EVALUATION OF IMTASIE HEALTH EDUCATION MODEL BASED ON KAILI CULTURE TO IMPROVE MOTHER BEHAVIOR IN EXCLUSIVE BREASTFEEDING

It evaluated the health education model on exclusive breastfeeding behaviour as a basis for the success of the target of achieving exclusive breastfeeding by implementing a tested culture-based health education model. This research is quantitative. A total of 84 people divided into two groups, 42 in the intervention group and 42 in the control group, were taken purposively according to the inclusion criteria. The intervention group received IMTASIE health education. Evaluate the health education model quantitatively with a quasi-experimental pre-test and post-test with a control group. Data was collected during the pre-test, intervention, and post-test. All data is collected by coaching nurses. The main research variables include myths, culture, knowledge, attitudes, practices and exclusive breastfeeding behaviour. The quantitative study results of the developed

Health workers play an essential role in maintaining the desire of mothers to breastfeed their babies while in the hospital. A consistent approach to helping mothers breastfeed is essential. Establishing breastfeeding protocols in a hospital environment can help standardize counselling and minimize conflicting information (MIFTAHUL RESKI PUTRA NASJUM, 2020).

METHODS
Qualitative research methods by collecting data using instruments given to respondents. Gutman scale instrument with yes or no answer options. If the statement is positive and the respondent answers yes or is correct, then the value is 1, and if the respondent answers no or is wrong, it will get a value of 0. On the other hand, if the statement is negative, the respondent answers yes or is correct, then the value becomes 0, whereas if the respondent answers no, it will obtain a value of 1. Then the value of the answer is scored and added up to see the relationship between the culture-based health education model and the practice/action of breastfeeding in the first month as the basis for the success of exclusive breastfeeding by postpartum mothers. All nurses working at the M health centre, postpartum mothers up to 1 month into live birth who met the inclusion criteria. Based on statistical tests, it was stated that the instruments used at the evaluation stage had been tested for validity (Correlation) and reliability (Cronbach Alpa). Of the 157 statements, the number of valid and reliable statements was 35, so instrument testing was repeated, and there were 70 valid and reliable statements. This statement is used in research.

Characteristics of Respondents
This study has the characteristics of the respondents, namely age, education, work, non-formal education, religion, and everyday language used at home. The characteristics of the respondents can be seen in table 1 below: Based on table 1, the proportion of mothers aged 20 -35 years (not at risk) in the intervention group was 83.3%, while in the control group, it was 57.1%. Educationally, 71.4% of mothers in the intervention group were secondary/higher, while in the control group, those with secondary education were 35.7%. The proportion of working mothers in the intervention group was 90.5%, while in the control group, 100% were working mothers. 42.9% of the intervention group mothers attended the pregnant women's class, while in the control group, who attended the pregnant women's class, 54.8%. All mothers in the intervention group were Muslims, while in the control group, 92.9% were Muslims. Regional and Indonesian languages were more frequently used colloquialisms in both the intervention and control groups.

Control (n=42) P value
Renata (SD) Renata (SD) Myth 4,3 (2,1) 4,9 (2,2) 0,173 Culture 6,7 (2,3) 7,0 (2,1) 0,571 Know 11,6 (5,3) 16,9 (3,0) <0,001 Attitude 5,5 (2,1) 8,4 (1,5) <0,001 Table 2 shows that the average maternal myth in the intervention group was 4.3 with a standard deviation of 2.1, while in the control group, it was 4.9 with a standard deviation of 2.2. The cultural mean in the intervention group was 6.7 with a standard deviation of 2.3, and in the control group was 7 with a standard deviation of 2.1. The mean knowledge in the intervention group was 11.6 with a standard deviation of 5.3; in the control group, it was higher, namely 16.9 with a standard deviation of 3. The mean attitude in the intervention group was 5.5, with a standard deviation of 2.1, while the mean attitude in the control was 8.4, with a standard deviation of 1.5.

