Correlation Between Breastfeeding Self-Efficacy and Sociocultural

Practices vs. Exclusive Breastfeeding in Children

Aged 6 Times 24 Months in Tengger Tribe

Safa Salsabila Audian Putri

, Lailatul Muniroh

and Hafifah Rahmi Indita

Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia

Research Group Center for Health & Nutrition Education, Counselling and Empowerment, Indonesia

Keywords: Toddlers, Exclusive Breastfeeding, Self-Efficacy, Family Support, Sociocultural Practices.

Abstract: Exclusive breastfeeding refers to the practice of feeding infants only breast milk for the first 6 months of life.

Several factors, including maternal, infant, and environmental influences, impact exclusive breasfeeding. This

study aimed to analyze the correlation between breastfeeding self-efficacy and sociocultural practices with

exclusive breastfeeding among children aged 6 to 24 months in the Tengger Tribe. The research employed an

analytical observational with case-control study design involving sample size of 57 respondents selected

through total sampling. The case group consisted of 29 nonexclusively breastfed mothers, while the control

group consisted of 28 exclusively breastfeeding mothers. Data collection included interviews using

questionnaires on mother’s characteristics, exclusive breastfeeding history, sociocultural practices, and

breastfeeding self-efficacy scale short form (BSES-SF). The study results revealed a higher level of

breastfeeding self-efficacy and sociocultural practices during breastfeeding among the control group.

Conversely, sociocultural practices during childhood were found to be higher in the case group. The study

indicated that sociocultural practices during the first 2 years of life (OR=0.13), and breastfeeding self-efficacy

(OR=2.93) were associated with exclusive breastfeeding in children aged 6-24 months. In conclusion, there

is a correlation between breastfeeding self-efficacy and sociocultural practices with exclusive breastfeeding

among children aged 6 to 24 months in the Tengger Tribe. Mothers who receive less information from family

members, engage in sociocultural practices during childhood, and have lower breastfeeding self-efficacy are

at a higher risk of not exclusively breastfeeding. Families should provide more support to breastfeeding

mothers, and healthcare workers should offer additional education on the risks of early complementary

feeding practices for children.

1 INTRODUCTION

Tengger Tribe is known for its strong cultural and

religious traditions ofHinduism, which profoundly

shapethe daily life of the people, including

breastfeeding and infant nutrition practices.Infants

withinthe Tengger Tribeencounter obstacles in

obtaining exclusive breastfeeding. Several

sociocultural nutrition practices, such as the provision

ofsugar water and mashed bananas to newborns,

affect mothers' understanding and concerns about

exclusive breastfeeding (Dyson, 2016). Furthermore,

the colostrum avoidance practicesdue to sociocultural

reasons or misconceptions and the dietary restrictions

on fish, chili, and green vegetables for breastfeeding

mothers also influence the patterns of exclusive

breastfeeding(Notoatmodjo, 2012).

Maternal knowledge of the benefits and

importance of exclusive breastfeeding plays a crucial

role in its success. Mothers with higherknowledge of

exclusive breastfeeding tend to practice more

consistently. However, research indicates that a

significant number of mothers in the Tengger Tribe

lack adequate knowledge about exclusive

breastfeeding and even doubt that breast milk alone is

sufficient to meet their babies’nutritional needs

(Bandura, 1997).

Family support, especially from spouses and

immediate family members, also performsa vital role

in the success of exclusive breastfeeding (WHO,

2018). Support in the form of information, practical

assistance, and emotional encouragement from the

family can help mothers overcome any breastfeeding

218

Putri, S. S. A., Muniroh, L. and Indita, H. R.

Correlation Between Breastfeeding Self-Efﬁcacy and Sociocultural Practices with Exclusive Breastfeeding in Children Aged 6 Times 24 Months in Tengger Tribe.

DOI: 10.5220/0012919800004564

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 218-224

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

challenges and ensure the continuation of exclusive

breastfeeding (Friedman, 2013).

Moreover, a psychosocial factor,namely

breastfeeding self-efficacy,also serves as a

contributory factor influencing the success of

exclusive breastfeeding. Mothers with highself-

efficacy are more likely to practice exclusive

breastfeeding and more easily overcome potential

barriers during the breastfeeding period (Dennis,

2003).

