Knowledge, attitudes and practices of men in a South African rural community in relation to exclusive breastfeeding

South African Family Practice, Volume 64, No. 1, Year 2022

Interprétation

Background: Several lifelong maternal, child and societal health benefits have been associated with exclusive breastfeeding (EBF). However, despite all the potential advantages, EBF rates have been consistently low in developing countries, including South Africa. It has been suggested that the knowledge, attitudes and practices of male partners in relation to EBF are amongst the important factors that contribute to the success of EBF practices. Hence, the aim of this study was to determine the knowledge, attitudes and practices of men in Botshabelo, Free State province, South Africa, regarding EBF. Methods: This study was designed as a cross-sectional analytical study that utilised a structured questionnaire administered to 200 adult men attending the outpatient department of a district hospital, in the Free State province, South Africa. Results: The majority (n = 83; 41.5%) of participants had poor knowledge of EBF but reported positive attitudes (n = 153, 76.5%) and good practices (n = 151, 75.5%) towards EBF, respectively. Age, levels of education, employment status, marital status and whether the participant accompanied his partner to the antenatal clinic were associated with adequate knowledge, positive attitudes and good practices in relation to EBF (p < 0.05). Conclusion: The study revealed a suboptimal level of knowledge on EBF in men in Botshabelo. Most men had positive attitudes and reported good practices in relation to EBF. Our findings highlight the need for targeted community-based intervention programmes directed to educating and promoting positive social and cultural change in relation to EBF amongst men in Botshabelo. This study was designed as a cross-sectional analytical study. The target population consisted of adult males (≥ 18 years) who attended the outpatient department of a district hospital, Free State, South Africa. The hospital is a public hospital in a community of about 181 712 people.15 The hospital serves as the referral centre for 13 primary healthcare clinics. An average of 70 patients are seen daily at the outpatient department, 21% (n = 15) of whom are adult males. A convenience sampling method was adopted for this study, and data were collected twice a week. At the time of this study, the estimated number of men ≥ 18 years old living in Botshabelo was N = 26 000 (sample frame).15 The estimated minimum sample size was calculated as n = 268 (at 90% confidence level [CL] and margin of error [MOE]: 0.05).16 The study population consisted of consenting men who were at least 18 years old, irrespective of whether they were married or had children. A colour-coded sticker system was used to ensure that no eligible male participant could participate in the study more than once (i.e. a colour-coded sticker was placed on a participant’s folder once the participant had completed the questionnaire). The development of the structured questionnaire that was used in this study was informed by findings from prior studies,17,18 after a thorough literature review and content analysis. Search terms, such as EBF, adult males and exclusive breast-feeding and knowledge of and attitudes of men towards EBF, were used to search for relevant articles during the literature review process. The databases used to access articles were Google Scholar, MEDLINE, PubMed, CINAHL, SABINET, Science Direct and Directory of Open Access Journals. Concepts were identified to formulate closed-ended questions, which were answered using an adapted Likert-scale ranking. The questionnaire was self-administered, made available in three languages commonly spoken in the local community (i.e. English, Sesotho and Setswana) and distributed manually. The self-administered questionnaire comprised five distinct sections. Section A of the questionnaire obtained data on participants’ eligibility to participate in the study. The demographic and socio-economic details of the participants were captured in Section B of the questionnaire. Questions in Section C assessed participants’ knowledge of aspects of EBF, whilst data on participants’ attitudes and practices regarding EBF were captured in Sections D and E, using a five-point Likert scale, that is, strongly agree, agree, not sure, strongly disagree and disagree. Prospective participants were briefed about the study by one of the researchers (O.M.M.). Participants were informed that they could choose to participate in the study, or not, and that failure to participate would not compromise their treatment at the hospital. A detailed explanation about the study (also contained in an information leaflet) was given to participants who gave verbal consent. Participants were also informed that implied consent was being given by agreeing to complete the questionnaire. One of the researchers (O.M.M.) and/or a research assistant assisted participants who were incapable of completing the questionnaire on their own. Participants were instructed to drop the completed questionnaire in a sealed box situated in the front desk at the outpatient department. O.M.M. emptied the box daily and all completed questionnaires were locked in a safe. Data from the questionnaires were inputted on a Microsoft Excel sheet on a computer with password protection. The questionnaire had no trace of identification, to ensure that data were collected anonymously. The study was conducted over a period of two months (August 2020 – September 2020). We performed a pilot study before the official start of data collection to test the suitability of the study design and methods, the chosen data collection method and the overall structure of the questionnaire. The pilot study consisted of 10 eligible adult men who were selected using convenient sampling. No changes to the structured question resulted from the pilot study. The estimated time needed to complete the questionnaire was 30 min. Questionnaire items were scored to determine the percentages of correct or expected and incorrect or unexpected responses. The scoring range of the knowledge questions was 10 (maximum) to 0 (minimum). A score of ≥ 70% (7/10) was considered ‘adequate knowledge’, scores between 50% (5/10) and 60% (6/10) were considered ‘average knowledge’ and a score of ≤ 40% (4/10) was regarded as ‘poor knowledge’. Attitude towards EBF was assessed by obtaining participant responses to 16 items using a five-point Likert scale. For the purpose of this study, ‘strongly agree’ and ‘agree’ responses were summed as ‘agree’, whilst the ‘strongly disagree’ and ‘disagree’ responses were summed as ‘disagree’. The expected responses to the attitude items 1–8 were ‘disagree’, whilst the expected responses for items 9–16 were ‘agree’. There were 10 items in the practice section, and participants’ responses were obtained using a five-point Likert scale. The five-point Likert scale was collapsed to three, that is, ‘Agree’, ‘Disagree’ and ‘Not sure’. Participants who scored ≥ 50% (≥ 5/10) were regarded as having ‘good’ EBF practices, and those who scored < 50% (< 5/10) were considered as having ‘poor’ EBF practices. The expected response for practice items 3 and 4 in the practice section was ‘disagree’, whilst the expected response for the other items in this section was ‘agree’. The data were analysed using Statistical Analysis System (SAS) version 9. Descriptive statistics (e.g. medians) was used for continuous variables, whilst frequencies and percentages were computed for categorical data. The associations between demographic data and knowledge, attitudes and practice scores were assessed using chi-square or Fisher’s exact tests. A p-value of < 0.05 was taken to be significant. The validity of the structured questionnaire was examined by comparing the questionnaire elements with those of previous and similar studies, as well as by conducting the pilot study. A departmental evaluation committee, consisting of consultant family physicians and a biostatistician, subjected the questionnaire to review and approval.19 The Health Sciences Research Ethics Committee of the University of the Free State (UFS-HSD2020/0324/2508) granted approval for the study. Further approval was obtained from the Head of the Free State Department of Health.

