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. 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. 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. 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.

Objective: This study aims to evaluate the effectiveness of digital health interventions compared to standard care in promoting exclusive breastfeeding (EBF) among postpartum women in low-and middle-income countries (LMICs). Methods: The PRISMA guidelines of reporting were followed for the searching of four databases and screening following eligibility criteria: articles presenting digital health interventions, conducted as randomized control trials (RCTs), quasi-experimental, or mixed-method studies, reporting on EBF duration and early initiation of breastfeeding, and published in the English language were included. Results: Of 1595 articles screened, only 10 published between 2013 and 2023 met the criteria. Most studies were from Nigeria (n = 3), with others from Kenya, South Africa, Ethiopia, China, India, and Lebanon. Six were RCTs, and four were quasi-experimental. The meta-analysis shows digital health interventions significantly increase EBF duration, with the strongest effects at 6 months (odds ratio (OR) = 2,1.66–2.40), followed by 5, 3, 2, and 1 month postpartum, including the initial feed. Conclusion: This suggests digital health interventions have the potential to enhance breastfeeding practices among postpartum mothers in LMICs. For future research, it is essential to consider accessibility, delivery intervention, healthcare professional collaboration, and the sustainable development of digital health interventions for postpartum mothers in LMICs.

Background: The six-month exclusive breastfeeding (EBF) rate almost halved between 2009 and 2013 in Northeast Thailand for no clear reason. Specific facilitators and barriers to six-month EBF have been identified for Thailand, but mothers’ views on these factors to continuing EBF breastfeeding until six months have not been explored in this region. Aim: This study aimed to prioritize mothers’ views on the identified facilitators and barriers of continuing six-month exclusive breastfeeding. Methods: Q-methodology was applied. This research was conducted at Well Baby Out-Patient Department of Khonkaen Hospital, Numphong Hospital and a private hospital. Thirty-four mothers, who had recently delivered infants aged between four and six months, were breastfeeding/had breastfed, were 20 to 40 years old, participated. Demographic data were analysed descriptively, and Q-method analysis was conducted using the PQ Method software 2.35. Results: There was consensus that having knowledge about the advantages of EBF was the most important facilitator of six-month EBF, and ‘not having any other responsibilities besides caring for her infant’ was the least important facilitator of six-month EBF. Three viewpoints emerged identifying different groups/clusters of mothers, namely, (1) caring for self, (2) requiring support and (3) breastfeeding knowledge. Conclusions: Despite some consensus among participants, three distinct viewpoints emerged regarding which facilitators and barriers were important to mothers. It is clear that a programme to improve the six-month EBF rate in Northeast Thailand would need to incorporate interventions or activities that address the different viewpoints identified.

Background: In implementation research, it is essential to involve all stakeholders in the development of complex interventions to ensure that the proposed intervention strategy is relevant and acceptable to the target area and group. The aim of this study was to involve stakeholders in conceptualising, developing, and prioritising a feasible intervention strategy to improve the 6‐month exclusive breastfeeding rate in North‐east Thailand. Concept mapping was used in a purposive sample including health care volunteers, health care professionals, and community leaders. During the first meeting, stakeholders (n = 22) expressed the generation of feasible interventions. During the second meeting, participants (n = 21) were asked to individually rate the feasibility of each intervention and to group them into relevant categories to enable multidimensional scaling and hierarchical cluster analysis. The outputs of analysis included the intervention list, cluster list, point map, point rating map, cluster map, and cluster rating map. All of these were shared with stakeholders (n = 17) during the third meeting to reach consensus on an intervention model. The final proposed intervention strategy included 15 feasible interventions in five clusters: health care services, community services, and education packages for parents, family members, and communities. These interventions were prioritised for implementation over a 3‐year period. Once the feasibility of each intervention is established, the proposed model could be implemented and incorporated into local health policy. After assessing intervention effectiveness, each intervention could be scaled up to other middle‐income countries to help improve overall maternal and child survival.

To address the reduction of the 6-month exclusive breastfeeding (EBF) rate in Northeast Thailand, a 3-year 6-month EBF intervention model was developed using concept mapping. A training for health-care professionals and community leaders was prioritized as the initial intervention. The aim was to assess the feasibility of the training intervention and its potential to improve 6-month EBF knowledge. A pre- and posttest, and an open question were conducted. Data were analyzed using t tests and thematic analysis. For the 17 health-care professionals and community leaders who participated, the mean 6-month EBF knowledge scores improved significantly from 5.28 to 10.21 (p value < .01). It is recommended that this workshop could be duplicated and scaled up in other regions across Thailand to standardize care.