Research Article

The Effect of Educational Intervention on Improvement of Breastfeeding Self-Efficacy: A Systematic Review and Meta-Analysis

Table 1

Summary of studies of the association between educational intervention and breastfeeding self-efficacy.

Author, year (location)Study designGroups (n)Participants and settingTime and format of classesInterventionFollow-up periodTools and outcomeResults

Ali et al. Iran [18]RCTsGroup 1: intervention, n = 95/100
Group 2: intervention, n = 93/100
Group 3: control, n = 95/100
Healthy primiparous women
Setting: hospital
Postpartum (individual class)
Telephone = no
Theory = no
Group 1: one session, direct face-to-face educational program (20 min)
Group 2: one session, indirect educational program using video CD + pamphlet (30 min)
Group 3: routine care
Up to 3 months after childbirthBreastfeeding self-efficacy tools: Dennis breastfeeding self-efficacy (33 items)Three months after childbirth, a significant difference was observed between the three groups in the mean of breastfeeding self-efficacy (). But there was not a significant difference between each intervention groups compared to control group ().

Heydari et al. Iran [19]RCTsGroup 1: intervention, n = 33/35
Group 2: control, n = 32/35
Healthy primiparous women
Setting: childbirth preparation classes
Pregnancy (group class)
Telephone = yes
Theory = no
Group1: one session, direct face-to-face educational program (45–60 min) + telegram chat up to 4 months after child birth
Group 2: routine care
Up to four months after childbirthBreastfeeding self-efficacy tools: Dennis breastfeeding self-efficacy (14 items)Four months after childbirth, a significant difference was observed between the two groups in the mean of breastfeeding self-efficacy ().

Azhari et al. Iran [20]RCTsGroup 1: intervention, n = 45
Group 2: intervention, n = 45
Group 3: control, n = 46
Healthy primiparous women
Setting: hospital
Postpartum (individual class)
Telephone = no
Theory = no
Group 1: one session direct face-to-face educational program (20–40 min)
Group 2: one session indirect educational program using the images
Group 3: routine care
1, 4, and 8 weeks after childbirthBreastfeeding self-efficacy tools: self-efficacy 14 itemsAfter three-stage follow-up, a significant difference was observed between the three groups in the mean of breastfeeding self-efficacy (). The highest mean was for the indirect educational group

Godarzi et al. Iran [21]RCTsGroup 1: intervention, n = 52
Group 2: control, n = 55
Healthy primiparous women
Setting: public health center
Pregnancy (group class)
Telephone = no
Theory = no
Group 1: two sessions (one session in third trimester and one session after child birth. Peer education method was held using lecture and group discussion approach
Group 2: routine care
Up to 8 weeks after child birthBreastfeeding self-efficacy tools: Dennis breastfeeding self-efficacy (14 items)Eight weeks after childbirth, a significant difference was observed between the two groups in the mean of breastfeeding self-efficacy ().
Chan et al. Hong Kong [22]RCTsGroup 1: intervention, n = 35/35
Group 2: control, n = 36/36
Healthy primiparous women
Setting: hospital
Pregnancy (group class)
Telephone = yes
Theory = yes
Group1: one session a self-efficacy-based breastfeeding, educational program was held as a workshop + two telephone call after childbirth (30–60 mn)
Group 2: routine care
Up to 2 weeks after child birthBreastfeeding self-efficacy tools: Dennis breastfeeding self-efficacy (14 items)Two weeks after childbirth, a significant difference was observed between the two groups in the mean of breastfeeding self-efficacy ().

Ansari et al. Iran [23]RCTsGroup 1: intervention, n = 60/65
Group 2: control, 60/65
Healthy pregnancy
Setting: public health center
Pregnancy (individual class)
Telephone = yes
Theory = yes
Group 1: two-session self-efficacy-based educational program with two-day interval for two hours + phone calls
Group 2: routine care
One month after child birthBreastfeeding self-efficacy tools: Dennis breastfeeding self-efficacy (33 items)One month after childbirth was a significant difference between two groups regarding self-efficacy mean ().

