Hrev_master Healthcare in Low-resource Settings 2024; volume 12:11765 Social media utilization and knowledge levels in exclusive breastfeeding among mothers in Indonesia Deswani Deswani,1 Dea Eki Rahmawati,2 Yuli Mulyanti,3 Syafdewiyani Syafdewiyani,3 Rita Ismail,4 Sri Djuwitaningsih1 1Nursing Professional Education Study Program Professional program, Ministry of Health Jakarta III Health Polytechnic, Bekasi; 2Nurse Professional Education Study Program Professional, Ministry of Health Jakarta III Health Polytechnic, Bekasi; 3Nursing Study Program Diploma III Program, Ministry of Health Jakarta III Health Polytechnic, Bekasi; 4Faculty of Health Sciences, Universitas Pembangunan Nasional Veteran Jakarta, Jakarta, Indonesia Abstract The utilization of social media for obtaining information on exclusive breastfeeding is driven by various user-friendly features that facilitate information retrieval. This study delves into under- standing the correlation between mothers’ engagement with social media for information and their knowledge levels regarding exclu- sive breastfeeding in Indonesia. Through a cross-sectional analy- sis involving 93 purposefully selected respondents, demographic factors such as age, education, occupation, social media usage for breastfeeding information, and knowledge levels were evaluated using a validated questionnaire. Descriptive analysis was applied to the data, and significance testing was conducted using Chi- square tests. The questionnaire underwent validity and reliability tests, confirming its robustness. Results indicated a significant association (p < 0.000) between social media usage for breastfeed- ing information and the knowledge levels of mothers successfully practicing exclusive breastfeeding. Mothers who achieved exclu- sive breastfeeding demonstrated a discernible level of knowledge about utilizing social media as an information source for breast- feeding. This study highlights the escalating role of social media in shaping mothers’ understanding of exclusive breastfeeding. The findings underscore the significance of targeted interventions and educational programs through social media platforms to enhance breastfeeding practices. Introduction According to the Lancet report, optimal breastfeeding prac- tices could save over 820,000 lives per year, constituting 13% of all deaths in children under the age of five.1 Breastfeeding has the potential to reduce one-third of respiratory infections and approx- imately half of all diarrhea episodes in low- and middle-income countries.2 In Indonesia, the projected percentage of women exclusively breastfeeding is 72.04% by 2022. Specifically in Jakarta Province, 67.22% of infants are exclusively breastfed as of 2022.3 Despite these figures, the percentage of women exclusively breastfeeding falls short of the 80% target set by the Ministry of Health of the Republic of Indonesia. According to the DKI Jakarta Central Bureau of Statistics (2022), East Jakarta holds the top position in Jakarta Province for population size. Cipayung District, with a population of 285,650, is ranked sixth. Within this population, there are 839 nursing mothers, all of whom have suc- cessfully practiced exclusive breastfeeding.4 Knowledge, successful early breastfeeding initiation, maternal employment, and spousal support are factors influencing exclu- sive breastfeeding.5 The sources of information on breastfeeding and related topics significantly contribute to mothers’ knowl- edge.6,7 Information is disseminated through intermediary sources, encompassing mass media such as print, electronic media, social media, educational channels, and the surrounding environment. The ease of information access is facilitated by the prevalence of social media as a contemporary communication tool and the rapid advancement of technology.8,9 There were 191.4 million social media users in Indonesia in 2022. This number has increased by 2.1 million (1% of users) from 2021, with women constituting 52.3% of this group.10 According to Kemp (2022)11 mothers often utilize social media Correspondence: Deswani Deswani, Nursing Professional Education Study Program Professional program, Politeknik Kesehatan Kemenkes Jakarta III, Bekasi, Indonesia. E-mail: desika_64@yahoo.co.id Key words: child health, exclusive breastfeeding, information, knowl- edge, social media. Contributions: DD conceptualization, data curation, formal analysis, methodology, validation, visualization, writing – original draft, review & editing; DER conceptualization, investigation, methodology, validation, and writing – original draft, review & editing; YM conceptualization, methodology, formal analysis, validation, and writing – original draft, review & editing; SS methodology, visualization, writing – review & editing; ri resources, investigation, and writing –review & editing; SD formal analysis, validation, writing – review & editing. Conflict of interest: the authors declare no conflict of interest. Ethics approval and consent to participate: based on ethical certificate IB 02.02/04328/2023, the research was approved by the Health Research Ethics Commission of the Poltekkes Kemenkes Jakarta III KEPK. Throughout the research, the researcher is mindful of the ethical princi- ples of information to consent, human rights respect, beneficence, and nonmaleficence. Patient consent for publication: written informed consent was obtained for anonymized patient information to be published in this article. Received: 11 September 2023. Accepted: 30 November 2023. Early access: 22 December 2023. