Path Analysis on the Effectiveness of Exclusive Breastfeeding Advocacy Program on Breastfeeding Practice using Theory of Planned Behavior

Valentina Dili Ariwati, Didik Tamtomo, Endang Sutisna Sulaeman


Background: Exclusive breastfeeding coverage was 52.30% in 2015, which was below the national target of 80%. For the past few years Klaten local government has launched the Exclusive Breastfeeding Advocacy Program with the objective to increase exclusive breastfeeding coverage. This study aimed to determine the effectiveness of Exclusive Breastfeeding Advocacy Program using Theory of Planned Behaviour framework.

Subjects and Method: This was an analytic observational study with retrospective cohort design. This study was conducted from 2 August to 16 September 2016 in Klaten and Magelang, Central Java, Indonesia. A total of 200 lactating mothers of infants aged 6 to 12 months was selected for this study by multi-stage random sampling. The dependent variables were exclusive breastfeeding and intention. The independent variables were exclusive breastfeeding advocacy program, attitude, subjective norm, and perceived behavior control. The data were collected  using a set of questionnaire, and analyzed by path analysis.

Results: The path model showed Goodness of Fit indices as follows: CMIN=4.24, p=0.374, GFI=0.99, NFI=0.99, CFI=1.00, RMSEA=0.017. Strong intention (b=0.15; p <0.001) had direct effect on exclusive breastfeeding. Positive atittude (b = 0.27; p<0.001), positive subjective norm (b=0.26; p <0.001), strong perception of behavior control  (b=0.25; p<0.001), and exclusive breastfeeding advocacy program (b=0.36; p<0.001), had positive effects on intention.

Conclusion: Intention has direct effect on exclusive breastfeeding. Atittude toward exclusive breastfeeding, subjective norm, and perception of behavior control, have positive effects on intention. Exclusive breastfeeding advocacy program is effective in increasing the likelihood of providing exclusive breastfeeding.

Keywords: exclusive breastfeeding advocacy program, attitude, subjective norm, perceived behavior control, intention, exclusive breastfeeding behavior.

Correspondence: Valentina Dili Ariwati. Masters Program in Public Health, Sebelas Maret University.

Journal of Health Promotion and Behavior (2016), 1 (3): 149-159

Full Text:



Agumadu UH, Racine EF, Laditka SB, Coffman MJ (2016). Associations between perceived value of exclusive breastfeeding among pregnant women in the united states and exclusive breastfeeding to three and six months postpartum: a prospective study. International Breastfeeding Journal. 11 (8): 1-10.

Ajzen I (1991). The theory of planned behavior. organizational behavior and human decision processes. 50 (1): 179-211.

Akour NA, Khassawneh MY, Khader YS, Ababneh AA, Haddad AM (2010). Factor affecting intention to breastfeed among syrian and jordanian mothers: a comparative crosssectional study. International Berastfeeding Journal. 5 (6): 1-8.

Arisman (2010). gizi dalam daur kehidupan. Jakarta: EGC.

Asriani DD, Itriyati F (2009). Gerakan inisiasi menyusui dini dan pemberian asi eksklusif kabupaten klaten. Diakses 3 Mei 2016.

Behera D, Kumar KA (2015). Predictors of Exclusive Breastfeeding Intention Among Rural Pregnant Women in India: A Study using theory of planned behavior. the international electronic journal of rural and remote health, education, practice, and policy. 15 (3405): 1-10.

Compton WC (2005). positive psychology. usa: wadsworth.

Dignam (1995). Understanding intimacy as experienced by breastfeeding women. health care for women international. 16 (5): 477-485.

Dinas Kesehatan Provinsi Jawa Tengah (2013). Buku profil kesehatan provinsi jawa tengah tahun 2012. Semarang: Dinas Kesehatan Provinsi Jawa Tengah.

Dinas Kesehatan Kabupaten Klaten (2008). Buku profil kesehatan kabupaten klaten tahun 2007. Klaten: Dinas Kesehatan Kabupaten Klaten.