Antoñanzas-Baztán et al. Spain [11]RCTsGroup 1: intervention n = 57/59
Group 2: control, n = 55/59
Healthy pregnancy
Setting: hospitals and community center
Pregnancy (group class)
Telephone = yes
Theory = no
Group 1: three-session educational program was held. In 28–39 gestational weeks, before discharge, and phone call 48–72 hours after childbirth
Group 2: usual care
4 and 8 weeks and 6 months after child birthBreastfeeding self-efficacy tools: Dennis breastfeeding self-efficacy (14 items)After three-stage follow-up, there was no significant difference between the two groups on BSES ().

Piro and Ahmed Iraq [24]RCTsGroup 1: intervention, n = 52/65
Group 2: control, n = 54/65
Healthy pregnancy
Setting: public health center
Pregnancy (group class)
Telephone = no
Theory = yes
Group 1: two-session self-efficacy-based educational program was held with two-day interval, each session lasting for 60–90 min + booklet + video
Group 2: routine care
Up to two months after child birthBreastfeeding self-efficacy tools: Dennis breastfeeding self-efficacy (14 items)Two months after childbirth, there was a significant difference between two groups regarding self-efficacy mean ().

Mohseni et al. Iran [25]RCTsGroup 1: intervention, n = 33/35
Group 2: control, n = 32/35
Healthy primiparous women
Setting: public clinics, home visit
Pregnancy (individual class)
Telephone = yes
Theory = no
Group 1: 3-session educational program was held per week in their house + an educational pamphlet + one visit home after childbirth
Group 2: routine care
1,2, and 6 weeks after childbirthBreastfeeding self-efficacy tools: Dennis breastfeeding self-efficacy (14 items)After three-stage follow-up, there was a significant difference between the two groups ().

Rabiepoor et al. Iran [26]RCTsGroup 1: intervention, n = 33
Group 2: control, n = 33
Healthy pregnancy
Setting: Public health center
Pregnancy (individual class)
Telephone = yes
Theory = no
Group 1: two-session couple educational program with 4-week interval + telephone call over study time. Training package included prenatal and postnatal care and lactation
Group 2: routine care
Up to one month after child birthBreastfeeding self-efficacy tools: Dennis breastfeeding self-efficacy (14 items)One month after childbirth, there was a significant difference between two groups regarding self-efficacy mean ().
Puharić et al. Croatia [27]RCTsGroup 1: intervention, n = 129/136
Group 2: intervention, n = 103/128
Group 3: control group, n = 123/136
Healthy primiparous women
Setting: hospitals
Pregnancy (individual class)
Telephone = yes
Theory = no
Group 1: three-session educational program included breastfeeding and parenting booklet + four proactive telephone calls (one session in pregnancy and three after delivery, at 2, 6, and 10 weeks)
Group 2: one-session educational program included pregnancy booklet + four proactive telephone calls (one in pregnancy and three after delivery, at 2, 6, and 10 weeks)
Group 3: routine care
Up to 3 monthsBreastfeeding self-efficacy tools: Dennis breastfeeding self-efficacy (14 items)Three months after childbirth, there was a significant difference between three groups regarding self-efficacy mean ().

Charoghchian Khorasani et al. Iran [28]RCTsGroup 1: intervention, n = 45
Group 2: control, n = 45
Healthy primiparous women
Setting: public health center
Pregnancy (group class)
Telephone = no
Theory = yes
Group 1: one-session self-efficacy-based educational program was held using lectures, role playing, posters, and CD + health literacy
Group 2: routine care
Up to 3 monthsBreastfeeding self-efficacy tools: Dennis breastfeeding self-efficacy (33 items)Three months after childbirth, a significant difference was observed between the two groups in the mean of breastfeeding self-efficacy ().

Vakilian et al. Iran [29]RCTsGroup 1: intervention, n = 65
Group 2: control, n = 65
Healthy primiparous women
Setting: hospital
Postpartum (individual class)
Telephone = no
Theory = no
Group 1: home-based educational program using pamphlet + CD
Group 2: routine care
Up to 4 weeksBreastfeeding self-efficacy tools: Dennis breastfeeding self-efficacy (14 items)Four weeks after childbirth, a significant difference was observed between the two groups in the mean of breastfeeding self-efficacy ().

