Adaptation and psychometric evaluation of the breastfeeding self-efficacy scale to assess exclusive breastfeeding

Meta-ethnography on the Experiences of Women From Around the World Who Exclusively Breastfed Their Full-Term Infants

OBJECTIVE

To synthesize evidence from qualitative studies on the experiences of women from around the world who exclusively breastfed their full-term infants.

DATA SOURCES

CINAHL Plus, PubMed, APA PsycInfo, Scopus, and ProQuest Dissertation & Theses Global.

STUDY SELECTION

We selected reports of qualitative studies that were conducted in high-, middle-, and low-income countries; published between January 2001 and February 2022 in English; and focused on the experiences of women who exclusively breastfed their full-term infants.

DATA EXTRACTION

We extracted the following data from included studies: methodological characteristics (i.e., country of origin, authors' disciplines, research design, sample size, sampling, data collection, and data analysis method), participants' demographics (i.e., age, parity, marital status, education, and exclusive breastfeeding duration) and direct participant quotes, and key concepts and themes about women's experiences of exclusive breastfeeding. We managed and stored extracted data using a Microsoft Excel spreadsheet.

DATA SYNTHESIS

We synthesized reciprocal translations using Noblit and Hare's approach to meta-ethnography. Five overarching themes emerged from the meta-synthesis: Favorable Conditions, Not a Smooth Journey,Support, Determination and Perseverance, and Reflections on Benefits.

CONCLUSION

In the included studies, participants experienced challenges with exclusive breastfeeding; however, they also recounted benefits. We recommend 6-month maternity leave and support from family and health care professionals to improve rates of exclusive breastfeeding.

Psychometrics of the breastfeeding self-efficacy scale and short form: a systematic review

BACKGROUND

The Breastfeeding Self-Efficacy Scale and its short-form were developed in Canada and have been used internationally among numerous maternal populations. However, the psychometric properties of the scales have not been reviewed to confirm their appropriateness in measuring breastfeeding self-efficacy in culturally diverse populations. The purpose of this research was to critically appraise and synthesize the psychometric properties of the scales via systematic review.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Three databases (EMBASE, MEDLINE, and PsycINFO) were searched from 1999 (original publication of the Scale) until April 27, 2022. The search was updated on April 1, 2023. Studies that assessed the psychometric properties of the BSES or BSES-SF were included. Two researchers independently extracted data and completed the quality appraisals.

RESULTS

Forty-one studies evaluated the psychometrics of the BSES (n = 5 studies) or BSES-SF (n = 36 studies) among demographically or culturally diverse populations. All versions of the instrument demonstrated good reliability, with Cronbach's alphas ranging from .72 to .97. Construct validity was supported by statistically significant differences in mean scores among women with and without previous breastfeeding experience and by correlations between the scales and theoretically related constructs. Predictive validity was demonstrated by statistically significant lower scores among women who ultimately discontinued breastfeeding compared to those who did not.

CONCLUSION

The BSES and BSES-SF appear to be valid and reliable measures of breastfeeding self-efficacy that may be used globally to (1) assess women who may be at risk of negative breastfeeding outcomes (e.g., initiation, duration and exclusivity), (2) individualize breastfeeding support, and (3) evaluate the effectiveness of breastfeeding interventions.

Breastfeeding Self-Efficacy: A Systematic Review of Psychometric Properties Using COSMIN

BACKGROUND

Breastfeeding self-efficacy has been proven to play a predictive role in enhancing breastfeeding initiation and continuation. Breastfeeding self-efficacy measurement tools have facilitated healthcare professionals' early identification and support of women at higher risk of early discontinuation of breastfeeding.

RESEARCH AIM

The aim of this study was to assess the psychometric properties of breastfeeding self-efficacy measurement tools.

METHOD

A systematic review was carried out in three phases. Phase One comprised a systematic literature review performed in PubMed, SCOPUS, Web of Science, and Cochrane Database of Systematic Reviews from February 2021 to January 2023, including 36 studies for final analysis. Phase Two provided a quality appraisal of the psychometric properties of each of the seven breastfeeding self-efficacy measurement tools, according to COnsensus-based Standards for the selection of health Measurement Instrument checklist (COSMIN) guidelines. Phase Three summarized and graded the overall quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) modified approach.

