Background. Breastfeeding is recognised as a complex behaviour which is influenced by many factors. This creates challengesfor all breastfeeding mothers and health professionals seeking to support women in their breastfeeding journey. Personal,psychosocial, cultural and economic factors create a complicated interplay which affects breastfeeding practices. Maternalmotivation is acknowledged as a determinant of breastfeeding behaviour; however, it is important to recognise that motivationis influenced by the culture and environment in which women live. Understanding how culture influences behaviour offersresearchers insight into breastfeeding practices.Objectives. The aim of this study was to identify the contextual and cultural influences that are communicated throughbreastfeeding instruction within a Thai setting.Methods. Observational data were collected at national, corporate and individual levels using the ARCS educational model (Keller,2008) and Gardenswartzet al’s (2003) cultural model to gain a deeper understanding of key factors influencing breastfeedingeducation and maternal motivation. A total of 75 hours of observation were completed in eight maternity environments. Thedata collected included national data profiles, corporate policies, protocols and everyday practices. Ethical approval was obtainedfrom universities in Northern Ireland and Northern Thailand.Findings. Published national breastfeeding rates were 49.6% for initiation and 15% for duration at six months. Breastfeedingpolicies in seven settings were identified and analysed. These were all based on the Baby Friendly Initiative (BFI) guidelines.Organisational culture was evident in the timing, venue and structure of the breastfeeding classes with individual and groupbreastfeeding classes prenatally and postnatally and specific self-efficacy and postnatal discharge classes. The maternity staff tookpride in what they termed ‘The Thai Way’ of breastfeeding and this was indicative of a specific cultural identity.Conclusion. This observation of Thai breastfeeding behaviour has demonstrated strong cultural influences as being inextricablylinked to individual and national goals. The systematic process of gathering information about the educational and culturalcomponents of breastfeeding behaviour and practices in a Thai setting using a combination of the ARCS model by Keller (2008)and Gardenswartz et al (2003) provided an enriched understanding of the interplay between the individual and societal factorsevident in this unique culture.
|Journal||Evidence Based Midwifery|
|Early online date||17 Mar 2017|
|Publication status||E-pub ahead of print - 17 Mar 2017|
Bibliographical noteReference text: Aikawa T, Pavadhgul P, Chongsuwat R, Sawasdivorn S, Boonshuyar C. (2012)
Maternal return to paid work and breastfeeding practices in Bangkok,
Thailand. Asia-Pacific Journal of Public Health 27(2): NP1253-62.
Bai Y, Wunderlich SM, Fly AD. (2011) Predicting intentions to continue exclusive
breastfeeding for six months: a comparison among racial/ethnic groups.
Maternal Child Health Journal 15(8): 1257-64.
Bamber S. (1999) Medicine, food and poison in traditional Thai medicine. Osiris
Bhawuk DP, Brislin R. (1992) The measurement of cultural sensitivity using
the concepts of individualism and collectivism. International Journal of
Intercultural Relations 16: 413-36.
Brand E, Kothari MS, Stark MA. (2011) Factors related to breastfeeding
discontinuation between hospital discharge and two weeks postpartum.
Journal of Perinatal Education 20(1): 36-44.
Buhi K. (2010) Culture and complex interventions: lessons for evidence, policy and
practice. The British Journal of Psychiatry 197(3): 172-3.
Burke E. (1973 – original work published 1790) Reflections on the revolution in
France. Anchor Press: Garden City, NY.
Butler R. (2000) What learners want to know: the role of achievement goals
in shaping information seeking, learning and interest: In: Sansone C,
Harackiewicz JM. (Eds.). Intrinsic and extrinsic motivation: the search for
optimal motivation and performance. Academic Press: San Diego: 162-88.
Deci EL, Ryan RM. (2000) The ‘what’ and ‘why’ of goal pursuits: human needs
and the self determination of behaviour. Psychological Inquiry 11(4): 227-68.
del Casino VJ. (2004) (Re)placing health and health care: mapping the competing
discourses and practices of ‘traditional’ and ‘modern’ Thai medicine. Health
and Place 10(1): 59-73.
