Background: In the Northwest Region of Cameroon, approximately 90% of women initiate breastfeeding; however, only 34% continue exclusive breastfeeding for the recommended six months (Kakute, et al., 2005; WHO, 2008). Entertainment-education is a mass-media communication strategy of placing educational information into media such as television programs, movies, and radio programs (Siegel & Lotenberg, 2007). This form of behavioral change communication has proven effective in addressing health-related issues in developing countries.

Purpose: The aim was to design an audio program and discussion guide to test the hypothesis that an audio program and discussion guide improves exclusive breastfeeding knowledge, beliefs, benefits, self-efficacy, and intention.

Methodology: This was a quasi-experimental mixed methods intervention study. In the qualitative phase, existing exclusive breastfeeding knowledge, beliefs, and practices were explored through conducting 12 key informant interviews (KIIs) and 6 focus group discussions (FGDs). In the quantitative phase differences in exclusive breastfeeding knowledge, beliefs, benefits, barriers, self-efficacy and intention between and within the control group (75 women, 42 partners) who listened to an audio program about injection safety and the intervention group (101 women, 48 partners) who listened to an audio program about exclusive breastfeeding were evaluated using pre- and posttests.

Analysis: KIIs and FGDs were conducted in the local languages, transcribed verbatim, and translated into English. Once a codebook was developed, related codes were linked into larger categories and organized into emergent themes, which guided the content of the audio program for the intervention group. Data from the pre- and post-tests were measured using Chi-Square, Wilcoxon Sign Test, and Binomial Logistic Regression.

Results: Three themes emerged that influence exclusive breastfeeding practices: woman's readiness to exclusive breastfeed, cultural influences towards exclusive breastfeeding, and perceived constraints to exclusive breastfeeding. These themes were incorporated into the audio program and discussion guide which was proven to significantly improve overall exclusive breastfeeding knowledge, beliefs, benefits, self-efficacy, and intention within the intervention group (p < 0.05).

Significance to Nutrition Education: This study provided insight into influences on exclusive breastfeeding practices. It also proved that an audio program and discussion guide is an effective method of providing breastfeeding education to this population.


School of Public Health

First Advisor

Susanne S. Montgomery

Second Advisor

Florence Fonteh

Third Advisor

Eddy Jara

Fourth Advisor

Gina Siapco

Degree Name

Doctor of Public Health (DrPH)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Breast Feeding -- methods -- Africa -- Cameroon; Breast Feeding -- psychology -- Africa -- Cameroon; Maternal-Child Nursing -- education -- Africa -- Cameroon; Health Knowledge, Attitudes, Practice -- Africa -- Cameroon; Self Efficacy -- Africa -- Cameroon; Health Promotion -- Africa -- Cameroon; Community Networks -- Africa -- Cameroon; Nutrition Surveys -- Africa -- Cameroon; Cameroon -- Statistics, Medical; Cameroon -- Social life and customs



Page Count

xiv; 233

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives