1

1 Review

2 Health Education on Self-Efficacy in Breastfeeding Mothers: Literature

3 Review
4 Abstract: Mother's milk (ASI) is the first food for newborns and is the main
5 nutrition for babies. Efficacy is important in breastfeeding, because it is used as a
6 parameter of the mother's ability to breastfeed. Knowledge is one of the mother's
7 self-efficacy factors for breastfeeding. Objective: The purpose of this study was
8 to determine whether there is an effect of health education on lactation
9 management on breastfeeding self-efficacy in mothers. Method: The research
10 design used is a literature review, starting with topic selection, then searching
11 through several databases, namely Google Scholar and Science Direct by
12 entering keywords. Results and conclusions: From ….. articles, we selected 9
13 relevant articles to identify the effect of health education on breastfeeding self-
14 efficacy in mothers.
15 Keywords: Health education, Breastfeeding self-efficacy, breastfeeding
16

17 1. Background
18 Exclusive breastfeeding is defined as breastfeeding alone without consuming
19 solid food or other liquids except vitamins, minerals and other medicines needed
20 for babies in their first 6 months of life.(Dodt et al., 2015). In addition to its
21 beneficial properties on infant well-being, breastfeeding reduces mortality caused
22 by infectious diseases. Exclusively breastfed babies have a lower risk of
23 developing gastrointestinal diseases and allergies(Jackson & Dennis, 2017).
24 Breastfeeding experience greatly influences subsequent breastfeeding. Due
25 to a history of failed breastfeeding and a shorter breastfeeding period in the child
26 due to previously unresolved breastfeeding problems and also low self-
27 confidence(Bai et al., 2019). These mothers have unpleasant experiences in
28 breastfeeding other children and this reduces their tendency to breastfeed, so
29 there is a need for health education for mothers.
30 Education for health professionals can be designed using new theories that
31 address a person's motivation to learn(Laliberté et al., 2016). Social cognitive
32 theory considers the construct of self-efficacy as the most important variable
33 influencing performance behavior and effective thinking and processes(Ansari et
34 al., 2014; Chan et al., 2016). Therefore, it can be considered as a key construct
35 when assessing learning needs and designing educational interventions. Self-
36 efficacy is a person's belief in their ability to organize and perform the tasks
37 necessary to achieve desired results.

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38 Breastfeeding education programs that focus on breastfeeding self-efficacy
39 have been made available to women of childbearing age in recent years. Several
40 studies have found that mothers with higher levels of breastfeeding self-efficacy
41 are more likely to breastfeed their newborns exclusively in the immediate
42 postpartum period.(Brockway et al., 2017a; Dodt et al., 2015). In particular, the
43 available evidence suggests a positive effect of the program's breastfeeding self-
44 efficacy intervention on the efficacy rate of breastfeeding and exclusive
45 breastfeeding at 1~2 months postpartum among mothers.(Brockway et al.,
46 2017b).
47 Health education on breastfeeding issues increases the rate of exclusive
48 breastfeeding. Many studies have demonstrated the positive effect of
49 breastfeeding counseling and interventions on the continuation of exclusive
50 breastfeeding(Tseng et al., 2020). However, according to the survey conducted,
51 there was no research on the effect of counseling on self-efficacy and
52 breastfeeding problems in women who failed to breastfeed(Suárez-Cotelo et al.,
53 2019). Therefore, this literature review was conducted to determine the effect of
54 counseling on breastfeeding self-efficacy and the frequency of breastfeeding
55 problems in women with breastfeeding failure.
56 2. Materials and methods
57 The search was conducted through the Science Direct and Google Scholar
58 databases to identify articles published from 2017 to 2020 and include studies
59 that were (1) published in qualitative or quantitative research journals; (2)
60 published between 2017 and 2020; (3) involve literature reviews, meta-analyses,
61 guidelines, cohorts, or randomized controlled trials (RCTs); (4) published in
62 English for the full text; and (5) provide clear conclusions. We excluded studies
63 that were (1) incomplete; (2) has not been disclosed as published; or (3) not
64 published in English.
65 The literature review involves the analysis of the documents carried out. This
66 stage consists of literature search through primary search strategy, secondary
67 search through study quality review, and study extraction.
68