Department for the Development of Thai Traditional and Alternative Medicine.
(2004) Guideline for applying traditional Thai medicine in personal health
care. Veteran Organization: Bangkok.
Department of Health, Ministry of Public Health. (2006) Evaluation of the
ninth national health plan. Department of Health, Ministry of Public
Department of Health, Ministry of Public Health. (2002) Reproductive health
profile. Department of Health, Ministry of Public Health: Bangkok.
Department of Health, Ministry of Public Health. (2000) Situation of Thai children
health. Department of Health, Ministry of Public Health: Bangkok.
Department of Health, Ministry of Public Health. (1996) Assessment on feeding
pattern of children 0-24 months of age. Nutrition Division, Ministry of Public
Department of Health, Ministry of Public Health. (1994) A study of breastfeeding:
a report. Family Health Division: Bangkok.
Dodgeson JE, Duckett L, Garwick A, Graham BL. (2002) An ecological perspective
of breastfeeding in an indigenous community. Journal of Nursing Scholarship
Eccles JS, Wigfield A. (2002) Motivational beliefs, values and goals. Annual Review
Psychology 53: 109-32.
Elter PT, Kennedy HP, Chesla CA, Yimyam S. (2014) Spiritual healing practices
among rural postpartum Thai women. Journal of Transcultural Nursing
(accessed 20 July 2015).
Ergenekon-Ozelci P, Elmaci N, Ertem M, Saka G. (2006) Breastfeeding beliefs and
practices among migrant mothers in slums of Diyarbakir, Turkey. European
Journal of Public Health 16(2): 143-8.
Fischer TP, Olson BH. (2014) A qualitative study to understand cultural factors
affecting a mother’s decision to breastfeed or formula feed. Journal of Human
Lactation 30(2): 209-16.
Foo LL, Quek SJ, Ng SA, Lim MT, Deurenberg-Yap M. (2005) Breastfeeding
prevalence and practices among Singapore Chinese, Malay and Indian mothers.
Health Promotion International 20(3): 229-37.
Gardenswartz L, Rowe A, Digh P, Bennet M. (2003) The global diversity desk
reference: managing an international workforce. Pfeiffer: San Francisco.
Glover M, Waldon J, Manaena-Biddle H, Holdaway M, Cunningham C.
(2009) Barriers to best outcomes for Maori: mothers’ perceptions, Whanau
perceptions and services. Journal of Human Lactation 25(3): 307-16.
Hammer MR. (2011) Additional cross-cultural validity testing of the Intercultural
Development Inventory. International Journal of Intercultural Relations 35:
Hangchaovanich Y, Voramongkul N. (2006) Breastfeeding promotion in Thailand.
Journal of the Medical Association of Thailand 89(4): 173-7.
Hofstede G. (1980) Culture’s consequences. Sage: Beverly Hills.
Hofstede G. (2001) Culture’s consequences: comparing values, behaviours,
institutions and organisations across nations. Sage: Thousand Oaks.
Im E. (2015) What makes an intervention culturally appropriate? Journal of
Transcultural Nursing 26(1): 5.
International Baby Food Action Network. (2012) The convention on the rights of
the child: report on the situation of infant and young child feeding in Thailand.
See: ibfan.org/art/IBFAN_CRC59_Thailand-2012.pdf (accessed 20 July 2015).
Jezewski MA. (1990) Culture brokering in migrant farmworker health care.
Western Journal of Nursing Research 12(4): 497-513.
Johnston ML, Eposito N. (2007) Barriers and facilitators for breastfeeding among
working women in the United States. Journal of Obstetric, Gynecologic and
Neonatal Nursing 36(1): 9-20.