Résumé de l’IA

Study Justification:

This study aimed to investigate the knowledge, attitudes, and practices of men in a South African rural community regarding exclusive breastfeeding (EBF). The justification for this study is that EBF has numerous health benefits for mothers, children, and society as a whole. However, EBF rates in developing countries, including South Africa, have remained low. It has been suggested that the knowledge, attitudes, and practices of male partners play a significant role in the success of EBF. Therefore, understanding the perspectives of men in relation to EBF is crucial for developing targeted interventions and promoting positive social and cultural change.

Highlights:

– The majority of men in the study had poor knowledge of EBF but reported positive attitudes and good practices towards EBF.
– Age, education level, employment status, marital status, and accompanying their partner to the antenatal clinic were associated with better knowledge, attitudes, and practices regarding EBF.
– The findings highlight the need for community-based intervention programs that specifically target men in Botshabelo, aiming to educate and promote positive social and cultural change in relation to EBF.

Recommendations:

Based on the study findings, the following recommendations can be made:

1. Develop targeted community-based intervention programs: These programs should focus on educating men about the benefits of EBF and addressing misconceptions or lack of knowledge.
2. Promote positive social and cultural change: Efforts should be made to challenge societal norms and promote a supportive environment for EBF among men in Botshabelo.
3. Involve men in antenatal care: Encourage men to accompany their partners to antenatal clinics, where they can receive information and support regarding EBF.

Key Role Players:

To address the recommendations, the following key role players are needed:

1. Healthcare professionals: They can provide education and counseling to men regarding EBF and its benefits.
2. Community leaders: They can promote and support community-based intervention programs and advocate for positive social and cultural change.
3. Non-governmental organizations (NGOs): NGOs can collaborate with healthcare professionals and community leaders to implement intervention programs and provide resources for education and support.

