Effectiveness of educational interventions conducted by telephone to promote breastfeeding: a systematic review of the literature

Oriá, Mônica Oliveira Batista; Dodou, Hilana Dayana; Chaves, Anne Fayma Lopes; Santos, Lívia Maria Damasceno Alves dos; Ximenes, Lorena Barbosa; Vasconcelos, Camila Teixeira Moreira

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Review Article • Rev. esc. enferm. USP 52 • 2018 • https://doi.org/10.1590/S1980-220X2017024303333 copy

Effectiveness of educational interventions conducted by telephone to promote breastfeeding: a systematic review of the literature

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To assess the effectiveness of telephone educational interventions on the duration and exclusiveness of breastfeeding.

Method

A systematic review of the literature was conducted including only Randomized Clinical Trials. The exposure factor was an educational intervention via telephone, and the outcomes were duration and exclusiveness of breastfeeding. Literature in Portuguese, English and Spanish published between 2010 and 2016 were searched for in the Cochrane, Lilacs, Medline and Scopus databases. The articles were analyzed through a results synthesis.

Results

241 articles were identified, of which 231 did not meet the inclusion criteria. Therefore, only 10 articles were reviewed. Four studies showed no efficacy related to breastfeeding. Regarding common characteristics, these studies were performed in short periods and in pairs. The others revealed efficacy regarding duration and/or exclusiveness of breastfeeding. The latter were mostly studies with long-term interventions and carried out by nurse lactation consultants.

Conclusion

The evidence demonstrates that the telephone is a viable technology for promoting breastfeeding, representing an alternative for the health units and health professionals that can contribute to mother-baby care.

