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“The Effectiveness of Informational Booklet on Knowledge &
Attitude Towards Human Milk Bank Among Postnatal Mothers in
Selected Hospital”
Mrs. Anusha Arun Kudtarkar
1
, Mrs. Saravanabavani Muthukrishnan
2
1
M.Sc. Nursing, St. Andrews College of Nursing, Pune
2
Hod of Child Health Nursing, St. Andrews College of Nursing, Pune
DOI:
https://doi.org/10.51583/IJLTEMAS.2026.150600167
Received: 01 July 2026; Accepted: 06 July 2026; Published: 18 July 2026
ABSTRACT
Human milk banks play an important role in providing safe and nutritious breast milk to infants who are unable
to receive milk directly from their mothers, especially premature and sick newborns. Adequate knowledge and
a positive attitude among postnatal mothers are essential for the acceptance and utilization of human milk
banking services. The present study was conducted to assess the effectiveness of an informational booklet
on knowledge and attitude towards human milk banks among postnatal mothers in a selected hospital.
METHODOLOGY: A quantitative research approach with a pre-experimental one-group pre- test–post-test
design was adopted for the study. The study was conducted among 60 postnatal mothers selected through a non-
probability convenient sampling technique from the postnatal ward of a selected hospital. The independent
variable of the study was the informational booklet, and the dependent variables were the knowledge and attitude
of postnatal mothers towards human milk banks. Data were collected using a structured knowledge
questionnaire and a Likert attitude scale. Results :The findings of the study revealed that in the pre- test,
48.33% of postnatal mothers had poor knowledge and 35% had average knowledge regarding human milk banks.
After the intervention, the post-test results showed significant improvement, with 63.33% of mothers
demonstrating excellent knowledge and 36.67% showing good knowledge. The mean knowledge score increased
from 6.87 to 15.87. Similarly, the attitude of mothers improved significantly from a pre-test mean score of 24.97
to a post- test mean score of 37.05, indicating a highly favourable attitude after receiving the informational
booklet. Statistical analysis using the paired t-test showed highly significant results (p < 0.0001) for both
knowledge and attitude. Conclusion: The study concluded that the informational booklet was highly effective
in improving the knowledge and attitude of postnatal mothers towards human milk banks. Educational
interventions such as informational booklets can be an effective strategy to increase awareness and promote
acceptance of human milk banking, ultimately contributing to improved neonatal health outcomes.
Keywords: Human Milk Bank, Postnatal Mothers, Knowledge, Attitude, Informational Booklet, Breast Milk
Donation, Neonatal Care.
INTRODUCTION
A human milk bank, breast milk bank or lactarium is a service that collects, screens, processes, pasteurizes, and
dispenses by prescription human milk donated by nursing mothers who are not biologically related to the
recipient infant. The optimum nutrition for newborn infants is breast milk for at least the first 6 months of life.
For women who are unable to breast feed or produce enough milk, pasteurized donor breast milk may be an
effective approach to feeding. Breast milk supplied by a woman other than the baby's mother that is not
pasteurized and informal breast milk sharing is associated with a risk of transmitting bacteria and viruses from
the donor mother to the baby and is not considered a safe alternative.
The primary and by far the largest group of consumers of human breast milk are premature babies. Infants with
gastrointestinal disorders or metabolic disorders may also consume this form of milk as well.
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The World Health Organization (WHO) recommends donor human milk for low- and very- low-birthweight
infants, as well as small and sick newborns who cannot be fed their mother’s own milk. Human milk banks
organize the collection, processing and distribution of donor human milk, acting as a bridge between donors and
recipients, and aiming to ensure the quality and safety of this biological product. These services should be
integrated components of care for small and sick newborns and a core mechanism for supporting lactation and
breastfeeding.
Need of the study
Human milk banks are found in over 700 locations worldwide, with a higher concentration in Europe, North
America, and parts of Latin America and Asia. However, the prevalence is lower in low- and middle-income
countries, where the establishment of milk banks is still in progress. According to the World Health Organization
(WHO), the establishment of milk banks is a crucial intervention to improve neonatal care globally. In the United
States, about 30–40 human milk banks exist, many of which are connected to neonatal intensive care units
(NICUs) to provide milk for preterm and sick infants.