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2023 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2024; 12:11765 doi:10.4081/hls.2023.11765 Publisher's note: all claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organi- zations, or those of the publisher, the editors and the reviewers. Any prod- uct that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. [Healthcare in Low-resource Settings 2024;12:11765] [page 89] Non -co mmerc ial us e o nly sites, including Facebook, YouTube, Instagram, TikTok, and WhatsApp.12 The province with the largest proportion of people using the internet is DKI Jakarta (85.55%), with women using it at a rate of 82.82%. East Jakarta has the second-highest rate of inter- net usage, with 87.78% of the female population using it. Social media is frequently employed to obtain health information, with a rate of 38.9%, as claimed by Rosini and Nurningsih (2018).13 Studies by Puspita and Edvra (2020)14 on social media communi- ties that support and empower women via breastfeeding reveal that nursing moms in these groups support and understand one another, exchanging breastfeeding-related experiences. The researchers aimed to understand the relationship between the knowledge level of mothers who have succeeded in providing exclusive breastfeed- ing and the use of social media as a source of information about breastfeeding. They were motivated by the data above, indicating that social media is used for health information searching due to various facilities that make it easier. The Indonesia Ministry of Health’s Strategic Plan and the National Medium-Term Development Plan both set an exclusive breastfeeding rate goal of 80% for the years 2020–2024.15 However, this aim for exclusive breastfeeding has not yet been achieved.16 It is intended that freely available material from social media would help mothers learn more about breastfeeding and improve the success of exclusive breastfeeding in DKI Jakarta. Therefore, this study aimed to determine the relationship between the use of social media as a source of information and the level of knowledge among mothers who have succeeded in providing exclusive breastfeeding. Materials and Methods Research design The approach of this study was a cross-sectional quantitative research design that employed correlation analysis to determine the extent to which women who successfully exclusively breastfed their infants were aware of using social media as a nursing resource. Study participants The population for this study consisted of 839 nursing moms. The sample included 93 nursing moms who visited the Posyandu (Integrated Health Post) in Cipayung District, Indonesia between March and May of 2023. Purposive sampling was employed as the sample strategy, and the inclusion criteria involved breastfeeding moms who were able to successfully breastfeed their children exclusively, had children between the ages of 6 and 24 months, were registered residents of the Cipayung district, and utilized social media platforms such as Facebook, WhatsApp, TikTok, YouTube, and Instagram. Variable, instrument and data collection Developed from the Kinasih research questionnaire (2017),17 there were ten questions in this survey; a “yes” response was assigned a value of 1, and a “no” response was assigned a value of 0. It could be inferred that the respondent was not effective in delivering exclusive breastfeeding if they selected “no” for any of the items. Questionnaire i) on the success of exclusive breastfeed- ing was the instrument utilized in this study; ii) The features of nursing moms, such as the mother’s age, her most recent educa- tional attainment, and her line of work, were included in the ques- tionnaire on the characteristics of the respondents; iii) Social Media Use Questionnaire: This survey asked respondents about their use of social media and their motivations. Researchers adapt- ed the Questionnaire on Mother’s Knowledge Level on Breastfeeding, which was produced by researchers from Endang Suprihatin (2018),18 based on the notion of Use and Gratification provided by Whiting and Williams (2013).19 There were ten multiple-choice questions about nursing in the knowledge questionnaire; the correct answer counted as one, and