Title:
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Adapting a motivational instructional model to identify and analyse Thai cultural influences on breastfeeding behaviour
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Breastfeeding is recognised as a complex behaviour. Maternal motivation and professional
support is critical in overcoming early challenges in the initiation and sustainment of
breastfeeding. The influence of culture remains under-researched and more knowledge is
required to explore the relationship between culture, breastfeeding and motivation. The aim
of this research was to explore the motivational and cultural influences on breastfeeding in a
Thai cultural setting.
Two literature reviews were used (meta-narrative and meta-synthesis) to explore the evidence
of the benefits of breastfeeding and cultural influences on maternal motivation. An
information analysis was completed to examine national policy, organisational policy and
routine practice in breastfeeding instruction. The meta-narrative review suggested a lack of
robust methodological evidence with an over-emphasis on the benefits of breastfeeding.
Meta-synthesis evidence showed a significant influence from cultural and community practices
on breastfeeding behaviour. Global policies were incorporated into national and local
breastfeeding policies.
The ARCS model of motivational design in breastfeeding was adapted to inform the analysis of
maternal motivational influences in a University hospital in Northern Thailand. The study was
regarded as "Iow risk". Ethical approval was obtained from Ulster University and Chiang Mai
University. Seventy five hours of observation (n=204) were completed in seven breastfeeding
environments. Thematic and content analysis were conducted through the implementation of
a systematic theoretical goal structure. A Breastfeeding Motivational Scale was translated and
adapted using WHO guidelines and was administered to a convenience sample (n=195) to
measure maternal value, expectation for success and midwife support. Descriptive and
inferential analyses were undertaken using SPSS v21.
Routine instruction emphasised the benefits and value of breastfeeding for mothers, infants
and the wider Thai society. Cultural beliefs and practices were included in routine
breastfeeding instruction. The motivational analysis determined Thai women had a higher than
expected value for breastfeeding. This research demonstrates that national, organisational and
cultural influences have a significant positive effect on women's motivation to breastfeed.
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