India has seen a significant rise in the number of human milk banks, especially in large urban hospitals. By 2020,
there were over 60 human milk banks in operation in India. This increase is attributed to rising awareness about
the importance of human milk for infant health and support from organizations like the Indian Academy of
Pediatrics.
Ambika (2022) conducted a study on Knowledge and Attitude Regarding Human Milk Banking among Postnatal
Mother in Selected Hospitals of Himachal Pradesh. The major finding showed that the majority of 48(48%)
having poor knowledge regarding human milk banking, 35(35%) postnatal mothers having average knowledge
on human milk banking and 17(17%) of postnatal mothers having poor knowledge on human milk banking.
majority of 40% postnatal mothers are showed unfavourable attitude. The analysis of the association between
various demographic factors and knowledge about human milk banks showed that none of the factors had a
statistically significant impact.
Therefore, the researcher felt the need to provide an informational booklet to improve knowledge and develop a
positive attitude towards human milk bank among postnatal mothers. This will help in promoting its acceptance
and utilization in clinical settings. The study also aims to enhance awareness and support better infant health
outcomes through simple and cost-effective education.
MATERIALS AND METHODS
A quantitative research approach with a pre-experimental one group pre-test and post-test research design was
adopted, involving assessment before and after the intervention. The sample consisted of 60 postnatal mothers
selected using a non-probability purposive sampling technique. Data were collected using a demographic data
sheet, a self-structured questionnaire to assess knowledge, and a 3-point Likert scale to assess attitude towards
human milk bank. The informational booklet was administered to the participants as an intervention, followed
by post-test assessment.
Reliability of the tools was established using Karl Pearson’s correlation coefficient, with values of 0.9250 for
knowledge and 0.8194 for attitude, indicating high reliability. A pilot study was conducted on 10% of the sample,
confirming the feasibility of the study and demonstrating the effectiveness of the informational booklet in
improving knowledge and attitude among postnatal mothers.
RESULTS AND DISCUSSION
Section-I
This section deals with the demographic data of postnatal mothers. The data is presented in the form of frequency
and percentage.
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The demographic data indicate that most participants were aged 18–25 years [39 (65.0%)]. Majority had higher
secondary education [31 (51.67%)]. Most participants were homemakers [42 (70.0%)] and primipara [39
(65.0%)]. A large proportion belonged to Hindu religion [29 (48.33%)] and had two children [28 (46.67%)].
Most participants had previous knowledge regarding human milk bank [52 (86.67%)], with video being the most
common source of information [30 (50.0%)]. Majority belonged to rural areas [39 (65.0%)] and most had family
income between 31,000–40,000 [28 (46.67%)]. Overall, the sample showed predominance of young,
homemaker, rural postnatal mothers with prior awareness of human milk bank.
Section II
This section deals with the assessment of knowledge and attitude towards human milk bank among postnatal
mothers. Assessment was done using a self-structured knowledge questionnaire and a 3-point Likert scale for
attitude.
Table 1 - Assessment of Knowledge Regarding Human Milk Bank among Postnatal Mothers.
N = 60
LEVEL OF KNOWLEDGE
PRE TEST
POST TEST
F
%
Mean
SD
F
%
Mean
SD
POOR (0 - 5)
29
48.33
6.87
2.85
0
0
15.87
1.7
AVERAGE (6-10)
21
35
0
0
GOOD (11-15)
10
16.67
22
36.67
EXCELLENT (16-20)
0
0
38
63.33
Table 1 depicts the assessment of knowledge regarding human milk bank among postnatal mothers, showing
improvement in knowledge after the intervention. In the pre-test, most participants 29 (48.33%) had poor
knowledge, 21 (35.0%) had average knowledge, and 10 (16.67%) had good knowledge, with none in the
excellent category. In the post-test, no participants remained in poor or average categories, while 22 (36.67%)
had good knowledge and the majority 38 (63.33%) achieved excellent knowledge. Overall, these findings
indicate that the informational booklet was effective in improving the knowledge of postnatal mothers regarding
human milk bank.
