The Effect of Educational Intervention on Improvement of Breastfeeding Self-Efficacy: A Systematic Review and Meta-Analysis

Effects of internet-based integrated care on breastfeeding outcomes and emotional well-being in primiparous women

OBJECTIVE

This study investigates the impact of Internet-based integrated care on breastfeeding outcomes and emotional well-being in primiparous women.

METHODS

We conducted a retrospective analysis of 154 primiparous women admitted to Baoji People's Hospital from July 2020 to September 2023. Participants were divided into an observation group (n = 58), which received internet-based integrated care, and a control group (n = 96), which received routine telephone follow-up. We compared breastfeeding outcomes, knowledge, self-efficacy, and infant physical development between the groups, and performed logistic regression to identify risk factors affecting breastfeeding.

RESULTS

Before the intervention, there were no significant differences in breastfeeding knowledge and self-efficacy scores between the groups (all P > 0.05). At 6 months postpartum, the observation group had a higher breastfeeding success rate and improved scores in breastfeeding knowledge and self-efficacy (all P < 0.05). Infants in the observation group exhibited better physical development compared to those in the control group (P < 0.05). Logistic regression analysis identified age (P = 0.019), mode of delivery (P = 0.006), and nipple condition (P = 0.029) as independent risk factors for exclusive breastfeeding, while education level (P < 0.001), type of employment (P = 0.002), and daily sucking frequency (P = 0.005) were identified as independent protective factors.

CONCLUSIONS

The Internet-based integrated care model significantly enhances breastfeeding knowledge, self-efficacy, and exclusive breastfeeding rates among primiparous women, while also supporting better infant physical development.

An exploration of prenatal breastfeeding self-efficacy: a scoping review

BACKGROUND

Breastfeeding self-efficacy is a woman's self-belief and confidence in her perceived ability to breastfeed. This modifiable determinant is strongly associated with breastfeeding initiation, exclusivity, and duration. It is unclear how important the timing of breastfeeding self-efficacy measurement and interventions are. The prenatal period appears underexplored in the literature and yet a prenatal focus provides increased opportunity for breastfeeding self-efficacy enhancement and further potential improvement in breastfeeding outcomes. This scoping review aims to synthesise the evidence on prenatal breastfeeding self-efficacy, describing for the first time the theoretical frameworks, measurement tools, and interventions used in the prenatal period.

METHODS

8 databases were searched using the PCC framework (Problem: breastfeeding, Concept: self-efficacy, Context: prenatal period). From 4,667 citations and 156 additional sources identified through grey literature and snowballing, data were extracted from 184 studies and 2 guidance documents. All were summarised descriptively and narratively.

RESULTS

Just over half (57%) of included studies stated their theoretical underpinning, with Bandura's Self-Efficacy Theory / Dennis' Breastfeeding Self-Efficacy Framework predominant. Only half of intervention studies incorporated theory in their design. More intervention studies were undertaken in the past decade than previously, but the level of theoretical underpinning has not improved. Prenatal interventions incorporating theory-led design and using components addressing the breadth of theory, more frequently reported improving breastfeeding self-efficacy and breastfeeding outcomes than those not theory-led. Intervention components used less frequently were vicarious or kinaesthetic learning (52.5%) and involvement of social circle support (26%). The Breastfeeding Self-Efficacy Scales were the most common measurement tool, despite being designed for postpartum use. Overall, issues were identified with the late prenatal timing of breastfeeding self-efficacy investigation and the design, content and phraseology of measurements and interventions used in the prenatal period.

CONCLUSION

This review provides novel insights for consideration in the design and conduct of breastfeeding self-efficacy studies in the prenatal period. Future research should aim to be theory-led, commence earlier in pregnancy, and embed the breadth of self-efficacy theory into the design of interventions and measurement tools. This would provide more robust data on prenatal breastfeeding self-efficacy's role in impacting breastfeeding outcomes.

