Perceptions of northeast Thai breastfeeding mothers regarding facilitators and barriers to six-month exclusive breastfeeding: focus group discussions

Thepha et al. International Breastfeeding Journal (2018) 13:14 DOI 10.1186/s13006-018-0148-y RESEARCH Open Access Perceptions of northeast Thai breastfeeding mothers regarding facilitators and barriers to six-month exclusive breastfeeding: focus group discussions Thiwawan Thepha1* , Debbie Marais2, Jacqueline Bell3 and Somjit Muangpin4 Abstract Background: The 6-month exclusive breastfeeding rate in the Northeast region of Thailand has recently significantly decreased in contrast to all other regions in Thailand. The factors that have influenced this decrease remain unknown. Hence, it is suggested that an investigation into factors that could improve or hinder EBF for 6 months in Northeast Thailand may be required to inform the development of relevant interventions to improve this situation. This study aimed to identify perceived facilitators and barriers to providing exclusive breastfeeding for 6 months in Northeast Thailand among breastfeeding mothers. Methods: Six focus group discussions were conducted with a total of 30 mothers aged 20 to 40 years who had children aged between 4 and 6 months and were currently breastfeeding or had breastfeeding experience. Participants were recruited through self-selection sampling from Khonkaen hospital (urban), Numphong hospital (peri-urban) and private hospitals (urban) in Khonkaen, Thailand. Thematic analysis was employed to analyse the data. Results: Five main themes, with 10 sub-themes, were identified as either facilitators (+) or barriers (−), or in some cases, as both (+/−). Breastfeeding knowledge, perceptions, maternal circumstances, support, and traditional food were the main identified themes. Mother’s breastfeeding knowledge, intention to breastfeed, and social media were perceived as facilitators. Perceptions, employment, and formula milk promotion were perceived as barriers. Family, healthcare, and traditional food were perceived as both facilitators and barriers. The perception that social media was a way to access breastfeeding knowledge and support mothers in Northeast Thailand emerged as a new facilitating factor that had not previously been identified in Thai literature relating to facilitators and barriers to exclusive breastfeeding. Intention to breastfeed, family support, healthcare support and traditional food were mentioned by all groups, whereas mothers from urban areas specifically mentioned mother’s breastfeeding knowledge, social media and employment sub-themes. Only mothers from the peri-urban area mentioned formula milk promotion and only mothers who had delivered in public hospitals mentioned the perceptions sub-theme. Conclusions: Knowledge about these facilitators and barriers may inform the design and development of specific and relevant interventions to improve the 6-month exclusive breastfeeding rate in the Northeast region of Thailand and be useful in other contexts. Social media emerged as a newly perceived facilitator in the Thai context and may be a useful inclusion in a 6-month exclusive breastfeeding intervention model. Keywords: Facilitator, Barrier, Six-month exclusive breastfeeding, Social media, Northeast Thailand, Focus group discussion * Correspondence: 1 Department of Advanced Midwifery, Faculty of Nursing, Khonkaen University, 123 Mittapap Road, Khonkaen, Thailand Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Thepha et al. International Breastfeeding Journal (2018) 13:14 Background Since 2001, 6 months of exclusive breastfeeding (6-month EBF) has been recommended [1] and a global target of 50% by 2025 has been set [2, 3]. The National Economic and Social Development Board of Thailand (2012) set a goal of 6-month EBF (30% of infants) at the 11th National Economic and Social Development Plan of Thailand 2012–2016 [4]. It can clearly be seen that, both internationally and in Thailand, 6-month EBF has been identified as a priority and is of public health concern. In Thailand, since 1989, many EBF initiatives, such as setting the National Breastfeeding Strategy, the BabyFriendly Hospital Initiative, the Thai Breastfeeding Center Foundation, the Family Relationship Project, and subscribing to the International Code of Marketing for Breastmilk Substitutes, have aimed to protect, promote and support 6-month of EBF [5–7]. However, despite these initiatives, the 6-month EBF rate in Thailand dropped from 15.0% in 2009 to 12.3% in 2013 and is far from reaching the national target [8, 9]. Among the five regions of Thailand, the 6-month EBF rate in the Northeast region was the only one to show a significant decrease from 26.9% in 2009 to 13.8% in 2013, while in all the other regions the rate increased slightly [8, 9] (Table 1). Therefore, the Northeast region of Thailand should be of specific concern and a focus area for interventions that aim to improve six-month EBF rates. Reasons for the drop in the rate of 6-month EBF in Thailand have not been identified. However, the facilitators and barriers to EBF in Thailand have been reviewed [10] and show that factors related to the mother, family support, situation and social context, infant factors, and healthcare profession and healthcare service influence EBF in Thailand. To inform the design and development of effective and relevant interventions for this region, it is important to explore the perceptions of mothers regarding specific facilitators and barriers that may be impacting on mothers’ ability to continually exclusively breastfeed for 6 months. Consequently, the aim of this study was to explore the perceptions of Northeast Thai breastfeeding mothers regarding facilitators and barriers to 6-month EBF. Methods Khonkaen province was purposively selected for the study setting as it includes one of the major cities of Northeast Thailand. Khonkaen is approximately 400 km north of Bangkok with a population of nearly 2 million Page 2 of 10 people and a birth rate of 11.84 per 1000 people in 2012 [11]. Mothers were recruited from three different settings within Khonkaen province to include mothers from urban and peri-urban areas as well as mothers who had delivered at public and private hospitals. The catchment areas were an urban public tertiary hospital (Well Baby Out Patient Department, Khonkaen Hospital), a peri-urban public secondary hospital about 35 km north of Khonkaen (Numphong hospital), and three privat (...truncated)