A Model for Fostering Self-Efficacy in Breastfeeding Mothers Through Self-Directed Learning in Nursing Care
DOI:
https://doi.org/10.31674/mjn.2025.v16i04.002Abstract
Background: The prevailing low coverage of exclusive breastfeeding in Indonesia has a profound impact on the health outcomes of both mothers and infants in the short and long term. Notably, the primary issue in this context pertains to maternal self-efficacy. No concurrent research has addressed a self-efficacy model grounded in self-directed learning among breastfeeding mothers. This study aims to develop a model to enhance breastfeeding confidence in mothers through self-directed learning, with significant implications for maternal and infant health. Methods: The research utilized cross-sectional methods to examine 200 mothers who were breastfeeding infants between the ages of 0 and 6 months. Data analysis was carried out using structural equation modelling (SEM). Results: The research findings indicate a significant relationship between breastfeeding self-efficacy and the autonomic process, as evidenced by a t-value of 9.414 and a beta coefficient of 0.492 (moderate correlation). An increase in breastfeeding self-efficacy positively correlates with the success of exclusive breastfeeding. This autonomous process is influenced by breastfeeding education design and personal attributes, all of which contribute to the enhancement of breastfeeding self-efficacy and, ultimately, the success of exclusive breastfeeding. The autonomous process is identified as a significant influencer of breastfeeding self-efficacy. Breastfeeding support significantly influences Personal Attributes (PA) but does not have a notable impact on the Autonomous Process. Conclusion: In conclusion, breastfeeding self-efficacy emerges as the principal determinant in bolstering the successful practice of exclusive breastfeeding, facilitated by self-directed learning capabilities. The capacity for self-regulation significantly impacts breastfeeding self-efficacy.
Keywords:
Autonomous Process, Breastfeeding, Self-Directed Learning, Self-EfficacyDownloads
References
Almohanna, A. A., Win, K. T., & Meedya, S. (2020). Effectiveness of internet-based electronic technology interventions on breastfeeding outcomes: Systematic review. Journal of Medical Internet Research, 22(5). https://doi.org/10.2196/17361
Al-Thubaity, D. D., Alshahrani, M. A., Elgzar, W. T., & Ibrahim, H. A. (2023). Determinants of high breastfeeding self-efficacy among Nursing Mothers in Najran, Saudi Arabia. Nutrients, 15(8). https://doi.org/10.3390/nu15081919
Amoo, T. B., Popoola, T., & Lucas, R. (2022). Promoting the practice of exclusive breastfeeding: a philosophic scoping review. BMC Pregnancy and Childbirth, 22(1). https://doi.org/10.1186/s12884-022-04689-w
Bandura, A. (1997). Self-efficacy: The exercise of control. W.H. Freeman. Retrieved from: https://shorturl.at/HXUNU . Accessed on 19th February 2024.
Bai, Y. K., Lee, S., & Overgaard, K. (2019). Critical review of theory use in breastfeeding interventions. Journal of Human Lactation, 35(3), 478–500. https://doi.org/10.1177/0890334419850822
Basheer, N. A., Al-Mutairi, N., & Al-Dosari, A. (2024). Effectiveness of motivational interviewing and cross platform messaging application in improving oral health knowledge, attitude and behaviours among pregnant women- a randomized controlled trial. Journal of Clinical Periodontology, 51(3), 345-354. https://doi.org/10.1111/jcpe.13156
Boateng, G. O., Martin, S. L., Collins, S. M., Natamba, B. K., & Young, S. L. (2018). Measuring exclusive breastfeeding social support: Scale development and validation in Uganda. Maternal and Child Nutrition, 14(3), 1–12. https://doi.org/10.1111/mcn.12579
Ceylan, S., & Şahin, S. (2020). Comparison of breastfeeding self-efficacy and breastfeeding success of obese and normal-weight mothers in the early period. African Health Sciences, 20(4), 2022–2031. https://doi.org/10.4314/ahs.v20i4.60
Chang, Y.-S., Beake, S., Kam, J., Lok, K. Y.-W., & Bick, D. (2022). Views and experiences of women, peer supporters and healthcare professionals on breastfeeding peer support: A systematic review of qualitative studies. Midwifery, 108 . https://doi.org/10.1016/j.midw.2022.103299