Effectiveness of male partner-targeted breastfeeding education and support interventions on mothers' breastfeeding self-efficacy in central Ethiopia: a cluster-randomized controlled trial

The purpose of this study was to evaluate the effect of male partners' targeted antenatal and postnatal breastfeeding education and support interventions on maternal breastfeeding self-efficacy in central Ethiopia. A two-arm parallel group cluster randomized controlled trial was carried out among couples in a community setting in the Hadiya Zone, central Ethiopia. A total of 408 couples from 16 clusters were randomly assigned to either the intervention (n = 204) or control group (n = 204). The analysis was conducted using an intention-to-treat approach. A generalized estimating equation (GEE) analysis was done to evaluate the effectiveness of the interventions. Maternal BFSE was significantly higher among mothers whose male partner received breastfeeding education and support interventions than those who did not receive the interventions (130 (65.0%) v 90 (45.9%), P < 0.001). The net effect of the intervention on improving maternal BFSE was 20.9% [95% CI: 16.9%-24.9%]. In the GEE model, maternal BFSE was 48% [RR = 1.48, 95% CI: 1.23, 1.79] higher in the intervention group than the control group. Involving male partners in breastfeeding promotion activities can enhance the mother's self-efficacy and confidence in breastfeeding.Trial registration: ClinicalTrials.gov identifier (NCT number), NCT05173454. Registered on 30/12/2021.

Effects of Face-to-Face Education Followed by Mobile Messaging to Primiparas on Maternal-Neonatal Care, Breastfeeding, and Motherhood Experience: A Randomized Controlled Trial

OBJECTIVE

This study aims to investigate the effectiveness of education on breastfeeding and basic maternal-neonatal care and mobile message support given to primiparous women in the postpartum period on breastfeeding and motherhood experiences.

METHODS

This prospective randomized controlled study was conducted in a hospital located in a city in Turkey, with 130 primiparous patients in the postpartum period (65 individuals in the experimental group and 65 individuals in the control group). Participants in the experimental group were provided with education on breastfeeding and basic maternal-neonatal care at the hospital, and mobile messages were sent with the same content as an education program for six weeks after discharge.

RESULTS

Mean scores of the breastfeeding self-efficacy (58.95 vs. 54.87; P<.05) and breastfeeding attitude (60.80 vs. 57.55; P<.05) are significantly higher in the experimental group compared to the control group. Similarly, the mean score of satisfaction with the motherhood experience is significantly improved in the experimental group compared to the control group (22.95 vs. 26.46; P<.05). It was determined that 89.2% of the women in the experimental group were still breastfeeding; 93.8% of them did not have nipple problems, and 60% of them did not use a bottle or pacifier in the six-month postpartum period (P<.05).

CONCLUSION

Education on breastfeeding and basic maternal-neonatal care given in the early postpartum period and mobile messages sent for six weeks after discharge may help to improve breastfeeding self-efficacy, breastfeeding attitude, and maternal experience satisfaction among primiparous women.

The impact of continuous and intermittent supportive counseling on self-efficacy and continuation of breastfeeding in lactating women affected by COVID-19: a quasi-experimental trial

BACKGROUND

Promoting exclusive breastfeeding can have a great effect in reducing the complications and mortality rate of mother and child.

OBJECTIVE

The study aimed to compare the effects of continuous and intermittent supportive counselling on the self-efficacy and continuity of breastfeeding among Lactating mothers with COVID-19.

METHODS

The study was a semi-experimental research method and was conducted on 73 mothers with COVID-19 who were hospitalized in Ayatollah Mousavi Hospital in Zanjan, Iran from May 2021 to April 2022. In the continuous counselling group, counselling was provided daily for 14 days, while in the intermittent counselling group, counselling was provided once a week for four weeks. Breastfeeding continuity was assessed based on the World Health Organization's classification, and breastfeeding self-efficacy was measured using Dennis' standard breastfeeding self-efficacy questionnaire (BSE) up to four months after delivery. The data were analyzed using chi-square tests, independent t-tests, paired t-tests, analysis of variance with repeated measures, and survival analysis (Kaplan-Meier) with a 95% confidence level.