the incorrect answer was scored zero. A response below 7 fell into the poor category, while those with a total score over 7 were con- sidered good. Thirteen questions with a “yes” response worth one and a “no” answer worth zero made up the social media use ques- tionnaire. A total score of >11 placed the responder in the high cat- egory of social media use, while a score of <11 placed them in the low group. The questionnaire’s validity was tested on 30 respondents, yielding r tables of 0.36, with r count > r table indicating that all question items were valid. Cronbach’s Alpha of 0.826 indicated that the questionnaire was trustworthy as a research tool. Data analysis The data were analyzed using univariate and bivariate tech- niques, and chi-square correlation analysis was employed to inves- tigate if there was a relationship between the independent variable, the use of social media as a source of breastfeeding information, and the dependent variable, the level of knowledge of mothers who were successful in exclusive breastfeeding. Ethical clearance Based on ethical certificate IB 02.02/04328/2023, the research was approved by the Health Research Ethics Commission of the Poltekkes Kemenkes Jakarta III KEPK. Throughout the research, the researcher was mindful of the ethical principles of informed consent, respect for human rights, beneficence, and nonmalefi- cence. Results Table 1 summarizes the characteristics of the research respon- dents. Among them, 60.2% are between the ages of 20 and 35, 53.8% have a higher education background, 52.7% do not work, and 55.9% utilize social media at a high level. WhatsApp has the highest number of social media subscribers (94.6%). The majority of nursing moms use social media to obtain information (86%), and the majority of breastfeeding mothers have a strong knowl- edge level (57%). Table 2 presents the findings of the chi-square test bivariate analysis. The age variable has a p-value of 0.268 (>0.05) and an odds ratio of 1.76, suggesting no significant link between age and the knowledge level of successful women in exclusive breastfeed- ing. The data analysis also indicates that nursing women aged 20- 35 had 1.76 times the chance of having a good level of knowledge compared to breastfeeding mothers aged > 35 years. On the other hand, the variables of work, education, and social media use showed a p-value of 0.035 (<0.05), indicating a significant rela- tionship with the knowledge level of breastfeeding mothers, with an odds ratio of 2.68. The mother’s employment status is signifi- cantly related to an increase in maternal knowledge, with a p-value of 0.019 and an odds ratio of 2.68, respectively. Transforming Healthcare in Low-Resource Settings: a Multidisciplinary Approach Towards Sustainable Solutions [page 90] [Healthcare in Low-resource Settings 2024;12:11765] Non -co mmerc ial us e o nly Discussion The findings of this study suggest that the age of nursing moth- ers is not associated with their level of understanding when it comes to providing exclusive breastfeeding. Knowledge is essen- tially described as an understanding that one or more people have acquired from experience and study.20–22 Therefore, a mother’s age may correlate with her nursing experience and wisdom.21 The majority of nursing women in this study were between the ages of 20 and 35, and they were among the most active social media users in the study. Age groups may have easier access to health-related information. The results of a survey in 2021 stated that the use of social media by women in Indonesia aged 18-34 years is higher than those aged > 35 years.23 Thus, breastfeeding mothers in the age group of 20-35 years have the potential to be empowered in disseminating information about breastfeeding through social media. This study is consistent with some previous studies that stated a relationship between education and mothers’ knowledge about exclusive breastfeeding. The learning process is influenced by education in the sense that the higher a person’s education, the easier it is for that person to acquire information, resulting in more knowledge.21,24,25 Education and health are also related, with higher levels of education making it easier to accept the concept of healthy living on one’s own.26 Consequently, nursing women pur- suing higher education have a 2.68-fold increased likelihood of attaining a good level of knowledge in this context. Transforming Healthcare in Low-Resource Settings: a Multidisciplinary Approach Towards Sustainable Solutions Table 1. Respondent characteristics (n=93). Variable Category Frequency Percentage (n) (%) Age 20-35 years 56 60.2 >35 years 37 39.8 Education High 50 53.8 Low 43 46.2 Work Work 44 47.3 Does not work 49 52.7 Use social media High 52 55.9 Low 41 44.1 The most frequently used social media platform* Facebook 57 61.3 WhatsApp 88 94.6 TikTok 38 40.9 YouTube 56 60.2 Instagram 62 