Chua, C. M. S., Mathews, J., Ong, M. S. B., Liew, K. K., & Shorey, S. (2023). Use of telelactation interventions to improve breastfeeding outcomes among mothers: A mixed-studies systematic review. Women and Birth, 36(3), 247–256. https://doi.org/10.1016/j.wombi.2022.06.011
De Roza, J. G., Fong, M. K., Ang, B. L., Sadon, R. B., Koh, E. Y. L., & Teo, S. S. H. (2019). Exclusive breastfeeding, breastfeeding self-efficacy and perception of milk supply among mothers in Singapore: A longitudinal study. Midwifery, 79. https://doi.org/10.1016/j.midw.2019.102532
Emmott, E. H., & Mace, R. (2015). Practical support from fathers and grandmothers is associated with lower levels of breastfeeding in the UK millennium cohort study. PLoS ONE, 10(7), 1–12. https://doi.org/10.1371/journal.pone.0133547
Galvão, D. M. P. G., Silva, E. M. B., & Silva, D. M. (2022). Use of new technologies and promotion of breastfeeding: integrative literature review. Revista Paulista de Pediatria, 40. https://doi.org/10.1590/1984-0462/2022/40/2020234
Gatti, L. (2008). Maternal Perceptions of Insufficient Milk Supply in Breastfeeding. Journal of Nursing Scholarship, 40(4), 355–363. https://doi.org/10.1111/j.1547-5069.2008.00234.x
Ghafourian Abadi, S., Dalil Heirati, S. F., Arvan, A., & Eslami-Kenarsari, H. (2024). The effect of a breastfeeding education program based on mobile application and telephone follow-up after discharge on self-efficacy of breastfeeding and exclusive breastfeeding until the first six months of birth in primiparous women undergoing caesarean section. Journal of Neonatal Nursing, 30(6), 798-802. https://doi.org/10.1016/j.jnn.2024.05.002
Gökşen, D. F. Y., & Özkan, S. (2024). The effect of online breastfeeding education on breastfeeding motivation: A randomized controlled study. Journal of Pediatric Nursing, 75, e42-e48. https://doi.org/10.1016/j.pedn.2023.12.026
Hair Jr, J. F., Hult, G. T. M., Ringle, C. M., Sarstedt, M., Danks, N. P., & Ray, S. (2021). Partial least squares structural equation modeling (PLS-SEM) using R: A workbook (p. 197). Springer Nature. https://doi.org/10.1007/978-3-030-80519-7
Hair, J. F., Risher, J. J., Sarstedt, M., & Ringle, C. M. (2019). When to use and how to report the results of PLS-SEM. European Business Review, 31(1), 2–24. https://doi.org/10.1108/EBR-11-2018-0203
Henseler, J., Ringle, C. M., & Sarstedt, M. (2015). A new criterion for assessing discriminant validity in variance-based structural equation modelling. Journal of the Academy of Marketing Science, 43(1), 115–135. https://doi.org/10.1007/s11747-014-0403-8
Huang, L., Gursoy, D., & Xu, H. (2014). Impact of personality traits and involvement on prior knowledge. Annals of Tourism Research, 48, 42–57. https://doi.org/10.1016/j.annals.2014.05.010
Huang, Y., Liu, Y., Yu, X., & Zeng, T. (2022). The rates and factors of perceived insufficient milk supply: A systematic review. Maternal & Child Nutrition, 18(1). https://doi.org/10.1111/mcn.13255
Kapti, R. E., Arief, Y. S., & Azizah, N. (2023). Mother’s knowledge as a dominant factor for the success of exclusive breastfeeding in Indonesia. Healthcare in Low-Resource Settings, 11(s1). https://doi.org/10.4081/hls.2023.11209
Li, F., Huang, C., Lin, Q., Xi, Y., Xiang, C., Yong, C., & Deng, J. (2022 a). Maternal characteristics, intention, self-efficacy, perceived social support, and exclusive breastfeeding practice: structural equation modelling approaches. Healthcare, 11(1). https://doi.org/10.3390/healthcare11010087
Li, L., Wu, Y., Wang, Q., Du, Y., Friesen, D., Guo, Y., Dill, S.-E., Medina, A., Rozelle, S., & Zhou, H. (2022 b). Determinants of breastfeeding self-efficacy among postpartum women in rural China: A cross-sectional study. PloS One, 17(4). https://doi.org/10.1371/journal.pone.0266273
Li, X., Du, J., & Long, H. (2020). Mechanism for Green Development Behavior and Performance of Industrial Enterprises (GDBP-IE) Using Partial Least Squares Structural Equation Modelling (PLS-SEM). International Journal of Environmental Research and Public Health, 17(22), 8450. https://doi.org/10.3390/ijerph17228450
Lojander, J., Axelin, A., & Niela-Vilén, H. (2024). ‘Breastfeeding exclusivity, difficulties, and support in the first days after hospital discharge: A correlational study.’ European Journal of Obstetrics & Gynecology and Reproductive Biology, 296, 76–82. https://doi.org/10.1016/j.ejogrb.2024.02.029
