UTAUT Model: An Approach to Evaluate the Acceptance of Public

Perception on Standard Operating Procedures for Early Initiation of

Breastfeeding for Section Caesarea Patients

Ana Pujianti Harahap

, Aulia Amini

, Indriyani Makmun

and Linda Meliati

Midwife Profesional Education Study Program, Department Faculty of Health Sciences,

Universitas Muhammadiyah Mataram, Indonesia

Midwife Study Program, Polytechnic the Ministry of Health Mataram, Indonesia

Keywords: Early Initiation of Breastfeeding (EIBF), Standard Operating Procedure (SOP), Sectio Caesarea (SC).

Abstract: Sectio Caesarea (SC) is one of the obstacles to the implementation of early initiation of breastfeeding (EIBF)

so that it requires appropriate Standard Operating Procedures (SOP). SOP will always be related to the

perception of voluntary public acceptance, which public acceptance of EIBF SOP for SC patients requires an

evaluation approach that is able to investigate the determining factors. This study aims to analyze public

perception of EIBF SOP for SC patients. This study used evaluation research through survey method and

Unified Theory of Acceptance and Use of Technology (UTAUT) model design approach. This evaluation

model emphasized the four key constructs of UTAUT: Performance Expectations, Business Expectations,

Social Influences, and Facilitating Conditions as independent variables and the dependent variables under

study, namely interests and behavior. This research involved forty samples with accidental sampling

technique. Population this study employed mothers who have given birth through SC. The results indicated

that social influence can significantly influence the mother's interest in implementing EIBF SC in accordance

with the SOP, namely the p-value of < 0.005, which is 0,028. According to SOP, the effect of facilitating

conditions on respondents' behavior in carrying out EIBF SC found that the p-value < 0.005 was 0.042. Survey

research results, EIBF SOP for SC patients be accepted in public by considering social aspects and the

availability of supporting facilities. It is necessary to conduct feasibility tests related to EIBF SOP for SC in

further research.

1 INTRODUCTION

According to a United Nations Children's Fund

(UNICEF) report, there were 54 neonatal infant

deaths (aged 0-28 days) per 1,000 live births

worldwide in 2020. Infant Mortality Rate (IMR)

become still a health problem in Indonesia. In 2020,

the number of IMR in Indonesia reached 72.0% and

occurred at the age of neonate, 0-28 days which is

caused by IUD include asphyxia, infection,

congenital abnormalities, tetanus moratorium, and

others. In 2021, infectious diseases contributed to

death in children aged 29 days - 11 months.

Pneumonia and diarrhea are still the main problems

causing 73.9% of mortality (pneumonia) and 14.5%

(diarrhea). One of the indicators carried out by the

https://orcid.org/0009-0000-1441-5707

Indonesian government to reduce the risk of mortality

in neonatal period children, which is 6-48 hours after

birth, is the First Neonatal Coverage. Services

provided include newborn care counselling, exclusive

breastfeeding, K vitamin, and hepatitis B. Early

Initiation of Breastfeeding (EIBF) is the first step

taken for the success of exclusive breastfeeding

(Kemenkes RI, 2020).

Early initiation of breastfeeding helps babies get

the first milk, namely colostrum. Early initiation of

breastfeeding (EIBF) can stimulate immunoglobulins

and lymphocytes found in colostrum to prevent

pathogenic infections during normal intestinal

maturation to protect infants from diarrhea.

Moreover, early initiation of breastfeeding can also

prevent hypothermia in newborns (Exavery et al.,

Harahap, A. P., Amini, A., Makmun, I. and Meliati, L.

UTAUT Model: An Approach to Evaluate the Acceptance of Public Perception on Standard Operating Procedures for Ear ly Initiation of Breastfeeding for Section Caesarea Patients.

DOI: 10.5220/0012898300004564

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 5th International Conference on Social Determinants of Health (ICSDH 2023), pages 24-29

ISBN: 978-989-758-727-6; ISSN: 2975-8297

2015). In Indonesia, EIBF in 2020 reached 66.06%.

In the West Nusa Tenggara (NTB) region, the

implementation of EIBF amounted to 86.5%. The

method of delivery with SC is one of the factors that

can affect the implementation of EIBF. Delivery by

Cesarean Section affects early initiation of

breastfeeding by 0.47 times higher than normal

delivery. Obstacles to SC delivery include having an

anesthetic effect, pain due to SC injuries, discomfort

in the mother, and lack of role of a team of health

workers (pediatricians, obstetricians, gynecologists,

and midwives) (Nurkholifa, Pamungkasari and

Prasetya, 2021). This research aligns with the

research by (Nurkholifa et al., 2021), which shows

that mothers who have just given birth do not have

autonomy in carrying out EIBF in the first hour of

birth. This is because they must follow procedures for

newborns carried out by the hospital and medical

teams to assist in the delivery process. Hence, they

need SOP in implementing early initiation of

breastfeeding for SC patients.