Shariat et al. Iran [12]RCTsGroup 1: intervention, n = 64
Group 2: control, n = 65
Healthy primiparous women
Setting: hospital
Postpartum (individual class)
Telephone = yes
Theory = no
Group 1: one-session educational program using pamphlet + CD
Group 2: routine care
Up to 6 monthsBreastfeeding self-efficacy tools: Dennis breastfeeding self-efficacy (33 items)After six months, there was no significant difference between the two groups on BSES ().

Rodrigues et al. Brazil [30]RCTsGroup 1: intervention, n = 59/104
Group 2: control, n = 40/104
Healthy pregnancy
Setting: hospital
Postpartum period (group class)
Telephone = no
Theory = no
Group 1: one-session educational program using flip chart (40 min)
Group 2: routine care
15, 30, 60, 90, and 120 days after child birthBreastfeeding self-efficacy tools: Dennis breastfeeding self-efficacy (14 items)After five-stage follow-up, there was a significant difference between the two groups ().
Chaves et al. Brazil [31]RCTsGroup 1: intervention, n = 39/66
Group 2: control, n = 38/66
Healthy pregnancy
Setting: hospital
Postpartum period (individual class)
Telephone = yes
Theory = no
Group 1: one-session face-to-face educational program + three telephone calls in 7, 15, and 30 days after discharge (70 min)
Group 2: routine care
2 and 4 months after child birthBreastfeeding self-efficacy tools: Dennis breastfeeding self-efficacy (14 items)After two months, there was no significant difference between the two groups on BSES (). After four months, there was a significant difference between the groups ().

Dodt et al. Brazil [32]RCTsGroup 1: intervention, n = 54/101
Group 2: control, n = 42/100
Healthy pregnancy
Setting: hospital
Postpartum period (individual class)
Telephone = yes Theory = no
Group 1: three-session educational program using flip chart in 6 hours postpartum, before discharge, and 2 months after child birth by telephone contact
Group 2: routine care
Up to 2 monthsBreastfeeding self-efficacy tools: Dennis breastfeeding self-efficacy (14 items)After two months, there was a significant difference between the two groups ().

Srinivas et al. USA [33]RCTsGroup 1: intervention, n = 50/63
Group 2: control, n = 53/63
Healthy pregnancy
Setting: hospital
Pregnancy (individual class)
Telephone = yes
Theory = no
Group 1: 11-session peer educational program was held, one session 28th weeks of pregnancy, one session within 3 to 5 days after delivery, weekly to 1 month, every 2 weeks up to 3 months, and once at 4 months using telephone call
Group 2: routine care
Up to 6 weeks after child birthBreastfeeding self-efficacy tools: Dennis breastfeeding self-efficacy (14 items)After six weeks, there was no significant difference between the two groups on BSES ().

Nekavand et al. Iran [34]RCTsGroup 1: intervention, n = 50
Group 2: control, n = 50
Healthy primiparous women
Setting: Hospital
Postpartum period (individual class)
Telephone = no
Theory = no
Group 1: one-session educational program within 5 hours after child birth + booklet
Group 2: routine care
Up to one monthBreastfeeding self-efficacy tools: Dennis breastfeeding self-efficacy (14 items)One month after childbirth, there was no significant difference between the two groups on BSES ().

Kronborg et al. Denmark [35]RCTsGroup 1: intervention, n = 582/603
Group 2: control, 575/590
Healthy primiparous women
Setting: hospital
Pregnancy (couple group class)
Telephone = no
Theory = no
Group 1: one-session educational program was held + lectures and discussions + shown a film for 9 hours
Group 2: routine care
Up to six weeks after child birthBreastfeeding self-efficacy tools: Dennis breastfeeding self-efficacy (14 items)After six weeks, there was no significant difference between the two groups on BSES ().

