Table 1 Characteristics of studies measuring the primary outcome of midwives’ KAP towards breastfeeding (n = 5)
Author (year); country | Study design, sample size, and characteristics | Follow-up schedule | Intervention (breastfeeding training programme) and control groups | Outcome(s) and measure(s) | Results |
|---|---|---|---|---|---|
Ekström et al.(2005); Sweden [25] | Longitudinal RCT. 28 midwives and 53 postnatal nurses During the follow-up period, 26 participants dropped out, resulting in a total response rate of 75.0% midwives and 64.2% nurses | Baseline and 1 year post-training | Intervention group: Programme: a process-oriented training programme Format: lectures and discussion Content: lectures on breastfeeding management and promotion, including discussions about counselling skills, and attitudes, and reflections on personal breastfeeding experiences Duration: 7 days Control group: No training | Attitudes towards breastfeeding: a validated self-designed breastfeeding attitudes instrument | • Breastfeeding training significantly improved attitudes towards breastfeeding of both midwives and postnatal nurses (p < 0.05) • Attitudes towards breastfeeding tended to be stable over 1 year, with only the regulating dimension scores decreasing slightly |
Moran et al. (2000); UK [26] | Quasi-experimental design Intervention group: 15 midwives Control group: 13 midwives | No follow-up (data were only collected once after training) | Intervention group: Programme: the 20-hourWHO/ UNICEF breastfeeding management course Content: the basic knowledge, skills and attitudes required to teach and support breastfeeding women Duration: 20 h (generally taught over 3 separate days within a 3- to 6-week period) Provider: midwives and health visitors employed by UNICEF as part of the UNICEF UK Baby Friendly Initiative Materials: A comprehensive and fully referenced workbook was provided for each participant Control group: No training | Knowledge and skills: Breastfeeding Support Skills Tool (BeSST) | • Significantly increased breastfeeding knowledge and skills were seen in the intervention group compared with the control group after the breastfeeding training programme (p < 0.01) |
Law et al. (2007); UK [27] | Quasi-experimental design Intervention group: 108 midwives Control group: 27 student midwives | Baseline and immediately after training | Intervention group: Programme: a breastfeeding training workshop Formats: lectures and role-play exercises Content: effective positioning and attachment and the use of hands-off teaching methods Duration: 4 h over 1 session Control group: No training | Knowledge and skills: BeSST | • Compared with baseline data, the total BeSST score increased significantly (p < 0.01) among participants in the intervention group after training • Compared with the control group, the total BeSST score was significantly higher in the intervention group (p < 0.01) after training, indicating the breastfeeding training programme enhanced midwives’ knowledge and skills |
Wang et al. (2012); Taiwan [28] | Quasi-experimental design Intervention group: 30 midwives and nurses Control group: 30 midwives and nurses | Baseline and immediately after training | Intervention group: Programme: breastfeeding courses Content: the importance of breastfeeding, breastfeeding assessment and support, common problems, and breastfeeding initiation Duration: 2 h per week for 4 weeks Providers: breastfeeding teachers from the National Health Bureau, Department of Health, Executive Yuan Materials: the National Health Bureau, Department of Health, Executive Yuan (2005) Guidelines for Breastfeeding Teaching Materials in Taiwan and Breastfeeding Question and Answer Manual were used Control group: No training | Knowledge and skills: The Breastfeeding Knowledge Scale Attitudes towards breastfeeding: The Breastfeeding Attitude Scale | • After training, breastfeeding knowledge and skills scores were significantly higher in the intervention group than in the control group (p < 0.01) • After training, attitudes toward breastfeeding scores were significantly better in the intervention group than in the control group (p < 0.05) |
Al-Nuaimi et al. (2019); USA [29] | Quasi-experimental design Intervention group: 42 midwives and nurses Control group: 40 midwives and nurses | Baseline and 2 weeks after training | Intervention group: Programme: An educational workshop Content: Anatomy and physiology of the breast; Physiology of milk production and hormonal physiology of breastfeeding; communication skills and building confidence with breastfeeding mothers; breastfeeding teaching methods; recommendations for healthy nutrition during breastfeeding; benefits of breastfeeding for mothers, infants and society; breastfeeding contraindications; common problems encountered by breastfeeding mothers; medications, or medical conditions that prevent or delay breastfeeding; appropriate positions for breastfeeding Duration: 2 h Materials: Based on up-to-date evidence, including recommendations from the WHO (2019) and the National Institute for Health and Care Excellence (NICE) (2015), 2 educational materials were developed, addressing the importance of breastfeeding initiation and child growth and development from birth to 5 years of age Control group: Provided with a 2-h workshop on child growth and development from birth to 5 years of age | Knowledge and skills: 2 validated questionnaires developed by the American Academy of Pediatrics Attitude towards breastfeeding: A 7-item breastfeeding attitude questionnaire | • After the educational workshop, knowledge and skills were significantly improved in the intervention group compared with the control group (p < 0.01) • After training, the intervention group had higher positive attitude scores than the control group (p < 0.01) |