RESULT

The included articles comprised 9,225 participants and seven breastfeeding self-efficacy measurement tools. The Breastfeeding Self-Efficacy Scale, Breastfeeding Self-Efficacy Scale - Short Form (BSES-SF), and Prenatal Breastfeeding Self-Efficacy Scale were supported by Grade A evidence sustaining their validity and reliability to assess breastfeeding self-efficacy in the continuum of maternity care. The BSES-SF is the most feasible tool in clinical practice and the most utilized internationally, available in 15 languages.

CONCLUSION

This systematic review provided a Grade A recommendation on breastfeeding measurement tools that will be helpful both for clinical and research purposes.Registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42021238450).

Psychometric testing of the breastfeeding self-efficacy scale to measure exclusive breastfeeding in African American women: a cross-sectional study

Background

In United States, African American women are the least likely group to breastfeed exclusively compared with Hispanic and non-Hispanic white women. It is crucial to examine the perceived confidence of African American women towards practicing exclusive breastfeeding. Previous studies have examined breastfeeding self-efficacy and other factors influencing exclusive breastfeeding. However, there is no research on exclusive breastfeeding self-efficacy of this population. The purpose of this study was to examine the validity and reliability of the breastfeeding self-efficacy scale to measure exclusive breastfeeding, and the relationship between exclusive breastfeeding self-efficacy and general self-efficacy and demographic variables in African American women.

Methods

Descriptive cross-sectional design was used. A convenience sample of 53 pregnant African American women completed an online survey. Construct and criterion-related validity were assessed and reliability of the breastfeeding self-efficacy scale to measure exclusive breastfeeding (BSES-EBF) was examined using Cronbach's reliability. The general self-efficacy scale measured general self-efficacy. Descriptive statistics, bivariate correlation and non-parametric analyses were performed using statistical package for social sciences (v.28).

Results

The breastfeeding self-efficacy to measure exclusive breastfeeding scale had a Cronbach's alpha score of 0.907. One principal component was extracted from the BSES-EBF scale, with an Eigenvalue of 5.271 and which explained 58.57% of the variance in the instrument. The mean prenatal exclusive breastfeeding self-efficacy of participants was 35.15 (±7.41) from a range of 9 to 45. Exclusive breastfeeding was significantly associated with general self-efficacy (r = 0.503, p ≤ 0.001) and exclusive breastfeeding intention (p = 0.034).

Conclusion

Breastfeeding self-efficacy scale to measure exclusive breastfeeding is a valid and reliable tool to measure exclusive breastfeeding self-efficacy in African American women. African American women had high exclusive breastfeeding self-efficacy (internal motivation). Hence, there is a need to address breastfeeding barriers and provide access to culturally sensitive support (external motivation) to increase exclusive breastfeeding in African American women.

Transcultural adaptation of a scale for exclusive breastfeeding to be used in Brazil

OBJECTIVE

The aim of this study was to perform a cross-cultural adaptation of the Breastfeeding Self-Efficacy Scale in Exclusive Breastfeeding for use in a Brazilian-Portuguese context.

METHODS

The cross-cultural adaptation process involved the translation from original English into Brazilian Portuguese by two qualified and independent translators. Both translations were synthesized into a single version that was back-translated into English. An expert committee was created to assess linguistic equivalences, formulating a pre-final version that was tested on ten nursing women attending a maternity hospital. To assess its psychometric properties, a cross-sectional study was carried out. The population consisted of 99 nursing women from a reference maternity hospital in southern Brazil. The scale's stability and internal consistency were measured through Cronbach's alpha. The Pearson's correlation coefficient and the intraclass correlation coefficient between two applications were assessed to ascertain the Breastfeeding Self-Efficacy Scale in Exclusive Breastfeeding-Br scale's reliability. The construct validity was evaluated through exploratory factorial analysis.

RESULTS

The Breastfeeding Self-Efficacy Scale in Exclusive Breastfeeding-Br showed a general Cronbach's alpha of 0.849. The test-retest analysis showed a Pearson's correlation coefficient of 0.483 and intraclass correlation coefficient of 0.645. The exploratory factorial analysis showed two domains among the nine items of the Breastfeeding Self-Efficacy Scale in Exclusive Breastfeeding-Br: the functional domain, including six items, and the cognitive domain, including three items, explaining 59.77% of the variance.