Javorski et al. Brazil [36]RCTsGroup 1: intervention, n = 56/66
Group 2: control, 56/66
Healthy pregnancy
Setting: basic health units
Pregnancy (individual class)
Telephone = no
Theory = no
Group 1: educational program was held using flip chart included picture and text
Group 2: routine care
2, 4, and 8 weeks after child birthBreastfeeding self-efficacy tools: Dennis breastfeeding self-efficacy (14 items)After 2, 4, and 8 weeks, a significant difference was observed between the two groups in the mean of breastfeeding self-efficacy ().
Araban et al. Iran [10]RCTsGroup 1: intervention 56/60
Group 2: control, n = 54/60
Healthy primiparous women
Setting: prenatal clinics
Pregnancy (group class)
Telephone = no
Theory = yes
Group 1: two-session group-based educational program was held + booklet and images + sending biweekly text messages up to 8 weeks after childbirth
Group 2: routine care
Up to 8 weeksBreastfeeding self-efficacy tools: Dennis breastfeeding self-efficacy (14 items)After 8 weeks, a significant difference was observed between the two groups in the mean of breastfeeding self-efficacy ().

Harris-Luna and Badr. California [37]RCTsGroup 1: intervention, n = 31
Group 2: control, n = 30
Healthy pregnancy
Setting: obstetric clinic
Pregnancy (individual class)
Telephone = yes
Theory = no
Group 1: bilingual Spanish-English educational program was held in three sessions (2 hours) + telephone support weekly for the first 4 weeks and then biweekly for up to 12 weeks after child birth
Group 2: routine care
Up to 12 weeks after child birthBreastfeeding self-efficacy tools: Dennis breastfeeding self-efficacy (14 items)After 12 weeks, a significant difference was observed between the two groups in the mean of breastfeeding self-efficacy ().

Mizrak et al. Turkey [38]RCTsGroup 1: intervention, n = 45
Group 2: control, n = 45
Healthy primiparous women
Setting: health centers
Pregnancy (group class)
Telephone = yes
Theory = yes
Group 1: two educational programs were held in a week using video (90–80 min) + home visit in 1, 4, and 8 weeks or telephone call
Group 2: standard care
1, 4, and 8 weeks after child birthBreastfeeding self-efficacy tools: Dennis breastfeeding self-efficacy (14 items)After 1, 4, and 8 weeks, a significant difference was observed between the two groups in the mean of breastfeeding self-efficacy ().

McQueen et al. Toronto [39]RCTsGroup 1: intervention, n = 61/68
Group 2: control, n = 73/81
Healthy primiparous women
Setting: hospital
Postpartum period (individual class)
Telephone = yes
Theory = yes
Group 1: two-session educational program based on self-efficacy theory was conducted in hospital, and one session was conducted by telephone within 1 week of discharge from hospital
Group 2: standard care
4 and 8 weeks after child birthBreastfeeding self-efficacy tools: Dennis breastfeeding self-efficacy (14 items)After 4 and 8 weeks, there was no significant difference between the two groups on BSES ().

Prasitwattanaseree et al. Thailand [40]RCTsGroup 1: intervention, n = 41/48
Group 2: control, n = 42/49
Healthy primiparous women
Setting: hospital
Pregnancy (individual class)
Telephone = yes
Theory = no
Group 1: twelve educational programs were held (2 sessions during pregnancy per week + 1, 2, and 3 days after birth + 7 days, 1 month, 6 weeks, and 3 and 6 months at home with telephone call
Group 2: usual care
At discharge and 6 weeks after child birthBreastfeeding self-efficacy tools: Dennis breastfeeding self-efficacy (14 items)At discharge, there was no significant difference between the two groups on BSES (). After 6 weeks, a significant difference was observed between the two groups in the mean of breastfeeding self-efficacy ().
Moudi et al. Iran [41]RCTsGroup 1: Intervention, n = 32/36
Group 2: intervention, n = 32/36
Group 3: control, n = 31/32
Healthy primiparous women
Setting: health centers
Pregnancy (individual class)
Telephone = yes
Theory = no
Group 1: peer support training was held in four sessions. One session was face to face in 36–38 weeks, and three sessions were done using telephone call in 1, 2, and 3 weeks after child birth
Group 2: provider training was held in four sessions. Two sessions were face to face, and the next two sessions were held in the 1 and 3 weeks after child birth by telephone call
Group 3: standard care
8 weeks after child birthBreastfeeding self-efficacy tools: Dennis breastfeeding self-efficacy (14 items)After 8 weeks, there was no significant difference between the three groups on BSES (). BSES at the end of the eighth week was significantly increased in peer support compared to provider groups ().