Consequently, the current study is expected to

identify factors contributing to the low coverage of

exclusive breastfeeding in The Tengger Tribe. The

presentresearch aims to understand the relationship

between maternal knowledge, family support,

breastfeeding self-efficacy, and

socioculturalpractices ofexclusive breastfeeding

among infants in the Tenggercommunity. The

findings of this study serve as a basis for designing

more effective programs and policies to increase

awareness and advocacy of exclusive breastfeeding.

Thus, it is hoped that the rate of exclusive

breastfeeding in The Tengger Tribe will rocket,

resulting in significant benefits for the health

growthand development of the infants in the region.

2 METHODS

A quantitative research method underpinned the

analytical observational designof this case-control

study. The research was conducted onTengger Tribe

mothers residing in Wonokitri Village, Tosari

District, Pasuruan Regency, East Java. The sample

size was 57 mothers, consisting of 28 in the exclusive

breastfeedinggroup (control) and 29 in the

nonexclusive breastfeeding group (case). The sample

comprised the whole population.

Data were collected through interviews using a

questionnaire to assess variables: exclusive

breastfeeding practices, breastfeeding self-efficacy,

and sociocultural nutrition practices. The collected

data were analyzed using a descriptive analysis

technique to present the characteristics of the

respondents. In addition, bivariate analyseswere

performed to explore the relationships between these

variables. Furthermore, a multivariate analysis was

also done to identify the influence each independent

variableexerts on the dependent variable.

This research yielded valuable insights intothe

relationship between breastfeeding self-efficacy,

sociocultural nutrition practices, and exclusive

breastfeeding practices among the Tengger Tribe

mothers in the research area. The findings revealedthe

factors influencing exclusive breastfeeding and

provided information to guide future interventions in

promotingbreastfeeding practices within the

community.

3 RESULTS

The research outcomesrevealed a multitude of

pertinent results that bear significance to the subjects

under investigation. These identified findings

encompasseddiverse insights, as outlined in Table 1.

Table 1: The Distribution of Children’s Characteristics

inWonokitri Village in 2022.

Children

characteristics

Exclusive

breastfeeding

Non-exclusive

breastfeeding

Age N % n %

6-12 months 10 35.7 8 27.6

13-24 months 18 64.3 21 72.4

Total 28 100 29 100

Gender N % n %

Male 11 39.3 14 48.3

Female 17 60.7 15 57.1

Total 28 100 29 100

Table 1 presents the statistical distribution of

children’s characteristics. The table summarizes data

on two key aspects: exclusive and non-exclusive

breastfeeding, categorized by age and gender. Inthe 6

to 12-monthage group, 35.7% of children were

exclusively breastfed, while 27.6% werenot

exclusively breastfed. A much more significant

percentage of distribution occurred in the 13 to 24

months age group;64.3% of childrenreceived only

breast milk,and 72.4% receivedany other foods or

fluids in addition to breast milk. Looking at the

gender distribution, 39.3% of boys received exclusive

breastfeeding, while 48.3% did not receive exclusive

breastfeeding. Among girls, 60.7% were exclusively

breastfed, and 57.1% were not exclusively breastfed.

These statistics provide insights into the prevalent

breastfeeding practices in the village, highlighting

variations in breastfeeding patterns based on age and

gender factors.

Correlation Between Breastfeeding Self-Efﬁcacy and Sociocultural Practices with Exclusive Breastfeeding in Children Aged 6 Times 24

Months in Tengger Tribe

219

Table 2: The Distribution of Parents’ Characteristics in

Wonokitri Village in 2022.

