Authors

1 Department of Midwifery, School of Nursing and Midwifery, Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R.Iran

2 Department of General Courses, School of Medicine, Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R.Iran

3 Department of Public Health, School of Public Health, Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R.Iran

Abstract

BACKGROUND: Mothers need the necessary skills to be empowered in successful breastfeeding.
This study aimed to investigate effectiveness of the distance education program on the mothers’
empowerment in exclusive breastfeeding.
MATERIALS AND METHODS: A randomized clinical trial study was done on 72 nulliparous pregnant
women 28–32 weeks with normal pregnancy. The qualified women were randomly assigned to the
intervention and control groups based on the random‑number table. The breastfeeding training
packages were sent to women in the intervention group via Telegram every week from 32 until
37 weeks of gestation. The mothers’ empowerment in breastfeeding (primary outcome) and the
exclusive breastfeeding rate (secondary outcome) were assessed by questionnaires.
RESULTS: Based on the repeated measured tests, although scores for all domains and also the
total score of the mothers’ empowerment in breastfeeding between two groups had increased
during the study period, there was a significant difference between the increasing trends of the
maternal empowerment domains in two groups (interaction P value ‹0.001). Also, the prevalence of
exclusive breastfeeding (secondary outcome) at 6 months was significantly higher in the intervention
group (81.8% and 57.1% in the intervention and control groups, respectively) (P = 0.028).
CONCLUSION: Distance education could increase all domains of the mothers’ empowerment in
breastfeeding after delivery. Also, exclusive breastfeeding at 6 months after delivery was significantly
higher in mothers who were receiving the distance education packages.