Practice Of Exclusive Breastfeeding (One Month)
Exclusive breastfeeding in this study was only evaluated for one month because this time greatly determines the continuation of the mother's practice of exclusive breastfeeding. If the mother has failed to give IMD and colostrum (IMD is given immediately after birth, and claustrum is given 3-7 days after live birth), then exclusive breastfeeding will also fail. The practice of exclusive breastfeeding can be seen in graph one below:

Graph 1. The practice of Exclusive Breastfeeding of Pre (plan) Intervention and Control Groups in Post (realization) at Puskemas M in 2017.
In the intervention group, there was a difference in the proportion of actions/practices towards exclusive breastfeeding before and after the intervention. However, in the control group, there was a decrease in the proportion of actions/practices towards breastfeeding (the desire to breastfeed exclusively was quite large, but the reality was small). The intervention group, pre-55.2 %, rose to 73.4% after the intervention. The pre-92% control group decreased to 65.8%.  Table 3 shows that the proportion of mothers aged 20-25 years giving exclusive breastfeeding is 76.3%, while mothers aged <20 years and >35 years who give exclusive breastfeeding is 68%. The proportion of mothers who gave exclusive breastfeeding with almost the same secondary/high and basic education level, namely 73.3% and 74.4%. 100% of mothers who do not work give exclusive breastfeeding, while only 72.5% of mothers who do not work. The proportion of mothers who gave exclusive breastfeeding from the intervention group was 85.7%, while in the control group, it was 61.9%. The proportion of mothers who, during pregnancy, planned to give exclusive breastfeeding and, after birth, were given exclusive breastfeeding was 75.4%. In comparison, those who did not plan to give exclusive breastfeeding and after birth gave exclusive breastfeeding was 69.6%.  9 (1,9) 0.031 Table 4 shows that the average myth for mothers who give exclusive breastfeeding is 5.0 with a standard deviation of 2.1, while for mothers who do not give exclusive breastfeeding, it is only 3.7 with a standard deviation of 2.1. The cultural mean for mothers who give exclusive breastfeeding is 7.2, with a mean distribution of 2.1, while for mothers who do not give exclusive breastfeeding, it is 5.9, with a standard deviation of 2.3.
The mean knowledge of mothers who give exclusive breastfeeding is almost the same as mothers who do not, namely 14.3 and 14.3, with a standard deviation of 4.9 and 5.4. The mean attitude of mothers who give exclusive breastfeeding is lower than those who do not.
Multivariate analysis using logistic regression. The variables that go into the model are group, age, education, breastfeeding plan, myths, attitudes and culture. After analysis, the following model was obtained: After that, the insignificant variables were removed, and the final model was obtained as follows: The predictor variables of exclusive breastfeeding from the results of the multivariate analysis after being controlled by age and education variables were the predictor variables significantly related to exclusive breastfeeding: the treatment group, the desire to give exclusive breastfeeding, myths and attitudes.
Mothers who received the intervention were 15.6 times more likely (95% CI = 1.6 -155.2) to breastfeed their babies than mothers who did not exclusively. Mothers who, during pregnancy, had plans to give exclusive breastfeeding were 27.4 times higher (95%CI=2.3 -320.7) to give exclusive breastfeeding than mothers who did not have the will to give exclusive breastfeeding during pregnancy. Mothers who will give exclusive breastfeeding increased 1.6 times for every change/increase of one unit/myth score. Mothers who will give exclusive breastfeeding increased 0.7 times for every change/increase of 1 unit/attitude score.
The most dominant predictor factor in exclusive breastfeeding is the plan to give exclusive breastfeeding. If a mother during pregnancy has planned to give exclusive breastfeeding to her baby in the future, it is very likely that after giving birth, she will give exclusive breastfeeding to her child. The second factor is the treatment group. Based on the analysis results, it is clear that the group that was given the intervention gave more exclusive breastfeeding.

