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EFFECT OF SHORT EDUCATIONAL MOVIE ON THE INCREASING KNOWLEDGE OF BREASTFEEDING MANAGEMENT IN BACIRO, GONDOKUSUMAN, YOGYAKARTA MUNICIPALITY, INDONESIA

Ayyu Sandhi, Wenny Artanty, Purwanta School of Nursing, Faculty of Medicine, Universitas Gadjah Mada, Indonesia

Abstract Background: Considering the benefit of breastfeeding, Indonesia has government regulation released on 2004 about exclusive breastfeeding for babies since they were born until 6 months-old, and it is suggested to stay giving the breastmilk continously until the babies were 2 years-old, accompanied by appropriate additional food. On the other side, the regulation is not followed by good performance. Data from UNICEF mention that since 2003-2008, exclussive breastfeeding rate in Indonesia is 32%. The low exclussive breastfeeding rate, as it shows inappropriate breastfeeding practice, could be affected by many factors, including deficient mothers knowledge. Health education using short educational movie is expected to increase mothers knowledge of breastfeeding management in order that they have awareness and motivation to breastfeed. Objective: To identify the effect of short educational movie on the increasing knowledge of breastfeeding management in Baciro, Gondokusuman, Yogyakarta municipality. Method: The study was a pre-experimental study that used one group pre test post test design. Subject of the study were 37 breastfeeding mothers. Samples were purposively chosen. Research instrument consisted of intervention tool (short educational movie of breastfeeding management) and questionnaire to assess knowledge of mothers. Data analysis used Wilcoxon test. Result: There was increasing of mean score of pre test and post test from 66.4 to 77.0. The result of statistical analysis to mean total score of pre test and post test showed p=0.000 (p<0.05); thus there was statistically significant difference in knowledge of participants before and after watching the movie. Conclusion: There was effect of short educational movie on the increasing knowledge of breastfeeding management.

Keywords: breastfeeding breastfeeding mothers

management,

health

education,

audiovisual,

INTRODUCTION Considering the benefit of breastfeeding, Indonesia has government regulation released on 2004 about exclusive breastfeeding for babies since they were born until 6 months-old, and it is suggested to stay giving the breastmilk continously until the babies were 2 years-old, accompanied by appropriate additional food [1]. On the other side, the regulation is not followed by good performance. Data from UNICEF mention that since 2003-2008, exclussive breastfeeding rate in Indonesia is 32% [2]. The low exclussive breastfeeding rate, as it shows inappropriate breastfeeding practice, could be affected by many factors, including deficient mothers knowledge [3]. Previous study held in another municipality in Indonesia stated that 50% of mothers dont know the meaning of exclussive breastfeeding. From the interview of health practitioners, information about exclussive breastfeeding is never explained comprehensively and in a good structure. Health practitioners never explain about the benefit of breastfeeding for mothers and babies, effective breastfeeding techniques, and how to stay exclussively breastfeeding if the mothers have to work [4]. Health education given in form of short educational movie has aim to improve mothers knowledge of breastfeeding management. Movie as an audiovisual media is considered to be right choice to deliver message, as it involves more senses of subject, providing skills and real-life situation, so the information can be simply understood [4,5,6]. Baseline problem in this study is how the short educational movie brings impact to increase knowledge of breastfeeding management? The aim of this study is to identify the effect of short educational movie on the increasing knowledge of breastfeeding management, and to assess the difference of knowledge of breastfeeding management, before and after the intervention. MATERIALS AND METHOD This pre-experimental study using one group pre test-post test design and held on February 2011 in Baciro village, Gondokusuman district, Yogyakarta municipality, Indonesia. Population of the study was 102 breastfeeding mothers who had babies 0-12 months old in the village. Inclusion criteria of this study was breastfeeding mothers who had babies 0-12 months old, had good health condition, able to write and read, and agreed to participate in this study by signing informed-consent. Exclusion criteria was mothers who were health workers and/or health professionals. Thirty seven participants were recruited using purposive sampling technique. Apparatus using in this study was short educational movie containing materials about breastfeeding management, and a questionnaire to measure mothers level of knowledge. The questionnaire has been tested to 35 breastfeeding mothers in Klitren district, Yogyakarta municipality which had the

same characteristics to population of the study. From 48 questions in the questionnaire, 18 questions were declared to be valid with correlation value between 0.356 0.597 and reliability value 0.709. Data were collected then analysed into 2 methods: univariat analysis which were presented into distribution and percentage, and bivariat analysis using Wilcoxon test to identify if the short educational movie brings impact to increase knowledge of breastfeeding management. While independent t-test was used to identify if characteristics of participants affect the increasing of knowledge. RESULTS AND DISCUSSION a. Characteristics of participants and its effect on the increasing knowledge of breastfeeding management Many factors such as breastfeeding experience [7], level of education [8], family income [9], and accessibility to information about breastfeeding are convinced to influence knowledge of breastfeeding management, since the previous study proved that mothers with higher level of education, better family income, and have breastfed 1 or more children had better knowledge of breastfeeding management, and showed better performance in breastfeeding practice [7,8,9]. Accessibility to information about breastfeeding, if it is given comprehensively and in a good structure also enable mothers to ensure the continuity of breastfeeding practice, overcome the existing obstacles during breastfeeding (such as baby attachment, sore nipples, pain when start to breastfeeding), reduce mothers anxiety and build up mothers confidence [10]. Table 1. Characteristics of participants and difference between pre test and post test mean value (n=37)
Characteristics of participants Age High risk (<20 or >35) Non high risk (20 35) Occupation Unemployment Worker Breastfeeding experience Having no child to breastfed Breastfed 1 or more children Education Low High (high school, Frequency (f) 5 32 28 9 Percentage (%) 13.5 86.5 75.7 24.3 Pre test Mean p value 66.7 66.3 65.3 69.8 0.971 Post test Mean p value 73.3 77.6 77.4 75.9 0.664

