience, 42 mothers (49.4%) had breastfed and

used formula milk for their infants, only 15 mothers

(17.6%) had ever given exclusive breastfeeding from

infants born to 6 months. 22 respondents (25.9%)

had no experience at all of breastfeeding, and 6

respondents (7.1%) only gave formula milk without

breast milk to their babies.

Thirty-nine people out of 85 husbands as

respondents in this study (45.9%) had good

knowledge on aspects of the benefits of breast milk

for their babies, while 11 respondents (12.9%) had

less knowledge. Lack of knowledge among

husbands included colostrum, problems during

breastfeeding, and incorrect perceptions about

exclusive breastfeeding, that breast milk may be

supplemented with other foods and formula for

infants under 6 months of age.

Attitudes demonstrated by husbands as

respondents about mothers who breastfed babies 0-6

months are mostly positive, which amounted to 53

respondents (62.4%). The husbands did not mind if

the mother could not handle housework when

breastfeeding her baby. Some other respondents, as

many as 32 respondents (37.6%), have a negative

attitude to breastfeeding mothers. This lies in the

aspect of responsibility for assisting the mother's

work during breastfeeding, and less

acknowledgement for the mothers that exclusive

breastfeeding is good for the baby. Some husbands

provide incorrect advice regarding breastfeeding

believing that supplemental feeding and formula

feeding could be given during an exclusive

breastfeeding period. Husbands also made

objections to the mothers breastfeeding in public

places.

Descriptions of breastfeeding self-efficacy

among mothers as respondents indicate that 35 from

85 respondents (41.2%) had high levels of

breastfeeding self-efficacy. Most mothers were

confident of managing sufficient breastfeeding and

breastfeeding situations as desired. Mothers with

low self-efficacy level numbered 19 persons

(22.3%), and 2 persons with very low self-efficacy

level of total mother respondents (2.4%). Some

mothers with low self-efficacy levels still had low

confidence in breastfeeding without formula, and

were not sure they could overcome problems during

breastfeeding. Mothers had low confidence in being

able to meet the nutritional needs of infants with

breast milk alone so that mothers chose to add infant

formula for babies under 6 months old.

Table 1: The correlation between husband’s knowledge about exclusive breastfeeding and breastfeeding self-efficacy on

mothers who had babies under 6 months in the work area of Puskesmas Pucang Sewu Surabaya (July, 2017).

Husband’s knowledge Breastfeedin

self-efficac

Total

h Moderate Low Ver

Low

f % f % f % f % Σ %

Goo

22 25.9 12 14.1 5 5.9 0 0 39 45.9

Moderate 11 12.9 13 15.3 10 11.8 1 1.2 35 41.2

Low 2 2.4 4 4.7 4 4.7 1 1.2 11 12.9

Total 35 41.4 29 34.1 19 22.4 2 2.4 85 100

earman rho test = 0.002. The coefficient correlation

(

)

= 0.338

Table 2: The correlation between husband’s attitude and breastfeeding self-efficacy on mothers with babies under 6 months

in the work area of Puskesmas Pucang Sewu Surabaya (July, 2017).

Husband’s attitude Breastfeedin

self efficac

Total

h Moderate Low Ver

Low

f% f%f% f% Σ %

Positive 33 38.8 20 23.5 0 0 0 0 53 62.3

Negative 2 2.4 9 10.6 19 22.3 2 2.4 32 37.7

Total 35 41.2 29 34.1 19 22.3 2 2.4 85 100

i S

earman rho

= 0.000. Koefisien korelasi

(

)

= 0.723

Husband Knowledge and Attitude Towards Mother’s Breastfeeding Self-Efﬁcacy

321

Table 1 shows that 22 mothers of 85 as

respondents (25.9%) who had high levels of

breastfeeding self-efficacy had husbands with good

knowledge about exclusive breastfeeding. Whereas

low breastfeeding self-efficacy was found in 4

mothers who had husbands with lack of knowledge

about exclusive breastfeeding (4.7%). The results of

statistical analysis using a Spearman rho correlation

test with significance level alfa <0.05 obtained p

value 0.002 with coefficient correlation (r) 0.338

meaning that there was a sufficient correlation

between husband knowledge and self-efficacy of

breastfeeding in mothers with infants aged 0-6

months.