Cost Items for Planning Recommendations:

While the actual cost will depend on the specific interventions and strategies implemented, the following cost items should be considered in planning the recommendations:

1. Development and printing of educational materials: This includes brochures, posters, and other resources to educate men about EBF.
2. Training and capacity building: Healthcare professionals and community leaders may require training to effectively deliver education and support services.
3. Program implementation and coordination: This includes costs associated with organizing community-based intervention programs, such as venue rental, transportation, and logistics.
4. Monitoring and evaluation: Resources should be allocated to assess the effectiveness of the intervention programs and make necessary adjustments.
Please note that the provided cost items are general considerations and may vary depending on the specific context and resources available.

Force de la preuve

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a cross-sectional analytical study with a sample size of 200 adult men. The study utilized a structured questionnaire to assess the knowledge, attitudes, and practices of men in relation to exclusive breastfeeding (EBF) in a South African rural community. The study found that while the majority of participants had poor knowledge of EBF, they reported positive attitudes and good practices towards EBF. The study also identified several factors associated with adequate knowledge, positive attitudes, and good practices in relation to EBF. The evidence in the abstract is based on a specific population and provides insights into the knowledge, attitudes, and practices of men in relation to EBF in the community. However, the study design is cross-sectional, which limits the ability to establish causality. To improve the strength of the evidence, future research could consider using a longitudinal design to assess changes in knowledge, attitudes, and practices over time. Additionally, expanding the sample size and including a more diverse population could enhance the generalizability of the findings.

Abstrait

This study was designed as a cross-sectional analytical study. The target population consisted of adult males (≥ 18 years) who attended the outpatient department of a district hospital, Free State, South Africa. The hospital is a public hospital in a community of about 181 712 people.15 The hospital serves as the referral centre for 13 primary healthcare clinics. An average of 70 patients are seen daily at the outpatient department, 21% (n = 15) of whom are adult males. A convenience sampling method was adopted for this study, and data were collected twice a week. At the time of this study, the estimated number of men ≥ 18 years old living in Botshabelo was N = 26 000 (sample frame).15 The estimated minimum sample size was calculated as n = 268 (at 90% confidence level [CL] and margin of error [MOE]: 0.05).16 The study population consisted of consenting men who were at least 18 years old, irrespective of whether they were married or had children. A colour-coded sticker system was used to ensure that no eligible male participant could participate in the study more than once (i.e. a colour-coded sticker was placed on a participant’s folder once the participant had completed the questionnaire). The development of the structured questionnaire that was used in this study was informed by findings from prior studies,17,18 after a thorough literature review and content analysis. Search terms, such as EBF, adult males and exclusive breast-feeding and knowledge of and attitudes of men towards EBF, were used to search for relevant articles during the literature review process. The databases used to access articles were Google Scholar, MEDLINE, PubMed, CINAHL, SABINET, Science Direct and Directory of Open Access Journals. Concepts were identified to formulate closed-ended questions, which were answered using an adapted Likert-scale ranking. The questionnaire was self-administered, made available in three languages commonly spoken in the local community (i.e. English, Sesotho and Setswana) and distributed manually. The self-administered questionnaire comprised five distinct sections. Section A of the questionnaire obtained data on participants’ eligibility to participate in the study. The demographic and socio-economic details of the participants were captured in Section B of the questionnaire. Questions in Section C assessed participants’ knowledge of aspects of EBF, whilst data on participants’ attitudes and practices regarding EBF were captured in Sections D and E, using a five-point Likert scale, that is, strongly agree, agree, not sure, strongly disagree and disagree. Prospective participants were briefed about the study by one of the researchers (O.M.M.). Participants were informed that they could choose to participate in the study, or not, and that failure to participate would not compromise their treatment at the hospital. A detailed explanation about the study (also contained in an information leaflet) was given to participants who gave verbal consent. Participants were also informed that implied consent was being given by agreeing to complete the questionnaire. One of the researchers (O.M.M.) and/or a research assistant assisted participants who were incapable of completing the questionnaire on their own. Participants were instructed to drop the completed questionnaire in a sealed box situated in the front desk at the outpatient department. O.M.M. emptied the box daily and all completed questionnaires were locked in a safe. Data from the questionnaires were inputted on a Microsoft Excel sheet on a computer with password protection. The questionnaire had no trace of identification, to ensure that data were collected anonymously. The study was conducted over a period of two months (August 2020 – September 2020). We performed a pilot study before the official start of data collection to test the suitability of the study design and methods, the chosen data collection method and the overall structure of the questionnaire. The pilot study consisted of 10 eligible adult men who were selected using convenient sampling. No changes to the structured question resulted from the pilot study. The estimated time needed to complete the questionnaire was 30 min. Questionnaire items were scored to determine the percentages of correct or expected and incorrect or unexpected responses. The scoring range of the knowledge questions was 10 (maximum) to 0 (minimum). A score of ≥ 70% (7/10) was considered ‘adequate knowledge’, scores between 50% (5/10) and 60% (6/10) were considered ‘average knowledge’ and a score of ≤ 40% (4/10) was regarded as ‘poor knowledge’. Attitude towards EBF was assessed by obtaining participant responses to 16 items using a five-point Likert scale. For the purpose of this study, ‘strongly agree’ and ‘agree’ responses were summed as ‘agree’, whilst the ‘strongly disagree’ and ‘disagree’ responses were summed as ‘disagree’. The expected responses to the attitude items 1–8 were ‘disagree’, whilst the expected responses for items 9–16 were ‘agree’. There were 10 items in the practice section, and participants’ responses were obtained using a five-point Likert scale. The five-point Likert scale was collapsed to three, that is, ‘Agree’, ‘Disagree’ and ‘Not sure’. Participants who scored ≥ 50% (≥ 5/10) were regarded as having ‘good’ EBF practices, and those who scored < 50% (< 5/10) were considered as having ‘poor’ EBF practices. The expected response for practice items 3 and 4 in the practice section was ‘disagree’, whilst the expected response for the other items in this section was ‘agree’. The data were analysed using Statistical Analysis System (SAS) version 9. Descriptive statistics (e.g. medians) was used for continuous variables, whilst frequencies and percentages were computed for categorical data. The associations between demographic data and knowledge, attitudes and practice scores were assessed using chi-square or Fisher’s exact tests. A p-value of < 0.05 was taken to be significant. The validity of the structured questionnaire was examined by comparing the questionnaire elements with those of previous and similar studies, as well as by conducting the pilot study. A departmental evaluation committee, consisting of consultant family physicians and a biostatistician, subjected the questionnaire to review and approval.19 The Health Sciences Research Ethics Committee of the University of the Free State (UFS-HSD2020/0324/2508) granted approval for the study. Further approval was obtained from the Head of the Free State Department of Health.

