Maternal and Child Health Journal

, Volume 18, Issue 1, pp 296–306 | Cite as

Effectiveness of a Breastfeeding Self-efficacy Intervention: Do Hospital Practices Make a Difference?

  • Keiko OtsukaEmail author
  • Masataka Taguri
  • Cindy-Lee Dennis
  • Kiriko Wakutani
  • Masayo Awano
  • Takuhiro Yamaguchi
  • Masamine Jimba


Breastfeeding self-efficacy interventions are important for improving breastfeeding outcomes. However, the circumstances that may influence the effectiveness of the interventions are unclear, especially in the context of hospitals with suboptimal infant feeding practices. Thus, we aimed to evaluate the effect of a self-efficacy intervention on breastfeeding self-efficacy and exclusive breastfeeding, and further assessed the difference in its effect by hospital-routine type. In this intervention study with a control group, 781 pregnant women were recruited from 2 “Baby-Friendly”-certified hospitals (BFH) and 2 non-Baby-Friendly Hospitals (nBFH) in Japan, and were allocated to an intervention or control group. Participants in the intervention group were provided with a breastfeeding self-efficacy workbook in their third trimester. The primary outcome was breastfeeding self-efficacy and the secondary outcome was infant feeding status. All analyses were stratified by the type of hospital, BFH or nBFH. In BFHs, the intervention improved both breastfeeding self-efficacy through 4 weeks postpartum (p = 0.037) and the exclusive breastfeeding rate at 4 weeks postpartum (AOR 2.32, 95 % CI 1.01–5.33). In nBFHs, however, no positive effect was observed on breastfeeding self-efficacy (p =  0.982) or on the exclusive breastfeeding rate at 4 weeks postpartum (AOR 0.97, 95 % CI 0.52–1.81); in nBFHs, supplementation was provided for breastfed infants and the mother and infant were separated in the vast majority of cases. Infant feeding status at 12 weeks was not improved in either hospital type. The intervention improved breastfeeding self-efficacy and exclusive breastfeeding at 4 weeks postpartum only in BFHs. When breastfeeding self-efficacy interventions are implemented, hospital infant feeding practices may need to be optimized beforehand.


Baby-Friendly Hospitals Breastfeeding self-efficacy Exclusive breastfeeding Intervention Japan 



This study was funded by the St. Luke’s Life Science Institute. The authors are most grateful to the women who participated in the survey at a particularly busy time in their lives, and to the staff members of the hospitals who distributed and collected the questionnaires. We also thank the following researchers who contributed to the development of the research protocol and analytic strategy: Colin Binns, Andy Lee, Toshinori Kitamura, Krishna Poudel, Junko Yasuoka, and Akira Shibanuma. Finally, we acknowledge the contribution of the following researchers in the conduct of the survey: Xiu-Fang Wang, Sumiyo Okawa, Yuko Matsuoka, and Kayoko Yoshikawa.


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Authors and Affiliations

  • Keiko Otsuka
    • 1
    Email author
  • Masataka Taguri
    • 2
  • Cindy-Lee Dennis
    • 3
  • Kiriko Wakutani
    • 4
  • Masayo Awano
    • 5
  • Takuhiro Yamaguchi
    • 6
  • Masamine Jimba
    • 1
  1. 1.Department of Community and Global Health, Graduate School of MedicineThe University of TokyoTokyoJapan
  2. 2.Department of Biostatistics and Epidemiology, Graduate School of MedicineYokohama City UniversityYokohamaJapan
  3. 3.Faculties of Nursing and Medicine, Department of PsychiatryUniversity of Toronto and Women’s College HospitalTorontoCanada
  4. 4.Women’s Health Outpatient WardOkinawa Miyako HospitalMiyakoJapan
  5. 5.Kanazawa UniversityKanazawaJapan
  6. 6.Division of BiostatisticsTohoku University Graduate School of MedicineSendaiJapan

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