Effectiveness of a brief motivational intervention to increase the breastfeeding duration in the first 6 months postpartum: Randomized controlled trial

Abstract

Aims To evaluate the effectiveness of a brief motivational intervention to increase the breastfeeding duration in the first 6 months postpartum in mothers who began breastfeeding in the first hour after birth and to explore the role of general and breastfeeding self‐efficacy in this relationship. Design A multi‐centre randomized controlled clinical trial. Methods Data were collected from February 2018 ‐ March 2019. Women were randomly assigned to an intervention group that received a brief motivational intervention (N = 44) or a control group that was offered standard education on breastfeeding (N = 44). Survival analysis techniques were carried out with a follow‐up of 6 months. In addition, the roles of breastfeeding and general self‐efficacy in the association between BMI and breastfeeding duration were explored through mediation/moderation analysis. Results Among 88 randomized patients (mean age, 32.82 years), 81 (92.04%) completed the trial. The survival analyses of exclusive breastfeeding and breastfeeding (exclusive and non‐exclusive) showed reductions in the risk of abandonment in the intervention group of 63% (aHR: 0.37 [0.22–0.60] p < .001) and 61% (aHR: 0.39 [0.20–0.78] p = .008), respectively. We found that self‐efficacy acted as a moderator of the effect of brief motivational intervention on breastfeeding self‐efficacy. A discrete indirect effect of brief motivational intervention through increased breastfeeding self‐efficacy was found on breastfeeding duration, with an index of moderated mediation of 0.08 (95% CI: 0.02–0.19). Greater positive variations in the breastfeeding self‐efficacy scores during follow‐up predicted exclusive and non‐exclusive breastfeeding duration. Conclusion A brief motivational intervention conducted in the immediate postpartum period increases breastfeeding and exclusive breastfeeding duration in the first 6 months. Although breastfeeding self‐efficacy seems to moderate the effect of brief motivational intervention on the increase in breastfeeding duration, other factors may influence its effectiveness. Further studies could focus on exploring how brief motivational intervention works and whether it also works for pregnant mothers who have not yet decided whether to breastfeed. Impact Brief motivational intervention could be introduced as part of routine care of women who begin breastfeeding to improve the low rates of exclusive breastfeeding at 6 months postpartum. Trial registration Unique Protocol ID: Moti003; https://ClinicalTrials.gov ID: NCT03357549.

Effect of a brief motivational intervention in the immediate postpartum period on breastfeeding self‐efficacy: Randomized controlled trial

“…Our findings suggest that bMI is more effective in improving the “intrapersonal thoughts” dimension of BSE, and that focusing the bMI on the intrapersonal thoughts dimension may be critical in improving the duration of breastfeeding and EBF in the first six months, consistent with our previous findings (Franco‐Antonio et al, 2020). Our finding that the effectiveness of the bMI in increasing BSE was limited by maternal educational level and baseline general self‐efficacy could in turn explain why only a small part of the effect of the bMI in increasing breastfeeding duration found in our previous work could be explained by changes in BSE (Franco‐Antonio et al, 2020). Therefore, the success of bMI on breastfeeding and EBF may be due to the development of other skills not related to BSE, such as the development of technical skills, improving the effectiveness in seeking support, or increasing women's persistence in achieving her goal.…”

“…We observed that educational level limited the differences found between the groups in the “technique” dimension but not in the “intrapersonal thoughts” dimension at 3 and 6 months. This finding may be relevant to better understanding how bMI improved the duration of breastfeeding, as we found in our previous analyses (Franco‐Antonio et al, 2020). The main causes of early weaning are related to difficulties with breastfeeding technique, including difficulty in carrying out breastfeeding on demand, achieving an adequate latch, and producing enough milk (Chapman & Perez‐Escamilla, 1999; Dewey et al, 2003).…”

“…Our findings, however, differ from previous reported research in which either associations between educational level and BSE scores were not found (Maleki‐Saghooni et al, 2017; Nankumbi et al, 2019; Ngo et al, 2019; Yang et al, 2016; Zhu et al, 2014) or associations between women with higher educational levels and higher BSE were found (Gökçeoğlu & Küçükoğlu, 2017). Similarly, this limitation of the efficacy of the intervention based on educational level was not found in our previous findings on breastfeeding rates (Franco‐Antonio et al, 2020). Therefore, our findings that the baseline BSE level was lower in women with a higher level of education may be due only to chance or to unidentified and unmeasured characteristics of this particular sample.…”

“…It is plausible that once successful breastfeeding is established, the mother's intrapersonal thoughts determine her motivation, satisfaction, and coping, which may be most influential factors in the maintenance of breastfeeding in the long term. This effect on “intrapersonal thoughts” dimension, could be related to the differences in rates of EBF found between the study groups, which increased as time progressed (first month, 90.5% vs. 64.3%; third month, 83.3% vs. 52.5%; and sixth month 56.1% vs. 20%; Franco‐Antonio et al, 2020). Nonetheless, the effects of the bMI on breastfeeding rates in the first month may have been due to the development of other skills not related to BSE.…”

“…Therefore, our findings that the baseline BSE level was lower in women with a higher level of education may be due only to chance or to unidentified and unmeasured characteristics of this particular sample. Furthermore, our previous work's mediation and moderation analyses showed that only a small part of the effect of of bMI on breastfeeding was mediated by the variation in BSE produced by the intervention (Franco‐Antonio et al, 2020). More research is needed to study these discrepant results.…”