RESULTS

The survival analysis revealed that the cessation of exclusive breastfeeding occurred in 17 cases within the continuous counselling group and in 22 cases within the intermittent counselling group. The rates of continuation for exclusive breastfeeding were 52.8% and 40.5% in the continuous and intermittent counselling group respectively. However, no statistically significant differences were observed in the continuation of breastfeeding and the trend of changes in the mean scores of breastfeeding self-efficacies between the continuous and intermittent counselling groups. Furthermore, comparing the change in breastfeeding self-efficacy scores between the one-month and four-month follow-ups within the continuous counselling group, a statistically significant increase was observed.

CONCLUSION

The results indicated no difference in the effectiveness of continuous and intermittent counseling methods in improving breastfeeding continuity in women with COVID-19. Further research is needed to explore the long-term effects of different counseling approaches on breastfeeding outcomes during crises.

TRIAL REGISTRATION

The study was registered on the Iranian Registry of Clinical Trials website on 29/06/2021 with the registration code IRCT20150731023423N19. It can be accessed via this link: https://irct.behdasht.gov.ir/user/trial/55391/view .

The effect of online breastfeeding education on breastfeeding motivation: A randomized controlled study

PURPOSE

The aim of this study was to examine the effect of online breastfeeding education on breastfeeding motivation.

DESIGN AND METHODS

The study had a single blind randomized, controlled, experimental design. The women in the online education group were primipara and in their postpartum 4-8 weeks and fulfilled inclusion criteria for the study. The study population comprised of the women presenting to the pregnancy outpatient clinic or giving birth in the gynecological and obstetrics clinic of a university hospital hospital in the West of Turkey and hearing about the Online Breastfeeding Education through social media. The sample size was calculated through a similar study. Data were collected between February 2022-November 2022. Simple random sampling was used and the study sample comprised of 50 women, of whom 25 were in the online breastfeeding education group and 25 were in the control group. Online breastfeeding education was given in groups of three or two, depending on availability, via the video communication platform (Zoom Video Communications). The control group received routine care. Data analysis was made with descriptive statistics, Wilcoxon rank sum test and Mann Whitney U test.

RESULTS

Integrative motivation (U = 284, p < .05) and intrinsic motivation-identified regulation (U = 196, p < .05) significantly increased compared to the control group.

CONCLUSION

Online breastfeeding education offered in the postpartum period can help to increase breastfeeding rates.

PRACTICE IMPLICATIONS

It is recommended that nurses monitor breastfeeding status in the postpartum period and motivate mothers with online breastfeeding training in cases where access is not available.

TRIAL REGISTRATION

Registered 12 February 2022 on www.

CLINICALTRIALS

gov (NCT05262231).

Breastfeeding Self-Efficacy, Personal Well-Being and Related Factors in Pregnant Women Living in a District of Istanbul

In this study, we examined breastfeeding self-efficacy levels, well-being and sociodemographic factors in pregnant women. The population of this descriptive study consisted of women with a pregnancy of 27 weeks or more in the Sultanbeyli district of Istanbul, Türkiye. A questionnaire was administered via telephone calls to pregnant women aged 18 years and older. The first part of the questionnaire included questions regarding breastfeeding history and sociodemographic information. The second part included the Prenatal Breastfeeding Self-Efficacy Scale, and the last part included the Personal Well-Being Scale. Higher scale scores indicate higher levels of self-efficacy and well-being. In total, 385 women participated in the study. The median age of the pregnant women was 28.0 years (18.0-43.0). The median gestational week was 33.0 (27.0-42.0). Among women who had received breastfeeding counseling, those with a higher level of knowledge about breastfeeding had higher breastfeeding self-efficacy (p < 0.05). Women with better economic status also had higher well-being scores (p < 0.05). There was a positive correlation between well-being and breastfeeding self-efficacy approaching the statistical significance level (p = 0.052). It is important to consider factors that may be associated with women's well-being and self-efficacy.