Saljughi et al. Iran [42]RCTsGroup 1: intervention, n = 37
Group 2: control, n = 37
Healthy pregnancy
Setting: health centers
Pregnancy group class)
Telephone = no
Theory = no
Group 1: one-session educational program using role playing approach (90 min)
Group 2: routine care
One week and 1 month after child birthBreastfeeding self-efficacy tools: breastfeeding self-efficacy (14 items)After 1 week and 1 month, a significant difference was observed between the two groups in the mean of breastfeeding self-efficacy ().

Khorshidifard et al. Iran [43]RCTsGroup 1: intervention, n = 88
Group 2: intervention, n = 88
Group 3: control, n = 88
Healthy primiparous women
Setting: health centers
Pregnancy individually + small group class)
Telephone = no
Theory = no
Group 1: direct face-to face-individually educational program in three sessions using lecture, discussion, and role playing approach
Group 2: small group educational program was held in three sessions
Group 3: routine care
After last session of education and after child birthBreastfeeding self-efficacy tools: Dennis breastfeeding self-efficacy (14 items)After last session of education and after child birth, there was a significant difference between three groups in the mean of breastfeeding self-efficacy ().

Otsuka et al. Japan [44]RCTsGroup 1: intervention, n = 136
Group 2: intervention n = 239
Group 3: control, n = 140
Group 4: control, n = 266
Healthy pregnancy
Setting: baby-friendly hospitals (BFHs)
Pregnancy (individual class)
Telephone = no
Theory = yes
Groups 1 and 2: self-efficacy workbook in six sections was completed by women
Groups 3 and 4: routine care
At discharge and 4 weeks after child birthBreastfeeding self-efficacy tools: Dennis breastfeeding self-efficacy (14 items)After controlling for potential confounding factors and time, the intervention resulted in an increase in the BSES-SF total score through 4 weeks postpartum in BFHs (), but it had no effect on breastfeeding self-efficacy ).
Khosravan, et al. Iran [45]RCTsGroup 1: intervention n = 40
Group 2: control n = 40
Healthy primiparous women
Setting: hospital
Pregnancy (individual class)
Telephone = no
Theory = yes
Group 1: six-session educational program using problem solving
Group 2: routine care
After last session of education and 3 months after child birthTools: Dennis breastfeeding self-efficacy (33 items)After last session of education and after child birth, there was a significant difference between two groups in the mean of breastfeeding self-efficacy ().

Salehi et al. Iran [46]RCTsGroup 1: intervention n = 70
Group 2: intervention n = 70
Group 3: control n = 70
Healthy primiparous women
Setting: health center
Pregnancy (group class)
Telephone = yes
Theory = no
Group 1: a motivational interview was held preweek in five sessions + three sessions of telephone counseling in 3–5 days, 1 and 4 months after discharge + telegram chat
Group 2: one session of lecture (2 hours) + question and answer panel
Group 3: routine care
2, 4, and 6 months after child birthTools: Dennis breastfeeding self-efficacy (14 items)In the lecture and control group, there was a significant increase until the second month (), and self-efficacy decreased in months 4 and 6 compared to the second months ().

Lutenbacher et al. USA [47]RCTGroup 1: intervention n = 76
Group 2: control n = 69
Participant healthy pregnancy
Setting: health center
Pregnancy individual class
Telephone = yes
Theory = no
Group 1: educational program based on the maternal infant health outreach worker (MIHOW) model by peer mentors (40 h)
Group 2: routine care (a minimal education intervention MEI)
2 weeks and 2 and 6 months after childbirthTools: Dennis breastfeeding self-efficacy (14 items)After three-stage follow-up, there was a significant difference between the two groups ().

