DOI: https://doi.org/10.14710/nmjn.v15i3.73812

Determinants of Maternal Adherence to Complementary Feeding Guidelines in Padang City, Indonesia: An Application of The Integrated Change Model

*Hermalinda Herman scopus  -  Department of Maternity and Pediatric Nursing, Faculty of Nursing, Universitas Andalas, Indonesia
Ying-Ju Chang scopus  -  Professor, Department of Nursing, College of Medicine, National Cheng Kung University, Taiwan
Open Access Copyright (c) 2025 by the Authors, Published by Department of Nursing, Faculty of Medicine, Universitas Diponegoro
Creative Commons License This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

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Abstract

Background: Maternal adherence to complementary feeding guidelines is crucial in preventing childhood malnutrition, yet adherence remains low. Although previous studies have identified several influencing factors, evidence from Indonesia is limited and lacks a theory-based explanation of how cognitive and behavioral determinants influence maternal feeding practices.

Purpose: This study applies the Integrated Change Model (I-Change Model) to examine the determinants of maternal adherence to complementary feeding guidelines.

Methods: A cross-sectional design was used, involving 579 mothers of children aged 6–23 months, selected through cluster-stratified random sampling. Maternal adherence to complementary feeding guidelines was assessed using the Infant and Young Child Feeding (IYCF) indicators, while a self-developed questionnaire, along with several modified questionnaires, was used to evaluate associated factors. Multiple logistic regression analysis was applied to identify the determinants of maternal adherence to these guidelines.

Results: Only 40.1% of mothers adhered to complementary feeding guidelines. Maternal adherence was significantly associated with higher education (AOR = 1.984; 95% CI: 1.053–3.739), positive attitudes (AOR = 5.752; 95% CI: 1.283–25.794), high self-efficacy in providing complementary feeding (AOR = 2.695; 95% CI: 1.426–5.091), and non-provision of formula milk (AOR = 0.549; 95% CI: 0.384−0.784). 

Conclusion: Maternal education, attitudes, self-efficacy, and non-provision of formula milk were identified as key determinants of adherence. These findings highlight the need for interventions focusing on enhancing maternal education, promoting positive attitudes, and improving self-efficacy. Future research should examine social support and sociocultural or economic factors through longitudinal studies to better understand their impact on adherence behaviors.

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Keywords: Complementary feeding; infants; malnutrition; maternal adherence and young children