Kaewsarn P, Moyle W. (2000) Cultural beliefs and breastfeeding duration of Thai
working women. Breastfeeding Review 8(1): 13-7.
Keller JM. (2010) Motivational design for learning and performance: the ARCS
model approach. Springer: New York.
Kelly YJ, Watt RG, Nazroo JY. (2006) Racial/ethnic differences in breastfeedinginitiation and continuation in the United Kingdom and comparison with
findings in the United States. Pediatrics 118(5): 2207-8.
Knafo A, Roccas S, Sagiv L. (2011) The value of values in cross-cultural research: a
special issue in honour of Shalom. Journal of Cross-Cultural Pyschology 42(2):
Manderson L. (1981) Roasting, smoking and dieting in response to birth. Social
Science and Medicine – Part B: Medical Anthropology 15(4): 509-20.
McInnes RJ, Hoddinot P, Britten J, Darwent K, Craig LCA. (2013) Significant other,
situations and infant-feeding behaviour change processes: a serial qualitative
interview study. BMC Pregnancy and Childbirth 13: 114.
Ministry of Public Health. (2006) Health policy in Thailand. See: http://bps.ops.
moph.go.th/HealthPolicy6.pdf (accessed 20 July 2015).
National Statistical Office. (2007) Final report: the multiple indicator cluster survey
(MICS). National Statistical Office: Bangkok.
Ong SF, Chan WS, Shefaly S, Chong YP, Klainin-Yobas P, He G. (2014) Postnatal
experiences and support needs of first-time mothers in Singapore: a descriptive
qualitative study. Midwifery 30(6): 772-8.
Oyserman D, Coon HM, Kemmelmeier M. (2002) Rethinking individualism
and collectivism: evaluation of theoretical assumptions and meta-analyses.
Psychological Bulletin 128(1): 3-72.
Parks M, Chesla C. (2007) Revisiting confucianism as a conceptual framework for
Asian family study. Journal of Family Nursing 13(3): 293-311.
Persad MD, Mesinger JL. (2007) Maternal breastfeeding attitudes: association with
breastfeeding intent and sociodemographics among urban primiparas. Journal
of Community Health 33(2): 53-60.
Phoutthakeo P, Otsuka K, Ito C, Sayamoungkhoun P, Kounnavoung S, Jimba M.
(2013) Cross-border promotion of formula milk in Lao People’s Democratic
Republic. Journal of Paediatrics and Child Health 50(1): 51-6.
Rohan M. (2000) A rose by any name? The values construct. Personality and Social
Psychology Review 4(3): 255-77.
Sagiv L, Schwartz SH. (2007) Cultural values in organisations: insights for Europe.
European Journal of International Management 1(3): 176-90.
Salguero CP. (2003) A Thai herbal: traditional recipes for health and harmony.
Findhorn Press: Findhorn Forres, Scotland.
Salguero CP. (2007) Traditional Thai medicine: buddhism, animism, ayurveda.
HOHM Press: Prescott, AZ.
Sansone C, Harackiewicz JM. (2000) Rewarding competence: the importance of
goals in the study of intrinsic motivation: In: Sansone C, Harackiewicz JM.
(Eds.). Intrinsic and extrinsic motivation: the search for optimal motivation and
performance. Academic Press: San Diego: 82-96.
Schwartz SH. (1999) Cultural value differences: some implications for work.
Applied Psychology: An International Review 48: 23-48.
Schwartz SH. (1992) Universals in the content and structure of values: theoretical
advances and empirical tests in 20 countries. Advances in Experimental Social
Psychology 25: 1-65.
Schwartz SH. (1990) Individualism-collectivism: critique and proposed refinements.
Journal of Cross-Cultural Psychology 21(2): 139-57.
Segawa M. (2008) Buddhism and breastfeeding. Breastfeeding Medicine 3(2):
Spatz DL. (2004) Ten steps for promoting breastfeeding for vulnerable infants. The
Journal of Perinatal and Neonatal Nursing 18(4): 385-96.
