A systematic review and meta-analysis of interventions incorporating behaviour change techniques to promote breastfeeding among postpartum women

ABSTRACT

The benefits of exclusive breastfeeding are well documented, yet few women adhere to recommendations. We report the Behaviour Change Techniques (BCTs) within interventions trialled internationally after pregnancy to promote exclusive and mixed breastfeeding as well as evidence of effectiveness. PsycINFO, EMBASE and MEDLINE databases were screened. Twenty-three (n = 23) studies met inclusion criteria. Three authors independently extracted data, coded interventions using the BCT v.1 taxonomy, and assessed study quality. There was a moderate significant effect of the interventions promoting exclusive breastfeeding up to four weeks postpartum (OR 1.77, [95% CI: 1.47–2.13]) but this effect slightly declined beyond thirteen weeks (OR 1.63, [95% CI: 1.07–2.47]). Twenty-nine BCTs were identified within interventions. ‘Credible source’ and ‘instruction on how to perform the behaviour’ were the most prevalent and ‘social support (unspecified)’ contributed to the effectiveness of exclusive breastfeeding interventions five to eight weeks postpartum. Using BCTs with cognitive and behavioural aspects may help women develop coping mechanisms promoting exclusive breastfeeding. Further trials are needed in countries with low breastfeeding rates such as the UK. The use of programme theory during intervention development and clear description of intervention components is recommended. This meta-analysis provides guidance for trials evaluating postpartum breastfeeding interventions.

KEYWORDS:

• Breastfeeding
• postpartum women
• post-natal women
• behaviour change techniques
• lactation

Acknowledgement

We would like to thank Simon Coates (UCL Librarian) for helping with initial searches. We would also like to thank Hannah Bains (UK Health Visitor and International Board Certified Lactation Consultant) and Vicki Rich (Vermont Breastfeeding Consultant and Doula) for their comments on the manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Angelos P. Kassianos http://orcid.org/0000-0001-6428-2623

Emma Ward http://orcid.org/0000-0002-7579-3215

Antonio Rojas-Garcia http://orcid.org/0000-0002-7792-4311

Caitlin Notley http://orcid.org/0000-0003-0876-3304

Additional information

Funding

This work was supported by a Cancer Research UK Population Research Committee – BUPA Foundation Fund – International Innovation Grant [C54889/A25592]. ARG was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care North Thames at Bart's Health NHS Trust (NIHR CLAHRC North Thames). CAS was supported by the National Center for Complementary and Integrative Health (NIH/NCCIH) [grant number K23AT008442]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.