The Influence of Age, Knowledge, Beliefs, Support, and Access to Health Care on 6 -Week Exclusive Breastfeeding among Postpartum Hill-Tribe Mothers

Main Article Content

Paparwarin Wangdi
Wanna Phahuwatnakorn
Piyanun Limruangrong


Purpose: To investigating the predictive of age, breastfeeding knowledge, cultural beliefs, breastfeeding support, and access to health care on 6-week exclusive breastfeeding of postpartum hill-tribe mothers.

Design: Predictive correlational design.

Methods: The study sample consisted of 177 postpartum hill-tribe mothers at the Primary and Holistic section, Omkoi hospital, Chiang mai, and Mae Sariang hospital, Mae Hong Son. Demographic Characteristics Questionnaire, the Breastfeeding Knowledge Questionnaire, the Cultural Beliefs Questionnaire, the Breastfeeding Support Questionnaire, Access to Health Care Questionnaire, and Breastfeeding Interview were used to collect data. Data were analyzed by using descriptive statistics and Logistic Regression analysis.

Main findings: The study findings showed that age, breastfeeding knowledge, cultural beliefs, breastfeeding support, and access to health care could together statistically significantly predict on 6-week exclusive breastfeeding of postpartum hill-tribe mothers by 9% (p < .05, Nagelkerke R2 = .09). The only access to health care was the factor that could predict on 6-week exclusive breastfeeding of postpartum hill-tribe mothers (Exp(B) = 4.60, 95%CI = 1.07, 19.83, p < .05).

Conclusion and recommendations: According to the study findings, access to health care could help postpartum hill-tribe mothers’ success in exclusive breastfeeding. Therefore, nurse-midwives should advice and promote exclusive breastfeeding for postpartum hill-tribe mothers especially in increasing communication routes during breastfeeding problems.

Article Details

How to Cite
Wangdi, P., Phahuwatnakorn, W. ., & Limruangrong, P. (2022). The Influence of Age, Knowledge, Beliefs, Support, and Access to Health Care on 6 -Week Exclusive Breastfeeding among Postpartum Hill-Tribe Mothers. Nursing Science Journal of Thailand, 40(2), 1–16. Retrieved from
Research Papers


Binns C, Lee M, Low WY. The long-term public health benefits of breastfeeding. Asia Pac J Public Health. 2016;28(1):7-14. doi: 10.1177/1010539515624964.

WHO, UNICEF. Tracking progress for breastfeeding policies and programmes: global breastfeeding scorecard 2017. Geneva: World Health Organization; 2017. 12 p.

Office of the National Economic and Social Development Board, Office of the Prime Minister. Thailand twelfth national economic and social development plan (2017-2021). Bangkok: WVO Officer of Printing Mill; 2016. 67 p. (in Thai).

Saramon P, Ruengorn C, Seangphichai S, Wonghankla B. Epidemic of inappropriate health products and associated adverse events among chronic disease patients in border area, Wieng Kan District, Chiang Rai Province. Thai Journal of Pharmacy Practice. 2019;11(2):307-17. (in Thai).

Potipairatana S. The potential development of ethnics group leaders in communication through online media for supporting accessibility to health services: operational research (round 1). Journal of Mass Communication. 2018;6(2):1-25. (in Thai).

Roesler AL, Smithers LG, Wangpakapattanawong P, Moore V. Stunting, dietary diversity and household food insecurity among children under 5 years in ethnic communities of northern Thailand. J Public Health (Oxf). 2019;41(4):772-80. doi: 10.1093/pubmed/fdy201.

Roesler AL, Smithers LG, Moore V, Wangpakapattanawong P. Local insights into improving child nutrition in northern Thailand: findings and recommendations regarding breastfeeding [scholar article]. The University of Adelaide, Chiang Mai University, KSC-GMS, ICRAF; 2014. 20 p.

Zhang Z, Zhu Y, Zhang L, Wan H. What factors influence exclusive breastfeeding based on the theory of planned behaviour. Midwifery. 2018;62:177-82. doi: 10.1016/j.midw.2018.04.006.

