Using cognitive‐behavioural techniques to improve exclusive breastfeeding in a low‐literacy disadvantaged population

Abstract

Despite being an important component of Pakistan's primary health care programme, the rates of exclusive breastfeeding at 6 months remain among the lowest in the world. Low levels of literacy in women and deeply held cultural beliefs and practices have been found to contribute to the ineffectiveness of routine counselling delivered universally by community health workers in Pakistan. We aimed to address this by incorporating techniques of cognitive-behavioural therapy (CBT) into the routine counselling process. We conducted qualitative studies of stakeholders' opinions (mothers, community health workers, their trainers and programme managers) and used this data to develop a psycho-educational approach that combined education with techniques of CBT that could be integrated into the health workers' routine work. The workers were trained to use this approach and feedback was obtained after implementation. The new intervention was successfully integrated into the community health worker programme and found to be culturally acceptable, feasible and useful. Incorporating techniques of CBT into routine counselling may be useful to promote health behaviours in traditional societies with low literacy rates.

Cognitive-Behavioral Counseling for Exclusive Breastfeeding in Rural Pediatrics: A Cluster RCT

“…The approach was integrated into the LHW program and tailored to the needs of disadvantaged communities. 13 We have demonstrated that cognitivebehavioral therapy (CBT) techniques can be taught to nonspecialist community health workers (LHWs) to bring about improvement in maternal well-being and child care, and that LHWs found these techniques to be very useful in communicating with "difficult to engage" families. 14,15 The current intervention was designed to be integrated into the routine training, supervision, and day-to-day work of LHWs.…”

“…13 The aim of the current study was to evaluate the impact of the intervention, delivered at scale, on both the rate and duration of EBF in the first 6 months of an infant's life through an effectiveness trial. Secondary aims included evaluating impact on traditional practices impeding EBF and levels of psychosocial distress among mothers.…”

“…Our formative research revealed that the LHWs' counseling had been too didactic and authoritarian, undermining the confidence of many women. 13 Using pictures to discuss traditional harmful practices rather than confronting the families, breaking tasks into manageable pieces, and helping mothers overcome problems in implementing behaviors made the LHWs much stronger agents for change. Although traditionally CBT techniques are used for the treatment of affective disorders such as depression, the current intervention did not have a significant impact on the levels of psychosocial distress.…”

“…This study reveals that seemingly sophisticated techniques of therapy can be simplified and incorporated into routine counseling practice. The techniques have much in common with other theory-based behavior change strategies, 13 but pay particular attention to the mother who may be disempowered, illiterate, and psychologically distressed. Such techniques may have a role in enhancing the effectiveness of not only EBF programs but other preventive programs delivered at scale in similar settings.…”

Factors associated with maternal health knowledge through community-based antenatal care program among pregnant women in rural Paraguay

“…A systematic review concerning utilization of ANC in developing countries identified several factors as affecting ANC attendance, such as maternal educational status, partner's educational status, marital status, availability and affordability of health care services, household income, etc 12 . However, culturally sensitive approaches, if implemented appropriately, can potentially be effective and affordable ways to improve women's health literacy, especially in traditional societies 13 . Capability of health care personnel and community based networks are important aspects of planning for such culturally sensitive approaches 14 .…”