Q-methodology identifies distinctive viewpoints of the facilitators and barriers to six-month exclusive breastfeeding in Northeast Thailand

Thiwawan Thepha* (Corresponding Author), Debbie Marais, Jacqueline Bell, Somjit Muangpin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: The six-month exclusive breastfeeding (EBF) rate almost halved between 2009 and 2013 in Northeast Thailand for no clear reason. Specific facilitators and barriers to six-month EBF have been identified for Thailand, but mothers’ views on these factors to continuing EBF breastfeeding until six months have not been explored in this region. Aim: This study aimed to prioritize mothers’ views on the identified facilitators and barriers of continuing six-month exclusive breastfeeding. Methods: Q-methodology was applied. This research was conducted at Well Baby Out-Patient Department of Khonkaen Hospital, Numphong Hospital and a private hospital. Thirty-four mothers, who had recently delivered infants aged between four and six months, were breastfeeding/had breastfed, were 20 to 40 years old, participated. Demographic data were analysed descriptively, and Q-method analysis was conducted using the PQ Method software 2.35. Results: There was consensus that having knowledge about the advantages of EBF was the most important facilitator of six-month EBF, and ‘not having any other responsibilities besides caring for her infant’ was the least important facilitator of six-month EBF. Three viewpoints emerged identifying different groups/clusters of mothers, namely, (1) caring for self, (2) requiring support and (3) breastfeeding knowledge. Conclusions: Despite some consensus among participants, three distinct viewpoints emerged regarding which facilitators and barriers were important to mothers. It is clear that a programme to improve the six-month EBF rate in Northeast Thailand would need to incorporate interventions or activities that address the different viewpoints identified.
Original languageEnglish
Pages (from-to)219-227
Number of pages9
JournalNutrition and Health
Issue number2
Early online date6 May 2021
Publication statusPublished - 1 Jun 2022

Bibliographical note

This article is derived from the dissertation requirements for a PhD in Nursing at the University of Aberdeen. The authors are grateful to all of the mother-participants for sharing their ideas and experiences during the study. We are also immensely grateful to Dr. Stephen Jeffares, University of Birmingham, UK for his comments in relation to Q-method data analysis. We also wish to thank the head of the Well Baby Out-Patient Department, Khonkaen Hospital as well as the head of the Well Baby Out-Patient Department at the community hospital for their facilitation during data collection.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.


  • facilitator
  • barrier
  • Northeast Thailand
  • six-month exclusive breastfeeding
  • Q-methodology


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