Mothers’ Medical-based Experience as the Most Sought-after Online Information by New Mothers During Pandemic COVID-19

In the past, new mothers were able to consult with their mothers about parenting and health issues. When they are married, many of them live not at home with their mothers. When they need information about childcare and health problems, they switch to using online information sources (Facebook, Instagram, the Health page, and WhatsApp group). This study explores how new mothers in Surabaya use online platforms to search for helpful information related to health during pandemic COVID-19. This study used a qualitative virtual ethnographic method by collecting data through interviews, FGDs, and participating in several online media platforms, including Facebook group Room for Children; id.theAsianparent.com; Instagram account @ruangmom, @kenapaharusvaksin, @obesitas, and WhatsApp “Kulwapp” group. The results reveal that new mothers prefer to enroll in Facebook private groups and only women members with open identities. While on Instagram, they prefer to communicate through questions and answer forums. The Health page that is the primary reference is id.theAsianparent.com. Meanwhile, involvement in the Kulwapp WhatsApp group is for convenience and safety to discuss issues surrounding sexual organs. The shifting information-seeking of new mothers to online platforms because of more theoretical and medically-based health information and experiences need.


INTRODUCTION
The vast development of information and communication technology today has brought changes in ways of parenting's attitude (Pedersen and Smithson 2013;Zaslow 2012). One of the changes is the way of how people use communication media not only to exchange messages but also as a medium to seek information that useful for themselves and their family and relatives. New research in Europe and America show the women trend, especially women who has young children, they spent a lot of time online to seek health information (Bouche and Migeot 2008).
This trend is also strengthened that parents today consume and collect huge information about parenthood through the Internet (Plantin and Daneback 2009).
The Internet provides a large amount of health-related information intended for parents. Health information is offered through a variety of platforms, such as commercial sites, health organisation sites, and government agencies site, social media, and other platforms. Thus, it is easy for everyone to access the information online, include for the mothers. Based on Indonesia Internet Service Provider Association (Asosiasi Penyelenggara Jasa Internet Indonesia [APJII]) survey, housewives were the eighth largest group who access Internet in Indonesia (APJII 2020:23). While the dominating age of Internet users was 20-34years old (APJII 2020).
This increasing trend of using mobile phone to access Internet among pregnant woman and millennial mothers in the age of 18-32, or they who were born between 1977 to 1997 (BabyCenter 2015; Hamzehei et al. 2018;The Interactive Advertising Bureau 2015).This is the generation who are get use to with the technology on their daily lives, and when they become mother, they still had close relationship with the technology and they maximizing the technology to become best version of mom they could be.
These millennial new mothers, are the parents of 50% of children now. They are different in lifestyle and hold graduate university degree. With so much information available online, they turn online for their daily needs and shopping habit (Keenan 2018). They use technology in the ways that the previous generation never thought of. Using fancy technology to facilitate baby care such as baby's heart rate monitor using apps that allow it to be shared with relatives, use social networking applications to ask questions and discuss with hundreds or even thousands of other new mothers who experience the same problems. To empower themselves with useful information, so they can make a healthy and safe choices (Alamiyah 2020;Markiewicz 2017) (Alamiyah 2020;Markiewicz 2017).
This trend to access health information online is also increase in Indonesia (Gashya and Alamiyah 2019). Based on Daily Social Survey, most of Indonesian used Internet to access health information with mobile phones (Priambada 2016).
APJII survey 2020 shows that health service is the seventh reason why Indonesian use Internet (APJII 2020). It is around 0,9% of 196,7 million Internet users in Indonesia, or 1,7 million people accessed Internet for health service. Furthermore, there are 6,8% or 13,3 million people of Internet users in Indonesia use social media to find health contents (APJII 2020). Also research by Arviani and Alamiyah (2019), which find that new mothers in Surabaya, use Internet to find information related with immunisation through Internet.
There are plenty researches discussing the topic of health information seeking on Internet. As done by Jacobs, Amuta, and Jeon who explore how United States (US) adult's population search for health information. They associated the demographic characteristic with health information seeking behaviour. Their study highlighted that the predictors of Internet use for health information seeking were being younger, have higher socio-economic status and have more education and the predictor of the use of traditional media and health care provider for health information were being older, having low Internet skill, and being Hispanic. This study also found that people with lower economic status were still relying on print media for health information seeking.
They summarize that online access to and the use of health information have given advantage to increase the knowledge of people about health and could help in decision making related to health problem. However, this nationwide study found that there is a digital disparity among different population. Certain group of population may have challenges in having the advantages of online health information. The group that has benefit from the available health information were group of people that have more education, younger, have higher socio-economic status and have more Internet skills (Jacobs, Amuta, and Jeon 2017).
Research on health information seeking behaviour has been carried out in various fields of science, including library science, information systems or human and computer interaction, as well as health science. Cline and Haynes on their comprehensive literature review stated the need for this health seeking behaviour to be discussing from communication perspective. Furthermore (Robinson et al. 1998) argue that online health seeking behaviour should be seen as an interactive health communication. Iinteractions of an individual with or using electronic device or communication technology to access or transmit health information or guidance and support related with health issue.
Cline and Haynes explain that to understand the online health seeking process we should frame them as communication process rather than see it through the information dissemination perspective or educational process. As they argue that Internet with all the features reflect the shifting paradigm with its interactivity and reciprocal influences. Thus, this health information seeking is a transactional process rather than one-way communication. How the Internet provides possibility and space for interaction, face to face and interpersonal needs fulfilment as empathy, validity, and self-disclosure, show the blend of interpersonal and mass communication.
However, in Indonesia researches discussing online health information from communication perspective are still rare (Arviani and Alamiyah 2019), the available research is limited to the topics of the application of online health information system in Hospital (Isnawati, Nugroho, and Lazuardi 2016;Susanto and Sukadi 2011). Therefore, the significant of this study is to provide evidence- resulting increasing number of health information seeking through online platforms (Roselina, Asmiyanto, and Andriany 2021). In this study we choose new mother as they are the main decision makers related to health and child rearing. Thus, this study focuses on how their activities online related with health information seeking.