69

70
71
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7
72
73
74
75
76
77 Sear Science Direct (n = …..)
Google Scholar (n = …..)
ch
78
79
Total number of articles (n = )
80
StrainArticles are excluded because they are not appropriate or irrelevant after screening
81 based on title and abstract (n = )
1. Duplication (n = )
82 2. Non-English publications (n = )
83 3. Incomplete article (n = )
4. Participants in the article do not have diabetes (n = )
84 5. Non-inclusion of PHC and precision medicine concepts (n = )
85
86
qualify Full text articles included in the literature
87
review (n = )
88
89
9 Articles included in the analysis (n =
90 Including
35)
91
92 Scheme 1.Flowchart of screening articles.
93

94 3. Results
95 This section can be divided by subheadings. It should provide a concise and
96 precise description of the experimental results, their interpretation, and the
97 experimental conclusions that can be drawn.
98 3.1. Analysis and compilation of literature searches
99 After analyzing 9 relevant studies comprehensively, summarized the
100 elements of health education on breastfeeding self-efficacy in mothers. The most
101 frequently used elements were the following: maternal knowledge, personalized
102 lifestyle, biodata or evidence based, patient preferences, interdisciplinary
103 collaborative practice, self-management, and direct patient priority care.
104 Therefore, we first explain the definition and operation of the concept of health
105 education provided to mothers.
106
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9
107

108

109 3.2. Discovery of elements and description of the concept concept

110 Nine articles were found for health education on breastfeeding self-efficacy
111 in mothers through literature study and discussing concept descriptions. Concepts
112 can be identified by extracting data from each article, comparable definitions are
113 used in each article and health interventions, then integrating the results.
114 Therefore, reaching the final result is reviewed. A description of the concepts and
115 strategies of each article can be seen in Table 1 and is explained below.
116 Table 1 Extraction results from articles

Title (Researcher, year) Journal Source Research methods Results Conclusion

Effectiveness of an integrated International a. Study design: A single-blind, randomized Ninety-three mothers completed the Breastfeeding education
breastfeeding education Journal of controlled trial. study. Data were compared for the interventions increase
program to improve self- Nursing Studies b. Population/sample: 104 breastfeeding self-efficacy intervention group (n = breastfeeding self-
efficacy and exclusive mothers 50) with the control group (n = 43). efficacy, infant feeding
breastfeeding rate: A single- c. Sampling technique: block-randomization Initial measures did not differ attitudes, and rates of
blind, randomized controlled to an intervention or control group between groups. The intervention exclusive breastfeeding.
study d. Single variable: Effectiveness of an group had significantly higher Breastfeeding education
(Juei-Fen Tsenga,d, Su-Ru integrated breastfeeding education breastfeeding self-efficacy at 36 programs can be
Chenb, Heng-Kien Auc, program to improve self-efficacy and weeks gestation (mean difference effective in maintaining
Roselyn Chipojola d,f, Gabrielle exclusive breastfeeding rate (MD): 7.3, p < .001), and postpartum breastfeeding in new
T. Lee , Pi-Hsia Lee d, Meei- e. Intervention: integrated breastfeeding at 1 week (p < .001), 1 month ( p < . mothers.
Ling Shyud, Shu-Yu Kuo, education program intervention (IBEP) 001) and 3 months (p < .01) with
2020) f. Instrument: Questionnaire MD: 6.7, 7.9, and 8.1, respectively;
g. Statistical test: independent t test, chi- the difference in scores from baseline
square or Fisher's exact test was also significantly greater for
gestational age at 36 weeks to 3
months (MD from 9.1~9.9, p < .001)
and 6 months postpartum (MD: 7.0, p
< .05). Infant feeding attitude scores
increased significantly from 36
weeks gestation to 6 months
postpartum for the intervention group
(MD from 3.5~7.4, p < . 05). Rates
for exclusive and predominant

10

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Title (Researcher, year) Journal Source Research methods Results Conclusion

postpartum breastfeeding were

significantly higher for the
intervention vs control group (p < .
02) at 1 week (98% vs 86%), 1 month
(100% vs 90.7%), and 3 months (94
% vs 76.7%). Postpartum odds ratio
(OR) for exclusive and predominant
breastfeeding was greater in the
intervention group at 3 months (OR =
4.7, 95% Confidence interval (CI),
1.2 -18.6; p = .05) and for Exclusive
breastfeeding at 6 months (OR: 2.82,
95% CI 1.0–8.1; p = .05)

