Hrev_master Healthcare in Low-resource Settings 2025; volume 13(s2):13102 Sociodemographic factors influencing beliefs and behaviors in herbal medicine use among postpartum mothers in Indonesia Irna Trisnawati, Mamat Mamat, Ari Antini Politeknik Kesehatan Kemenkes Bandung, Indonesia Abstract The incidence of herbal medicine consumption is significant among postpartum mothers. However, its long-term use may pose potential risks. This study aimed to investigate the correlation between sociodemographic factors, beliefs, and behaviors related to the consumption of herbal medicine among postpartum mothers in Indonesia. This study employed a cross-sectional correlational design with a sample of 170 postpartum mothers (1-42 days postpartum), determined using G*Power version 3.1. Purposive sampling was used for participant selection. The variables inclu- ded sociodemographic factors, beliefs, and behaviors related to herbal medicine consumption. Data were analyzed using the Kruskal-Wallis and Mann-Whitney tests. The findings revealed that residency (p=0.001), age (p=0.043), education level (p=0.0001), number of children (p=0.0001), pregnancy complica- tions (p=0.006), and labor complications (p=0.027) were signifi- cantly correlated with beliefs regarding herbal medicine consum- ption. Meanwhile, age (p=0.039) and number of children (p=0.0001) were significantly correlated with herbal medicine consumption behavior. This study highlights the strong influence of sociodemographic factors on the use of postpartum herbal medicine. While many mothers perceive herbal medicine as bene- ficial, monitoring its long-term effects and potential risks is essen- tial. Future research should focus on ensuring safe use of herbal medicine, integrating traditional and modern healthcare practices, and enhancing education on evidence-based postpartum care. Introduction Herbal medicines are used in traditional healthcare systems worldwide.1 Despite limited scientific evidence regarding their clinical efficacy and safety, herbal remedies are believed to offer various health benefits. However, long-term and excessive use may cause adverse effects and potential interactions with conven- tional drugs, with severe interactions occurring in approximately 7.1% of cases.2 Herbal medicines are derived from various parts of plants, including leaves, stems, flowers, roots, and seeds.3,4 The World Health Organization (WHO) estimates that 80% of the glo- bal population relies on traditional and complementary medicines for primary healthcare.5 The prevalence of herbal medicine con- sumption varies across countries, with reported usage rates ran- ging from 40% to 65% in India and China, and 31% in Belgium, 49% in France, and 70% in Canada.6 The widespread use of herbal medicine is largely influenced by the perception that it is safe due to its natural origins and long-standing traditional use.7,8 In many cultures, herbal medicine is commonly used during pregnancy, childbirth, and postpartum recovery. Research in Tanzania found that sociocultural beliefs and practices during the perinatal period remain strong, including the use of herbal concoc- tions after childbirth, which may increase the risk of postpartum infections.9,10 Similarly, in Ethiopia, pregnant women frequently consume herbal medicine without prescriptions, citing easy access, affordability, and confidence that their illness is not severe.11 The Indonesian government permits the use of herbal medicine, ensuring its safety and quality through monitoring, eva- luation, and regulation.12,13 However, prolonged and excessive use may still pose risks, particularly due to potential interactions with pharmaceutical drugs.14,15 Some herbal compounds inhibit cyto- chrome P450 enzymes, leading to unintended pharmacological Correspondence: Mamat Mamat, Politeknik Kesehatan Kemenkes Bandung, Indonesia. E-mail: mamat.researcher@gmail.com Key words: beliefs; behavior; herbal medicine; postpartum; sociodemo- graphic. Contributions: IT, study conceptualization, methodology, data collection, data analysis, result tabulating, data management, results and discussion; MM, formal analysis, validation, and writing—original draft; AA, review and editing. All authors have read and approved the final version of the manuscript and agreed to be accountable for all aspects of the work. Conflict of interest: the authors have no conflict of interest to declare. Ethics approval