com/heidy.arviani) and web survey link through SurveyMonkey
Researchers held an offline FGD in a representative, easy to access, and open window room for eighteen participants who agreed to join in FGD. By splitting participants into two small groups, researchers obey the health protocol COVID-19 with physical distancing. Discussion with a small group of people gave benefit in handling the discussion interactively and participants felt secure to describe their experiences (Fortune, Reid, and Miller 2013;Lamb 2013). Criteria for participants are new mothers in Surabaya who have first time experiences to take care a child. Some participants also identified themselves as stay at home moms, one as a paediatric resident who has a toddler, some were working mom, and some were local-health community volunteers. participants that has low status economy and lower education level.

RESULTS AND DISCUSSION
When new mothers need information related to health, which source of information they would go first. Most new mothers indicated that they prefer to go to doctor or to go online as their first source of information. While others indicated that they would post question on social media, read health book, or journal, and ask for help to family. There is a difference pattern between younger participants and older participants. Participants who choose to go online and browse the Internet first, indicated themselves as aged from less than 25 years to 35, have bachelor or master degree, with mostly they have family income above 5 million per month and several informants indicate themselves to have family income lower than 5 million per month. While they who prefer go to doctor or other medical personnel when they need health information mostly aged above 36. However, since the healthcare resources is limited during the pandemic, these mothers with different age and education, they turn to online to fulfil their information need.
Health information seeking is an effort to fulfil a certain health need. It is the need, which motivate people to do some action. Some of the motivation why these new mother use Internet to search for health information online were; first, information for self-care, mental health, and COVID-19 related articles. The main reason why new mothers look for information online, is that they need explanation when they experience a health symptom or when they were sick.  The third motivation is to look for more detailed information. When informant consult with doctor and they did not satisfy with doctor explanation, they would find for more detailed information on Internet, as indicated by an informant that as she had a very short consultation time with doctor and she feel that she did not have enough explanation thus she chooses to find the information herself.
"When my daughter got anaemia, what makes my daughter anaemia so she needs blood transfusion twice, she didn't had bleeding or even no nosebleed, she is fine but why she need transfusion twice, I was surprised, also the doctor. I just don't understand, so I go online, to find maybe there's same case out there." (Natalia, 41 years, stay-at-home parent)

