The effect of a combined intervention on exclusive breastfeeding in primiparas : an RCT

Prenatalna / postnatalna intervencija koja uključuje proaktivnu telefonsku podršku i pisane materijale provedena je na uzorku od 400 žena iz Splitsko-dalmatinske županije u Hrvatskoj a kojima je ovo prva trudnoća. Žene su randomizirane u tri grupe intervencija (IS), aktivna kontrolna (AKS) i standardna kontrolna skupiina (SKS) od studenog 2013. do prosinca 2016. Primarni ishod bio je isključivo dojenje (EBF) s 3 mjeseca. Sekundarni ishodi bili su poteškoće s dojenjem, stavovi prema hranjenju dojenčadi, samoučivkovitost dojenja i stope dojenja s 3 i 6 mjeseci. Od 400 žena, 45 (11%) se izgubilo tijekom praćenja, a konačne analize provedene su na 129 (IS), 103 (AKS) i 123 (SKS) sudionice. Stope EBF s 3 mjeseca bile su značajno veće za IS (OR 4,6, 95% CI 2,7 do 8,1; EBF 81%) kao i sa 6 mjeseci (OR 15,7, 95% CI 9,1 do 27,1; EBF 64%) u usporedbi s SKS (EBF 47% sa 3 mjeseca, a 3% u 6 mjeseci). Viši postoci zabilježeni su i za AKS nakon 3 mjeseca (OR 2,2, 95% CI 1,3 do 3,8, EBF 68%) i 6 mjeseci (OR 2,3, 95% CI 1,4 do 3,9, EBF 16%). Ispitanice IS-a zabilježile su najveći porast pozitivnog stava prema dojenčadi, u usporedbi s početnom vrijednosti, i značajno veću samoučinkovitost dojenja. Ispitanice SKS imale su znatno veće poteškoće s dojenjem, u dobi od 3 i 6 mjeseci, u usporedbi s AKS i IS. Tiskani materijali za dojenje i proaktivna telefonska podrška žena na kojima je ovo prva trudnoća pokazali su učinkovitim sredstvom za povećanje stope dojenja, smanjenje poteškoća s dojenjem i poboljšanje samoučinkovitosti i stava prema prehrani dojenčadi. An antenatal/postnatal intervention involving proactive telephone support and written materials was conducted among primiparas. 400 women, from the Split-Dalmatia County, Croatia, were randomised between November 2013 and December 2016 into three groups: intervention (IG), active control (ACG) and standard care (SCG). Primary outcome was exclusive breastfeeding (EBF) at 3 months. Secondary outcomes included breastfeeding difficulties, attitudes towards infant feeding, breastfeeding self-efficacy and social support. Practice staff were blinded to group allocation. Of 400 women, 45 (11%) were lost to follow-up, and final analyses were conducted on 129 (IG), 103 (ACG) and 123 (SCG) participants. EBF rates at 3 months were significantly higher for the IG (OR 4.6, 95% CI 2.7 to 8.1; EBF 81%) as well as at 6 months (OR 15.7, 95% CI 9.1 to 27.1; EBF 64%) compared to SCG (EBF 47% at 3 months, and 3% at 6 months). Higher rates were also observed for the ACG at 3 months (OR 2.2, 95%CI 1.3 to 3.8, EBF 68%) and 6 months (OR 2.3, 95%CI 1.4 to 3.9, EBF 16%). Participants in the IG had the highest increase in positive attitudes towards infant feeding, in comparison to baseline, and significantly higher breastfeeding self-efficacy. Participants in SCG experienced significantly more breastfeeding difficulties, both at 3 and 6 months, in comparison to AC and IGs. Written breastfeeding materials and proactive telephone support among primiparas are an effective means of increasing breastfeeding rates, decreasing breastfeeding difficulties and improving self-efficacy and attitudes towards infant feeding.