Effectiveness of theory-based educational interventions on breastfeeding self-efficacy and exclusive breastfeeding: A systematic review and meta-analysis

Background: Enhancing breastfeeding self-efficacy and intention is crucial for successful breastfeeding. Educational interventions highlighting breastfeeding self-efficacy and breastfeeding plans have been developed to help mothers initiate and sustain breastfeeding practices. Research aim: This study aimed to determine whether the use of theory-based educational interventions, i.e., the theory of breastfeeding self-efficacy or theory of planned behavior, is associated with improved breastfeeding outcomes and to identify key factors of effective breastfeeding educational programs. Methods: We used electronic databases and reference lists of articles to identify published randomized controlled trials of educational programs that adopted the breastfeeding self-efficacy theory or theory of planned behavior. Results: In total, 24 randomized controlled trials were identified, and 5678 mothers were included in those studies, with 4178 mothers in the breastfeeding self-efficacy group and 1500 mothers in the theory of planned behavior group. Mothers who received theory-based interventions had better breastfeeding outcomes for up to 6 months postpartum (standardized mean difference =0.63, 95% confidence interval: 0.34~0.92 for self-efficacy scores at 1~2 months; odds ratio =1.82, 95% confidence interval: 1.27~2.61 for the exclusive breastfeeding rate at 1~2 months; and odds ratio =2.19, 95% confidence interval: 1.24~3.89 for the exclusive breastfeeding rate at 3~6 months). Mothers who were from non-Organization for Economic Co-operation and Development countries, were of older age, had participated in an educational program in a hospital setting, or had used an integrative class format had higher levels of self-efficacy and longer breastfeeding durations to 6 months. Conclusions: Theory-based educational interventions are effective in improving breastfeeding self-efficacy and exclusive breastfeeding rates at 6 months. Future breastfeeding educational programs incorporating the theories of breastfeeding self-efficacy and planned behavior would be helpful in promoting sustained breastfeeding practices among mothers.