Effectiveness of theory-based International a. Research design: published randomized In total, 24 randomized controlled The theory-based
educational interventions on Journal of controlled trials were identified, and 5678 educational intervention
breastfeeding self-efficacy and Nursing Studies b. Population/sample: healthy mothers who mothers were included in the study, was effective in
exclusive breastfeeding: a have term babies, who intend to with 4178 mothers in the increasing breastfeeding
systematic review and meta- breastfeed, or who are breastfeeding breastfeeding self-efficacy group and self-efficacy and
analysis c. Sampling technique: randomized 1500 mothers in the theory of exclusive breastfeeding
(Roselyn Chipojola MSN, controlled trial planned behavior group. Mothers rates at 6 months. Future
Hsiao-Yean Chiu PhD, Mega d. Dependent variable: Breastfeeding self- who received the intervention-based breastfeeding education
Hasanul Huda MSN, Yen-Miao efficacy and exclusive breastfeeding theory had better breastfeeding programs that combine
Lin MSN, Shu-Yu Kuo PhD, e. Independent variable: The effectiveness outcomes up to 6 months postpartum. breastfeeding self-
2020) of theory-based educational intervention efficacy theory and
f. Intervention: Educational programs are planned behavior will
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Title (Researcher, year) Journal Source Research methods Results Conclusion

offered through a face-to-face mode (12 assist in promoting

studies) or include a combination of face- sustainable breastfeeding
to-face and telephone modes (12 studies) practices among mothers.
g. Statistical test: Correlation test

Design, implementation and Nurse a. Research design: The Kirkpatrick model Participants' satisfaction with higher This educational
evaluation of an education Education in b. Population/sample: 43 health workers education measures in all aspects was intervention increases
course to promote professional Practice c. Sampling technique: Total Sampling measured (greater than 3.9 in a score professional confidence
self-efficacy for breastfeeding d. Single variable: Design, implementation of 0-5). Professionals showed signs in breastfeeding efficacy
care and evaluation of an education course to of not being able to increase self- and performance
(Elena Antoñanzas- promote professional self-efficacy for efficacy levels of adequacy to support
Baztana,b,e , Maria-J. Pumar- breastfeeding care breastfeeding (Wilcoxon test p-value
Méndezc,d,e, Blanca Marín- e. Intervention: The intervention has a pre- = < 0.05, before intervention; median
Fernándezb, Maria D. Redín- post design. = 55, [IQR] = 11; after intervention:
Aretab, Maider Belintxonc,d,e, f. Instrument: Questionnaire median = 60, [IQR] = 14) .
Agurtzane Mujikac,d,e,1, Olga g. Statistical test: Wilcoxon test Participants, managers, and course
Lopez-Dicastillo, 2020) organizers identified changes in the
way professionals care for
breastfeeding mothers.

The Effect of Antenatal International a. Research design: Case Study There was no significant difference This study concluded
Education on Breastfeeding Journal of b. Population/sample: This study was between the groups in the mean that the use of breast
Self-Efficacy: Primiparous Caring Sciences conducted in 6 family health centers antenatal BSES-SF scores. However, milk and support for
Women in Turkey (eFrHC) in Eskisehir. There are a total of there was a significant difference pregnant women from
(Berrak Mizrak, RN, MSN, 90 respondents. between the groups in the mean prenatal to gestational
Nebahat Ozerdogan, PhD, c. Sampling technique: Total Sampling BSES-SF exchange rate at 1, 4 and 8 age increase the
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Title (Researcher, year) Journal Source Research methods Results Conclusion

Ertugrul Colak, PhD, 2017) d. Dependent variable: Breastfeeding weeks after birth, with scores being effectiveness of
mother's self-efficacy higher in the intervention group at breastfeeding and
e. Independent variable: Antenatal education this point. At 1 and 8 weeks after successful breastfeeding.
f. Intervention: Researchers provided birth, the intervention group had a Breastfeeding nurses
breastfeeding counseling to the much higher success rate of should be informed about
intervention group to develop the breastfeeding than the control group. the self-efficacy of
effectiveness of breastfeeding. breastfeeding in mothers.
g. Instruments: Antenatal Questionnaire, Nurses should try to
Postnatal Questionnaire, Breastfeeding incorporate the
Self-efficacy Scale, LATCH effectiveness of
Breastfeeding Assessment Tool breastfeeding into
h. Statistical test: two-way repeated breastfeeding education.
measures ANOVA, post hoc Holm-Sidak