Table 2 - Assessment of Attitude Regarding Human Milk Bank among Postnatal Mothers.
n = 60
LEVEL OF ATTITUDE
PRE TEST
POST TEST
F
%
Mean
SD
F
%
Mean
SD
STRONGLY AGREE (36-45)
0
0
24.97
3.11
38
63.33
37.05
3.06
AGREE (26-35)
19
31.67
22
36.67
DISAGREE (15-25)
41
68.33
0
0
Table 2 depicts the assessment of attitude regarding human milk bank among postnatal mothers, showing
improvement in attitude after the intervention. In the pre-test, most participants 41 (68.33%) had a negative
attitude (disagree) and 19 (31.67%) had a moderately positive attitude (agree), with none in the strongly agree
category. In the post-test, none of the participants remained in the disagree category, while 22 (36.67%) showed
agree and the majority 38 (63.33%) showed strongly agree attitude. Overall, these findings indicate that the
informational booklet was effective in improving the attitude of postnatal mothers towards human milk bank.
Section III
This section deals with the effectiveness of Informational booklet on knowledge and attitude towards human
milk bank among postnatal mothers. It consists of two parts-
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Table No.3 - Effectiveness of Informational booklet on knowledge towards human milk bank among
postnatal mothers. n = 60
EFFECTIVENESS OF
INFORMATION
BOOKLET ON
KNOWLEDGE
Mean
SD
DF
T test
calculated
value
P Value
Remark
Pre test
6.87
2.85
59
22.19
<.0001
S
Post test
15.9
1.73
59
Table No. 3 shows the effectiveness of the informational booklet on knowledge regarding human milk bank
among postnatal mothers by comparing pre-test and post-test scores. The mean knowledge score increased from
6.87 in the pre-test to 15.9 in the post-test, with standard deviations of 2.85 and 1.73 respectively. The calculated
t-test value was 22.19 with 59 degrees of freedom, and the p-value was <0.0001, indicating a statistically
significant difference. Overall, these findings indicate that the informational booklet was highly effective in
improving the knowledge of postnatal mothers regarding human milk bank.
Table No. 4 - Effectiveness of Informational booklet on Attitude towards human milk bank among
postnatal mothers. n =60
EFFECTIVENESS OF
INFORMATION BOOKLET ON
ATTITUDE
Mean
SD
DF
T test calcaluated
value
P value
Remark
Pre test
24.97
3.11
59
24.01
<.0001
S
Post test
37.1
3.06
59
Table No. 4 shows the effectiveness of the informational booklet on attitude towards human milk bank among
postnatal mothers by comparing pre-test and post-test scores. The mean attitude score increased from 24.97 in
the pre-test to 37.1 in the post-test, with standard deviations of 3.11 and 3.06 respectively. The calculated t-test
value was 24.01 with 59 degrees of freedom, and the p-value was <0.0001, indicating a statistically significant
difference. Overall, these findings indicate that the informational booklet was highly effective in improving the
attitude of postnatal mothers towards human milk bank.
Section IV
This section deals with the Finding Related to correlate the knowledge with attitude towards human milk bank
among postnatal mothers.
Table No.5 - Correlate the knowledge with attitude towards human milk bank among postnatal mothers.
n = 60
EFFECTIVENESS OF INFORMATION
BOOKLET ON KNOWLEDGE AND
ATTITUDE
Mean
SD
DF
R test calculated value
PValue
Remark
Pre test Knowledge
6.87
2.85
59
0.9250
0.33
NS
Pre test Attitude
25.0
3.11
59
0.8194
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Table no.5 analyzes the correlation between knowledge and attitude scores using Karl Pearson’s correlation
coefficient. The findings showed that the mean knowledge score was 6.87 and mean attitude score was 25.0 in
the pre-test, with standard deviations of 2.85 and 3.11 respectively. The calculated r-values were 0.9250 for
knowledge and 0.8194 for attitude, with a p-value of 0.33, which is greater than 0.05 and hence not statistically
significant. Thus, there was no significant correlation between knowledge and attitude towards human milk bank
among postnatal mothers.
Section V
This section deals with analysis and interpretation of data in order to find out association of knowledge and
attitude towards human milk bank with selected demographic variables using chi-square test. For knowledge
scores, variables such as age, education, occupation, parity, religion, number of children, previous knowledge,
source of information, living area, and family income showed no statistically significant association (p > 0.05).
