A Systematic Review of the Effectiveness of Breastfeeding Intervention Delivery Methods

Objective To analyze breastfeeding intervention delivery methods to determine the likelihood of successful breastfeeding outcomes of e-based interventions compared to provider-based interventions. Data Sources Eligible studies were identified by searching MEDLINE, CINAHL, Academic Search Elite, Health Source: Nursing/Academic Edition, SOC INDEX, and PsycINFO. Study Selection Studies were included if they were conducted in a developed country, published between the years 2004 and 2008, included a concurrent control group, and reported frequency data on breastfeeding initiation or duration. The suitability of design and quality of execution were evaluated using the Centers for Disease Control procedure for systematic reviews. Twenty-one articles met the criteria for inclusion. Data Extraction Study design, demographics, intervention/control conditions, settings, sampling strategies, potential threats to validity, and breastfeeding outcomes were abstracted and entered into a database for analysis and synthesis. Data Synthesis Odds ratios were calculated for each individual study, and studies were stratified into 2 groups by intervention delivery type. The pooled results indicated that studies using e-based interventions had a moderate effect on breastfeeding (odds ratio=2.2 [1.9-2.7], d=0.5); whereas provider-based interventions had very little to no effect (odds ratio=1.1 [1.0-1.2], d=0.03). Conclusions Results indicate that breastfeeding promotion programs delivered via the Internet may be an appealing alternative to time-consuming and expensive provider-based breastfeeding education and support.