Mesters et al. Netherland [48]RCTsGroup 1: intervention, n = 44
Group 2: control, n = 45
Healthy pregnancy
Setting: health center
Pregnancy (individual class)
Telephone = no
Theory = yes
Group 1: four-session educational program using a theory-based booklet and pre- and postnatal home visits (2 sessions of face to face and one session as a home visit in prenatal + 1 session home visit in postnatal)
Group 2: routine care
3 months after child birthTools: Dennis breastfeeding self-efficacy (14 items)A statistically significant difference was observed between 8 months of pregnancy and 3 months postpartum in which self-efficacy expectation increased in both groups ().

Edwards et al. USA [49]RCTsGroup 1: intervention, n = 7
Group 2: control, n = 8
Healthy primiparous women
Setting: hospital
Pregnancy individual
Telephone = no
Theory = no
Group 1: educational program using a computer agent
Group 2: usual care
At dischargeTools: Dennis breastfeeding self-efficacy (14 items)At discharge, no significant difference was observed between the three groups on BSES ().
Noel-Weiss et al. Canada [50]RCTsGroup 1: intervention, n = 41
Group 2: control, n = 39
Healthy primiparous women
Setting: hospital
Postpartum group class
Telephone = yes
Theory = yes
Group 1: the intervention was a 2.5-hour prenatal breastfeeding workshop designed using Bandura’s theory of self-efficacy and adult learning principles
Group 2: routine care
4 and 8 weeks after childbirthTools: Dennis breastfeeding self-efficacy (14 items)After 4 weeks, there was a significant difference between the two groups (). After 8 weeks, no significant difference was observed between the two groups ().

Hauck et al. Australia [51]RCTsGroup 1: intervention, n = 123
Group 2: control, n = 123
Healthy primiparous women
Setting: hospital
Pregnancy individual class
Telephone = no
Theory = no
Group 1: the intervention was a 3-hour prenatal breastfeeding workshop + breastfeeding journal Bandura’s theory
Group 2: routine care
12 weeks after child birthTools: Dennis breastfeeding self-efficacy (33 items)After 12 weeks, no significant difference was observed between the two groups ().

Mehrabi et al. Iran [52]RCTsGroup 1: intervention, n = 60
Group 2: control, n = 60
Healthy women
Setting: health center
Pregnancy individual class
Telephone = yes
Theory = no
Group 1: mobile messaging on breastfeeding self-efficacy educational program
Group 2: routine care
After 2 weeks after child birthTools: Dennis breastfeeding self-efficacy (14 items)After 2 weeks, there was a significant difference between the two groups().

Schlickau, Nebraska, USA [53]RCTsGroup 1: intervention, n = 33
Group 2: control, n = 15
Healthy primiparous women
Setting: health
Pregnancy individualGroup 1: one-session educational program based on Pender’s health promotion model (HPM) and support after child birth during the follow-up period
Group 2: standard care
2 weeks after child birthTools: Dennis breastfeeding self-efficacy (14 items) 2 weeksAfter 2 weeks, there was a significant difference between the two groups().

Gallegos et al. Australia [54]RCTsGroup 1: intervention, n = 114
Group 2: control, n = 86
Healthy women
Setting: health center
Postpartum group class
Telephone = yes
Theory = no
Group 1: weekly educational massage for eight weeks + Facebook page involvement
Group 2: standard care
8 weeks after child birthTools: Dennis breastfeeding self-efficacy (14 items)After 8 weeks, no significant difference was observed between the two groups ().

Abuidhail et.al. Jordan [55]A prospective RCTGroup 1: intervention, n = 56
Group 2: control, n = 56
Participant: healthy pregnancyPregnancy (individual class)Group 1: two-session educational program was held using videos and images. It can be accessed by website with connecting Internet by computers or smart phones or any device + one notification text massage with mobile 3 days after last educational program
Group 2: routine care
Up two weeks after child birthTools: Dennis breastfeeding self-efficacy (14 items)After adjusting for preintervention scores, there was no significant difference between the experimental and control groups on postintervention scores on BSES ().