Breast milk has nutrients and energy that are suitable for babies. Breastfeeding helps reduce morbidity and mortality rates including the development of babies. The World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) have recommended and supported breastfeeding within the first hour after birth and exclusive during the first six months of breastfeeding. Breastfeeding with supplementary food can feed the baby until two years old. WHO [1] aimed to increase the rate of exclusive breastfeeding in the first six months by at least 50 percent by 2025. However, the rate of exclusive breastfeeding in the first six months is still lower than the target in developed and developing countries. The United Nations Children's Fund 2019 Annual Report showed that the exclusive breastfeeding rate in the first six months around the world is 38 percent. In Thailand, the exclusive breastfeeding rate is 14 percent [2], especially among adolescent mothers, has a lower rate of exclusive breastfeeding rate than other groups. [3,4] Several studies have found that barriers preventing adolescent mothers to breastfeed their babies are insufficient breast milk, advice from grandmothers or relatives in providing water to babies, infants crying frequently, and returning to work or study. [5,6] The main concern is body image that adolescent mothers are struggling with breastfeeding in public places. [7] In Thai culture, adolescent mothers have to face negative views about inappropriate parenthood, social norms, family and social pressures, and no bargaining power in the family and the economy. In addition, many adolescent mothers are abandoned when they become pregnant and single mothers.[8] According to, the environment of adolescent mothers in the US is an obstacle in breastfeeding, including independent ways of life [9], lack of social support and social stigma, and difficulty in breastfeeding.
Breastfeeding is a health promotion that is good for the health of baby and mother which should promote as part of daily life considering the conceptual framework from Pender's health promotion theory.[10] This framework consists of 3 parts: 1) personal characteristics and experiences related to that behavior, including personal factors; 2) behavior that is specific to perception and feeling, such as perceived benefits, awareness of obstacles, self-efficacy
Towards interpersonal influence and influence from the situation; and 3) determination to practice behavior. All of those will result in the desired health promotion behavior. Nowadays, digital plays an important role and influence in daily life, resulting in information that can be found by oneself. Especially, most teenagers like to use digital technology. Therefore, using available information technology, such as computers, mobile phones, tablets, and online media can provide information for adolescent mothers. However, adolescent mothers should understand how to find reliable information, and evaluate various data for them. [11] The use of information technology is therefore important to promote breastfeeding among adolescent mothers.
From the literature review, several factors that involve the rate of breastfeeding are family support and perceived maternity care practices regarding breastfeeding. [12] These factors may affect the health promotion behavior of breastfeeding for Thai mothers, especially adolescent mothers to achieve exclusive breastfeeding recommendation of the World Health Organization and the United Nations Children's Fund.
There is limited knowledge of factors on breastfeeding in adolescent mothers in many countries including Thailand. There are also differences in the population, lifestyle patterns, and cultures. Therefore, it is necessary to study the predictive ability of factors on breastfeeding among Thai adolescent mothers to enhance knowledge about facilitating or dealing with obstacles that affect exclusive breastfeeding and provide suitable nursing guidance.
Objectives of the study
To explore predictive breastfeeding factors among Thai adolescent mothers, including personal characteristics (age, marital status, education, and occupation), intention to be pregnant, recognition of benefits about breastfeeding, perception of obstacles to breastfeeding, self-efficacy in breastfeeding, family support, perception of mother and infant care practice and knowing information technology.
Conceptual framework
This research is based on Pender's health promotion theory [10] which consists of 3 parts: 1) personal characteristics and experiences associated with such behavior, including personal factors; 2) behavior that is specific to perception and feeling, including perceived benefits, awareness of obstacles, perceived self-efficacy; and 3)determination/intention to change behavior. Family support uses Biswas’s concept of family support in breastfeeding. The content is based on the social support theory of the House. [13] Perceived maternity care practices regarding breastfeeding based on concepts of Olayaya, Dee, Shama, and Smith (2016) [14] assess perceptions of Thai adolescent mothers regarding support of healthcare providers about breastfeeding. Digital literacy uses concepts that data users know, understanding of communication tools, information seeking, and evaluation of various media and information. [11]