Based on data obtained from the West Nusa

Tenggara provincial general hospital, data on the

number of patients who gave birth with SC in 2017

was 288 (88%) out of a total of 327 deliveries. Of the

patients who give birth through SC, most never have

EIBF. Patients who gave birth normally were 39

people (22%). Data obtained from the regional

general hospital of West Nusa Tenggara province,

also a referral hospital for West Nusa Tenggara

province, showed that the number of deliveries with

SC in 2017 was 1,022 people. The operational

standards for early initiation of breastfeeding in SC

patients should prioritize patient comfort (Retno Dwi

Andayani et al., 2017). Support from various parties

is required for implementing EIBF, from

husbands/families, health workers, and maternity

hospitals, especially facilities (Retno et al., 2016).

Before doing EIBF, SC patient needs to be given

information on its implementation (Lyellu et al.,

2020) (Ara et al., 2018). This study assessed public

perception of EIB SOP for SC, used as input for

public acceptance. Previous research on obstacles to

early initiation of breastfeeding implementation in

post-sectio caesarea patients found that standard

operating procedures still needed to be created. From

the results of the description above, this study aims to

analyze the "public perception of EIB SOP for SC

patients in Mataram City area”.

Table 1: Hypothesis.

H1 There is an influence of Performance

Expectations on the interest of mothers

to carry out Standard Operational

Procedure for Early Initiation of

Breastfeeding for Sectio Caesarea

atients

H2 There is an influence of Business

Expectations on the interest of mothers

to carry out Standard Procedure for Early

Breastfeeding Initiation for Sectio

Caesarea patients

H3 There is an Influence of Social on the

mother's interest to carry out Standard

Procedure for Early Breastfeeding

Initiation for Sectio Caesarea patients

H4 There is an influence of Facilitating

Conditions on the behavior of mothers to

carry out Standard Procedure for Early

Breastfeeding Initiation of Sectio

Caesarea patients

2 MANUSCRIPT PREPARATION

2.1 Design

This type of research is evaluation research through a

survey method approach. Research design used the

Unified Theory of Acceptance and Use of

Technology (UTAUT) model. This evaluation model

emphasized the four keys of UTAUT constructs:

Performance Expectations, Business Expectations,

Social Influence, Facilitating Conditions as

independent variables, and Interests and Behaviors as

dependent variables. The samples in the study were

as many as 40 samples. The sample and population in

this study was mothers who had given birth through

SC delivery method in the Mataram City Area.

Analysis used Chi Square, and multiple regression

analysis. The independent variables studied

Performance Expectations, Business Expectations,

Social Influences, and Facilitating Conditions. The

dependent variables were Interest and Behavior.

2.2 Measurement

The data collection method uses questionnaires and

was distributed with Google Form. The data scale

used the Likert scale, with four instrument results:

Strongly Agree, Agree, Disagree and Strongly

Disagree. The questionnaire used has been tested for

validity and reliability using the Pearson Product

UTAUT Model: An Approach to Evaluate the Acceptance of Public Perception on Standard Operating Procedures for Early Initiation of

Breastfeeding for Section Caesarea Patients

Moment and Cronbach's Alpha tests. The

questionnaire has been declared valid and reliable

with the result of the value of rcount> rtable which is

> 0.312. The significant value of 5% is < 0.05.

2.3 Sample

The study included forty participants, and the

sampling method used Popability Sampling with

Stratified random sampling. The quora for each

Puskesmas (Community Health Center) in the

Mataram City area was determined based on

proportion, and only four Puskesmas providing

service (PONED) were selected to ensure

representative samples. The sampling technique

employed was accidental sampling. The inclusion

criteria involved mothers who had undergone

Caesarean Section (SC) delivery in Mataram City

area within the last five years and were willing to

participate as respondents. Exclusion criteria

comprised mothers whose babies had complications,

such as asphyxia, low birth weight, congenital

abnormalities, and mothers with comorbidities such

bleeding, PEB, and infection.

3 RESULT

3.1 Characteristics of Respondents

Table 2: Frequency Distribution Characteristics of Mrs X

as Sectio Caesarea Respondents.