and consent to participate: this research was approved by the Health Research Ethics Commission, Politeknik Kesehatan Kemenkes Bandung, Indonesia, No. 62/KEPK/EC/V/2023. During the research, the researcher paid attention to the ethical principles of informed consent, respect for human rights, beneficence, and non-malef- icence. Consent for publication: written informed consent was obtained for anonymized patient information to be published in this article. Availability of data and materials: all data generated or analyzed during this research are included in this published article. Funding: this research was supported by a research grant from DIPA Politeknik Kesehatan Kemenkes Bandung, contract No. SP DIPA-024- 12.2.632221/2023/date 10/3/2023. Acknowledgments: we are thankful to the Director and funding staff of Politekkes Bandung, who were supported by DIPA funding. Received: 14 September 2024. Accepted: 11 March 2025. Early view: 4 July 2025. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2025 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2025; 12(s2):13102 doi:10.4081/hls.2025.13102 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. [page 50] [Healthcare in Low-resource Settings 2025;13(s2):13102] effects.14,15 The lack of comprehensive data on the safety of herbal medi- cine use during pregnancy and postpartum remains a major con- cern.16 A study found that 55.7% of women utilized traditional health services during the postpartum period, with 48% consuming pre-packaged herbal remedies and 31.8% preparing their own her- bal concoctions. However, improper consumption of certain herbal medicines can be harmful. For example, turmeric consumption during pregnancy may stimulate uterine contractions, potentially leading to miscarriage.17 Therefore, consultation with healthcare professionals who are knowledgeable about herbal medicine is essential to prevent adverse effects and ensure appropriate medical interventions when necessary.17 The limited availability of reliable information about herbal medicines further contributes to concerns about their quality and accuracy.18 To enhance consumer safety, it is crucial for regulatory authorities and manufacturers to prioritize quality assurance and proper labeling of herbal products.18 Additionally, healthcare providers should routinely document tra- ditional medicine use among pregnant and postpartum women, offering evidence-based guidance to eliminate harmful practi- ces.9,10 Sociodemographic factors play a significant role in determi- ning herbal medicine consumption during pregnancy, childbirth, and postpartum. These factors influence women’s decisions and behaviors, including income level, education, cultural beliefs, and healthcare access.19 Research suggests that postpartum herbal medicine use is more prevalent among women from lower-income groups, likely due to cultural traditions or financial constraints.20 Conversely, educated women tend to use herbal remedies more fre- quently, possibly because they have greater access to information and healthcare resources.21 Other factors influencing herbal medicine consumption inclu- de perceived health risks, sources and quality of information, vul- nerability to health complications, and trust in alternative medici- ne.22 Some studies indicate that women with positive perceptions of herbal medicine’s safety and effectiveness are more likely to use it, whereas those with negative attitudes tend to avoid it. However, even women with negative attitudes may consume herbal medicine if they lack access to conventional healthcare.21 Given the cultural and economic diversity in Indonesia, understanding how sociode- mographic factors influence herbal medicine consumption is essential for public health interventions. Healthcare professionals must advise expectant and postpartum mothers in a way that is cul- turally sensitive, evidence-based, and safety-focused. Based on the issues discussed, this study aimed to determine the correlation bet- ween sociodemographic factors and beliefs and behaviors regar- ding herbal medicine consumption among postpartum mothers in Indonesia. Meterials and Methods Research design This study employed a cross-sectional correlational design and involved postpartum mothers across primary healthcare in West Java, Indonesia. Study participant The sample size was calculated using G-Power Software ver- sion 3.1. Hypothesis testing used the assumption