The effect of prenatal BMC Women's a. Research design: randomized controlled The mean (SD) of breastfeeding self- Research shows that
counseling on breastfeeding Health clinical trial efficacy was 119.3 (10.5), 128.3 (8.3) prenatal counseling can
self-efficacy and frequency of b. Population/sample: 108 pregnant women and 133.8 (10.3) in the intervention improve mothers'
breastfeeding problems in with breastfeeding failure at Tabriz group and 105.3 (16.1), 105.7 (19.7) efficacy of breastfeeding
mothers with previous Health Center during 2017-2018 and 109.4 (24.7) in the control group and solve most
unsuccessful breastfeeding: a c. Sampling technique: Random Sampling in the control group. 15th day, 2nd breastfeeding problems
randomized controlled clinical d. Dependent variable: efficacy of and 4th month after delivery, during the postpartum
trial breastfeeding and frequency of respectively. There was a significant period.
(Fahimeh Sehhatie Shafaei1, breastfeeding problems in mothers with difference in breastfeeding self-
Mojgan Mirghafourvand and previous unsuccessful breastfeeding efficacy between the intervention and
Shiva Havizari, 2020) e. Independent variable: prenatal counseling control groups on day 15 (p < 0.001),
f. Intervention: The intervention group had and day 2 (p < 0.001 and 4 (p <
four sessions of prenatal counseling and 0.001) months after delivery.
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Title (Researcher, year) Journal Source Research methods Results Conclusion

the control received only routine care. Frequency of breastfeeding problems

Then, mothers who gave birth to their
children received counseling for up to 4
months after giving birth.
g. Instrument: Breastfeeding Self-Efficacy
(BSES) Questionnaire and the frequency
of breastfeeding problems
h. Statistical test: chi-square test
repeated measure ANOVA test
at the 15th (p = 0.008), 2nd (p <
0.001 and 4th (p < 0.001) postpartum
were significantly different in most
cases the intervention group when
compared with the controls.
and

Breastfeeding knowledge and
relation to prevalence
(María del Carmen Suárez-
Cotelo, 2018)
Journal of a. Research design: Prospective descriptive 297 pregnant women participated in The level of knowledge
School of study the study, of whom: 90.4% wanted to of pregnant women about
Nursing b. Population/sample: 297 third trimester exclusively breastfeed their babies, regular breastfeeding and
pregnant women who attended maternal but only 28.2% continued to 6 influencing the choice of
education class (ME) with a midwife at months. The level of knowledge how to breastfeed their
the Puskesmas during the data collection about regular breastfeeding and it babies and the duration
period. was observed that it affects the of exclusive
c. Sampling technique: Total sampling intention and type of feeding of the breastfeeding. Strategies
d. Single variable:Breastfeeding knowledge newborn, so it is an element that should be implemented
and relation to prevalence should be considered when to increase knowledge
e. Interventions: Data were collected on developing an educational strategy to and increase
mothers' intentions to feed newborns and increase the rate of breastfeeding. breastfeeding rates.
their knowledge of
breastfeeding.Acoustic stimulation for 10
minutes once a day for seven consecutive
days using headphones
f. Instrument: Self-filling questionnaire
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Title (Researcher, year) Journal Source Research methods Results Conclusion

g. Statistical test: Chi-square test

The effect of a combined Maternal and a. Study design: This was a single-centre, The primary outcome was exclusive Written breastfeeding
intervention on exclusive Child Nutrition controlled, randomized, three-arm, breastfeeding (EBF) at 3 months. materials and proactive
breastfeeding in primiparas: A superior study, with blind-outcome Secondary outcomes included telephone support among
randomized controlled trial assessment. breastfeeding difficulties, attitudes primiparas are effective
(Drita Puhari, Mario Malicˇki, b. Population/sample: The study population toward infant feeding, breastfeeding ways to increase
Josip Anđelo Borovac, Vladimir was primigravida, with singleton self-efficacy and social support. breastfeeding rates,
parac, Boris Poljak, Nađa Arac, pregnancies, who came to the obstetrician Practice staff are not aware of group reduce breastfeeding
Nero Marinovi, Nives Lueti, at 20 to 32 weeks of gestation. allocation. Participants in the IG had difficulties and improve
Irena Zakarija-Grkovi, 2019) c. Sampling technique: Randomization and the highest increase in positive self-efficacy and
blinding Sampling attitudes toward infant feeding, attitudes toward infant
d. Dependent variable: exclusive compared with baseline, and feeding.
breastfeeding in primiparas significantly higher efficacy of
e. Independent variable: combined breastfeeding. Participants in the
intervention SCG experienced significantly more
f. Intervention: The intervention in this difficulty breastfeeding, both at 3 and
study consisted of printed educational 6 months, compared to AC and IG.
materials and four proactive telephone
calls. The breastfeeding booklet contains
information from Session three.
g. Statistical tests: chi-square tests and
ordinal regression