Matériaux

N/A

Innovations

Based on the provided information, here are some potential innovations that can be used to improve access to maternal health:

1. Male Partner Involvement Programs: Develop targeted community-based intervention programs that specifically focus on educating and engaging male partners in the importance of exclusive breastfeeding (EBF). These programs can provide information on the benefits of EBF, address misconceptions, and promote positive attitudes and practices towards EBF.

2. Cultural Sensitivity Training: Implement training programs for healthcare providers to enhance their cultural sensitivity and understanding of the local community’s beliefs and practices regarding breastfeeding. This can help healthcare providers effectively communicate with men and address any cultural barriers or misconceptions related to EBF.

3. Community Health Workers: Train and deploy community health workers who can actively engage with men in the community, providing education and support on EBF. These workers can conduct home visits, organize community workshops, and serve as a bridge between healthcare facilities and the community.

4. Mobile Health (mHealth) Solutions: Utilize mobile technology to deliver targeted health messages and reminders to men regarding EBF. This can include SMS/text messages, mobile applications, or voice calls that provide information, tips, and reminders about the importance of EBF and how men can support their partners in this practice.

5. Peer Support Groups: Establish peer support groups for men where they can share experiences, receive guidance, and learn from each other about the benefits and challenges of EBF. These groups can provide a safe space for men to discuss their concerns, ask questions, and receive support from others who have gone through similar experiences.

6. Workplace Support: Collaborate with employers to create supportive environments for men to actively participate in EBF. This can include providing flexible work schedules, designated spaces for breastfeeding or expressing milk, and educational materials for employees about the importance of EBF.

7. Mass Media Campaigns: Develop mass media campaigns, such as radio or television advertisements, that target men and promote the benefits of EBF. These campaigns can raise awareness, challenge societal norms, and encourage men to actively support their partners in practicing EBF.

It is important to note that the implementation of these innovations should be context-specific and tailored to the needs and cultural beliefs of the community in Botshabelo, South Africa.

AI Innovations Description

Based on the study’s findings, here is a recommendation that can be developed into an innovation to improve access to maternal health:

Develop a targeted community-based intervention program aimed at educating and promoting positive social and cultural change regarding exclusive breastfeeding (EBF) among men in Botshabelo, South Africa.

