Implementation Of Culture-Based Peer Educators To Improve Husbands' Roles In Supporting Exclusive Breastfeeding Among The Angkola Batak Ethnic Group

Abstract

Background: Exclusive breastfeeding is influenced not only by maternal factors but also by husbands’ knowledge, attitudes, and practical support. This study developed and evaluated an Angkola Batak culture-based peer educator intervention to strengthen husbands’ support for exclusive breastfeeding.

Methods: An explanatory sequential mixed-method design was used. The qualitative phase involved three husbands as primary informants and seven key informants consisting of traditional, religious, and community leaders. Findings from the qualitative phase informed the development of a culturally adapted peer educator module. The quantitative phase used a quasi-experimental pretest-posttest control-group design involving 80 husbands, with 40 in the intervention group and 40 in the control group. Outcomes included knowledge, attitude, action, and domains of husband support. Exclusive breastfeeding was monitored monthly for six months. Within-group changes were assessed using paired statistical tests, while between-group comparisons used the Mann-Whitney U test. Effect sizes and 95% confidence intervals were reported where estimable.

Results: The intervention group demonstrated significant improvements across the measured husband-support outcomes, with large effects for the principal behavioral outcomes. At six months, 32 of 40 mothers (80.0%) in the intervention group sustained exclusive breastfeeding through six months compared with 15 of 40 (37.5%) in the control group. The risk ratio was 2.13 (95% CI 1.39–3.28), the risk difference was 42.5 percentage points (95% CI 23.0–62.0), and the odds ratio was 6.67 (95% CI 2.44–18.21). The month-six checklist status was treated as a separate measure from sustained breastfeeding across the entire six-month period to avoid conflating two different outcome definitions.

Conclusion: An Angkola Batak culture-based peer educator intervention was associated with improved husbands’ support and a higher proportion of sustained exclusive breastfeeding. The findings support culturally responsive peer education as a potentially useful strategy for strengthening family support for breastfeeding. Because the study used a quasi-experimental design and did not formally account for peer-educator clustering or longitudinal repeated measurements in the primary analysis, the findings should be interpreted as an observed association rather than definitive causation.