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  1. Aber, H., Kisakye, A. N., & Babirye, J. N. (2018). Adherence to complementary feeding guidelines among caregivers of children aged 6-23 months in Lamwo district, rural Uganda. The Pan African Medical Journal, 31, 14955. https://doi.org/10.11604/pamj.2018.31.17.14955
  2. Ahmad, A., Madanijah, S., Dwiriani, C. M., & Kolopaking, R. (2020). Determinant factors of maternal knowledge on appropriate complementary feeding of children aged 6–23 months in Aceh. Journal of Nutritional Science and Vitaminology, 66, S239-S243. https://doi.org/10.3177/jnsv.66.S239
  3. Ahmed, J. A., Sadeta, K. K., & Lenbo, K. H. (2022). Magnitude and factors associated with appropriate complementary feeding practice among mothers of children 6–23 months age in Shashemene town, Oromia- Ethiopia: Community based cross sectional study. PloS One, 17(3), e0265716. https://doi.org/10.1371/journal.pone.0265716
  4. Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179-211. https://doi.org/10.1016/0749-5978(91)90020-T
  5. Allotey, D., Flax, V. L., Ipadeola, A. F., Kwasu, S., Adair, L. S., Valle, C. G., Bose, S., & Martin, S. L. (2022). Fathers’ complementary feeding support strengthens the association between mothers’ decision-making autonomy and optimal complementary feeding in Nigeria. Current Developments in Nutrition, 6(7), nzac098. https://doi.org/10.1093/cdn/nzac098
  6. Assefa, D. G., Woldesenbet, T. T., Molla, W., Zeleke, E. D., & Simie, T. G. (2021). Assessment of knowledge, attitude and practice of mothers/caregivers on infant and young child feeding in Assosa Woreda, Assosa Zone, Benshangul Gumuz Region, Western Ethiopia: A cross-sectional study. Archives of Public Health, 79(1), 170. https://doi.org/10.1186/s13690-021-00690-5
  7. Athavale, P., Hoeft, K., Dalal, R. M., Bondre, A. P., Mukherjee, P., & Sokal-Gutierrez, K. (2020). A qualitative assessment of barriers and facilitators to implementing recommended infant nutrition practices in Mumbai, India. Journal of Health, Population and Nutrition, 39(1), 7. https://doi.org/10.1186/s41043-020-00215-w
  8. Black, M. M., Lutter, C. K., & Trude, A. C. B. (2020). All children surviving and thriving: Re-envisioning UNICEF's conceptual framework of malnutrition. The Lancet Global Health, 8(6), e766-e767. https://doi.org/10.1016/s2214-109x(20)30122-4
  9. Bujang, M. A., Sa’at, N., Sidik, T., & Joo, L. C. (2018). Sample size guidelines for logistic regression from observational studies with large population: Emphasis on the accuracy between statistics and parameters based on real life clinical data. Malaysian Journal of Medical Science, 25(4), 122-130. https://doi.org/10.21315/mjms2018.25.4.12
  10. Carabaza, A. M., Murimi, M., Daba, A. K., & Vipham, J. (2021). Factors associated with recommended complementary feeding practices among children in Sidama and Oromia regions in Ethiopia. Current Developments in Nutrition, 5, 164. https://doi.org/10.1093/cdn/nzab035_072
  11. de Vries, H. (2017). An integrated approach for understanding health behavior; The I-Change Model as an example. Psychology and Behavioral Science International Journal, 2(2), 555585. https://doi.org/10.19080/pbsij.2017.02.555585
  12. Fanta, M., & Cherie, H. A. (2020). Magnitude and determinants of appropriate complementary feeding practice among mothers of children age 6–23 months in Western Ethiopia. PloS One, 15(12), e0244277. https://doi.org/10.1371/journal.pone.0244277
  13. Food and Agriculture Organization of the United Nations. (2014). Guidelines for assessing nutrition-related knowledge, attitudes and practices: KAP manual. Food and Agriculture Organization of the United Nations. https://www.fao.org/3/i3545e/i3545e.pdf
  14. Gebretsadik, M. T., Adugna, D. T., Aliyu, A. D., & Belachew, T. (2023). Optimal complementary feeding practices of children aged 6-23 months in three agro-ecological rural districts of Jimma zones of southwest Ethiopia. Journal of Nutritional Science, 12, e40. https://doi.org/10.1017/jns.2023.26
  15. Gupta, K. K., Attri, J. P., Singh, A., Kaur, H., & Kaur, G. (2016). Basic concepts for sample size calculation: Critical step for any clinical trials. Saudi Journal of Anaesthesia, 10(3), 328-331. https://doi.org/10.4103/1658-354X.174918
  16. Herman, H., Chang, Y.-J., & Dlamini, M. D. (2024). Cross-cultural adaptation and validation of the Medical Outcome Study Social Support survey among mothers of children aged 6–23 months in Indonesia. Journal of Pediatric Nursing, 75, e58-e64. https://doi.org/10.1016/j.pedn.2023.12.029
  17. Herman, H., Mansur, A. R., & Chang, Y.-J. (2023). Factors associated with appropriate complementary feeding: A scoping review. Journal of Pediatric Nursing, 71, e75-e89. https://doi.org/10.1016/j.pedn.2023.04.017
  18. Holand, B. L., de Oliveira Agostini, C., Pacheco, M. C. M., de Leon, D. M. Z., Drehmer, M., & Bosa, V. L. (2022). Association between breastfeeding and complementary feeding in pre-pandemic and pandemic COVID-19 times: Maternar cohort study. Jornal de Pediatria, 98(5), 496–503. https://doi.org/10.1016/j.jped.2021.12.007