Barriers to optimal breastfeeding of medically complex children in the UK paediatric setting: a mixed methods survey of healthcare professionals

BACKGROUND

Breastfeeding is indisputably significant for infants and children, as well as their mothers. However, when breastfed children are admitted to the paediatric ward, they may experience breastfeeding modification due to clinical challenges, lack of staff training and institutional barriers. Although previous research has identified multiple barriers to optimal feeding within the maternity, neonatal and community settings, we know less about the barriers that exist in paediatrics. Paediatric healthcare staff attitudes, training and awareness as well as ward culture are likely to have an impact on the experiences of families but are relatively unresearched in the paediatric setting, especially with regard to the multidisciplinary nature of clinical paediatric care. The aim of this study was to explore the attitudes, awareness and perceived barriers to effective breastfeeding support provision, as well as healthcare professional perception of barriers for families.

METHODS

This was a mixed methods study utilising a questionnaire which was completed by 409 healthcare professionals who identified as working within the paediatric setting. It included responses from paediatricians of all training grades, nurses, healthcare assistants and allied health professionals. Qualitative data from professionals were analysed to develop themes around professional and perceived parent barriers to optimal breastfeeding.

RESULTS

This study explored the barriers experienced by staff, as well as professionals' perception of parent barriers. These included lack of knowledge of how to help, a default formula culture, the pressure of maintaining strict fluid balance and breastfeeding being a low priority in the face of critical illness. Of the paediatric departments represented by this sample of healthcare professionals, most had a relatively poor culture of supporting breastfeeding, with multiple institutional barriers identified. Most professionals felt that there was not enough support for breastfeeding families on an average shift, and a large proportion identified as being one of just a few breastfeeding advocates on their ward.

CONCLUSION

In this relatively motivated and experienced sample of healthcare professionals, there were many identified barriers to optimal breastfeeding which could potentially be addressed by training that is carefully nuanced for the paediatric population. Ensuring that paediatric multidisciplinary healthcare professionals have sufficient skills and knowledge would address the identified challenge of poor awareness of breastfeeding and of how to overcome clinical lactation obstacles. Further improvements at policy level need to address the systemic lack of resourcing in paediatrics, as well as the lack of embedded breastfeeding-friendly organisational structures.

Self-efficacy in the context of nursing education and transition to practice as a registered practitioner: A systematic review

AIM

The aim of this systematic review is to identify, describe and synthesize evidence from experimental studies conducted to measure and conceptualize self-efficacy within the context of nursing education and the transition of nursing students to practice as a registered practitioners.

DESIGN

Systematic review.

METHODS

Papers were screened by four independent reviewers, and data were extracted using a standardized data extraction tool. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance and checklists were used to guide this review.

RESULTS

The review included 47 studies, using a quasi-experimental pre-test-post-test design (n = 39) and randomized control trials (n = 8). Various teaching and learning interventions were used to enhance self-efficacy; however, there is no definitive conclusion to be drawn regarding the most effective educational interventions. Various instruments were used in the studies to measure self-efficacy. 10 of these were related to general self-efficacy, while 37 instruments measured self-efficacy in the context of specific skills.

Factors Associated With Initiating Breastfeeding and Continuing it for At Least 4 Months in Consuelo, a Rural Town in the Dominican Republic