Parents

characteristics

Exclusive

breastfeeding

Non-exclusive

breastfeeding

Mothers’ age n % n %

<20 years 3 10.7 7 24.1

20-34 years 23 82.1 22 75.9

≥35 years 2 7.2 0 0

Total 28 100 29 100

Fathers’ education

Not going to school 1 3.6 1 3.4

Not completing

elementary school

3 10.7 3 10.3

Graduated from

elementary school

5 17.9 1 3.4

Graduated from

junior high school

13 46.4 14 48.3

Graduated from

senior high school

5 17.9 8 27.6

Graduated from

university

1 3.6 2 6.9

Total 28 100 29 100

Mothers’ education n % n %

Not completing-

elementary school

3 10.7

2 6.9

Graduated from

elementary school

3 10.7

2 6.9

Graduated from

junior high school

15 53.6

16 55.2

Graduated from

senior high school

6 21.4

6 20.7

Diploma/ bachelor 1 3.6

3 10.3

Total 28 100 29 100

Table 2 informs the distribution of

parents’characteristics. It outlines the percentages of

exclusive and non-exclusive breastfeeding based

onparents’age ranges and educational backgrounds.

The data reveals that mothers aged 20 to 34 had the

highest rates of exclusive breastfeeding (82.1%), and

those aged under 20 years had the lowest (10.7%).

Regarding fathers’education, junior high school

graduates had the highest exclusive breastfeeding

rates (46.4%), while those with no formal education

and having collegedegrees similarly had the lowest

(3.6%). Concerning mothers’education, junior high

school graduates had the highest exclusive

breastfeeding percentages (53.6%). These

interpretations provided a snapshot of the relationship

between parents’characteristics and breastfeeding

practices in Wonokitri Village.

3.1 The Relationship Between

Breastfeeding Self-Efficacy And

Exclusive Breastfeeding

The results indicated a positive

correlation,suggestingthat as confidence in

breastfeeding increased, so didthe practice of

exclusive breastfeeding. The odds ratio (OR) of 2.93

further supported these findings, implying that

mothers with higher confidence in breastfeeding were

2.93 times more likely to breastfeed exclusively than

those with lower self-confidence.

In this study, the majority of mothers in the

exclusive breastfeeding group had high breastfeeding

self-efficacy (60.7%). In contrast, most mothers who

did not practice exclusive breastfeeding had moderate

self-efficacy (58.6%). The results suggested that

breastfeeding self-efficacy occupied an essential role

in promoting the practice of exclusive breastfeeding.

It highlighted the importance of empowering and

supporting mothers to build their breastfeeding self-

efficacy, as this could significantly contribute to the

success of exclusive breastfeeding initiatives.

Therefore, healthcare providers should focus on

interventions to improve self-efficacy toraise

exclusive breastfeeding rates among new mothers in

the Tengger community.

This relationship is also explained in Table 3. The

table illustrates the distribution of exclusive and non-

exclusive breastfeeding among mothers based on the

breastfeeding self-efficacy level. The analysis of the

relationship between breastfeeding self-efficacy and

exclusive breastfeeding revealed interesting findings.

Mothers with high self-efficacy demonstrated a

significantly higher rate of exclusive breastfeeding

(60.7%) and a relatively lower percentage of non-

exclusive breastfeeding (34.5%).

In contrast, among mothers with medium

breastfeeding self-efficacy, the percentage of

exclusive breastfeeding dropped to 39.3%, while the

proportion of non-exclusive breastfeeding increased

to 58.6%.

ICSDH 2023 - The International Conference on Social Determinants of Health

220

Table 3: Relationship Between Breastfeeding Self-Efficacy

and Exclusive Breastfeedingin Wonokitri Village in 2022.

Mothers’brea

stfeeding

self-efficacy

Exclusive

reastfeedin

Non-exclusive

reastfeedin

n %

High 17 60.7

10 34.5

2.9

Moderate 11

39.3

17 58.6

Low 0

2 6.9

Total 28

100

29 100

Interestingly, no mother in the low self-efficacy

category practiced exclusive breastfeeding. Instead,

6.9% of mothers with low self-efficacy provided non-

exclusive breastfeeding.

These observations suggested a clear relationship

between breastfeeding self-efficacy and exclusive

breastfeeding practices. Mothers with higher

breastfeeding self-efficacy were more likely to

breastfeed their infants exclusively than those with

medium or low self-efficacy.