CONCLUSION

The Breastfeeding Self-Efficacy Scale in Exclusive Breastfeeding-Br was considered adequate for the cultural context and reliable and valid for Brazilian nursing women.

Pathways linking social support, self-efficacy, and exclusive breastfeeding among women in northern Uganda

Despite improvements in infant feeding practices over the past two decades, the prevalence of exclusive breastfeeding (EBF) is below global targets. Social support can create an enabling environment for recommended infant feeding practices such as EBF, but the types of social support most important for sustained EBF and their potential mechanisms of action have not been thoroughly characterized. We therefore aimed to assess the relationship between EBF-specific social support, EBF self-efficacy, and EBF at 1 and 3 months among postpartum women in northern Uganda. Women (n = 238, 36.2% living with HIV) were recruited during pregnancy. EBF, social support, and EBF self-efficacy were assessed at 1 and 3 months postpartum. Path analysis was used to assess relationships between these factors. Most mothers exclusively breastfed to 1 (80.8%) and 3 months postpartum (62.9%). EBF-specific, but not general, social support differed by EBF status. EBF-specific social support was associated with higher odds of EBF, which was almost fully mediated by EBF self-efficacy. That is, there was evidence that social support primarily influences EBF through its association with self-efficacy. In sum, EBF-specific social support and self-efficacy likely promote EBF and are modifiable factors that can be intervened upon.

Determinants of breastfeeding self-efficacy among postpartum women in rural China: A cross-sectional study

Background

Breastfeeding self-efficacy is known to positively influence breastfeeding behaviors. While previous research has studied the determinants of breastfeeding self-efficacy in general, these determinants are unstudied among postpartum women in rural China. This study aims to describe the breastfeeding self-efficacy of postpartum women in rural China and identify determinants of breastfeeding self-efficacy using the Dennis breastfeeding self-efficacy framework.

Methods

Using a multi-stage random cluster sampling design, cross-sectional survey data were collected from 787 women within the 0–6 months postpartum period in 80 rural townships. Surveys collected data on breastfeeding self-efficacy, characteristics related to the Dennis breastfeeding self-efficacy framework, and demographic characteristics. Multiple linear regression analysis was used to identify determinants of breastfeeding self-efficacy.

Results

Participants reported a moderate level of breastfeeding self-efficacy, with an item mean score of 3.50. Self-efficacy was lowest for exclusive breastfeeding. Breastfeeding attitudes (β = 0.088, P< 0.001), breastfeeding family support (β = 0.168, P< 0.001), and social support from significant others (β = 0.219, P< 0.001) were positively associated with breastfeeding self-efficacy. Breastfeeding problems, including trouble with latching (β = -0.170, P< 0.001), not producing enough milk (β = -0.148, P< 0.001), and milk taking too long to secrete (β = -0.173, P< 0.001) were negatively associated with breastfeeding self-efficacy.

Conclusion

The findings indicate that positive attitudes, breastfeeding family support and social support contribute to greater breastfeeding self-efficacy in rural China, whereas difficulties with breastfeeding are associated with reduced self-efficacy. Researchers and practitioners should investigate effective strategies to improve social support and family support for breastfeeding, promote positive attitudes towards breastfeeding, and provide women with actionable solutions to breastfeeding problems.

Predictive capacity for breastfeeding and determination of the best cut-off point for the breastfeeding self-efficacy scale-short form

INTRODUCTION

The most widely used tool for assessing breastfeeding self-efficacy is the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). This study assesses the relationship between the BSES-SF score and the risk of breastfeeding (BF) cessation and determines the cut-off point in the scale score that optimizes detection of this risk in primary health care pediatric consultations.

METHODS

Secondary data analysis of the LAyDI study. Cohort study carried out through a research network of primary care pediatricians (PAPenRed). A newborn was recruited every month for one year by 210 pediatricians. The cohort was followed for 24 months. Mothers responded to the BSES-SF at the first visit. General pregnancy and delivery data were collected and assessed to determine whether breastfeeding was exclusive or supplemented during the first 6 months.

RESULTS

N = 1845. The Area Under the ROC Curve for the exclusive BF was 0.790 (0.765-0.815) the first month and 0.760 (0.734-0.786) the second month. For 4 and 6 months, as well as for any age in mothers who give supplemented BF, the Area Under the Curve was less than 0.75 and its predictive capacity was not considered to be good. For a sensitivity of 80% in detecting mothers at risk of BF cessation with the BSES-SF, the cut-off score was 58.

