Participatory Health Cadre Model to Improve Exclusive Breastfeeding Coverage with King’s Conceptual System

Figures & data

Table 1 In-Depth Interview

Element	Sub-Element	Interview Statements from Informants
Interaction	Trust	I follow all the recommendations from the health cadres so that my breast milk is abundant and flows smoothly. The family and breastfeeding mothers are happy when the cadres come to provide assistance and give guidance on breastfeeding.
	Cooperation	When I meet breastfeeding mothers, if I face difficulties, yes, I involve healthcare professionals. I also encourage the breastfeeding mother’s husband and other family members to participate because social support is crucial for the success of exclusive breastfeeding. The family, especially the grandmother, provides encouragement and support to the breastfeeding mother to eat healthily and nutritiously. The way to interact with breastfeeding mothers to increase awareness of exclusive breastfeeding is by providing adequate knowledge about the benefits and proper techniques of breastfeeding, as well as offering support from the husband, family, and the community.
Perception	Absorption	Exclusive breastfeeding, in my opinion, is very important because it enhances the baby’s immune system and strengthens the bond between the mother and the baby.
	Understanding	In my opinion, exclusive breastfeeding has significant benefits for both mothers and infants. For mothers, exclusive breastfeeding can expedite postpartum recovery, reduce the risk of breast cancer, and enhance emotional bonding with the baby. For infants, exclusive breastfeeding provides optimal nutrition, boosts the immune system, and lowers the risk of infections and chronic diseases in the future.
	Acceptance	My efforts to raise awareness among breastfeeding mothers include providing adequate education about the benefits and proper methods of breastfeeding. I also strive to involve families and the community in supporting breastfeeding mothers. Additionally, I play a role in organizing health integrated post activities that focus on providing information and support to breastfeeding mothers.
Communication	Openness	I always provide the necessary information to breastfeeding mothers regarding exclusive breastfeeding. I explain the benefits of exclusive breastfeeding, the correct methods of breastfeeding, and the support that can be provided by family and the surrounding community.
	Empathy	The use of easily understood language and providing real examples of the benefits of exclusive breastfeeding can make it more understandable and encourage efforts to listen and understand the needs and concerns of breastfeeding mothers. This provides positive support and motivation.
	Support	The right way to ensure that mothers are confident in providing exclusive breastfeeding to their babies until the age of 6 months is by providing adequate education about the benefits and proper techniques of breastfeeding. It is also essential to involve family and the community in providing support. I play a role in organizing health integrated post activities that focus on providing information and support to breastfeeding mothers. Additionally, it is crucial to offer support from husbands, family, and the community to maintain the motivation and self-confidence of breastfeeding mothers to exclusively breastfeed their babies until the age of 6 months.
	Feedback	Breastfeeding mothers reportedly receive questions from health cadres after being provided with information. The cadres ask whether they understand or not and present one to two questions based on what has been taught. I was instructed to practice the breast massage technique that involves “kneading” (addressing blockages or congestion) by the cadre after she finished teaching.
Transaction	Participation	Yes, I provide physical guidance to the cadre to inform breastfeeding mothers about increasing exclusive breastfeeding. I provide a guidebook on empowering breastfeeding mothers in the exclusive breastfeeding program, containing information about the benefits of exclusive breastfeeding, the correct way to breastfeed, and the support that can be provided by the family and the surrounding community.
	Attitude	The cadres have already participated sufficiently by providing education and involving families and the community in offering support.
Role	Expected behavior	I provide the necessary information for breastfeeding mothers regarding exclusive breastfeeding. I explain the benefits of exclusive breastfeeding, the correct way to breastfeed, and the support that can be provided by family and the surrounding community.
	Specified rules	The method used involves providing a handbook for empowering breastfeeding mothers in the exclusive breastfeeding program. Additionally, an educational approach and participation in health integrated post activities, where I provide information and support to breastfeeding mothers, and involve family and the community in providing support.
Growth and Development	Movement	The cadres undergo training to enhance awareness of breastfeeding mothers in promoting exclusive breastfeeding. The training provides me with knowledge and skills to provide education and support to breastfeeding mothers, as well as ways to overcome the challenges often faced by breastfeeding mothers.
	Changes in thinking	My experience in monitoring babies receiving exclusive breastfeeding has been through home visits and health integrated post activities. I monitor the growth and development of babies and provide support and education to breastfeeding mothers on the correct way to provide exclusive breastfeeding.
	Self-actualization	There are records from the cadres about mothers who provide exclusive breastfeeding.
Time	Time intensity	Support is provided periodically to breastfeeding mothers regarding exclusive breastfeeding. I conduct home visits and health integrated post activities to provide information and support to breastfeeding mothers, as well as involving family and the community in providing support.
	Obstacles	The right time for the cadres to provide explanations to mothers for breastfeeding preparation is during pregnancy. This is because mothers gain sufficient information and preparation about the benefits and correct methods of exclusive breastfeeding. Additionally, health integrated posts and health education can also provide information and support to breastfeeding mothers.
Space	Expectations	My hope for the exclusive breastfeeding program is that all breastfeeding mothers can understand the importance of exclusive breastfeeding and implement it successfully. I hope this program can improve the health of both the baby and the mother, as well as strengthen the emotional bond between mother and child.
	Actions	The actions taken to ensure that mothers continue to practice exclusive breastfeeding for their babies involve providing adequate education about the benefits and correct methods of exclusive breastfeeding. I also offer support and motivation to breastfeeding mothers and involve families and communities in providing support.

Figure 1 Proposed participatory model of health cadres to improve exclusive breastfeeding coverage.

Table 2 Descriptive Statistics and t-Test Results

Variable	N	Descriptive Statistics					t-Statistics
		Minimum	Maximum	Mean	Mean Different	Std. Deviation	t-Table	p-value
Pretest perception of health cadres regarding exclusive breastfeeding.	90	0	18	6.16	10.53	4.287	20.659	0.000
Posttest perception of health cadres regarding exclusive breastfeeding.	90	12	20	16.69		2.222
Valid N (listwise)	90

Table 3 N-Gain Test Results

Descriptive Statistics
	N	Minimum	Maximum	Mean	Std. Deviation
N Gain	90	0.00%	100.00%	72.76%	0.23
Valid N (listwise)	90

Table 4 Coverage of Exclusive Breastfeeding Mothers

Region	Total Postpartum Mothers		Total	After Mentoring
	May 2021 (1st Month)	June 2021 (2nd Month)
				Achieved	Not Achieved	Refused to be Mentored
I	16	17	33	28	5	0
II	14	15	29	24	4	1
III	15	16	31	28	1	2
Total	45	48	93	80 (86.02%)	10 (10.75%)	3 (3.23%)