3.2 Relationship Between Sociocultural

Nutrition Practices and Exclusive

Breastfeeding

Based on the results of the analysis, the study

investigated the relationship between several

sociocultural factors and exclusive breastfeeding

among infants in the Tengger ethnic community. The

first factor examined was cultural practices during

childbirth. The findings indicated that cultural

practices during childbirth had an insignificant

influence on exclusive breastfeeding. The data did not

show any differences between the two groups,

suggesting that cultural practices during deliverydid

not play a role in determining exclusive breastfeeding

practices among the Tengger mothers.

The second factor explored was cultural practices

during breastfeeding. While a higher percentage of

mothers in the exclusive breastfeeding group

practiced sociocultural nutrition during

breastfeeding, the analysis impliedno significant

correlationbetween sociocultural practices and

exclusive breastfeeding.

Lastly, the present study also investigated cultural

practices during infancy. The data revealed that a

higher proportion of mothers in the non-exclusive

breastfeeding group practiced sociocultural nutrition

practices during infancy. The analysis demonstrated

a significant negative correlation between

sociocultural practices during infancy and exclusive

breastfeeding. The correlation coefficient of -0.473

suggested a relatively strong negative relationship

between the two variables. The odds ratio (OR) of

0.13 indicated that mothers practicing sociocultural

nutrition practices in their infant care were 0.13 times

less likely to achieve exclusive breastfeeding success

than those who did not follow such practices. Thus,

sociocultural nutrition practices in infant care were a

protective factor in achieving exclusive

breastfeeding.

Therefore, these findings highlighted a complex

interplay of sociocultural factors influencing

exclusive breastfeeding practices among Tengger

mothers. While some cultural practices during

breastfeeding and infancy showed associations with

exclusive breastfeeding, cultural practices during

childbirth did not demonstrate any significant impact

on exclusive breastfeeding rates. Understanding these

relationships helped to create targeted interventions

and support systems to promote exclusive

breastfeeding among the Tengger Tribe and other

similar cultural contexts.

After conducting a regression analysis, the results

revealed that the independent variable most strongly

associated with exclusive breastfeeding is the

sociocultural nutrition practices during infancy. On

the other hand, the family emotional support did not

emerge as the variable with the closest relationship to

exclusive breastfeeding sinceit lacked a descriptive

association with the dependent variable. This

relationship is also explained in the following tables.

Table 4: The Relationship Between Sociocultural Nutrition

Practices during Childbirth and Exclusive Breastfeeding in

Wonokitri Village in 2022.

Child birth

culture

Exclusive

reastfeedin

Non-exclusive

reastfeedin

n% n %

With cultural

influences

0 0 0 0

No cultural

influence

100 29 100

Total 28 100 29 100

Table 5: The Relationship Between Sociocultural Nutrition

Practices during Breastfeeding and Exclusive

Breastfeeding in Wonokitri Village in 2022.

Breastfeeding

culture

Exclusive

reastfeeding

Non-exclusive

reastfeeding

n% n %

With cultural

influences

17 60.7 15 51.7

No cultural

influence

11 39.3 14 48.3

Total 28 100 29 100

Correlation Between Breastfeeding Self-Efﬁcacy and Sociocultural Practices with Exclusive Breastfeeding in Children Aged 6 Times 24

Months in Tengger Tribe

221

Table 6: The Relationship Between Sociocultural Nutrition

Practices in Children Under Two and Exclusive

Breastfeeding in Wonokitri Village in 2022.

Infancy (under

two years old)

culture

Exclusive

Breastfeeding

Non-exclusive

reastfeeding

n % n %

With cultural

influences

8 28.6 22 75.9

0.13

No cultural

influence

20 71.4 7 24.1

Total

28 100 29 100

The provided tables presented the distribution of

exclusive breastfeeding and non-exclusive

breastfeeding among Tengger Tribe mothers in

Wonokitri Village, based on whether their

sociocultural nutrition practices during different

periods (childbirth, breastfeeding, and infancy) were

influenced by culture or not.

Regarding infant birth culture, it is evident that

mothers who were influenced by culture during this

period did not practice exclusive breastfeeding at all.

On the contrary, all mothers not influenced by culture

exclusively breastfed their infants. This indicates a

strong association between infant birth culture and

exclusive breastfeeding practices.