Similarly, for attitude scores, none of the demographic variables showed a statistically significant association (p
> 0.05). Thus, no selected demographic variable significantly influences knowledge and attitude towards human
milk bank among postnatal mothers.
DISCUSSION
The present study on the effectiveness of an informational booklet among postnatal mothers can be compared
with Roshani & Mahadalkar’s (2020) study on knowledge and attitude regarding human milk donation. Both
studies revealed poor to average baseline knowledge and mixed attitudes among mothers, with mean knowledge
scores of 6.87 (SD 2.85) and 8.89 (SD 3.06), and mean attitude scores of 24.97 (SD 3.11) and 28.56 (SD 9.62)
respectively.
While Roshani & Mahadalkar’s descriptive study showed no improvement in knowledge or attitude, the present
study demonstrated that an informational booklet significantly enhanced both knowledge (post-test mean 15.9)
and attitude (post-test mean 37.1), proving the effectiveness of structured interventions. Both studies also found
no significant association with socio- demographic variables, indicating that lack of awareness is widespread.
This suggests that continuous health education is essential to improve acceptance of human milk donation.
Both the present study and Ambika Chauhan’s (2022) study found that postnatal mothers had poor to average
knowledge and largely unfavorable attitudes towards human milk banking. In Chauhan’s study, 48% of mothers
had poor knowledge and 40% showed unfavorable attitudes, while in the present study, the pre-test means
knowledge (6.87, SD 2.85) and attitude (24.97, SD 3.11) scores also reflected low awareness.
The major difference is that Chauhan’s study was descriptive with no intervention, whereas the present study
introduced an informational booklet, which significantly improved both knowledge (15.9, SD 1.73) and attitude
(37.1, SD 3.06) with statistical significance (p < 0.0001). Additionally, Chauhan reported associations of
knowledge with age and religion, and attitude with education, while the present study found no significant
association with socio-demographic variables. Thus, both studies confirm low baseline awareness, but the
present study highlights the effectiveness of structured teaching in improving knowledge and attitude.
Implications Of Study
Nursing Education
Nursing educators can incorporate informational booklets into teaching plans for maternal andchild health
nursing. Students can be encouraged to create and use similar educational aidsduring clinical postings, which
helps develop their skills in health teaching, communication,and counseling. This practical experience builds
confidence in addressing sensitive issuesrelated to breastfeeding and milk donation.
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Nursing Administration
Nursing administrators can play a vital role by integrating human milk bank education intoroutine postnatal care
protocols. Informational booklets can be made widely available inpostnatal wards, neonatal intensive care units
(NICU), and outpatient departments, ensuringaccessibility for all mothers.
Nursing Service
Nurses play a pivotal role in educating postnatal mothers about human milk banks. Using informational booklets
during hospital stays and follow-up visits, they can clarify doubts and misconceptions regarding the safety,
collection, storage, and usage of donor human milk.
Nursing Research
This study highlights opportunities for future research in nursing, such as evaluating the comparative
effectiveness of different teaching methods, including booklets, videos, digital media, and counseling sessions.
CONCLUSION
The present study concludes that the informational booklet was highly effective in improving the knowledge and
attitude towards human milk bank among postnatal mothers. The findings revealed a statistically significant
improvement in knowledge scores from pre-test (mean 6.87) to post-test (mean 15.9) and in attitude scores from
pre-test (mean 24.97) to post-test (mean 37.1) at p < 0.0001.
The study also found that there was no significant association between knowledge and attitude with selected
socio-demographic variables, indicating that awareness regarding human milk bank is uniformly low across
different groups.
Thus, the study emphasizes that structured educational interventions such as informational booklets are effective,
simple, and cost-efficient methods to enhance awareness and promote positive attitudes towards human milk
banking, ultimately contributing to improved neonatal health outcomes.
Declaration By Authors
Ethical Approval: The study was approved by the institutional ethics committee of St. Andrews College of
Nursing, Pune. The study participants were briefed about the purpose and nature of the study and written
informed consent was obtained before data collection.
Acknowledgement: The authors express their sincere gratitude to all postnatal mothers who participated in the
study and to the hospital authorities for their support. The authors also acknowledge the guidance and assistance
received during the conduct of the study.
Source of Funding: There is no funding Source for this study.
Conflict of Interest: The authors declare no conflict of interest.
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