_______ (2013). buku profil kesehatan kabupaten klaten tahun 2012. Klaten: Dinas Kesehatan Kabupaten Klaten.

_______ (2014). Buku Profil Kesehatan Kabupaten Klaten Tahun 2014. Klaten: Dinas Kesehatan Kabupaten Klaten.

_______ (2015). Buku profil kesehatan kabupaten klaten tahun 2014. Klaten: Dinas Kesehatan Kabupaten Klaten.

Departemen Kesehatan Republik Indonesia (2006). pedoman inisiasi menyusui dini. Jakarta: Departemen Kesehatan Republik Indonesia.

Donnan PT, Dalzell J, Symon A, Rauchhaus P, Hodge EM, Kellet G, Wyatt JC, Whitford HM. (2013). Prediction of initiation and cessation of breastfeeding from late pregnancy to 16 weeks: The Feeding Your Baby (FYB) Cohort Study. BMJ Open. 3 (3274): 1-10.

Fishbein M, Ajzen I (1975). Belief, attitude, intention, and behavior: an introduction to theory and research. philippines: Addison Wesley Publishing Company.

Giles M, Connor S, McClenahan C, Mallett J, Stewart Knox B, Wright M (2007). Measuring young people’s attitude to breasfeeding using the theory of planned behavior. Journal of Public Health. 29 (1): 17-26.

Hamilton K, Daniels L, White KM, Murray M, Walsh A (2011). Predicting mothers’ decisions to introduce complementary feeding at 6 months. an investigation using an extended theory of planned behaviour. Appetite. 56 (3): 674-681.

Ikatan Dokter Anak Indonesia (2009). air susu ibu dan tumbuh kembang anak. Diakses 10 Maret 2016.

Infact Canada (2010). Breastfeeding. http://www.infactcanada. Diakses 10 Maret 2016.

Kementerian Kesehatan Republik Indonesia (2014). Riset Kesehatan Dasar (RISKESDAS) 2013. Jakarta: Kementerian Kesehatan Republik Indonesia.

_______ (2013). Profil Kesehatan Indonesia 2012. Jakarta: Kementerian Kesehatan Republik Indonesia.

_______ (2014). Pusat Data dan Informasi Kementerian Kesehatan Republik Indonesia. Jakarta: Kementerian Kesehatan Republik Indonesia.

Kementerian Pemberdayaan Perempuan dan Perlindungan Anak (2010). penerapan sepuluh langkah menuju keberhasilan menyusui. Jakarta: Kementerian Pemberdayaan Perempuan dan Perlindungan Anak.

Kurniawati D, Hargono R (2014). faktor determinan yang mempengaruhi kegagalan pemberian asi eksklusif pada bayi usia 6-12 bulan di kelurahan mulyorejo wilayah kerja Puskesmas Mulyorejo Surabaya. Jurnal Promkes. 2 (1): 15-27.

Lupton D, Fenwick J (2001). they’ve forgotten that i’m the mum: constructing and practicing motherhood in special care nurseries. Social Science & Medicine. 53: 1011-1021.

Mutuli LA, Walingo MK (2014). Appicability of theory of planned behavior in understanding breastfeeding intention of postpartum women. International journal of multidisciplinary and current research. 2: 258-266.

Perkumpulan Perinatologi Indonesia (2011). Manajemen laktasi. jakarta: perkumpulan perinatologi indonesia.

Puspita YA (2015). perbedaan persepsi kontrol diri ibu hamil terhadap intensi ibu untuk memberikan ASI eksklusif pada kelas ibu hamil plus di puskesmas Muara Teweh Kabupaten Barito Utara. Jurnal Edu Health. 5 (2): 123-130.

Roekminto R (2012). Upaya peningkatan program ASI di Kabupaten Klaten. dinkes klaten Diakses 2 Maret 2016.

Surat Keputusan Kepala PPKKS Gantiwarno Nomor 440/110/14/12 tentang Program Kawal ASI.

UNICEF Indonesia (2012). Ringkasan kajian kesehatan ibu dan anak., dari Diakses pada tanggal 13 Maret, 2016.

Wattimena I, Susanti NL, Marsuyanto, Y. (2012). women’s psychological strengths in breastfeeding. jurnal kesehatan masyarakat nasional. 7 (2): 56-62.

Young J, Anne E (2015). what to expect when you’re expecting: communication, body image, and breastfeeding decisions. north carolina: communication, rhetoric, and digital media.


  • There are currently no refbacks.