title: Using cognitive-behavioural techniques to improve exclusive breastfeeding in a low-literacy disadvantaged population.
abstract: Despite being an important component of Pakistan's primary health care programme, the rates of exclusive breastfeeding at 6 months remain among the lowest in the world. Low levels of literacy in women and deeply held cultural beliefs and practices have been found to contribute to the ineffectiveness of routine counselling delivered universally by community health workers in Pakistan. We aimed to address this by incorporating techniques of cognitive-behavioural therapy (CBT) into the routine counselling process. We conducted qualitative studies of stakeholders' opinions (mothers, community health workers, their trainers and programme managers) and used this data to develop a psycho-educational approach that combined education with techniques of CBT that could be integrated into the health workers' routine work. The workers were trained to use this approach and feedback was obtained after implementation. The new intervention was successfully integrated into the community health worker programme and found to be culturally acceptable, feasible and useful. Incorporating techniques of CBT into routine counselling may be useful to promote health behaviours in traditional societies with low literacy rates.
authors: Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK. atif.rahman@liverpool.ac.uk
authors: Atif
authors: A
authors: Rahman
authors: Zaeem
authors: Z
authors: Haq
authors: Siham
authors: S
authors: Sikander
authors: Ikhlaq
authors: I
authors: Ahmad
authors: Mansoor
authors: M
authors: Ahmad
authors: Assad
authors: A
authors: Hafeez
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000706:statistics & numerical data* / Q000639:trends; D015928:Cognitive Behavioral Therapy; D003376:Counseling; D003469:Culture; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007407:Interviews as Topic; D010043:Outcome and Process Assessment, Health Care; D010154:Pakistan; D016032:Randomized Controlled Trials as Topic; D055815:Young Adult