No Characteristic F %

1. Age

• 20-35 27 67,5

• <20 and >35 years 13 32,5

Total 40 100

2. Experience

• EIBF

• Never EIBF

67,5

32,5

Total 40 100

In Table 1 the respondents in this study are mothers

who had given birth through the Sectio Caesarea

delivery method in Mataram City Area in the last five

years in 2022, with a sample of 40 respondents. The

characteristics of respondents used in this study are

age and experience. The age characteristics of most

respondents are respondents aged 20-35 years, of 27

respondents (67.5%). Meanwhile, the age at risk in

mothers aged < 20 years and >35 years as many as 13

respondents (32.5%). The characteristics of

respondents based on experience obtained most of the

experience of mothers who have carried out EIBF

amounted to 27 respondents (67.5%), and those who

have never had experience EIBF as many as 13

respondents (32.5%).

3.2 Performance Expectations,

Business Expectations, Social

Influences, Facilitating Conditions,

Interests, and Behaviors Standard

Procedures for Early Initiation for

Breastfeeding of Sectio Caesarea

Patients

Table 3: Distribution of respondents based on Standard

Performance Expectations of EIBF for SC Patients.

Performance Expectations Frequency %

Beneficial 26 65

Non Beneficial 14 35

Business Expectations Frequency %

Easy to Implement 30 75,0

Difficult to Implement 10 25,0

Social Influence Frequency %

Need social support 21 52,5

No need social support 19 47,5

Facilitating Conditions Frequency %

Certain 26 65,0

Not sure 14 35,0

Interest Frequency %

Interested 24 60,0

Not interested 16 40,0

Total 40 100

Table 2 shows that respondents' performance

expectations of EIBF SOP for SC patients mostly

have a perception of more useful, of 26 respondents

(65%). Respondents' business expectations of EIBF

SOP for SC patients mostly have an easy perception

to be implemented by 30 respondents (75%). Social

influence, with most respondents' perceptions stated

that they needed social support by 21 respondents

(52.5%). Furthermore, in the aspect of conditions that

facilitate most respondents have a confident

perception to follow EIBF based on EIBF SOP for SC

patients by 26 respondents (65%). Then, regarding

respondents' interest in being willing to follow

instructions according to EIBF SOP for SC patients,

most of the respondents are interested as 24

respondents (60%).

The findings in Table 2 show that public

perception of SOP EIBF for SC, when assessed from

Performance Expectations, Business Expectations,

Social Influences, Facilitating Conditions, Interests

and Behaviors, is mostly more than 50% acceptance.

ICSDH 2023 - The International Conference on Social Determinants of Health

The ease of respondents in carrying out Early

Initiation of Breastfeeding in labour with the Sectio

Cesarea method can be assessed from respondents'

Performance Expectations of the benefits and

:advantages obtained from the Standard Operating

Procedure for Early Breastfeeding Initiation

Implementation of Sectio Caesarea patients. EIBF

Benefits for mothers and their babies include

increasing the baby's chances of obtaining colostrum,

supporting the success of exclusive breastfeeding,

strengthening the mother-baby relationship, and

improving the baby's health (WHO, 2017),

(Padmavathi et al., 2014). The first milk or colostrum

obtained when carrying out EIBF has exceptional

nutritional and health value for infants because it

contains fat-soluble proteins, vitamins, and anti-

bacterial ingredients. Regarding its convenience,

business expectations refer to how easily a person

uses a system (Darmansyah & Yosemin Karnvati,

2017). Most respondents, as many as 30 (75%), think

that SOP are easy to implement. This shows

respondents will be comfortable carrying out EIBF in

labour with SC. Patient discomfort is one of the

influencing factors in the implementation of EIBF.

The mother's ability to carry out EIBF is seen from

comfort during the implementation. The comfort

experienced by mothers can facilitate the mechanism

of removing breast milk (Retno et al., 2016), (Wu et

al., 2018).

3.3 The Effect of Performance

Expectations, Business

Expectations, and Social Influence

on Community Interest in Using

EIBF SOP for SC Patients

In table 4 of the three variables, namely performance

expectations, business expectations, and social

influence, only social influence factors affect the

mother's interest in implementing EIBF in accordance

with the SO EIBF P for SC patients with a p value

result of < 0.05, which is 0.028.

Table 4: Effect of Performance Expectations, Business

Expectations, Social Influence on Community Interest

using EIBF SOP for SC patients.

3.4 The Effect of Facilitating

Conditions on Community

Behaviour Using EIBF SOP for SC

Patients

Table 5: Effect of Facilitating Conditions on Community

Behavior using EIBF SOP.

In table 5, it is found that the facility variable has an

influence on people's behavior to use the EIBF SOP

for SC. The p value < 0.05, which is 0.042. This

shows that there is a relationship between facilitating

conditions and maternal behavior in using EIBF SOP.