Objective. We assessed the proportion of and factors associated with mothers initiating and continuing breastfeeding (BF) for ≥4 months in a rural town of the Dominican Republic. Methods. A survey was administered to 190 mothers of children cared for at a free clinic in Consuelo. Modified bivariate and multivariable Poisson regressions were utilized in data analysis. Results. BF was initiated in 89.5% of cases and continued ≥4 months in 81.7% of cases. Maternal education beyond secondary school [adjusted RR = 1.13, 95% CI: (1.04-1.24), 0.010], and visiting both public and private antenatal clinics [adjusted RR = 1.25; 95% CI: (1.10-1.37), 0.010] were associated with BF initiation. Public and private antenatal clinic attendance [adjusted RR = 1.01, 95% CI: (0.45-2.23), 0.020], Cesarean section [adjusted RR = 0.81, 95% CI: (0.68-0.98), 0.026], number of biological children [adjusted RR = 0.95, 95% CI: (0.90-1.00), 0.032] and maternal employment [adjusted RR = 0.89, 95% CI: (0.79-0.99), 0.048] were associated with BF continuation. Conclusions. These results provide valuable insights for targeting specific populations in future breastfeeding education interventions.

Determinants of High Breastfeeding Self-Efficacy among Nursing Mothers in Najran, Saudi Arabia

Many factors have been found to correlate with satisfactory Exclusive Breastfeeding (EBF) practices. The relationships between EBF practices and associated factors are complex and multidimensional; Breastfeeding Self-Efficacy (BSE) is the most important psychological factor that may help the mother to overcome any expected barriers. This study investigates the determinants of high breastfeeding self-efficacy among Saudi nursing mothers.

METHODS

This is a descriptive cross-sectional study investigating the determinant of BSE among 1577 nursing mothers in primary health centers in Najran City, Saudi Arabia. The study uses a cluster random sampling technique. Data collection was performed from June 2022 to January 2023 using a self-reported questionnaire that encompasses the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), Gender Friendly Breastfeeding Knowledge Scale (GFBKS), Iowa Infant Feeding Attitude Scale (IIFAS), and a basic data questionnaire to assess women's demographic factors and obstetric history.

RESULTS

The mean score for all BSES-SF items was between 3.23-3.41, the highest mean score was in mothers who felt comfortable breastfeeding with family members present (3.41 ± 1.06), and the lowest mean was in mothers who could breastfeed their baby without using formula as a supplement (3.23 ± 0.94). The overall BSE score was high among 67% of the study participants. Binary logistic regression showed that being a housewife, being highly educated, having breastfeeding experience, and being multiparous are positive predictors for high BSE (p ≤ 0.001). In addition, having adequate breastfeeding knowledge and positive breastfeeding attitudes were positively associated with higher BSE (p = 0.000).

CONCLUSION

BSE can be predicted by modifiable predictors such as mothers' education, working status, parity, breastfeeding experience, adequate breastfeeding knowledge, and positive attitudes toward breastfeeding. If such predictors are considered during breastfeeding-related educational interventions, it could lead to more effective and sustainable effects in community awareness regarding breastfeeding.

First-time parents' experiences related to parental self-efficacy: A scoping review

Becoming a parent for the first time is a major transition, and parental self-efficacy (PSE) is considered an important predictor of parenting functioning. We aimed to describe and synthesize qualitative studies that explore first-time parents' experiences related to PSE in the transition to parenthood in the first-year postpartum. We conducted a scoping review in accordance with international guidelines. The main search strategy consisted of searches in six electronic databases. We selected studies based on predetermined inclusion and exclusion criteria, extracted data, and conducted a descriptive qualitative thematic analysis. We included 58 studies (presented in 61 reports) with 1341 participants from 17 countries. Most of the participants (89%) were mothers, and a third of the studies were task-specific regarding breastfeeding. The thematic analysis of the findings concerning PSE revealed five main, interconnected themes: culture-factors in society and the healthcare services; parents-processes within the parents; tasks-different parental tasks; support-parents' perceived support from professionals, peers, friends, family, and partner; and child-the child's well-being and feedback. This scoping review describes qualitative studies on first-time parents' experiences related to PSE. The findings inform future studies of PSE and clinical practice by confirming the importance of PSE in the transition to parenthood, the complexity of different factors that may have an impact, and the centrality of breastfeeding in PSE. Based on these findings, we suggest that a full systematic review with quality assessment would be appropriate.