Stockdale J, Sinclair M, Kernohan WG, Keller JM, Dunwoody L, Cunningham JB,
Lawther L, Weir P. (2008) Feasibility study to test ‘designer breastfeeding’: a
randomised controlled trial. Evidence Based Midwifery 6(3): 76-82.
Stockdale J, Sinclair M, Kernohan WG, Keller J. (2011) Understanding motivational
theory and psychology of breastfeeding: In: Bryar R, Sinclair M. (Eds.). Theory
of midwifery practice. Palgrave McMillan: Basingstoke: 92-112.
Stockdale J, Sinclair M, Kernohan WG. (2014) Applying the ARCS design model
to breastfeeding advice by midwives in order to motivate mothers to personalise
their experience. Evidence Based Midwifery 12(1): 4-10.
Sutton J, Meizi H, Despard C, Evans A. (2007) Barriers to breastfeeding in a
Vietnamese community: a qualitative exploration. Canadian Journal of Dietetic
Practice and Research 68(4): 195-200.
Tarrant M, Dodgeson JE, Fei ST. (2004) Becoming a role model: the breastfeeding
trajectory of Hong Kong women breastfeeding longer than six months.
International Journal of Nursing Studies 41(5): 535-46.
Teich AS, Barnett J, Bonuck K. (2014) Women’s perception of breastfeeding barriers
in early postpartum period: a qualitative analysis nested in two randomised
controlled trials. Breastfeeding Medicine 9(1): 9-15.
Thomas M, Avery V. (1997) Infant feeding in Asian families: early practices and
growth. HMSO: London.
Trading Economics. (2014) Exclusive breastfeeding (% of children under
six months) in Thailand. See: tradingeconomics.com/thailand/exclusivebreastfeeding-
20 July 2015).
Triandis HC, Chan DK, Bhawuk DPS, Iwao S, Sinha JB. (1995) Multi-method
probes of allocentrism and idiocentrism. International Journal of Psychology
Trickett EJ. (2009) Community psychology: individuals and interventions in
community context. Annual Review of Psychology 60: 395-419.
Unger JB, Schwartz SJ. (2012) Conceptual considerations in studies of cultural
influences on health behaviour. Preventative Medicine 55(5): 353-5.
United Nations Children’s Fund. (2013) State of the world’s children. UNICEF:
Waterman AS. (1984) The psychology of individualism. Praeger: New York.
Whiting BB. (1976) The problem of the packaged variable: In: Riegal KF,
Meachams JA. (Eds.). The developing individual in a changing world.
Williams RM. (1970) American society: a sociological interpretation (third edition).
Knopf: New York.
The World Bank. (2013) Thailand overview. See: worldbank.org/en/country/
thailand/overview (accessed 20 July 2015).
World Breastfeeding Trends Initiative. (2010) Country name: Thailand. See: http://
worldbreastfeedingtrends.org/report/WBTi-Thailand-2010.pdf LINK BROKEN
Should this be: http://www.worldbreastfeedingtrends.org/GenerateReports/
countrysubmit.php?country=TH (accessed 20 July 2015).
WHO. (2014) The World Health Organization’s infant-feeding recommendations.
WHO. (2002) Complementary feeding: report of the global consultation and
summary of guiding pronciples for complementary feeding of the breastfed
child. WHO: Geneva.
WHO. (1998) The world health report – life in the 21st century: a vision for all.
WHO. (1981) International code of marketing of breastmilk. WHO: Geneva.
WHO, UNICEF. (2013) (1989??) Ten steps to successful breastfeeding. tensteps.org
(accessed 20 July 2015) http://whqlibdoc.who.int/publications/9241561300.
pdf in Protecting, promoting and supporting breastfeeding: the special role of
Yimyam S, Hanpa W. (2014) Developing a workplace breastfeeding support model
for employed lactating mothers. Midwifery 30(6): 720-4.
- evidence-based midwifery