Looking at the relationship between breastfeeding

period culture and exclusive breastfeeding, mothers

whose breastfeeding practices were influenced by

culture had a higher percentage of exclusive

breastfeeding than those who were not.

For the infant period culture, the data indicates

that mothers not influenced by culture had a

significantly higher percentage of exclusive

breastfeeding than those affectedby culture.

4 DISCUSSION

The study establishes a strong link between

breastfeeding self-efficacy and exclusive

breastfeeding. Maternal confidence, a core aspect of

self-efficacy, emerges as pivotal (Dennis, 2003).

Self-efficacy is influenced by personal experiences

and societal feedback and impacts exclusive

breastfeeding outcomes (Bandura, 1997).

Challenges affecting self-efficacy are evident;

mothers stop breastfeeding due to perceptions of

breast milk insufficiency and social beliefs that

exclusive breastfeeding leavestheir babies hungry.

External pressures, such as family advocating

formula milk, hinder exclusive breastfeeding,

particularly within the Tengger Tribe.

Conversely, the success ofexclusive breastfeeding

practices stems from healthcare professionals’

recommendations and infants’a version to formula

milk. Such professional guidance acts as verbal

persuasion, augmenting maternal self-efficacy. These

findings align with Listiani’s study, corroborating the

relationship between breastfeeding self-efficacy and

exclusive breastfeeding (Listiani, 2021). Similarly,

Chinese research highlighted that low milk supply

erodes self-efficacy, while personal experiences and

external support enhance it (Li et al., 2022).

The present study also demonstrates a significant

association between sociocultural nutrition practices

during infancy and exclusive breastfeeding. Cultural

norms significantly influence breastfeeding practices.

Habits stemming from these norms affect decisions

and choices (Kasmini, 2012). Contradictory practices

during pregnancy and breastfeeding persist due to

beliefs and misconceptions. The earlyintroduction of

complementary feeding, driven by perceptions of

inadequate milk supply, is also evident, echoing

findings in Aceh and Indragiri (Safri & Putra, 2013;

Sari & Sari, 2022).

To end this discussion, the study emphasizes the

intricate interplay between breastfeeding self-

efficacy and sociocultural nutrition practices. It

highlights the pivotal role of maternal confidence and

cultural influences in shaping exclusive breastfeeding

behavior.

5 CONCLUSIONS

As addressed in the current research analysis, several

conclusions can be drawn. Firstly, the exclusive and

non-exclusive breastfeeding groups primarily consist

of male infants aged 13 to 24 months, with parents

having completed junior high school education,

working as farmers, and living belowtheregional

minimum wageincome.

Of the 57 infants in the Tengger ethnic community

in Wonokitrivillage, 28 received exclusive

breastfeeding. Most mothers in exclusive and non-

exclusive breastfeeding groups demonstrate good

knowledge of breastfeeding.

Both exclusive and non-exclusive breastfeeding

groups receive adequate emotional, instrumental, and

appraisalsupport from their families. The

informational family support for the exclusive

breastfeeding group isprimarilyhigh, but low in the

non-exclusive breastfeeding group.

The majority of mothers in the exclusive

breastfeeding group have high breastfeeding self-

efficacy, while most mothers in the non-exclusive

ICSDH 2023 - The International Conference on Social Determinants of Health

222

breastfeeding group have moderate breastfeeding

self-efficacy.

Furthermore, sociocultural practices during

childbirth are generally positive, and no significant

cultural influence is observed. During breastfeeding,

the most common practices arecolostrum avoidance

and dietary restrictions. Early complementary feeding

is the most common sociocultural practice during the

infant phase. During infancy, breastfeeding self-

efficacy and sociocultural nutrition practices

establish significant and moderately strong

correlations with exclusive breastfeeding.

Based on these findings, healthcare providers in

Wonokitri Village are advised to enhance education

for breastfeeding mothers and their families about the

importance of exclusive breastfeeding and the risks of

early complementary feeding.

ACKNOWLEDGEMENTS

We express our deep gratitude to the Tengger

community residing in Wonokitri Village, Tosari

District, Pasuruan Regency, East Java Province for

providing the supportive academic atmosphere

required to complete this research.

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