Chanapai S, Sinsuksai N, Thananowan N, Phahuwatanakorn W. Knowledge, attitude, self-efficacy, spousal and nurse support predicting 6-weeks exclusive breastfeeding. Nursing Science Journal of Thailand. 2014;32(1):51-60. (in Thai).

Ekure E, Antia-Obong O, Udo JJ, Edet E. Maternal exclusive breast-Feeding practice in Calabar, Nigeria: some related social characteristics. Niger J Clin Pract. 2003;6(2):92-4.

Nuampa S, Sinsuksai N, Phahuwatanakorn W, Chanprapaph P. Personal factors, first feeding time and nurse support in predicting successful exclusive breastfeeding at discharge in mothers with cesarean section. Nursing Science Journal of Thailand. 2013;31(2):49-59. (in Thai).

Balogun OO, Dagvadorj A, Anigo KM, Ota E, Sasaki S. Factors influencing breastfeeding exclusivity during the first 6 months of life in developing countries: a quantitative and qualitative systematic review. Matern Child Nutr. 2015;11(4):433-51. doi: 10.1111/mcn.12180.

Kounnavong S, Pak-Gorstein S, Akkhavong K, Palaniappan U, Berdaga V, Conkle J, et al. Key determinants of optimal breastfeeding practices in Laos. Food Nutri Sci. 2013;4:61-70. doi: 10.4236/fns.2013.410A010.

Rueangseree M. Factors affected to exclusive breastfeeding only at least 6 month of adolescent postpartum mothers attending health promoting hospitals Muang District Ubon Ratchathani Province. UBRU Journal for Public Health Research. 2017;6(1):37-48. (in Thai).

Kakute PN, Ngum J, Mitchell P, Kroll KA, Forgwei GW, Ngwang LK, et al. Cultural barriers to exclusive breastfeeding by mothers in a rural area of Cameroon, Africa. J Midwifery Womens Health. 2005;50(4):324-8. doi: 10.1016/j.jmwh.2005.01.005.

Osman H, El Zein L, Wick L. Cultural beliefs that may discourage breastfeeding among Lebanese women: a qualitative analysis. Int Breastfeed J. 2009;4:12. doi: 10.1186/1746-4358-4-12.

Thepha T, Marais D, Bell J, Muangpin S. Perceptions of northeast Thai breastfeeding mothers regarding facilitators and barriers to six-month exclusive breastfeeding: focus group discussions. Int Breastfeed J. 2018;13:14. doi: 10.1186/s13006-018-0148-y.

Jintrawet U, Tongsawas T, Somboon L. Factors associated with the duration of exclusive breastfeeding among postpartum mothers. Nursing Journal. 2014;41:133-44. (in Thai).

Fang DM, Stewart SL. Social–cultural, traditional beliefs, and health system barriers of hepatitis B screening among Hmong Americans: a case study. Cancer. 2018;124(7 Suppl 7):1576-82. doi: 10.1002/cncr.31096.

Brown CRL, Dodds L, Legge A, Bryanton J, Semenic S. Factors influencing the reasons why mothers stop breastfeeding. Can J Public Health. 2014;105(3):e179-85. doi: 10.17269/cjph.105.4244.

Lipsey MW, Wilson DB. Practical meta-analysis (applied social research methods series; Vol.49). Thousand Oaks, CA: Sage Publications; 2001. 247 p.

House JS. Work stress and social support. Reading, MA: Addison-Wesley. 1981. 156 p.

Penchansky R, Thomas JW. The concept of access: definition and relationship to consumer satisfaction. Med Care. 1981;19(2):127-40. doi: 10.1097/00005650-198102000-00001.

Szczepura A. Access to health care for ethnic minority populations. Postgrad Med J. 2005;81(953):141-7. doi: 10.1136/pgmj.2004.026237.

Kang C, Tomkow L, Farrington R. Access to primary health care for asylum seekers and refugees: a qualitative study of service user experiences in the UK. Br J Gen Pract. 2019;69(685):e537-45. doi: 10.3399/bjgp19X701309.

Gunmongkol S. The construction of a campaign to motivate Karen women to use contraceptives in Omkoi District, Chiang Mai [master’s thesis]. Chiang Mai: Chiang Mai Rajabhat University; 2013. 81 p. (in Thai).