A c h m a d : M o t h e r s ' M e d i c a l -b a s e d E x p e r i e n c e a s t h e M o s t S o u g h t -a f t e r O n l i n e I n f o r m a t i o n b y N e w M o t h e r s D u r i n g P a n d e m i c C O V I D -19 | 87
Fourth, to be spread to others. In addition to seek information for themselves to be given at the health socialisation, they get the information especially from Instagram when they did not understand what is being given at the information session (see figure 3).  Almost all respondents stated that they use search engine, especially Google to find health information. They preferred Google as it is considered to have varied information, complete and wide topic, so they could find what they need. The preferable link destination is health websites as it has ample of scientific article with credible source of information, clear source of information, authorship, and institution. While the most preferable information is article that written by health practitioner.  Most of research participants mentioned Google, as shown on Table 1, as it is an easy to use platform, simple yet complete. They can browse any topics they want from Google. While WhatsApp is used when informant need answer of a question or need discussion. They can post question to the group or search from the archived documents in the group. "Kulwap" or Kuliah WhatsApp is online class deliver through WhatsApp application, usually organize by admin of existing group, where they invite an expert to give short presentation of certain specific topics on WhatsApp and continue with discussion, the time is limited for example one hour. This Kulwap can be a free discussion or paid. Depend on the speaker. Or an organizer organizes a Kulwap and invite people to join to a temporary group through broadcasted link. The group would be dismissed if the discussion were done. It could last for several hour or several days, which the speaker provides further consultation. This form of health information searching is preferred by the informant when they need a deep discussion or for further knowledge about certain topics for example stunting on children, how to success on breastfeeding e cetera.
This form is having high credibility as they usually known the speaker as expert.
Turning to the health-based application, it used mostly by the younger mom, from consultation application such as Alodoctor (https://play.google.com/store/apps /details?id=com.alodokter.android) to health monitoring application as pregnancy or menstrual application. They use it to support their health journey. On Instagram, participants follow specific health practitioner account, personal or institution to get health information shared by them.
While on Facebook participants usually see post about health information unintentionally on their FB timeline, if they interested, they would go to the link.
While when informant needs some information, they would go to the personal FB profile of popular health practitioner they know to see their post about certain health topic. Or they would go to the Facebook group for example, Breast-feeding mama group, children health group, homemade healthy baby food, et cetera. Where they could find archived documents wrote by expert, read note from group admin who are also a health practitioner, and other document posted on the group. They also stated that they gain information from reading the discussion on the group wall, other people question with same topics. They would read from the comment column and learn from the practitioner, for example paediatric answer or from experience shared by other parents who encounter same experiences.
Information credibility is important, wrong information would lead to wrong knowledge, wrong decision-making. Almost all participants were aware that information on the Internet might not be true, they aware the possibility of hoaxes and not credible information. Moreover, the mother stated that they always cross checking the information with many sources and compare to other platform or ask the doctor to check the credibility of information. Most of participants stated their satisfaction with the availability of information available on the Internet. They feel that the information can help them deal with the problems that occur related to health and help them in making decisions and take actions, particularly when there is a critical situation or when there is family member who get sick.
Turning to the credibility of information, the research participants develop several strategies to check the credibility and reliability of the information. The strategy mentioned by the respondents were sources cross-checking, author profile checking, websites checking, post question on social media and ask health practitioner. They explained that they usually compare one article to another. These mothers would open multiple tabs on Google to see how different site or article said about one topic. Furthermore, these mothers used to see who publish the article, whether it is a government official site, non-profit institution, personal site, or commercial sites. Besides that, the informants do profile checking of the author, whether they are journalist or health practitioner. The close the author to the medical field the more the informant trusts the article. The other strategy is to discuss with friends, family, and health practitioner such as doctor, nurse, or Posyandu cadre.
"I used to check whether the site is reliable or no, crosschecking the information in several reliable sites, see who were the writer whether a journalist from credible mass media or just blog, not every blog has a valid and true information and the one that responsible of the blog is an individual, not an official site of a company or an organisation". informant, language, sources format and content as shown on Figure 5. Besides that, informant stated that they avoided content with advertising intention.

Figure 5.
Types of attractive health information through online platform for new mothers

Source: authors' analysis
This study shows that the use of online platform to access health information is become common among mothers in Surabaya. The participants are going online to search online information to get more detailed information, to get useful information for their selves and significant others and also to empower other women. Furthermore, new mothers not only searching information but also learn to empower themselves and other people. With the knowledge they have the can made better-informed decision-making and they deliver the knowledge to their community. Another thing is that some informant mentioned that they prefer to go online to find information related to private topic. As when people going online, they can browse and interact online anonymously.
There is a difference pattern of Internet use among younger new mothers and previous generation. The young mother with the characteristic as having academic degree, some work in public area and some are housewives, having good  what happen to themselves and to find solutions for health problems they experience, and even to consult with doctor.
Surely that way of technology use could enhance the knowledge of new mothers and also increasing their awareness that will also increasing the health literacy of new mothers (Jacobs et al. 2017). Even though the health literacy could bridge the social status and health, thus the changing pattern of health information could lead to the reduce of the social gap on health. The use of Internet provides possibility for these women to empower themselves and also involving the new mother in the empowerment process in their environment. As have been done by the Integrated Healthcare Centre (Posyandu) cadre that they search from health information material online and then they inform it to the members of Posyandu, to be disseminate to the community. The community itself has a good perception of Posyandu cadre credibility level, thus the cadre should ensure that they give reliable health information (Dewi and Anisa 2018).

| T h e J o u r n a l o f S o c i e t y and M e d i a 5 ( 1 )
Another form of women empowerment through Internet is when one of the new mothers who is also a resident of paediatric made an Instagram account compiling and creating health information content post it regularly aims to provide valid and quality of health information, trying to straighten the wrong information and hoax which is scatter out in the community. The Instagram account itself has a significant number of followers. The increasing use of internet to access health information in among new mothers in Surabaya is become more popular. New mothers prefer to use mobile phone to access the information to fulfil various needs.
New mothers in Surabaya could harness the digital device to improve their quality of life and also to empower the community.
Yet the difference demographic factor as age, education level, and family income influence the pattern of new mothers use of Internet. Even though that factor could not apply for the entire informant. Hence this study provides description of how new mothers harnessing digital technology for the ease of their life.

CONCLUSION
The new mothers in Surabaya need to increase the level of health literacy and improve the ability make decision concerning their health. So that social media should provide health information to increase the level of public knowledge. This study insists that the government and stakeholders in the health sectors provide valid health information. In addition, the government must provide literacy in the form of basic skills for mothers to obtain useful health information in social media, in order to distinguish positive and negative contents.