Effectiveness of a Breastfeeding Self-efficacy Intervention: Do Hospital Practices Make a Difference?

Abstract

Breastfeeding self-efficacy interventions are important for improving breastfeeding outcomes. However, the circumstances that may influence the effectiveness of the interventions are unclear, especially in the context of hospitals with suboptimal infant feeding practices. Thus, we aimed to evaluate the effect of a self-efficacy intervention on breastfeeding self-efficacy and exclusive breastfeeding, and further assessed the difference in its effect by hospital-routine type. In this intervention study with a control group, 781 pregnant women were recruited from 2 “Baby-Friendly”-certified hospitals (BFH) and 2 non-Baby-Friendly Hospitals (nBFH) in Japan, and were allocated to an intervention or control group. Participants in the intervention group were provided with a breastfeeding self-efficacy workbook in their third trimester. The primary outcome was breastfeeding self-efficacy and the secondary outcome was infant feeding status. All analyses were stratified by the type of hospital, BFH or nBFH. In BFHs, the intervention improved both breastfeeding self-efficacy through 4 weeks postpartum (p = 0.037) and the exclusive breastfeeding rate at 4 weeks postpartum (AOR 2.32, 95 % CI 1.01–5.33). In nBFHs, however, no positive effect was observed on breastfeeding self-efficacy (p = 0.982) or on the exclusive breastfeeding rate at 4 weeks postpartum (AOR 0.97, 95 % CI 0.52–1.81); in nBFHs, supplementation was provided for breastfed infants and the mother and infant were separated in the vast majority of cases. Infant feeding status at 12 weeks was not improved in either hospital type. The intervention improved breastfeeding self-efficacy and exclusive breastfeeding at 4 weeks postpartum only in BFHs. When breastfeeding self-efficacy interventions are implemented, hospital infant feeding practices may need to be optimized beforehand.

Reliability and Validity of the Japanese Version of the Iowa Infant Feeding Attitude Scale

“…We measured exclusive breastfeeding after discharge because supplementing breastfed infants is common in hospitals in Japan. 11,15 Maternal Characteristics Factors known to be associated with exclusive breastfeeding were measured in the third trimester or before discharge. These included age, [16][17][18] education level, 17,18 economic status, [16][17][18] parity, 18 marital status, 17,18 previous experience of exclusive breastfeeding for more than 3 months, 19 delivery in a BFH, 20 perceived support for breastfeeding from a partner, 16 infant's birth weight, 17,21 delivery by cesarean section, 18 returning to work within 6 months after delivery, 21 and mistimed or unwanted pregnancy.…”

Development of a Breastfeeding Support Scale for Couples

“…Breastfeeding self-efficacy interventions are important for improving breastfeeding outcomes (34). Breastfeeding self-efficacy is mother's belief about her ability and capacity to accomplish a task or to deal with the challenges of breastfeeding (7,35,36).…”

Supporting women to achieve breastfeeding to six months postpartum – The theoretical foundations of a successful program

“…Furthermore, Dennis (22,23) claims that women with high breastfeeding self-efficacy will be able to control their anxiety and emotional disturbances to stay calm and respond appropriately when they need extra support. Research supports that an individual's behaviour or task performance can be influenced by their self-efficacy (20,(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). In a randomised controlled trial of 889 Australian women, Forster, McLachlan, and Lumley (37) found a significant relationship between high breastfeeding self-efficacy scores and duration of breastfeeding at four months (λ 2 = 14.89, p <.001).…”

“…Dennis (23) recommended strategies to improve women's breastfeeding self-efficacy. Some studies have used these strategies and demonstrated success in increasing woman's sense of self-efficacy; however, none of those studies were effective in promoting prolonged breastfeeding (30,32,(34)(35)(36)38).…”