Keywords

1. Alidadi‑Shamsabadi E, Savabi‑Esfahani M. The relationship
between maternal perception of social support and breastfeeding
patterns. J Edu Health Promot 2022;11:30.
2. Joshi A, Amadi C, Meza J, Aguire T, Wilhelm S. Evaluation of a
computer‑based bilingual breastfeeding educational program on
breastfeeding knowledge, self‑efficacy and intent to breastfeed
among rural Hispanic women. Int J Med Inform 2016;91:10‑19.
3. Victora CG, BahlR, Barros AJD, França GVA, Horton S, Krasevec J,
et al. Breastfeeding in the 21st century: Epidemiology, mechanisms,
and lifelong effect. Lancet J 2016;387:475‑90.
4. Masoumi SZ, Khalili A, Shayan A, Roshanaei GH, Ahmadi SH.
Effects of counseling on adherence to exclusive breastfeeding in
mothers of hospitalized late preterm infants in Fatemieh hospital,
Hamadan, Iran, 2014. Int J Med Res Health Sci 2016;5:61‑6.
5. World Health Organization. Global nutrition targets 2025:
Childhood overweight policy brief, 2014. Available from: https://
www.who.int/nutrition/publications/globaltargets2025_
policybrief_overweight/en/.
6. Groleau D, pizarro KW, Molino L, Gray‑Donald K, Semenic S.
Empowering women to breastfeed: Does the baby friendly
initiative make a difference? Matern Child Nutr 2017;13:e12370.
7. Mosca F, Gianni ML. Human milk: Composition and health
benefits. Pediatr Med Chir 2017;39:155. doi: 10.4081/pmc.2017.155.
8. Maharlouei N, Pourhaghighi A. Factors affecting exclusive
breastfeeding, using adaptive LASSO regression. Int J Community
Based Nurs Midwifery 2018;6:260‑71.
9. Chan MY, Ip WY, Choi KC. The effect of a self‑efficacy‑based
educational programme on maternal breast feeding self‑efficacy,
breast feeding duration and exclusive breast feeding rates:
A longitudinal study. Midwifery 2016;36:92‑8.
10. Ansari S, Abedi P, Hasanpoor S, Bani S. The effect of interventional
program on breastfeeding self‑efficacy and duration of exclusive
breastfeeding in pregnant women in Ahvaz, Iran. Int Sch Res
Notices 2014;2014:510793.
11. Meedya S, Fahy K, Kable A. Factors that positively influence
breastfeeding duration to 6 months: A literature review. Women
Birth 2010;23:135‑45.
12. Heidari Z, Keshvari M, Kohan S. Clinical trial to comparison
the effect of family‑centered education‑supportiv program
on mothers’ empowerment in breast‑feeding. Int J Pediatr
2016;4:1445‑51.
13. Abuidhail J, Mrayan L, Jaradat D. Evaluating effects of prenatal
web‑based breastfeeding education for pregnant mothers in their third trimester of pregnancy: Prospective randomized control
trial. Midwifery 2019;69:143‑9.
14. Tavares APC, Leit BS, Silveira IA, Santos TDD, Brito WAP,
Camacho Aclf. Analysis of Brazilian publications on distance
education in nursing: Integrative review. Rev Bras Enferm
2018;71:214‑22.
15. Gossenheimer AN, Bem T, Carneiro ML, Castro MS. Impact of
distance education on academic performance in a pharmaceutical
care course. PLoS One 2017;12:e0175117.
16. Howe CJ, Jawad AF, Tuttle AK, MoserJT, Preis C, Buzby M, et al.
Education and telephone case management for children with
type 1 diabetes: A randomized controlled trial. J Pediatr Nurs
2005;20:83‑95.
17. Cole‑Lewis H, Kershaw T. Text messaging as a tool for behavior
change in disease prevention and management. Epidemiol Rev
2010;32:56‑69.
18. World Health Organization & UNICEF. Breast feeding promotion
and support in baby friendly hospital (A 20‑hour course for
maternity staff), 2006. Available from: https://apps.who.int/
nutrition/publications/infantfeeding/bfhi_trainingcourse_s3/
en/index.html.
19. Mohapatra I, Roy A. Breastfeeding awareness and perception
among antenatal mothers: A cross‑sectional study in urban
slum population of Bhubaneswar, Odisha. J Educ Health Promot
2018;7:60.
20. Pitts A, Faucher MA, Spencer R. Incorporating breastfeeding
education into prenatal care. Breastfeed Med 2015;10:118‑23.
21. Giles M, Millar S, Armour C, McClenahan C, Mallett J,
Stewart‑Knox B. Promoting positive attitudes to breastfeeding:
The development and evaluation of a theory‑based intervention
with school children involving a cluster randomised controlled
trial. Matern Child Nutr 2015;11:656‑72.
22. Scott JA, Binns CW, Oddy WH, Graham KI. Predictors of
breastfeeding duration: Evidence from a cohort study. Pediatrics
2006;117:646‑55.
23. Huang MZ, Kuo SC, Avery MD, Chen W, Lin KC, Gau ML.
Evaluating effects of a prenatal web‑based breastfeeding
education programme in Taiwan. J Clin Nurs 2007;16:1571‑9.
24. Grassley JS, Connor KC, Bond L. Game‑based online antenatal
breastfeeding education: A pilot. Appl Nur Res 2017;33:93‑5.
25. Kang JS, Choi SY, Ryu EJ. Effects of a breastfeeding
empowerment programme on Korean breastfeeding mothers:
A quasi‑experimental study. Int J Nurs Stud 2008;45:14‑23.
26. Robinson A, Davis M, Hall J, Lauckner C, Anderson AK. It
takes an E‑Village: Supporting African American mothers in
sustaining breastfeeding through facebook communities. J Hum
Lac 2019;35:569‑82.
27. Taheri Z, Bakouei F. The relationship between mothers’
empowerment in breastfeeding with exclusive breast feeding in
infants. J Babol Univ Med Sci 2019;21:85‑92.
28. Song SM, Park MK. Effects of breastfeeding empowerment
program on breastfeeding self‑efficacy, adaptation and
continuation in primiparous women. J Korean Acad Nurs
2016;46:409‑19.
29. Parsa P, Boojar A, Roshanai G, Bakht R. The effect breastfeeding
counseling on self‑efficacy and continuation breastfeeding among
primiparous mothers: A randomized clinical trial. Avicenna J
Nurs Midwifery Care 2016;24 :98-104.
30. Militello LK, Kelly SA, Melnyk BM. Systematic review of
text‑messaging interventions to promote healthy behaviors in
pediatric and adolescent populations: Implications for clinical
practice and research. Worldviews Evid Based Nurs 2012;9:66‑77.
31. Harari N, Rosenthal MS, Bozzi V, Goeschel L, Jayewickreme T,
Onyebeke C, et al. Feasibility and acceptability of a text message
intervention used as an adjunct tool by WIC breastfeeding
peer counsellors: The LATCH pilot. Matern Child Nutr
2018;14e12488.
32. Flax VL, Ibrahim AU, Negerie M, Yakubu D, Leatherman S,
Bentley ME. Group cell phones are feasible and acceptable
for promoting optimal breastfeeding practices in a women’s
microcredit program in Nigeria. Matern Child Nutr
2017;13:10.1111/mcn. 12261. doi: 10.1111/mcn. 12261.
33. Kimani‑Murage EW, Griffiths PL, Wekesah FM, Wanjohi M,
Muhia N, Muriuki P, et al. Effectiveness of home‑based nutritional
counselling and support on exclusive breastfeeding in urban poor
settings in Nairobi: A cluster randomized controlled trial. Global
Health 2017;13:90