of tolerance devi- ation (α)=0.05, impact size = 0.25, and power level = 0.80 (80%). Based on these calculations, the sample size was determined to be 170. The sampling was conducted using a purposive sampling technique from March to June 2023. The inclusion criteria in this study were mothers in the postpartum period (1-42 days after delivery), who had a history of consistent consumption of herbal medicines from pregnancy to the postpartum period, were able to read and understand the questionnaire, and were willing to provide informed consent to participate in the study. Exclusion criteria in this study were postpartum mothers who used herbal medicine only occasionally or inconsistently during pregnancy and postpar- tum, had cognitive or mental disorders that may affect understand- ing of questions in the questionnaire or interview, and used certain medical therapies that interact with herbal medicine and may cause bias in the study. Variables The variables used were sociodemographic, including residen- ce, age, occupation, education level, number of children, income, frequency of antenatal care (ANC), place of delivery, history of last pregnancy problems, history of previous delivery problems, and postpartum problems. The dependent variables were beliefs and behavior on the consumption of herbal medicines. Instrument The instrument used in this study was a questionnaire that included sociodemographic variables and dependent variables related to beliefs and behavior regarding herbal medicine consum- ption. The sociodemographic variables measured included residen- ce (urban and rural), age group (>35 years, 20-35 years, and <20 years), occupation (laborer/employee and housewife), education level (elementary school, junior high school, senior high school, and university), number of children (≤3 children and >3 children), income (>IDR 5,257,834 and 35 years) had higher belief (99.92, p=0.043) and behavior scores (100.82, p=0.039) compared to younger age groups. Older mothers tend to have stronger beliefs in and a higher tendency to consume herbal medicine compared to younger mothers. Mothers with ele- mentary school education had the highest belief scores (105.76, p=0.0001) compared to those with higher education levels. However, behavior scores were not significantly different across education levels (p=0.142). Lower education levels are associated with stronger beliefs in herbal medicine, but actual behavior (con- sumption) does not significantly differ. Mothers with more than 3 children had significantly higher belief scores (120.93, p=0.0001) and behavior scores (110.44, p=0.0001) than those with fewer chil- dren. Mothers with more children tend to believe in and consume herbal medicine more than those with fewer children. Mothers who gave birth at home had higher belief scores (109.40, p=0.111) and higher behavior scores (108.30, p=0.119) than those who delivered in maternity homes/hospitals, but these differences were not stati- stically significant. Place of delivery is not a strong predictor of beliefs or behavior regarding herbal medicine. Mothers who expe- rienced pregnancy complications had significantly higher belief scores (113.95, p=0.006) and marginally higher behavior scores (104.95, p=0.052) than those without complications. Mothers who experienced birth complications had significantly higher belief Pathways of Change, Part II Table 1. Sociodemographic of postpartum mothers (n=170). Demographic variables (n=170) Frequency Percent (%) Residence Urban 96 56.4 Rural 74 43.6 Age group >35 years 45 26.5 20-35 years 115 67.6 <20 years 10 5.9 Occupation Laborer/employee 9 5.3 Housewife 161 94.7 Education level Elementary school 65 38.2 Junior high school 58 34.1 Senior high school 42 24.7 University 5 2.9 Number of children ≤3 children 121 71.2 >3 children 49 28.8 Income ≥IAP 5.257.834 30 17.6 35 years 5 99.92 0.043** 45 100.82 0.039** 20-35 years 115 79.05 (α≤0.05) 115 80.53 (α≤0.05) <20 years 10 94.80 10 73.65 Job Laborer/employee 9 75.11 0.513* 9 72.72 0.409* Housewife 161 86.08 (α<0.05) 161 86.21 (α<0.05) Education Elementary school 65 105.76 0.0001** 65 96.25 0.142** Junior high school 58 75.92 (α≤0.05) 58 79.73 (α≤0.05) Senior high school 42 68.82 42 78.37 University 5 73.30 5 72.60 Number of children ≤3 children 121 71.15 0.0001* 121 75.40 0.0001* >3 children 49 120.93 (α≤0.05) 49 110.44 (α≤0.05) Income IDR 5.257.834 30 73.93 0.153* 30 85.25 0.975*