TY - JOUR
T1 - Effectiveness of Social-psychological Interventions at Promoting Breastfeeding Initiation, Duration and Exclusivity
T2 - A Systematic Review and Meta-analysis
AU - Davie, Philippa
AU - Chilcot, Joseph
AU - Chang, Yan-Shing
AU - Norton, Sam
AU - Hughes, Lyndsay Dawn
AU - Bick, Debra
PY - 2020/10/1
Y1 - 2020/10/1
N2 - Evidence for the health benefits of breastfeeding is well substantiated but breastfeeding uptake and duration remains low worldwide. Individual level breastfeeding promotion programmes are behavioural interventions, targeting malleable social-psychological processes to change behaviour. This systematic review aimed to investigate whether such interventions are effective at improving breastfeeding initiation, duration and exclusivity, and breastfeeding support. A three-stage search strategy identified eligible articles from six databases. Nine controlled-clinical trials and 11 quasi-experimental trials were included. Random-effects meta-analyses identified significant improvements in rates of breastfeeding initiation (N = 2,213; OR = 2.32, 95% CI [1.33, 4.03], p = .003; I2 = 0%, p = .966) and suggested improved exclusive breastfeeding rates up to six months postpartum (N = 3,671; OR = 1.84, 95% CI [1.38, 2.45], p <.001; I2 = 68.7%, p <.001). After considering small-sample effects, estimates for exclusive breastfeeding across the postpartum period were non-significant. There were no improvements in women maintaining any (i.e. non-exclusive) breastfeeding to one, two, three, four or six months postpartum (N = 4,153; OR = 0.88, 95% CI [0.72, 1.09], p = .253). Evidence for improvements in perceived and actual breastfeeding support was limited. Sub-group analyses suggest standalone postnatal interventions targeting first-time mothers may support breastfeeding uptake. Findings should be interpreted cautiously as the quality of evidence for each outcome was low with a high risk of bias. Future efforts to support women to breastfeed should assimilate behaviour change research, with process evaluation to identify effective processes to inform a high-quality evidence-base for implementation in practice.
AB - Evidence for the health benefits of breastfeeding is well substantiated but breastfeeding uptake and duration remains low worldwide. Individual level breastfeeding promotion programmes are behavioural interventions, targeting malleable social-psychological processes to change behaviour. This systematic review aimed to investigate whether such interventions are effective at improving breastfeeding initiation, duration and exclusivity, and breastfeeding support. A three-stage search strategy identified eligible articles from six databases. Nine controlled-clinical trials and 11 quasi-experimental trials were included. Random-effects meta-analyses identified significant improvements in rates of breastfeeding initiation (N = 2,213; OR = 2.32, 95% CI [1.33, 4.03], p = .003; I2 = 0%, p = .966) and suggested improved exclusive breastfeeding rates up to six months postpartum (N = 3,671; OR = 1.84, 95% CI [1.38, 2.45], p <.001; I2 = 68.7%, p <.001). After considering small-sample effects, estimates for exclusive breastfeeding across the postpartum period were non-significant. There were no improvements in women maintaining any (i.e. non-exclusive) breastfeeding to one, two, three, four or six months postpartum (N = 4,153; OR = 0.88, 95% CI [0.72, 1.09], p = .253). Evidence for improvements in perceived and actual breastfeeding support was limited. Sub-group analyses suggest standalone postnatal interventions targeting first-time mothers may support breastfeeding uptake. Findings should be interpreted cautiously as the quality of evidence for each outcome was low with a high risk of bias. Future efforts to support women to breastfeed should assimilate behaviour change research, with process evaluation to identify effective processes to inform a high-quality evidence-base for implementation in practice.
KW - Breastfeeding
KW - behaviour change
KW - child health
KW - infant feeding
KW - intervention
KW - psychological
UR - http://www.scopus.com/inward/record.url?scp=85068874647&partnerID=8YFLogxK
U2 - 10.1080/17437199.2019.1630293
DO - 10.1080/17437199.2019.1630293
M3 - Article
SN - 1743-7199
VL - 14
SP - 449
EP - 485
JO - Health Psychology Review
JF - Health Psychology Review
IS - 4
ER -