An exploration of prenatal breastfeeding self-efficacy: a scoping review protocol

Objective: To synthesise the evidence on prenatal breastfeeding self-efficacy, including identifying concepts and theoretical frameworks that underpin its development, the evidence on its measurement, interventions used to improve it, and association with breastfeeding outcomes. Background: Breastfeeding self-efficacy is described as a woman's self-belief and confidence in her perceived ability to breastfeed. It is a modifiable measure that is strongly associated with breastfeeding outcomes such as initiation, exclusivity, and duration. Interventions aimed at increasing self-efficacy are often in the postnatal period and have been shown to be effective at improving breastfeeding outcomes. The prenatal period appears to be underexplored in the literature and yet focusing on enhancing it may have the potential for further improvements in self-efficacy and on subsequent breastfeeding outcomes. A comprehensive knowledge synthesis on prenatal breastfeeding self-efficacy is lacking. Methods: The search will include databases across health, psychology, sociology, and the grey literature on breastfeeding guidance. Once the PCC framework (Problem: breastfeeding, Concept: self-efficacy, Context: prenatal period) is met, sources of evidence from any contextual setting will be eligible for inclusion. Limits will not be applied on geographic location or year of publication. The PRISMA-ScR flow diagram of search and study selection will be used to report final figures. Two independent reviewers will perform title and abstract screening and full text review. Data will be charted to provide a logical and descriptive summary of the results that align with the objectives. Conclusion: The results will provide an understanding of what has been done in the space and what gaps exist, informing recommendations for the timing of measurement and the design of prenatal interventions.

Breastfeeding competency and its influencing factors among pregnant women in third trimester pregnancy: a cross-sectional study

Competency is closely related to the occurrence of the behavior. Breastfeeding competence is the mastery of different breastfeeding factors which intervene in breastfeeding behavior. Breastfeeding competence could improve the breastfeeding behavior. However, few studies have paid attention to the status and the influencing factors of breastfeeding competency. The breastfeeding competency of pregnant women in third trimester pregnancy has the greatest impact on breastfeeding behavior after childbirth. Therefore, the objective of this study were to investigate the breastfeeding competency level and independent risk factors for breastfeeding competency among pregnant women in third trimester pregnancy. A cross-sectional survey method and convenience sampling method was used in the study. The general information questionnaire including age, gestational week, educational background, and so on were used to investigate the general information of pregnant women and their husbands. A breastfeeding competency scale (BCS) was used to investigate the breastfeeding competency of pregnant women. The total score of the BCS ranges from 38 to 190, with higher scores indicating greater breastfeeding competency. Lower level, medium level and higher level are 38-89, 90-140 and 141-190 respectively. Type-D Scale-14 (DS14) was used to investigate the type D personality of pregnant women. A multivariable linear regression was used to examine the independent predictors of breastfeeding competency. A total of 550 questionnaires were collected and finally 525 effective questionnaires were collected. The age of 525 pregnant women is (30.24 ± 3.954) years old. The breastfeeding competency score of pregnant women was (134 ± 19.741). Multivariable linear regression analysis showed that higher breastfeeding competency in pregnant women were reported among pregnant women who gestational age ≥ 256 days (37 weeks) (B = 8.494, p < 0.001), the previous breastfeeding experience were exclusive breastfeeding (B = 17.384, p < 0.001) and partial breastfeeding (B = 16.878, p < 0.001), participating in pregnant women school 2-3 times (B = 10.968, p = 0.013) and ≥ 5 times (B = 13.731, p = 0.034). Pregnant women with lower breastfeeding competency were found in women who were judged to have type D personality (B = - 6.358, p < 0.001). The result can explain 25.8% of the variation in the total breastfeeding competency score. This should be considered an important issue by maternal and child health care in the medical system that the moderate level of breastfeeding capacity among pregnant women. Differentiated and targeted breastfeeding support and services for pregnant women should be carried out based on influencing factors of breastfeeding competency.