CONCLUSIONS

Mothers with a BSES-SF score below 58 points in primary health care, are at risk of early withdrawal of exclusive BF within two months.

The Effect of Oketani Breast Massage on Successful Breastfeeding, Mothers' Need for Breastfeeding Support, and Breastfeeding Self-Efficacy: an Experimental Study

BACKGROUND

The negative effects of cesarean section on breastfeeding are a major global concern.

PURPOSE

This study aimed to determine the effect of Oketani breast massage on the maternal need for support during breastfeeding, breastfeeding success, and breastfeeding self-efficacy.

SETTING

Three hospitals affiliated to Shahid Beheshti University of Medical Sciences in Tehran, Iran, from April to July 2019.

STUDY DESIGN

The participants in this experimental study were 113 pregnant women who were candidates for cesarean section. The mothers were selected using convenience sampling and randomly assigned. In addition to routine care, the mothers in the intervention group received Oketani breast massages twice. However, the mothers in the control group received routine care. The data were collected using the Infant Breastfeeding Assessment Tool (IBFAT), LATCH Assessment Score, and the Breastfeeding Self-Efficacy Scale (BSES). The data were analyzed with SPSS 20 software via the independent samples t test, the Mann-Whitney U test, and the chi-square test.

RESULTS

The results of the study suggested that the breastfeeding success rate, which was evaluated with IBFAT in both the first two breastfeeding stages and the last pre-discharge breastfeeding, was significantly higher for the mothers in the intervention group (p < .001). In addition, the mother's need for support, which was evaluated with LATCH in the first two breastfeeding stages (p = .044) and the last pre-discharge breastfeeding (p < .001) in the intervention group, was less. The total number of breastfeeding sessions from birth to discharge was higher in the intervention group (p = .002). Furthermore, the mothers in the intervention group breastfed their infants in a significantly shorter time interval (p = .002). Breastfeeding self-efficacy, according to the BSES, was significantly higher in the mothers of the intervention group (p < .001).

CONCLUSION

Oketani massage can be used as a care intervention by nurses to improve breastfeeding in mothers who undergo cesarean sections.

The association of breastfeeding self-efficacy with breastfeeding duration and exclusivity: longitudinal assessment of the predictive validity of the Greek version of the BSES-SF tool

INTRODUCTION

While breastfeeding self-efficacy (BSES) is an important modifiable determinant of breastfeeding, a structured assessment is not standard practice in Cyprus. We assessed the Greek version of the Breastfeeding Self-Efficacy Scale (BSES-SF), including its predictive validity in terms of Breastfeeding (BF) and Exclusive Breastfeeding (EBF) up to the sixth month.

METHODS

A methodological study with longitudinal design among 586 mother-infant dyads, as part of the "BrEaST Start in Life" project. BSES was assessed 24-48 h after birth and at the first month. Breastfeeding status was assessed at the clinic, the 1st, 4th and 6th month. The association between BSES and breastfeeding was estimated in logistic regression models and its diagnostic ability in ROC analysis.

RESULTS

With Mean = 3.55 (SD = 0.85), BSES was moderate, and lower among Cypriot women, primiparas and those who delivered by Cesarean Section (C/S). There was good internal consistency across the 14 items (Cronbach's α = 0.94) while factor analysis revealed a two-factor structure. BSES scores were higher among mothers who initiated exclusive breastfeeding (M = 3.92, SD = 0.80) compared to breastfeeding not exclusively (M = 3.29, SD = 0.84) and not breastfeeding (M = 3.04, SD = 1.09; p-value < 0.001). There was a stepwise association with exclusivity (40.5% in the highest vs 7.9% lowest quartile of self-efficacy). The association between in-hospital BSES and long-term EBF persisted in multivariable models. Women in the upper quartile of BSES at 48 h were more likely to breastfeed exclusively by adjOR = 5.3 (95% CI 1.7-17.1) at the 1st and adjOR = 13.7 (95% CI 2.7-68.6) at the 4th month. Similar associations were observed between self-efficacy at the 1st month and BF at subsequent time-points. High first month BSES (> 3.96 as per ROC) had 58.9% positive and 79.6% negative predictive value for breastfeeding at 6 months which reflects higher sensitivity but lower specificity.

