Aims: To evaluate the effectiveness of a brief motivational intervention to increase the breastfeeding duration in the first 6 months postpartum in mothers who began breastfeeding in the first hour after birth and to explore the role of general and breastfeeding self-efficacy in this relationship.
Design: A multi-centre randomized controlled clinical trial.
Methods: Data were collected from February 2018 - March 2019. Women were randomly assigned to an intervention group that received a brief motivational intervention (N = 44) or a control group that was offered standard education on breastfeeding (N = 44). Survival analysis techniques were carried out with a follow-up of 6 months. In addition, the roles of breastfeeding and general self-efficacy in the association between BMI and breastfeeding duration were explored through mediation/moderation analysis.
Results: Among 88 randomized patients (mean age, 32.82 years), 81 (92.04%) completed the trial. The survival analyses of exclusive breastfeeding and breastfeeding (exclusive and non-exclusive) showed reductions in the risk of abandonment in the intervention group of 63% (aHR: 0.37 [0.22-0.60] p < .001) and 61% (aHR: 0.39 [0.20-0.78] p = .008), respectively. We found that self-efficacy acted as a moderator of the effect of brief motivational intervention on breastfeeding self-efficacy. A discrete indirect effect of brief motivational intervention through increased breastfeeding self-efficacy was found on breastfeeding duration, with an index of moderated mediation of 0.08 (95% CI: 0.02-0.19). Greater positive variations in the breastfeeding self-efficacy scores during follow-up predicted exclusive and non-exclusive breastfeeding duration.
Conclusion: A brief motivational intervention conducted in the immediate postpartum period increases breastfeeding and exclusive breastfeeding duration in the first 6 months. Although breastfeeding self-efficacy seems to moderate the effect of brief motivational intervention on the increase in breastfeeding duration, other factors may influence its effectiveness. Further studies could focus on exploring how brief motivational intervention works and whether it also works for pregnant mothers who have not yet decided whether to breastfeed.
Impact: Brief motivational intervention could be introduced as part of routine care of women who begin breastfeeding to improve the low rates of exclusive breastfeeding at 6 months postpartum.
Trial registration: Unique Protocol ID: Moti003; https://ClinicalTrials.gov ID: NCT03357549.
目的: 评价对产后1小时开始母乳喂养的产妇在产后前6个月进行短期激励性干预以延长母乳喂养时间的有效性,并探讨一般自我效能感和母乳喂养自我效能感在这一关系中的作用。 设计: 多中心随机对照临床试验。 方法: 收集了2018年2月至2019年3月期间的数据资料。经随机分配,将产妇分为两组,一组为接受短期激励性干预的干预组(N = 44),另一组为接受母乳喂养标准教育的对照组(N=44)。随访时间6个月,并进行生存分析。此外,通过调解/适度性分析,还探讨了母乳喂养自我效能感和一般自我效能感在体重指数与母乳喂养持续时间二者关系中的作用。 结果: 88名随机患者中(平均年龄32.82岁)中有81例(92.04%)完成了试验。纯母乳喂养和母乳喂养(纯母乳喂养和非纯母乳喂养)的生存分析表明,干预组的放弃风险分别降低了63%(aHR: 0.37 【0.22-0.60】 p < .001)和61%(aHR: 0.39【0.20-0.78】 p = .008)。我们发现,自我效能感可调节短期励性干预对母乳喂养自我效能感的影响。通过提高母乳喂养自我效能感,短期励性干预对母乳喂养持续时间具有离散的间接影响,且适度调解指数为0.08(95% CI: 0.02-0.19)。在随访期间,母乳喂养自我效能感评分的正向变化较大,因此可用于预测纯母乳喂养和非纯母乳喂养的持续时间。 结论: 产后立即进行短期激励性干预,可延长产后前6个月的母乳喂养和纯母乳喂养时间。虽然母乳喂养自我效能感似乎可调解短期激励性干预措施对增加母乳喂养持续时间的效果,但其他因素也可能会对其有效性产生影响。未来研究可侧重于探讨短期激励性干预的作用方式,以及其是否对尚未决定进行母乳喂养的孕妇有所影响。 影响: 可实施短期激励性干预措施,作为开始进行母乳喂养的产妇的日常护理的一部分,以提高产后6个月的纯母乳喂养率。 试验注册: 唯一协议编号:Moti003;北美临床试验中心编号:NCT03357549。.
Keywords: breastfeeding; breastfeeding self-efficacy; brief motivational intervention; midwives; motivational interviewing; nursing.
© 2019 John Wiley & Sons Ltd.