Impacts of antenatal nursing BMC a. Research design: experimental study Self-efficacy of breastfeeding during Current investigations
interventions on mothers' Pregnancy and b. Population/sample: 130 pregnant women pregnancy and after two months of show that antenatal
breastfeeding self-efficacy: an Childbirth attending a primary health care center delivery in the experimental group breastfeeding education
experimental study were randomly assigned to the trial was significantly higher. The is an effective way to
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Title (Researcher, year) Journal Source Research methods Results Conclusion

(Safiya Sabri Piro and Hamdia c. Sampling technique: Purposive Sampling experimental group had a higher level increase breastfeeding
Mirkhan Ahmed, 2020) d. Dependent variable: efficacy of of knowledge and attitude than the self-efficacy levels,
breastfeeding in mothers subjects in the control group. In which enhances
e. Independent variable: antenatal nursing addition, exclusively breastfeeding exclusive breastfeeding
intervention mothers had higher postnatal self- practices.
f. Intervention: The experimental group efficacy levels in the experimental
received two 60-session 90-minute group and control groups compared to
breastfeeding education based on formula-fed women (52.00 vs 39.45
breastfeeding self-efficacy theory along in controls and 57.69 vs 36.00 in
with routine care. mothers' knowledge, experimental subjects; P < 0.001).
attitudes, prenatal and postnatal self-
efficacy towards breastfeeding were
compared between the two groups.
g. Instrument: The Iowa Infant Feeding
Attitude Scale measured the attitudes.
Prenatal Breastfeeding Self-Efficacy
Scale measured the self-efficacy during
pregnancy and Breastfeeding Self-
Efficacy-Short Form measured the self-
efficacy in postnatal period
h. Statistical test: Pearson Chi-Square test or
independent t-test

The effect of breastfeeding International a. Research design: quasi-experimental The mean BFSE scores differed This study suggests that
education with grandmothers' Breastfeeding study significantly between the groups with breastfeeding education
attendance on breastfeeding Journal b. Population/sample: 64 primiparous and without grandmothers at the time with grandmothers'
self-efficacy and infant feeding women of discharge (60.15 ± 4.47 vs. 56.84 presence is effective in
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Title (Researcher, year) Journal Source Research methods Results Conclusion

pattern in Iranian primiparous c. Sampling technique: Purposive Sampling ± 6.22, independent t-test; p = 0.017), increasing mothers'
women: a quasi-experimental d. Dependent variable: efficacy of and at 4 weeks (61.71 ± 2.66 vs. breastfeeding self-
pilot study breastfeeding and infant diet in 56.62 ± 9.12, p = 0.004) and 8 weeks efficacy. Family-centred
(Tayebeh Gharaei, Leila Amiri- primiparous women after delivery (63.68 ± 2.14 vs. 60.03 programs should be
Farahani1, Shima Haghani and e. Independent variable: breastfeeding ± 6.32, p = 0.003) . There were no considered in animal
Syedeh Batool Hasanpoor- education with grandma's presence significant differences in infant feeding education to
Azghady, 2020) f. Intervention: Breastfeeding education is feeding patterns between the groups increase exclusive
designed according to the manual for over the same time period breastfeeding.
monitoring baby-friendly hospitals.
g. Instrument: The Breastfeeding Self-
Efficacy Scale-Short Form (BSES-SF)
h. Statistical tests: The chi-squared and
Fisher's exact tests
117 4. Discussion
118 The main result of this study was the finding of the effect of health education
119 on self-efficacy in breastfeeding mothers. In order to implement the interventions
120 in each article to improve self-efficacy, patients must explain pressing issues to
121 the healthcare professional using a shared decision-making tool. Discussions
122 between patients and health professionals during health education are likely to
123 lead to the presentation of options for improving self-efficacy in breastfeeding
124 mothers. Discussion of options between healthcare professionals and patients can
125 ensure agreement on benefits, risks, costs, including patient beliefs, values,
126 lifestyle. The information collected is evidence of patient preferences.
127 Self-management in mothers' knowledge of seeking information and
128 applying it is also an important component of any intervention as in 9 articles.
129 Self-management involves prioritizing appropriate action decisions for the
130 patient. Self-efficacy encourages patients through self-management to follow a
131 plan (e.g., tests, medications, procedures, behavior change) that is formulated in
132 collaboration with health professionals as during health education.(Gharaei et al.,
133 2020). For self-management, understanding of facts or perspectives among
134 patients is required. Verifying and clarifying this understanding is very important
135 for health literacy. Obviously, the decision to apply self-management to solve a
136 problem is not always made when the problem is first discussed. As such,
137 healthcare professionals should arrange follow-up to track the outcomes of
138 decisions that have been made together. Several articles have reported on the
139 application and effectiveness of health education on self-management in
140 approaches to increasing efficacy in breastfeeding mothers. This concept is
141 appropriate for these patients as it prioritizes appropriate problem solving and
142 reduces unnecessary interventions. Furthermore, lifestyle considerations become
143 increasingly important. Therefore, empirical research is needed to verify the
144 effectiveness of this concept.
145 In the article that was appointed, research was carried out by giving a pre-
146 test before counseling and post-test after being given counseling. However, in
147 several other articles it is not explained how long the research will take. The
148 instrument used to measure the level of knowledge in the study was using a
149 questionnaire. The questionnaire was given in two stages, namely before and
150 after the research was conducted with the same questions.