CONCLUSIONS

The Greek version of BSES-SF showed good metric properties (construct, know-group, concurrent and predictive validity). In the absence of community support structures or programmes in Cyprus, prevalence of breastfeeding remains low. This suggests a need for policy, educational and community support interventions, including the systematic use of BSES scale as a screening tool to identify those at higher risk for premature BF discontinuation.

An evaluation of a prenatal individualised mixed management intervention addressing breastfeeding outcomes and postpartum depression: A ramdomised controlled trial

AIMS AND OBJECTIVES

To determine the effects of an individualised mixed management combined lactation education and psychoeducation intervention on breastfeeding outcomes and postpartum depression (PPD) at 3 and 42 days postpartum.

BACKGROUND

Pregnant women with antenatal depression are prone to postpartum depression and failure in breastfeeding.

DESIGN

Eligible women participated in a randomised single-blind controlled trial. Results are reported as per the CONSORT 2010 statement.

METHODS

Participants were recruited from December 2017-August 2018 at a major teaching hospital located in Shanghai. Primiparous women (n = 182) with an Edinburgh Postnatal Depression Scale score ≥9 were randomly enrolled in the intervention group (n = 91) or the control group (n = 91). The intervention group participated in a 4-session face-to-face mixed management intervention targeting perinatal depression and breastfeeding. The control group received usual care. Breastfeeding and psychological outcomes were measured during the third trimester (≥28 weeks and <35 weeks), and at 3 and 42 days postpartum.

RESULTS

There were statistically significant differences in rates of overall and exclusive breastfeeding, initial breastfeeding experience, breastfeeding behaviour and self-efficacy between the two groups at 3 and 42 days postpartum (p < .05). Intention-to-treat linear mixed model analysis showed that EPDS scores were statistically significantly different between groups over time (F = 20.42, p < .001). Intervention group were more satisfied with their husbands' care and care received during the first month postpartum (p < .05).

CONCLUSIONS

The results demonstrate the effectiveness and feasibility of delivering an individualised mixed management intervention combining lactation guidance with psychological support during pregnancy.

RELEVANCE TO CLINICAL PRACTICE

This study supports the need to identify pregnant women at risk of perinatal depression and indicates that the prenatal individualised mixed management intervention has the potential to reduce PPD and help achieve better breastfeeding outcomes.

Black/African American Breastfeeding Experience: Cultural, Sociological, and Health Dimensions Through an Equity Lens

Background: Disparities in breastfeeding (BF) continue to be a public health challenge, as currently only 42% of infants in the world and 25.6% of infants in the United States are exclusively breastfed for the first 6 months of life. In 2019, the infants least likely to be exclusively breastfed at 6 months are African Americans (AA) (17.2%). Materials and Methods: A scoping review of the literature was undertaken by using Arksey and O'Malley's six-stage framework to determine key themes of AA women's experience BF through an equity lens. Electronic databases of CINAHL and PubMed were searched for peer-reviewed, full-text articles written in the English language within the past 5 years by using the terms BF, AA, Black, sociological, cultural, equity, health, attitude, exposure, initiation, continuation, barriers, and facilitators. Results: Initially, 497 articles were identified, and 26 peer-reviewed articles met the eligibility criteria. Through an equity lens, three main themes emerged, which summarized AA women's BF experience: cultural (family, peers and community support; misconceptions; personal factors), sociological (prejudices, racism, home environment; financial status; sexuality issues; BF role models; employment policies), and health dimensions (family involvement; timely and honest information from staff; baby-friendly hospital initiatives; postnatal follow-up; special supplemental nutrition program for women, infants, and children). Conclusion: For AA women, exclusively BF is beset with diverse cultural, health, and sociological challenges. Multifaceted approaches are needed for successful resolution of BF challenges to bridge the racial gap in BF in the United States. Future studies may explore interventions targeted to modifiable barriers to improve BF outcomes.

[Predictive capacity for breastfeeding and determination of the best cut-off point for the breastfeeding self-efficacy scale-short form]

INTRODUCTION

The most widely used tool for assessing breastfeeding self-efficacy is the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). This study asses the relationship between the BSES-SF score and the risk of breastfeeding (BF) cessation and determine the cut-off point in the scale score that optimizes detection of this risk in primary health care pediatric consultations.

