Effectiveness of educational and supportive intervention for primiparous women on breastfeeding related outcomes and breastfeeding self-efficacy: A systematic review and meta-analysis

Background: Breastmilk is the most nutritious food for infants to support their growth and protect them from infection. Breastfeeding promotion is an important topic for infant health; and different educational and supportive approaches to interventions have been prompted and targeted at antenatal, postnatal or both periods to promote and sustain exclusive breastfeeding. This systematic review aimed to identify the effective approaches to educational and supportive interventions to improve breastfeeding. Objective: To examine the effects of different approaches to educational and supportive interventions that can help sustain breastfeeding and improve breastfeeding self-efficacy for primiparous postnatal women; and to identify key characteristics of the effective interventions in terms of delivery time, format and mode, main components, use of theoretical framework, and number of sessions. Methods: Eleven electronic databases and reference lists of the eligible articles were searched. Ran-domised controlled trials of educational and supportive interventions published in English and Chinese language over recent 20 years were identified and screened against the review criteria. Risk of bias of the included studies was assessed. Primary outcome measures were exclusive breastfeeding and partial breastfeeding rate. Secondary outcomes included breastfeeding self-efficacy, breastfeeding knowledge and other breastfeeding related outcomes. Meta-analysis was performed in terms of <= 2 months, 3-5 months and >= 6 months postpartum. Results: Thirteen articles that met the inclusion criteria were included and showed an acceptable risk of bias. Educational and supportive interventions were found effective in increasing exclusive breastfeed-ing rate at <= 2 months and 6 months, partial breastfeeding rate as well as enhancing breastfeeding self-efficacy at <= 2 months. The optimal delivery time, format and structure of the interventions included: (a) delivering from antenatal to postnatal period; (b) multicomponent involving antenatal group educa-tion, postnatal individual breastfeeding coaching and telephone follow-ups; (c) both individual and group basis; (d) being guided by self-efficacy theory; and (e) having >= 3 sessions. Conclusions: The findings suggest multicomponent, theory-based intervention with >= 3 sessions delivered via both face-to-face teaching and telephone follow-ups across antenatal and postnatal period can be effective to enhance exclusive breastfeeding over 6-month, partial breastfeeding and breastfeeding self-efficacy over 2-month postpartum. Registration number: CRD42020175473 at the International Prospective Register of Systematic Reviews (PROSPERO). (c) 2021 Elsevier Ltd. All rights reserved.