Perceptions of northeast Thai breastfeeding mothers regarding facilitators and barriers to six-month exclusive breastfeeding: focus group discussions.

Background: The 6-month exclusive breastfeeding rate in the Northeast region of Thailand has recently significantly decreased in contrast to all other regions in Thailand. The factors that have influenced this decrease remain unknown. Hence, it is suggested that an investigation into factors that could improve or hinder EBF for 6 months in Northeast Thailand may be required to inform the development of relevant interventions to improve this situation. This study aimed to identify perceived facilitators and barriers to providing exclusive breastfeeding for 6 months in Northeast Thailand among breastfeeding mothers.

Methods: Six focus group discussions were conducted with a total of 30 mothers aged 20 to 40 years who had children aged between 4 and 6 months and were currently breastfeeding or had breastfeeding experience. Participants were recruited through self-selection sampling from Khonkaen hospital (urban), Numphong hospital (peri-urban) and private hospitals (urban) in Khonkaen, Thailand. Thematic analysis was employed to analyse the data.

Results: Five main themes, with 10 sub-themes, were identified as either facilitators (+) or barriers (-), or in some cases, as both (+/-). Breastfeeding knowledge, perceptions, maternal circumstances, support, and traditional food were the main identified themes. Mother's breastfeeding knowledge, intention to breastfeed, and social media were perceived as facilitators. Perceptions, employment, and formula milk promotion were perceived as barriers. Family, healthcare, and traditional food were perceived as both facilitators and barriers. The perception that social media was a way to access breastfeeding knowledge and support mothers in Northeast Thailand emerged as a new facilitating factor that had not previously been identified in Thai literature relating to facilitators and barriers to exclusive breastfeeding. Intention to breastfeed, family support, healthcare support and traditional food were mentioned by all groups, whereas mothers from urban areas specifically mentioned mother's breastfeeding knowledge, social media and employment sub-themes. Only mothers from the peri-urban area mentioned formula milk promotion and only mothers who had delivered in public hospitals mentioned the perceptions sub-theme.

Conclusions: Knowledge about these facilitators and barriers may inform the design and development of specific and relevant interventions to improve the 6-month exclusive breastfeeding rate in the Northeast region of Thailand and be useful in other contexts. Social media emerged as a newly perceived facilitator in the Thai context and may be a useful inclusion in a 6-month exclusive breastfeeding intervention model.