LAUSR

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.