0.161

0.684

15 22 7 30

40.5 59.5 18.9 81.1

70.7 0.518 63.4 53.2 69.4 0.021

78.5 0.818 76.0 67.5 79.3 0.059

university) Family income Below regional minimum wage (115 US$ per month) Above regional minimum wage (>115 US$ per month) Accessibility to information about breastfeeding Getting information about breastfeeding (from television, newspaper, website, family/significant others, health professionals) Never getting information about breastfeeding before

23

62.2

64.0 0.295

76.6 0.821

14

37.8

70.2

77.8

29

78.4

68.2

79.5

0.273

0.136

21.6

59.7

68.1

In this study, before watching the movie, mothers who had higher level of education showed p value 0.021 (p<0.05) which meant level of education influenced mothers in attaining better pre test score. But after watching the movie, all of the characteristics of participants showed p value more than 0.05, which meant no significant difference post test score to each group of characteristics of participants. It showed that the increasing of knowledge truly happened as a result of intervention given, not influenced by characteristics of participants. b. Effect of short educational movie on knowledge of breastfeeding management Table 2. Comparation between pre test and post test mean value of participants (n=37)
Knowledge about breastfeeding management (in general) Pre test Post test Mean value and deviation standard 66.4 15.49 77.0 15.05 Statistic test Z -4.439 p 0.000

In this study we could see that there was statistically significant difference (p<0.05) on mothers knowledge during and after watching the movie. It showed that short educational movie could increase mothers knowledge about breastfeeding management significantly, which simply could be interpreted as audiovisual media chosen delivery the message effectively. It went along with Kang et als study result which mentioned that audiovisual media using in the breastfeeding empowerment programme could improve knowledge and

breastfeeding skills if compared to control group which only received oral information during postpartum counseling sessions [11]. According to Notoatmodjo, successful health education is affected by many factors, such as method, materials/message delivered, person who deliver the message, and the media [12]. Right choice of media and interesting package influence delivery meaning of the message [13], besides, media using in health education is meant to involve senses as much as possible to catch the meaning of the message, so audience can have a better understanding [4]. There is a close relationship between using variety of media with human ability to take in and to memorize. Human brains capability to memorize message delivered by audio media after 3 days is 10%, visual (text) is 40%, and audiovisual is 65% [14]. Audiovisual media can present the information in more concrete way than words to say or to published. It also has creative aspect which can attract people interest [15], let alone the information about breastfeeding management which the participants never watched before. From those facts it is understandable that learning process which only involves one kind of sense will give limited learning stimulation. The using of audiovisual media will provide better learning stimulation [16] to ensure more knowledge attained. There was only two aspects of knowledge about breastfeeding management which did not show statistically significant difference between pre test and post test. Those aspects were breastmilk production (p=0.290) and effective breastfeeding techniques (p=0.129). This might be caused by three factors: (1) environmental factors which prolactin and oxytocin flow picture were blurred by sunlight (went into the room through the large windows) and some instructions in the part of effective breastfeeding techniques were unclearly heard, disturbed by sound of aeroplanes; (2) in the part of breastmilk production and effective breastfeeding techniques there were some terms which probably unfamiliar for participants such as prolactin, oxytocin, the name of breastfeeding position, in fact in arranging audiovisual the difficult terms should not be used; (3) there was possibility when participants received information about breastfeeding before, information about these two aspects were not completely explained. Table 3. Comparation between pre test and post test mean value of participants in each subject of breastfeeding management (n=37)
Knowledge about breastfeeding management (per subject) Exclussive breastfeeding Mean value and deviation standard Statistic test Z p

Pre test Post test Breastmilk production Pre test Post test Benefit of breastmilk Pre test Post test Benefit of breastfeeding Pre test Post test Effective breastfeeding techniques Pre test Post test Existing obstacles during breastfeeding Pre test Post test Breastfeeding management for working mothers Pre test Post test

62.2 34.39 74.8 35.49 52.7 24.14 56.1 27.89 78.4 26.31 87.4 19.80 70.3 46.33 91.9 27.67 67.6 22.89 76.6 24.68 64.3 30.33 86.5 22.51

-2.089

0.011

-1.057

0.290

-2.300

0.021

-2.309

0.021

-1.157

0.129

-2.183

0.029

70.3 24.89 90.5 19.85

-3.873

0.000

CONCLUSION Based on the result of this study, we can conclude that there is effect of short educational movie on the increasing knowledge of breastfeeding management in Baciro, Gondokusuman, Yogyakarta municipality, Indonesia which can be seen from the increasing mean value of knowledge, before and after watching the movie. ACKNOWLEDGMENT The authors wish to thank the following for support to this study: 1. Prof. dr. Ali Ghufron Mukti, M.Sc., Ph.D, as dean of Faculty of Medicine of Universitas Gadjah Mada, Yogyakarta. 2. Dr. Fitri Haryanti S, S.Kp., M.Kes as head of School of Nursing, Faculty of Medicine of Universitas Gadjah Mada, Yogyakarta. 3. Public Health Centre Gondokusuman I Yogyakarta municipality. 4. All mothers who generoulsy shared their time to the authors. REFERENCES [1] Sitaresmi, M.N. Isu kebijakan tentang pemberian ASI secara eksklusif. Retrieved 27 Juni 2010 from:http://kebijakankesehatanindonesia.net/node/2 [2] UNICEF. At a glance : Indonesia. Retrieved 27 Juni 2010 from : http://www.unicef.org/infobycountry/indonesia_statistics.html

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