This program should focus on increasing knowledge about the benefits of EBF, addressing misconceptions or myths, and providing practical information on how men can support and encourage their partners to practice EBF. It should also emphasize the importance of men accompanying their partners to antenatal clinics and actively participating in discussions about breastfeeding.

The innovation could include the following components:

1. Educational workshops: Organize workshops or information sessions specifically for men in the community. These sessions should provide evidence-based information on the benefits of EBF, addressing common concerns or misconceptions, and practical tips for supporting breastfeeding mothers.

2. Peer support groups: Establish peer support groups for men where they can share experiences, ask questions, and receive guidance from other fathers who have successfully supported their partners in practicing EBF. These groups can provide a safe and supportive environment for men to discuss their concerns and challenges.

3. Mobile technology: Utilize mobile technology, such as SMS or mobile apps, to deliver educational messages and reminders to men about the importance of EBF and their role in supporting breastfeeding mothers. These messages can be personalized based on the stage of pregnancy or the age of the baby.

4. Community champions: Identify and train community champions, such as respected community leaders or influential individuals, who can advocate for EBF and promote positive attitudes and practices among men. These champions can serve as role models and help create a supportive community environment for breastfeeding mothers.

5. Engaging healthcare providers: Collaborate with healthcare providers, including doctors, nurses, and midwives, to ensure that they are equipped with the knowledge and skills to provide accurate and supportive information to men during antenatal and postnatal care visits. This can include training healthcare providers on effective communication strategies and addressing common concerns or misconceptions about breastfeeding.

By implementing this targeted community-based intervention program, it is expected that the knowledge, attitudes, and practices of men in Botshabelo regarding EBF will improve. This, in turn, can contribute to increased rates of exclusive breastfeeding and ultimately improve maternal and child health outcomes in the community.

AI Innovations Methodology

Based on the provided study, here are some potential recommendations for improving access to maternal health:

1. Male involvement programs: Develop targeted community-based intervention programs that specifically focus on educating and engaging men in the importance of exclusive breastfeeding (EBF). These programs can include workshops, support groups, and educational materials to increase knowledge and promote positive attitudes and practices towards EBF.

2. Antenatal education: Enhance antenatal education programs to include information about the benefits of EBF and involve both expectant mothers and their male partners. This can help ensure that both parents are well-informed and supportive of EBF practices.

3. Cultural and social change: Implement initiatives that promote positive social and cultural change regarding EBF among men. This can involve community-wide campaigns, media outreach, and collaborations with local leaders and influencers to challenge traditional beliefs and norms that may hinder EBF practices.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Baseline data collection: Gather data on the current knowledge, attitudes, and practices of men regarding EBF in the target community. This can be done through surveys, interviews, or focus groups.

2. Intervention implementation: Implement the recommended interventions, such as male involvement programs and enhanced antenatal education. Ensure that these interventions are well-designed, culturally appropriate, and accessible to the target population.

3. Monitoring and evaluation: Continuously monitor the implementation of the interventions and collect data on their reach and effectiveness. This can involve tracking attendance rates, conducting post-intervention surveys, and gathering feedback from participants.

4. Data analysis: Analyze the collected data to assess the impact of the interventions on improving access to maternal health. Compare the baseline data with the post-intervention data to identify any changes in knowledge, attitudes, and practices related to EBF among men.

5. Interpretation and recommendations: Interpret the findings of the data analysis and draw conclusions about the effectiveness of the interventions. Based on the results, make recommendations for further improvements or modifications to the interventions to maximize their impact.

6. Scaling up and sustainability: If the interventions prove to be successful, consider scaling them up to reach a larger population. Develop strategies to ensure the sustainability of the interventions, such as securing funding, training local healthcare providers, and integrating the interventions into existing healthcare systems.

By following this methodology, it will be possible to simulate the impact of the recommended interventions on improving access to maternal health and identify effective strategies for promoting EBF practices among men in the target community.

Auteurs et co-auteurs

Statistics:

Authors: 6

Identifiers:

DOI: 10.4102/safp.v64i1.5366

ISSN: 20786190

Research Areas:

Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants

Study Countries:

South Africa

Study Design:

Cohort Study, Cross Sectional Study, Grounded Theory, randomised-control-trial

Study Approach:

Mixed-methods, Qualitative, Quantitative, Systematic Review

Participants Gender:

Male

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