The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
Int J Nurs Stud. 2021 May;117:103874. doi: 10.1016/j.ijnurstu.2021.103874. Epub 2021 Jan 15.
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.
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.
Eleven electronic databases and reference lists of the eligible articles were searched. Randomised 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.
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 breastfeeding 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 education, 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.
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.
CRD42020175473 at the International Prospective Register of Systematic Reviews (PROSPERO).
母乳是婴儿最具营养的食物，可促进其生长并防止感染。促进母乳喂养是婴儿健康的重要议题；并且针对产前、产后或两者兼顾的时期，已经提出并实施了不同的教育和支持干预措施，以促进和维持纯母乳喂养。本系统评价旨在确定促进母乳喂养的有效教育和支持干预措施方法。
探讨不同教育和支持干预措施方法对初产妇产后持续母乳喂养和提高母乳喂养自我效能的效果；并确定有效干预措施在交付时间、形式和模式、主要组成部分、理论框架的使用以及课程次数方面的关键特征。
检索了 11 个电子数据库和合格文章的参考文献列表。根据审查标准，确定并筛选了最近 20 年来以英文和中文发表的教育和支持干预随机对照试验。评估纳入研究的偏倚风险。主要结局指标为纯母乳喂养率和部分母乳喂养率。次要结局指标包括母乳喂养自我效能、母乳喂养知识和其他与母乳喂养相关的结局。根据产后≤2 个月、3-5 个月和≥6 个月进行了荟萃分析。
纳入了 13 篇符合纳入标准的文章，且偏倚风险可接受。教育和支持干预措施在增加产后≤2 个月和 6 个月的纯母乳喂养率、部分母乳喂养率以及提高产后≤2 个月的母乳喂养自我效能方面是有效的。干预措施的最佳交付时间、形式和结构包括：（a）从产前到产后；（b）多组分，包括产前小组教育、产后个人母乳喂养辅导和电话随访；（c）个体和小组基础；（d）以自我效能理论为指导；以及（e）至少 3 次。
研究结果表明，在产前和产后期间通过面对面教学和电话随访相结合，提供至少 3 次基于多组分、理论的干预措施，可有效提高 6 个月以上的纯母乳喂养率、部分母乳喂养率和产后 2 个月以上的母乳喂养自我效能。
CRD42020175473 在国际前瞻性系统评价注册库（PROSPERO）。