Discussion
Based on the results of the research on the model test, it was found that the practice of breastfeeding for the first month increased from 55.2% before the intervention was carried out to 73.4% after the intervention was carried out, but in the control group, there was a decrease in the percentage from 92% who answered yes to 65 .8%. These statistical results prove that if a behaviour change is planned, it will produce the desired change, as is the behaviour of breastfeeding mothers in Taipa, with the habit of giving pagata bananas to babies under 6 months of age, not giving pagata bananas, and only giving breast milk and giving formula milk, due to the condition of the mother and baby which does not allow for exclusive breastfeeding (one month). The predictor variables for exclusive breastfeeding were IMTASIE intervention, desire to breastfeed and breastfeeding myths.
Another study on breastfeeding practices conducted on 210 women in Kelantan, Malaysia, identified 97.1% breastfeeding in the first month. The prevalence of exclusive breastfeeding at one month was 54.4%. Cessation of exclusive breastfeeding was associated with late initiation, difficulty, and duration of breastfeeding. Women who started breastfeeding more than 1 hour after giving birth and those with breastfeeding difficulties were more likely to stop exclusive breastfeeding (Alina, Manan, & Isa, 2013).
Research on the implementation/practice of early breastfeeding initiation in the community of Puskesmas Mamboro Palu, Central Sulawesi Province, shows that most mothers have sufficient education, sufficient knowledge, and a positive attitude. Most health workers have promoted IMD, and most mothers have family support for breastfeeding (Pont, 2022).
Education, in contrast to knowledge and the practice of exclusive breastfeeding (Pont, 2022). According to the researcher's analysis, the differences occur because the methods used differ. In this study, the predictors of exclusive breastfeeding were identified as IMTASIE intervention, desire to breastfeed and breastfeeding myths.
Exclusive breastfeeding at Puskesmas M obtained information that mothers who received the intervention were 15.6 times higher (95% CI = 1.6 -155.2) and would provide exclusive breastfeeding for their babies than mothers who did not receive the intervention. The intervention given to the mother has a positive effect. Namely, the mother can give breast milk as early as possible so that the baby no longer gets other food or drinks, such as pagata bananas or honey, during the first month (evaluation) of the baby's life.
Another positive effect that can be seen from mothers who receive intervention is an increase in knowledge and awareness that giving food and drink to babies as early as possible can interfere with the baby's health. Based on these reasons, mothers no longer provide food or drink, as is the custom of the Taipa people, namely giving pagata bananas and honey to newborns.
Research in Mexico City found an increase in exclusive breastfeeding with the intervention of at least three times home visits by co-counsellors. Research in Sub-Saharan Africa shows that intervention by conducting five or more home visits by peer counsellors significantly increases exclusive breastfeeding at 12 and 24 weeks postpartum (Von Salmuth et al., 2021).
The Congo study found that the proportion of infants receiving exclusive breastfeeding at six months of age was higher in the intervention area (57.7%) than in the comparison area (2.7%), with a confidence interval of 95%. The intervention group had a higher body weight at 12 months (8.42 kg) than those without intervention (7.97 kg). This study concludes that the promotion of breastfeeding by community volunteers in endemic malnourished areas in the rural Democratic Republic of Congo increases the duration of exclusive breastfeeding from birth (Balaluka et al., 2012), Related studies resulted in statistically significant increases in EBF due to breastfeeding promotion interventions of 43% at day 1, 30% less than one month, and 90% at months 1 to 5 months. This study concludes that combined individual and group counselling interventions appear superior to individual or group counselling interventions alone. Interventions in developing countries have a more significant impact than in developed countries (Von Salmuth et al., 2021).
Mothers during pregnancy plan to exclusively breastfeed 27.4 times more (95%CI=2.3 -320.7) than mothers who do not have the will to breastfeed exclusively during pregnancy. The most dominant factor in exclusive breastfeeding is the plan to provide exclusive breastfeeding. The second factor is intervention or treatment. Based on the results of the analysis clearly shows that the group gave more exclusive breastfeeding compared to the group without intervention or treatment.
Research conducted in Ethiopia resulted in 30.7% of mothers breastfeeding exclusively breastfeeding. Maternal health services have yet to be maximized but contribute to mothers carrying out exclusive breastfeeding practices. Strengthening antenatal and maternity services will improve exclusive breastfeeding practices (Ayalew, 2020).
Research on breastfeeding practices in infants 0 to 6 months using the breastfeeding performance index (BPI) and its relationship to childhood diseases in Ethiopia identified more than 80% of infants not receiving optimal breastfeeding practices based on the Breastfeeding Performance Index. This research has important implications for optimal breastfeeding to reduce childhood disease (Mulatu et al., 2021).
Research on the causes of stopping exclusive breastfeeding in Melbourne, Australia, identified 79% of postpartum mothers as experiencing nipple pain, 58% having nipple damage, and 23% having vasospasm.
Using the IMTASIE model in this study provides a new means to promote exclusive breastfeeding based on the development of transcultural theory and health promotion theory (Proced-Preceed). This model influences behaviour change, and the results can be seen in the trial model with indicators of breastfeeding practices carried out by respondents in the intervention group as the results of statistical tests in this study.