  19. Jannat-Alipoor, Z., Ghaffari, F., Navabi, N., & Fotokian, Z. (2021). Iranian mothers’ cultural beliefs about weaning: A cross-sectional study in West Mazandaran Province, Iran. International Journal of Pediatrics, 9, 12855-12864. https://doi.org/10.22038/ijp.2020.54223.4287
  20. Janz, N. K., & Becker, M. H. (1984). The health belief model: A decade later. Health Education Quarterly, 11(1), 1-47. https://doi.org/10.1177/109019818401100101
  21. Mamo, Z. B., Wudneh, A., & Molla, W. (2022). Determinants of complementary feeding initiation time among 6–23 months children in Gedeo Zone, South Ethiopia: Community-based case-control study. International Journal of Africa Nursing Sciences, 16, 100418. https://doi.org/10.1016/j.ijans.2022.100418
  22. Ministry of Health, Republic of Indonesia. (2024). Profil kesehatan Indonesia 2023 [Indonesia health profile 2023]. Ministry of Health, Republic of Indonesia. https://kemkes.go.id/app_asset/file_content_download/172231123666a86244b83fd8.51637104.pdf
  23. Prasopkittikun, T., Tilokskulchai, F., Sinsuksai, N., & Sitthimongkol, Y. (2006). Self-efficacy in Infant Care Scale: Development and psychometric testing. Nursing & Health Sciences, 8(1), 44-50. https://doi.org/10.1111/j.1442-2018.2004.00266.x
  24. Rakotomanana, H., Hildebrand, D., Gates, G. E., Thomas, D. G., Fawbush, F., & Stoecker, B. J. (2020). Maternal knowledge, attitudes, and practices of complementary feeding and child undernutrition in the Vakinankaratra region of Madagascar: A mixed-methods study. Current Developments in Nutrition, 4(11), nzaa162. https://doi.org/10.1093/cdn/nzaa162
  25. Reynolds, E. C., Onyango, D., Mwando, R., Oele, E., Misore, T., Agaya, J., Otieno, P., Tippett Barr, B. A., Lee, G. O., & Akelo, V. (2021). Mothers’ perspectives of complementary feeding practices in an urban informal settlement in Kisumu County, Western Kenya. Current Developments in Nutrition, 5(5), nzab065. https://doi.org/10.1093/cdn/nzab065
  26. Saaka, M., Saapiire, F. N., & Dogoli, R. N. (2021). Independent and joint contribution of inappropriate complementary feeding and poor water, sanitation and hygiene (WASH) practices to stunted child growth [Article]. Journal of Nutritional science, 10. https://doi.org/10.1017/jns.2021.103
  27. Sekartaji, R., Suza, D. E., Fauziningtyas, R., Almutairi, W. M., Susanti, I. A., Astutik, E., & Efendi, F. (2021). Dietary diversity and associated factors among children aged 6–23 months in Indonesia. Journal of Pediatric Nursing, 56, 30-34. https://doi.org/10.1016/j.pedn.2020.10.006
  28. Sheikh, N., Akram, R., Ali, N., Haque, S. R., Tisha, S., Mahumud, R. A., Sarker, A. R., & Sultana, M. (2020). Infant and young child feeding practice, dietary diversity, associated predictors, and child health outcomes in Bangladesh. Journal of Child Health Care, 24(2), 260-273. https://dx.doi.org/10.1177/1367493519852486
  29. Sherbourne, C. D., & Stewart, A. L. (1991). The MOS social support survey. Social Science & Medicine, 32(6), 705-714. https://doi.org/10.1016/0277-9536(91)90150-b
  30. Som, S. V., Van Der Hoeven, M., Laillou, A., Poirot, E., Chan, T., Polman, K., Ponce, M. C., & Wieringa, F. T. (2021). Adherence to child feeding practices and child growth: A retrospective cohort analysis in Cambodia. Nutrients, 13(1), 137. https://doi.org/10.3390/nu13010137
  31. Spyreli, E., McKinley, M. C., & Dean, M. (2022). An online survey of dietary quality during complementary feeding; Associations with maternal feeding self-efficacy and adherence to dietary recommendations. BMC Nutrition, 8(1), 100. https://doi.org/10.1186/s40795-022-00595-8
  32. The RAND Corporation. (2023). Social support survey instrument. RAND Corporation. https://www.rand.org/health-care/surveys_tools/mos/social-support/survey-instrument.html
  33. United Nations Children’s Fund. (2021). Southeast Asia regional report on maternal nutrition and complementary feeding. UNICEF East Asia and the Pacific Regional Office. https://www.unicef.org/eap/reports/maternal-nutrition-and-complementary-feeding
  34. United Nations Children’s Fund (UNICEF), World Health Organization, & International Bank for Reconstruction and Development/ The World Bank. (2021). Levels and trends in child malnutrition: Key findings of the 2021 edition of the joint child malnutrition estimates. www.who.int/teams/nutrition-and-food-safety/databases/nutgrowthdb
  35. Wali, N., Agho, K., & Renzaho, A. M. N. (2019). Past drivers of and priorities for child undernutrition in South Asia: A mixed methods systematic review protocol. Systematic Reviews, 8(1), 189. https://doi.org/10.1186/s13643-019-1112-7
  36. World Health Organization, & United Nations Children’s Fund. (2021). Indicators for assessing infant and young child feeding practices: Definitions and measurement methods. World Health Organization
  37. Yeni, F., Herman, H., & Deswita, D. (2023). Preliminary reports on the experiences of mothers in the early introduction of complementary feeding to their infants: A phenomenological study. Central European Journal of Paediatrics, 19, 24. https://doi.org/10.5457/p2005-114.333

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