METHODS

Secondary data analysis of the LAyDI study. It is a cohort study. It was carried out through a research network of primary care pediatricians (PAPenRed). A newborn was recruited every month for one year by 210 pediatricians. The cohort was followed for 24 months. Mothers responded to the BSES-SF at the first visit. General pregnancy and delivery data were collected and assessed to determine whether breastfeeding was exclusive or supplemented during the first six months.

RESULTS

n = 1,845. The area under the ROC curve for the exclusive BF was 0.790 (0.765-0.815) the first month and 0.760 (0.734-0.786) the second month. For four and six months, as well as for any age in mothers who give supplemented BF, the Area Under the Curve was less than 0.75 and its predictive capacity was not considered to be good. For a sensitivity of 80% in detecting mothers at risk of BF cessation with the BSES-SF, the cut-off score was 58.

CONCLUSIONS

Mothers with a BSES-SF score below 58 points in primary health care, are at risk of early withdrawal of exclusive BF within two months.

Mediating role of healthy behavioral ability in maternal mental resilience and breastfeeding self-efficacy in primiparae

BACKGROUND

Due to the lack of psychological preparation for the newborn baby, primiparae are prone to anxiety and tension, which leads to a low rate of breastfeeding. Therefore, how to improve the rate of breastfeeding by identifying the relevant factors is an important research topic.

AIM

To explore the mediating role of healthy behavioral ability in maternal mental resilience and breastfeeding self-efficacy in primiparae.

METHODS

A total of 80 primiparae at Yiwu Central Hospital of Zhejiang Province from January 2019 to December 2019 were selected by convenience sampling method. The Self-rated Abilities for Health Practices Scale (SRAHP), Connor-Davidson Resilience Scale (CD-RISC), and Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) were used for the questionnaire survey.

RESULTS

The total SRAHP score of the 76 primiparae was 67.23 ± 9.15, total CD-RISC score was 56.48 ± 5.49, and total BSES-SF total score was 48.52 ± 8.79. Pearson correlation analysis showed that all dimensions of maternal health behavior ability, mental resilience, and breastfeeding self-efficacy were positively correlated (P < 0.05). The test procedure of mediating effect was adopted. Step 1 suggested that psychological resilience had a positive predictive effect on breastfeeding self-efficacy (β = 0.482, P < 0.05). Step 2 suggested that mental resilience had a positive predictive effect on healthy behavioral capacity (β= 0.497, P < 0.05). In step 3, healthy behavioral ability was added as the third level variable, and it was found that healthy behavioral ability had an impact on breastfeeding self-efficacy (β = 0.726, P < 0.05), suggesting that healthy behavioral ability plays a mediating role in the relationship between mental resilience and breastfeeding self-efficacy. The mediating effect was 0.349 (0.726 × 0.482), accounting for 39.67% of the total effect (0.733 × 0.412/0.882 × 100%).

CONCLUSION

Healthy behavioral ability plays a mediating role in maternal psychological resilience and breastfeeding self-efficacy in primiparae. Improving maternal health behavioral ability in clinical work can improve mental resilience and breastfeeding self-efficacy, which is of great significance for promoting breastfeeding.

Mixed-Methods Systematic Review of Behavioral Interventions in Low- and Middle-Income Countries to Increase Family Support for Maternal, Infant, and Young Child Nutrition during the First 1000 Days

Fathers, grandmothers, and other family members' influence on maternal, infant, and young child nutrition (MIYCN) is widely recognized, yet synthesis of the effectiveness of engaging them to improve nutrition practices during the first 1000 d is lacking. We examined the impact of behavioral interventions to engage family members in MIYCN in low- and middle-income countries through a mixed-methods systematic review. We screened 5733 abstracts and included 35 peer-reviewed articles on 25 studies (16 with quantitative and 13 with qualitative data). Most quantitative studies focused on early breastfeeding, primarily engaging fathers or, less often, grandmothers. Most found positive impacts on exclusive breastfeeding rates and family members' knowledge and support. The few quantitative studies on complementary feeding, maternal nutrition, and multiple outcomes also suggested benefits. Qualitative themes included improved nutrition behaviors, enhanced relationships, and challenges due to social norms. Interventions engaging family members can increase awareness and build support for MIYCN, but more rigorous study designs are needed. This systematic review is registered at PROSPERO as CRD42018090273, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=90273.