Development and evaluation of a self care program on breastfeeding in Japan: A quasi-experimental study

BACKGROUND: Although the importance of breastfeeding is well known in Japan, in recent years less than 50% of mothers were fully breastfeeding at one month after birth. The purpose of this study was to develop a self-care program for breastfeeding aimed at increasing mothers' breastfeeding confidence and to evaluate its effectiveness. METHODS: A quasi-experimental pretest-posttest design was conducted in Japan. The intervention, a breastfeeding self-care program, was created to improve mothers' self-efficacy for breastfeeding. This Breastfeeding Self-Care Program included: information on the advantages and basics of breastfeeding, a breastfeeding checklist to evaluate breastfeeding by mothers and midwives, and a pamphlet and audiovisual materials on breastfeeding. Mothers received this program during their postpartum hospital stay. A convenience sample of 117 primiparous women was recruited at two clinical sites from October 2007 to March 2008. The intervention group (n = 55), who gave birth in three odd-numbered months, received standard care and the Breastfeeding Self-Care Program while the control group (n = 62) gave birth in three even numbered months and received standard breastfeeding care. To evaluate the effectiveness of the Breastfeeding Self-Care Program, breastfeeding self-efficacy and breastfeeding rate were measured early postpartum, before the intervention, and after the intervention at one month postpartum. The study used the Japanese version of The Breastfeeding Self-Efficacy Scale Short Form (BSES-SF) to measure self-efficacy. RESULTS: The BSES-SF score of the intervention group rose significantly from 34.8 at early postpartum to 49.9 at one month after birth (p < 0.01). For the control group, the score rose from 39.5 at early postpartum to 46.5 at one month after birth (p = 0.03). The early postpartum fully breastfeeding rate was 90% for the intervention group and 89% for the control group. At one month postpartum, the fully breastfeeding rate declined significantly to 65% for the control group compared to 90% for the intervention group (p = 0.02). CONCLUSION: Results indicate that the Breastfeeding Self-Care Program increased mothers' self-efficacy for breastfeeding and had a positive effect on the continuation of breastfeeding. TRIAL REGISTRATION NUMBER: UMIN000003517