4 DISCUSSION

In this study, the mothers' age is mainly at

reproductive age 27 respondents (67.5%), which

means that the time is right to get pregnant and give

birth (Table 1). According to Retno's research (2017),

of 282 mothers who gave birth with the SC method,

70% aged 20 and 35 years old. At this age, the mother

is included in the early adult stage, where the mother

can determine the willingness to action that was taken

on her (Rudi Zalukhu, 2015) included in following

UTAUT Model: An Approach to Evaluate the Acceptance of Public Perception on Standard Operating Procedures for Early Initiation of

Breastfeeding for Section Caesarea Patients

action instructions by the SOP for EIBF

implementation for SC patients in this study. Based

on respondents' experience with a history of

childbirth before having carried out EIBF, more than

50%, of 27 respondents (67.5%) have had EIBF in

their previous labour history. This shows that

respondents have at least received information related

to implementing EIBF. Besides the health workers,

peers can also obtain information (Ara et al., 2018).

Of the ten steps of breastfeeding success, one of them

is the provision of information carried out by health

workers about the benefits and management of

breastfeeding, including the implementation of EIBF

(WHO, 2017), (Lyellu et al., 2020), (Syukur &

Purwanti, 2020).

The study's results based on the social influence

on EIBF SOP of SC patients did not show a

significant difference between the categories of need

for social support and not requiring support. Social

support in this study included family, husband, and

health worker. Mothers who give birth with the SC

delivery method have been unable to give a

significant role because of the influencing conditions.

Mothers should receive practical support to start,

establish, and manage general breastfeeding

difficulties (WHO, 2017), (Getaneh et al., 2021).

Research in Tanzania states that implementing EIBF

on patient SC in Hospital Dear Mother and the

support of health workers in the operating room

primarily determined a child patient's position

success during EIBF Sustainability. Besides, it is

supported by healthcare provider facilities (Lyellu et

al., 2020) (Jerin et al., 2020), (Jerin et al., 2020),

(Sampieri et al., 2022). The support of health workers

in the operating room primarily determines

sustainability and it is supported by healthcare

provider facilities (WHO, 2017), (Retno et al., 2016).

In this study, respondents' interest in carrying out

EIBF in the SC delivery method according to the SOP

is relatively high, about 24 respondents (60%). The

research results by (Padmavathi et al., 2014) show

that EIBF in the SC delivery method has several risk

factors, including age, religion, family income, and

parity. This research aligns with research by (Verret-

Chalifour et al., 2015) which states that maternal

interest is very influential in implementing EIBF, as

much as 95%. The behavior in this study is how

respondents respond in carrying out every action

taken in implementing EIBF by the SOP for

implementing EIBF in SC patients. The results

showed that most participants responded positively to

SOP, of 25 respondents (62.5%). This states that

respondents can accept SOP to be implemented.

Based on research by (Nurkholifa, Pamungkasari and

Prasetya, 2021), childbirth with the SC method can

still be carried out and is more likely to be carried out

immediately. According to (WHO, 2017), EIBF is

carried out immediately after the baby is born, and

skin contact between mother and baby can be carried

out (Nguyen et al., 2021),(Dzulham et al., 2020).

The analysis results in Table 3 are variables that

most influence the mother's interest in carrying out

the Sectio Caesarea Early Initiation of Breastfeeding

by the Standard Operating Procedures, namely social

influences. This influence is the support from

husbands, family, and health workers. Most social

influences that require social support are interested in

running EIBF by the SOP 16 respondents (40%).

Based on the research results by (Lyellu et al., 2020)

in Tanzania, the implementation of EIBF in SC

patients at the Mother and Child Care Hospital is

supported by various things, including support from

health workers. The team of health workers must be

align by providing support through services during

the EIBF implementation. The preparation stage

before EIBF includes the EIBF process and post-

EIBF implementation to support success in

breastfeeding (Exavery et al., 2015). The results of

the analysis in Table 4 indicate the effect of the

Independent variable on the Dependent variable,

namely the influence of facilitating conditions on

people's behavior using the EIBF SOP for SC patients

in the Mataram City Region in 2022.

5 CONCLUSIONS

Most respondents aged 20-35 years amounted to 27

respondents (67.5%). Social influence can

significantly affect mothers' interest in carrying out

EIBF SC with a p-value of < 0.005, of 0.028.

According to SOP, the effect of facilitating conditions

on respondents' behavior in carrying out EIBF SC

found that the p-value < 0.005 is 0.042. From the

results of the study, it is recommended to conduct a

feasibility test on EIBF SOP of SC.

ACKNOWLEDGEMENTS

Universitas Muhammadiyah Mataram supported this

work.

ICSDH 2023 - The International Conference on Social Determinants of Health

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UTAUT Model: An Approach to Evaluate the Acceptance of Public Perception on Standard Operating Procedures for Early Initiation of

Breastfeeding for Section Caesarea Patients