Bobbi Be Best: the development and evaluation of an audio program and discussion guide to promote exclusive breastfeeding in Cameroon, Central Africa

One risk factor for infant and childhood morbidity is not exclusive breastfeeding (EBF) during the first six months of life. Entertainment Education (EE) is a communication strategy consisting of placing educational information into television, movies, and radio programs. In developing countries this form of behavioral change communication has proven effective in addressing health-related issues; however, no research has determined if EE is effective in promoting EBF. The objective of this research was to develop an EE audio program and discussion guide and to determine if a series of four 15-minute episodes and post-listening discussion improved knowledge, perceived benefits, self-efficacy, and intention and decreased misconceptions and perceived barriers toward EBF in the Kumbo West Health District, Cameroon. Pregnant women and their partners were assigned to either the control group (N = 116; 74 women, 42 partners) or intervention group (N = 148; 99 women, 49 partners) based on expected date of delivery. All control and intervention group participants completed a questionnaire prior to listening to the first and after the last episode. Pre- and post-listening questionnaires were used to determine changes in the EBF knowledge, misconceptions, perceived barriers, self-efficacy, and intention variables as a result of exposure to the audio program. The Wilcoxon Sign Rank test showed significant improvement in all of the variables, except perceived barriers, within the intervention group (p < 0.05) and the Mann-Whitney test indicated significant differences between the control and intervention group in all of the variables (p < 0.05), indicating that using an audio program and discussion guide based on the EE model is an effective tool for promoting EBF in this setting. The strength of this approach is that it goes beyond simply telling women about what constitutes EBF, but addresses misconceptions and perceived barriers that may prevent women from practicing EBF for six months.

Incorporating cultural beliefs in promoting exclusive breastfeeding

INTRODUCTION

Since 2003, the World Health Organization has recommended exclusive breastfeeding for the first 6 months of life. In the Northwest region of Cameroon approximately 90% of women initiate breastfeeding, yet only 34% of these women exclusively breastfeed for the recommended six months.

AIM

To determine influences on women's exclusive breastfeeding practices.

METHODS

Semi-structured interviews were conducted with six women and six men followed by focus group discussions with three groups of women and three groups of men in the Kumbo West Health District, Northwest region, Cameroon. All participants were selected using theoretical sampling to assure triangulation.

RESULTS

Three themes emerged that influence exclusive breastfeeding practices: woman's readiness to exclusively breastfeed; cultural influences towards exclusive breastfeeding; and perceived constraints to exclusive breastfeeding.

CONCLUSION

These emergent themes were used to create a theoretical framework that is useful for developing a breastfeeding health education intervention in non-Western settings.