Maleki, A., Faghihzadeh, E., & Youseflu, S. (2021). the effect of educational intervention on improvement of breastfeeding self-efficacy: a systematic review and meta-analysis. Obstetrics and Gynecology International, 2021. https://doi.org/10.1155/2021/5522229
Maviso, M. K., Kaforau, L. M., & Hastie, C. (2023). Influence of grandmothers on breastfeeding practices in a rural community in Papua New Guinea: A critical discourse analysis of first-time mothers’ perspectives. Women and Birth, 36(2), e263–e269. https://doi.org/10.1016/j.wombi.2022.08.001
McGuire, T. M. (2018). Drugs affecting milk supply during lactation. Australian Prescriber, 41(1), 7–9. https://doi.org/10.18773/austprescr.2018.002
Mizrak Sahin, B., Ozerdogan, N., Ozdamar, K., & Gursoy, E. (2019). Factors affecting breastfeeding motivation in primiparious mothers: An application of breastfeeding motivation scale based on self-determination theory. Health Care for Women International, 40(6), 637–652. https://doi.org/10.1080/07399332.2018.1526289
Moon, H., & Woo, K. (2021). An integrative review on mothers’ experiences of online breastfeeding peer support: Motivations, attributes and effects. Maternal & Child Nutrition, 17(3). https://doi.org/10.1111/mcn.13200
Nagel, E. M., Howland, M. A., Pando, C., Stang, J., Mason, S. M., Fields, D. A., & Demerath, E. W. (2022). Maternal psychological distress and lactation and breastfeeding outcomes: a narrative review. Clinical Therapeutics, 44(2), 215–227. https://doi.org/10.1016/j.clinthera.2021.11.007
Neifert M. (2001). Prevention of breastfeeding tragedies. Paediatric Clinics of North America, 48(2), 273–297. https://doi.org/10.1016/S0031-3955(08)70026-9
Nisman, W. A., Aryas, D., Ratnasari, E., Widya, M., Yonanta, N., Rahmasari, S., & Annisa, V. N. (2021). Infant feeding practices and analysis of factors affecting exclusive breastfeeding. Jurnal Keperawatan Soedirman, 16(3). https://doi.org/10.20884/1.jks.2021.16.3.1726
North, K., Gao, M., Allen, G., & Lee, A. C. (2022). Breastfeeding in a global context: epidemiology, impact, and future directions. Clinical Therapeutics, 44(2), 228–244. https://doi.org/10.1016/j.clinthera.2021.11.017
Omolola Adams, C., Ewu, G., Ugwu, V., Shakirat, I., & Joseph, E. (2020). Barrier and motivation to exclusive breast feeding amongst mothers accessing care at the University of Abuja Teaching Hospital. International Journal of Immunology, 8(4), 70. https://doi.org/10.11648/j.iji.20200804.12
Siah, P., Ooi, C., Zaman, W. K., & Low, S. (2023). Social networking sites usage and quality of life among senior citizens. Asian Journal of Social Health and Behavior, 6(2), 79. https://doi.org/10.4103/shb.shb_138_22
Taha, Z., Garemo, M., El Ktaibi, F., & Nanda, J. (2022). Breastfeeding practices in the united arab emirates: prenatal intentions and postnatal outcomes. Nutrients, 14(4). https://doi.org/10.3390/nu14040806
Titaley, C. R., Dibley, M. J., Ariawan, I., Mu’asyaroh, A., Alam, A., Damayanti, R., Do, T. T., Ferguson, E., Htet, K., Li, M., Sutrisna, A., & Fahmida, U. (2021). Determinants of low breastfeeding self-efficacy amongst mothers of children aged less than six months: results from the BADUTA study in East Java, Indonesia. International Breastfeeding Journal, 16(1). https://doi.org/10.1186/s13006-021-00357-5
Wong, M. S., Mou, H., & Chien, W. T. (2021). Effectiveness of educational and supportive intervention for primiparous women on breastfeeding related outcomes and breastfeeding self-efficacy: A systematic review and meta-analysis. International Journal of Nursing Studies, 117. https://doi.org/10.1016/j.ijnurstu.2021.103874
World Health Organization (2023). The self-care competency framework: At a glance. In Self-care competency framework: Volume 3. Curriculum guide for health and care workers to support people’s self-care (pp. ix–x). World Health Organization. Retrieved from: http://www.jstor.org/stable/resrep56555.6. Accessed on 15th March, 2024.
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 The Malaysian Journal of Nursing (MJN)

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.