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151 Another core intervention to improve self-efficacy is based on the care of a
152 team of professionals, including medical specialists, nurses, nurse specialists,
153 pharmacists, and nutritionists.(Shafaei et al., 2020). In addition, mothers are
154 involved in decision-making and preparation of care programs and goals. Every
155 professional should implement an interdisciplinary communication platform and
156 cooperation model. The extension model when health education is centered on
157 breastfeeding mothers can increase mother's knowledge about exclusive care for
158 individuals and allow the establishment of an accurate treatment plan, thereby
159 increasing the effectiveness of health education on self-efficacy in breastfeeding
160 mothers(Piro & Ahmed, 2020). This concept makes it possible to provide
161 services for high quality or special quality cases. In addition, this type of service
162 considers not only medical care but also the personality of the mother based on
163 biographical data or evidence, patient preferences, and patient priority direct care.
164 Effective model design, innovation and practical interventions ensure good
165 patient outcomes and better self-management.
166 Inadequate breastfeeding education during prenatal preparation is one of the
167 documented barriers to breastfeeding during the early postpartum period(Mizrak
168 et al., 2017). However, most prenatal classes are delivered with a traditional
169 didactic approach, which limits the effectiveness of changing breastfeeding
170 behavior(Antoñanzas-Baztan et al., 2020; Tseng et al., 2020). Expectations of
171 breastfeeding efficacy improve breastfeeding behavior by increasing self-
172 confidence through performance achievement, vicarious learning, verbal
173 persuasion, and physiological responses. Our intervention program provides a
174 learning experience using interactive methods prior to the postpartum period that
175 has the potential to increase participants' confidence and their ability to
176 breastfeed successfully. This was confirmed in open feedback at the end of the 3-
177 week program and demonstrated the breastfeeding knowledge and skills learned
178 at IBEP and BSES-SF prepared them for breastfeeding before the birth of their
179 child. All participants in our program were first-time mothers and fathers, and as
180 such, receiving IBEP and BSES-SF during the prenatal stage may have eased the
181 transition to breastfeeding.
182 Incorporating four aspects of self-efficacy expectations, with particular
183 attention to novice mothers, partially explained the higher breastfeeding self-
184 efficacy scores for the intervention group in our study. Mothers have the
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185 opportunity to experience performance gains during simulated breastfeeding
186 scenarios as they practice correct breastfeeding positions with a crying real-life
187 prop, which also increases their confidence when their own baby cries and needs
188 to be fed. Fathers are often excluded from breastfeeding education and feel
189 powerless to support mothers during breastfeeding(Chipojola et al., 2020).
190 Including a support partner in our program allows couples to experience
191 simulated scenarios together and learn to cope as a team, gain knowledge of
192 breastfeeding skills in a safe environment, and practice how to support each
193 other.
194 The results of this literature review can be considered for applying in health
195 education, especially in an effort to increase mother's knowledge about exclusive
196 breastfeeding. So that people understand and understand more about exclusive
197 breastfeeding and mothers have the intention to give exclusive breastfeeding to
198 their children.
199

200 5. Conclusion

201 Self-efficacy in breastfeeding mothers through a health education approach

202 encourages mothers through self-management to follow a plan (eg, tests,
203 treatment, procedures, behavior change) that is formulated in collaboration with
204 health professionals such as during health education. For self-management,
205 understanding of facts or perspectives among patients is required. Verifying and
206 clarifying this understanding is very important for health literacy. Obviously, the
207 decision to apply self-management to problem solving is not always made when
208 the problem is first discussed.

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221 Reference

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