Table 2 shows that 33 from 85 mothers with high

breastfeeding self-efficacy had husbands with

positive attitudes (38.8%), while 19 mothers with

low breastfeeding self-efficacy were found who had

husbands with negative attitudes about exclusive

breastfeeding (22.3%). The results of statistical

analysis using a Spearman correlation test obtained p

= 0.000 with a correlation coefficient (r) of 0.723

which means there is a strong correlation between

the husband's attitude with self-efficacy

breastfeeding in mothers with infants aged 0-6

months, the more positive the husband's attitude, the

better breastfeeding self-efficacy.

4 DISCUSSION

The better the knowledge possessed by the husband,

the higher the level of self-efficacy possessed by the

mother. Husbands who have a good knowledge of

breastfeeding can lead to a higher level of

understanding. Kong and Lee (2004) state that the

husband’s knowledge affects the support provided

by the husband when the mother breastfeeds her

baby. The increasing understanding of husbands

about breastfeeding can raise awareness for

husbands to be positive by supporting mothers to

breastfeed their babies (Bich & Cuong 2017). Thus,

affecting the psychological condition of the mother

and increasing self-confidence, and hence improving

a mother’s breastfeeding self-efficacy.

There are four sources that can affect a person's

level of self-efficacy, experience of success, other

people's experiences, verbal persuasion, and

physical-emotional circumstances (Dennis 2003).

Verbal persuasion could be defined as supporting

information that is communicated verbally by other

influential persons which states that a person has the

ability to do something (Dennis 2011). One of the

important influences in shaping the self-efficacy of a

mother is family, especially the husband. The family

is the smallest unit in the community where many

mothers spend time taking care of the baby so that

the family, especially the husband, has an important

role in providing support that can affect the

psychological condition of the mother while

breastfeeding her baby (Kusumaningrum et al.

2010). Information that will be used to provide

verbal persuasion to nursing mothers depends on the

knowledge of husbands who provide support

(Rumaseuw et al. 2018). The knowledge possessed

by husbands about exclusive breastfeeding can be

important for verbal persuasion of mothers who

breastfeed their babies.

A husband’s positive attitude has a significant

effect to improving breastfeeding self-efficacy in

mothers with infants aged 0-6 months. The source of

self-efficacy through verbal persuasion is used to

convince a person of their ability to perform a

particular task. People who are experience verbal

persuasion have the ability to better master the tasks

related to that persuasion and try harder to deal with

problems. The suggestion can contribute

significantly in improving self-efficacy (Dennis

2011).

Husbands become an important part in verbal

persuasion for breastfeeding mothers because it is

the closest person who can improve the physical and

psychological state of the mother (Kohan et al.

2016). This can be caused by the knowledge and

attitude factors of the husband (Rumaseuw et al.

2018). A husband’s positive attitude can affect the

level of a mother's self-efficacy through the source

of verbal persuasion. A husband’s positive attitude

can be demonstrated through the provision of

maternal support to always breastfeed the baby.

Positive attitudes shown by husbands will cause

positive emotions in mothers who are able to

increase the hormone oxytocin so that milk

production becomes more fluent because the mother

feels cared for and supported (Roesli 2008). This

stable emotional state can have an impact on

enhancing the mother’s self-efficacy while

breastfeeding her baby. The more the husband has a

positive attitude towards breastfeeding, the higher

the level of the mother’s self-efficacy during

breastfeeding.

The lack of a husband's role in the process of

breastfeeding the baby is due to cultural habits; one

is the division of roles in which the husband only

plays an obligatory part as the breadwinner and the

mother takes care of all household affairs including

the matter of breastfeeding (Bich & Cuong 2017).

While Roesli (2008) states that the husband can play

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

322

an active role in supporting the success of

breastfeeding the baby by being positive through the

provision of attention and assistance, and

encouraging the mother to continue to breastfeed her

baby because not infrequently mothers who

experience emotional and physical conditions are

less stable after delivery (Sari 2011). This can lead

to a reduction in the mother’s level of self-efficacy

in breastfeeding her baby. A husband’s positive

attitude can help to prevent a reduction in the level

of self-efficacy possessed by the mother.

5 CONCLUSION

Most of the husbands in this study had good levels

of knowledge and positive attitudes about exclusive

breastfeeding. This affects the high level of

breastfeeding self-efficacy in the mother, especially

regarding the aspect of the mother's belief in being

able to meet the needs of breastfeeding for infants

for 6 months.

The findings of this study indicate that it is very

important that health education about exclusive

breastfeeding be given continuously, not only to the

mother but also to the support system around the

mother, especially husbands, in order to create an

environment conducive to supporting exclusive

breastfeeding.

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