Authors: Resti Utami  ( Department of Nursing, Airlangga University, Surabaya, Indonesia. )
Yuni Sufyanti Arief  ( Department of Nursing, Airlangga University, Surabaya, Indonesia. )

Objective: To present an overview of breastfeeding self-efficacy interventions to enhance the implementation of exclusive breastfeeding for mothers with low birth weight infants.

 

Method: The systematic review comprised search for randomised controlled trials and quasi-experimental studies published between January 2014 to January 2022 on Scopus, ScienceDirect, Sage journals, ProQuest, Google Scholar and PubMed databases using the Population-Intervention-Comparison-Outcome framework and in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. The analytical quality of the studies was assessed using the Critical Appraisal Skills Programme checklist.

 

Results: Of the 339 studies initially identified, 10(2.94%) qualified for detailed analysis. Breastfeeding self-efficacy interventions could notably enhance the implementation of exclusive breastfeeding.

 

Conclusion: Breastfeeding self-efficacy interventions can be modified and effectively used by nurses to improve the implementation of exclusive breastfeeding for mothers with low birth weight infants.

 

Keywords: Breastfeeding, Milk, Infant, Low birth weight, Intervention. (JPMA 73: S-153 [Suppl. 2]; 2023)

 

DOI:https://doi.org/10.47391/JPMA.Ind-S2-35

 

Introduction

 

Exclusive breastfeeding (EBF) has extraordinary advantages for optimising the growth, development and staying power of low birth weight (LBW) infants.^1,2 Breastfeeding (BF) contributes to short- and long-term health results for both mother and infant.³ BF can reduce the incidence of pre-menopausal breast and/or ovarian cancers, in addition to type 2 diabetes mellitus (T2DM) for the mother.^4,5 Infants who are exclusively breastfed can have a decreased risk of infections owing to immune protection.^3,5 However, maintaining EBF can be a challenge for many mothers.⁶

The EBF prevalence is still low at 18% inside the first 48 hours of LBW life, and by the sixth month, one-third women continue to breastfeed, but effectively it is 1 in 20 in EBF terms.⁷ The BF rate of LBW mothers was found to be lower than that of mothers who gave birth at term⁸. Usually, early BF termination is based on mother’s notion that there is not sufficient milk.⁵ Mother’s perception related to BF behaviour is called breastfeeding self-efficacy (BSE), which is recognised as an essential modifiable factor for successful BF related to LBW neonates.^4,9-11 BSE can have an effect, among other things, on the way a mother responds to various demanding situations in the BF procedure.^9,12,13

The health belief model (HBM) is a principle that is broadly used to explain health behaviours, including BSE interventions. The 4 factors that determine  the perceived level of confidence are; overall performance achievement,  representative experience, verbal persuasion, and physiological and affective states.¹⁴ The current systematic review was planned to present BSE interventions used in literature to improve BSE implementation for LBW neonates.

 

Materials and Methods

 

The systematic review comprised randomised controlled trials (RCTs) and quasi-experimental studies published between January 2014 to January 2022 that were searched on Scopus, ScienceDirect, Sage journals, ProQuest, Google Scholar and PubMed databases in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses PRISMA checklist.¹⁵

Key words and Boolean operators (AND, OR, and AND NOT) were used in line with the Population-Intervention-Comparison-Outcome (PICO) framework (Table 1).¹⁶ Studies included were RCTs or controlled clinical trials to decrease the risk of unknown factors, comprised mother or both parents with LBW/premature neonates, had interventions associated with BSE based on education, training and counselling, used smartphone applications for follow-ups.

 

 

The studies identified were imported into the Mendeley application, and duplicates were removed. Studies that did not meet the inclusion criteria were also excluded. The analytical quality of the studies was assessed using the Critical Appraisal Skills Programme (CASP) checklist (Table 2).¹⁷

 

 

 

 

Data was noted to evaluate BSE interventions based on social learning theory to increase EBF in LBW cases.^14,18

 

Results

 

Of the 339 studies initially identified, 10 (2.94%) qualified for detailed analysis (Figure).^{1,10, 19–26,27} Of the total, 7(70%) studies examined BSE interventions primarily based on self-efficacy theory.^10,19-23 BF performance is identified through an education/ knowledge provision and demonstration.

 

 

Educating mothers can significantly reduce scheduled BF and improve on-demand BF.²⁸ Demonstration activities based on previous BF experiences can be done using a doll^1,28 on days 2-3 when the babies are cared for in the nursery.^10,25,28 Building confidence by learning from others was identified through counselling activities carried out by nurses to explore the experience of mothers learning BF skills.²⁹ The primary counselling consultation was carried out face-to-face, and subsequent sessions continued via smartphones.¹⁰ Counselling was carried out flexibly according to the mother’s condition.¹

Verbal persuasion through encouragement from friends and family as well as by nurses helped maintain EBF.^1,7 Encouraging mothers to begin pumping on day one post-delivery also helped.²⁰

It was found to be crucial to apply BSE interventions to reduce postpartum distress and to increase BSE²¹. Stress counselling management could also be used as an intervention as it has been shown³⁰ that the combination of stress control counselling in BF education programmes can enhance self-efficacy and BF duration in mothers.

In the current review, 5(50%) studies involved face-to-face and telephone contact with mothers in providing BSE interventions.^1,10,21,24

 

Discussion

 

BSE is a variable that can be modified through nursing interventions.^12,14 It is an important component underlying sustainable BF practices.³¹ The first few weeks post-delivery are very crucial in this regard.¹⁰

BSE interventions increased EBF at six months postpartum. Overall, a BSE intervention with focus on the HBM theory¹⁴ is recommended as an appropriate strategy to increase the initiation or duration of BF. The most effective HBM-based BSE interventions consist of 4 sessions to produce a significant effect, especially for the first one month postpartum, including a performance of BF behaviour, representative experience (seeing other people breastfeeding), verbal persuasion (encouraging and praise), and physiological reactions that may affect breastfeeding practice.¹⁴ A study³ reported that BSE ratings had been higher at 4-6 weeks postpartum.

Six of the studies reviewed used a combination of hospital and community settings. A study³ has reported that combined hospital and community settings showed better outcomes. Presenting education during hospitalisation and follow-up at home reduces BF-associated issues, strengthens present BF information, and encourages mothers to practise EBF for up to 6 months.³²

Interventions involving face-to-face and telephone contact with mothers significantly maintain EBF.³³ Such interventions are recommended as they are feasible, low-cost and may reduce early weaning.

 

Conclusion

 

BSE interventions can be modified and effectively used by nurses to improve the implementation of EBF for mothers with LBW infants.

Limitation: The current literature review was not registered with the Prospective Register of Systematic Reviews (PROSPERO), which is a limitation.

 

Acknowledgment: We are grateful to the Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia, Faculty of Medicine, Universitas Airlangga, Surabaya, and to the Faculty of Nursing and Midwifery, Nahdlatul Ulama University, Surabaya, Indonesia.

 

Disclaimer: The study was presented at the 13th International Nursing Conference, 2022, at Universitas Airlangga, Indonesia.

 

Conflict of Interest: None.

 

Source of Funding: None.

 

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