66.7 Reason for use Social media* Social interaction 77 82.8 Access information 80 86 about breastfeeding Fill the free time 77 82.8 Discuss 72 77.4 Breastfeed Exchange information about breastfeeding 78 83.9 Knowledge level Good 53 57 Poor 40 43 *Respondent can choose more than 1 answer. Table 2. Correlation of mother characteristics with breastfeeding knowledge levels (n=93) Variable Knowledge level Poor Good Total p OR n % n % n % Age >35 years 19 51.4 18 48.6 37 100 0.268 1.76 20-35 years 21 37.5 35 62.5 56 100 Education Low 24 55.8 19 44.2 43 100 0.035 2.68 High 16 32 34 68 50 100 Work Work 25 56.8 19 43.2 44 100 0.019 2.98 Does not work 15 30.6 34 69.4 49 100 Use of social media as a source of breastfeeding information Low 23 56.1 18 43.9 41 100 0.040 2.63 High 17 32.7 35 67.3 52 100 OR, odds ratio. [Healthcare in Low-resource Settings 2024;12:11765] [page 91] Non -co mmerc ial us e o nly According to the study’s findings, the employment status of mothers is related to the knowledge level of breastfeeding mothers who efficiently provide exclusive breastfeeding. Breastfeeding mothers who have a job but are not currently working demonstrate a high level of expertise. This study’s results, in conjunction with those of another study,27 suggest a relationship between work and a mother’s understanding of exclusive breastfeeding. If their work- place lacks a dedicated breastfeeding room, working mothers require more time and space to directly nurse their babies.28 Working women encounter challenges in providing exclusive breastfeeding since their leave period is too short compared to the nursing period; hence, formula milk becomes the preferred option when mothers return to work.29,30 This situation has led to an increase in non-working nursing mothers. Working mothers encounter difficulties in giving exclusive breastfeeding, particular- ly when their workplace does not offer a designated breastfeeding room.28 Consequently, the prevalence of non-working nursing mothers is increasing. This underscores the importance of provid- ing working mothers with adequate time and suitable spaces to directly nurse their babies. The majority of nursing women who use WhatsApp as a social media platform exhibit a high level of understanding, primarily due to the accessibility of information. The findings of this investigation align with those of previous stud- ies. According to this study, a significant relationship exists between using social media as a source of breastfeeding guidance and the knowledge level of mothers who have successfully prac- ticed exclusive breastfeeding. Breastfeeding mothers in the high category of social media use for breastfeeding information have a 2.63 times higher likelihood of being knowledgeable compared to those in the low category. The utilization of social media for dis- seminating breastfeeding information proves to be beneficial. The majority of nursing women who use WhatsApp for social media exhibit a good degree of understanding, with information availability being a key factor. The findings of this investigation align with previous studies, indicating that social media can posi- tively influence breastfeeding-related attitudes, knowledge, and behaviors.31,32 According to this study, a significant relationship exists between using social media as a source of breastfeeding guidance and the knowledge level of parents who have successful- ly practiced exclusive breastfeeding. Breastfeeding mothers who use social media as a source of breastfeeding information in the high category have a 2.63 times higher likelihood of being knowl- edgeable than mothers who use social media as a source of breast- feeding information in the low category. The use of social media to provide breastfeeding information can be beneficial. Conclusions Breastfeeding success is notably high among mothers exten- sively using breastfeeding information, especially those with high- er education and non-working status. Conversely, young, employed, and less-educated breastfeeding women face challenges in providing exclusive breastfeeding. This specific group requires targeted attention to ensure the success of exclusive breastfeeding programs. The study underscores the impact of information tech- nology and social media on shaping individuals’ beliefs, emphasiz- ing the role of new information in enhancing breastfeeding knowl- edge. These findings guide interventions to help social media users access reliable breastfeeding information, enabling health profes- sionals to educate the public about nursing experiences via these platforms. References 1. Victora CG, Bahl R, Barros AJD, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016;387:475-90. 2. WHO. Implementation guidance: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services - the revised Baby-friendly Hospital Initiative [Internet]. 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