Breast Feeding; Health Education; Telephone; Maternal-Child Nursing; Review

Author	Sample/ Losses	Intervention provider	Period of intervention	Description of the Intervention
Efrat et. al., 2015⁽²⁴24. Efrat MW, Esparza S, Mendelson SG, Lane CH. The effect of lactation educators implementing a telephone-based intervention among low-income Hispanics: a randomised trial. Health Educ J [Internet]. 2015 [cited 2016 July 10];74(4):424-41. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4771064/ https://www.ncbi.nlm.nih.gov/pmc/article... ⁾	298 pregnant women/ 59.55%	A health professional lactation consultant by the IBLCE (International Board of Lactation Consultant Examiners) and with experience as a lactation educator	Early in the third trimester of pregnancy until the 6^th month postpartum	Instrument used: Intervention monitoring protocol created by the principal investigator. Aspects considered: Prenatal: increasing the support to start breastfeeding, reducing barriers related to breastfeeding and providing advance guidance about what to expect during the first weeks of breastfeeding. Postpartum: increasing support for exclusive breastfeeding, reinforcing the knowledge received during the prenatal care phone call, addressing any concerns related to breastfeeding and referrals of participants who report breastfeeding problems to health services. Compared to the use of the telephone: 1) Control group received routine service guidelines. 2) Intervention group received routine service in addition to guidance over the phone, with 4 calls in the prenatal period and 17 calls in the postpartum period. Assessment of BF and EBF: The type of BF and duration rates at 72 hours, 1 month, 3 months and 6 months were evaluated.
Bunik et al., 2010⁽²⁵25. Bunik M, Shobe P, O’Connor ME, Beaty B, Langendoerfer S, Crane L, et al. Are 2 weeks of daily breastfeeding support insufficient to overcome the influences of formula? Acad Pediatr. 2010;10(1):21-8.⁾	341 low-income latin puerperal women/ 27%	Trained bilingual nurses (English and Spanish)	First two weeks postpartum (daily phone calls)	Instruments used: Culturally adapted protocols developed based on national and public health references regarding BF. Aspects considered: Cultural issues of BF, advantages of colostrum and of a good latch; benefits of breastfeeding; engorgement; breast pain; causes for baby crying; supplementary formulas; family support; support groups; maternal diseases; medications and diet; milk storage; return to work or to school, and other difficulties. Compared to the use of the telephone: 1) Control group received routine service guidelines. 2) Intervention group received routine service guidelines plus two more weeks of daily telephone calls. Assessment of BF and EBF: The type of BF and duration rates at 1 month and 6 months were evaluated.
Tahir et al., 2013⁽²⁶26. Tahir NM, AlSadat N. Does telephone lactation counselling improve breastfeeding practices? A randomised controlled trial. Int J Nurs Stud. 2013;50(1):16-25.⁾	357 puerperal women/ 10.9%	Midwife nurses certified as lactation consultants	Up to the sixth month postpartum, two phone calls per month	Instruments used: Educational materials about guidelines on breastfeeding and the use of the standard operating procedure to standardize the intervention. Aspects considered: Definitions concerning the BF practice in accordance with the recommendations of the World Health Organization. Compared to the use of the telephone: 1) Control group received routine service guidelines. 2) Intervention group received the routine service guidelines plus phone calls held twice a month. Assessment of BF and EBF: The type of BF and duration rates at 1, 4 and 6 months were evaluated.
Srinivas et al., 2015⁽²⁷27. Srinivas GL, Benson M, Worley S, Schulte E. A clinic-based breastfeeding peer counselor intervention in an urban, low-income population: interaction with breastfeeding attitude. J Hum Lact. 2015;31(1):120-8. DOI: 10.1177/0890334414548860⁾	120 pregnant women/ 14.2%	By pairs (trained women with successful experiences in breast-feeding)	Until the fourth month postpartum	Instruments used: Iowa Infant Feeding Attitude Scale and the Breastfeeding Self-Efficacy Scale to guide the intervention. Aspects considered: Basic guidelines on breastfeeding. Compared to the use of the telephone: 1) Control group received routine service guidelines. 2) Intervention group received routine service guidelines plus telephone contact within 3 to 5 days after delivery, weekly over the 1^st month, every 2 weeks up to the 3^rd month and once a month up to 4 months. Assessment of BF and EBF: The type of BF and duration rates at 1 and 6 months were evaluated.
Rasmussen et al., 2011⁽²⁸28. Rasmussen KM, Dieterich CM, Zelesk ST, Altabet JD, Kjolhede CL. Interventions to increase the duration of breastfeeding in obese mothers: the Bassett improving breastfeeding study. Breastfeed Med. 2011;6(2):69-75. DOI: 10.1089/bfm.2010.0014⁾	50 obese puerperal women/ 20%	Lactation consultant certified by the IBLCE	Up to 72 hours postpartum (a phone call before the delivery and two other calls at 24 and 72 hours)	Instrument used: A script to standardize the intervention created by the researchers, however the consultants also addressed other important issues that came up during the phone calls. Aspects considered: Knowledge, expectations and questions of women in relation to BF in the prepartum; demands and difficulties with BF in the postpartum. Compared to the use of the telephone: Group 1: a) Group that received the routine service; b) Group that received a call in the prepartum and two in the postpartum, the first at 24 hours and the second at 72 hours. Assessment of BF and EBF: EBF and duration rates at 7 and 30 days and the type of BF at 30 and 90 days were evaluated.
Reeder et al., 2016⁽²⁹29. Reeder JA, Joyce T, Sibley K, Arnold D, Altidang O. Telephone peer counseling of breastfeeding among WIC participants: a randomized controlled trial. Pediatrics [Internet]. 2014 [cited 2016 July 12];134(3):e700-9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4143999/ https://www.ncbi.nlm.nih.gov/pmc/article... ⁾	1,948 pregnant women/ 3.2%	By pairs (trained women with successful experiences in breast-feeding)	Up to 4 months postpartum	Instrument used: A report generated by the data system that included previous calls made. Aspects considered: Benefits of BF, breastfeeding techniques and difficulties with BF. Compared to the use of the telephone: 1) Group that received the routine service. 2) Group that received the routine service plus low-frequency counseling: four calls, two in prenatal care and two up to the second week postpartum. 3) Group that received the routine service plus high-frequency counseling: eight calls, four in the prenatal period and four up to the fourth month postpartum. Assessment of BF and EBF: The type of BF and duration rates at 1, 3 and 6 months were evaluated.
Fu et al., 2014⁽³⁰30. Fu IC, Fong DY, Heys M, Lee IL, Sham A, Tarrant M. Professional breastfeeding support for first-time mothers: a multicentre cluster randomised controlled trial. BJOG. 2014;121(13):1673-84. DOI: 10.1111/1471-0528.12884⁾	724 Chinese puerperal women/ 0.3%	Nurses with extensive experience and certified lactation consultants	Up to the fourth week postpartum	Instrument used: Intervention Protocol created by the principal investigator. Aspects considered: Benefits of exclusive breastfeeding, lactation physiology and common issues related to early breastfeeding, breastfeeding techniques, evaluation of feeding behaviors and manual expression of breastmilk, emotional and physical health of the mother, and guidance on issues such as low weight gain, insufficient milk, return to work, milk storage. Compared to the use of the telephone: 1) Group that received the routine service; 2) Group that received the routine service plus three more sessions of breastfeeding support in the maternity ward, 30-45 minutes each; 3) Group that received routine services plus weekly phone support of 20-30 minutes up to the fourth week postpartum. Assessment of BF and EBF: EBF and its duration at 1, 2 and 3 months postpartum were evaluated.
Carlsen et al., 2013⁽³¹31. Carlsen EM, Kyhnaeb A, Renault KM, Cortes D, Michaelsen KF, Pryds O. Telephone-based support prolongs breastfeeding duration in obese women: a randomized trial. Am J Clin Nutr. 2013;98(5):1226-32. DOI: 10.3945/ajcn.113.059600⁾	226 obese puerperal women/ 8.5%	Health professional certified as lactation consultant by the IBLCE	Up to the sixth month postpartum	Instrument used: A structured Protocol. Aspects considered: Issues related to physical and psychological aspects of breastfeeding and the well-being of mother and child, the difficulties and possible solutions. Compared to the use of the telephone: 1) Group that received routine services. 2) Group that received routine services plus three calls in the first month, a call at every 2 weeks until the second month and subsequently once a month until 8 weeks postpartum. Assessment of BF and EBF: Comparison of the duration medians of the EBF at 3 and 7 days, at 4 weeks and at 3 months after delivery. Comparison of the BF median at 6 months.
Flax et al., 2016⁽³²32. Flax VL, Negerie M, Ibrahim AU, Leatherman S, Daza EJ, Bentley ME. Integrating group counseling, cell phone messaging, and participant-generated songs and dramas into a microcredit program increases Nigerian women’s adherence to international breastfeeding recommendations. J Nutr [Internet]. 2014 [cited 2016 July 12];144(7):1120-4. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4481538/ https://www.ncbi.nlm.nih.gov/pmc/article... ⁾	461 pregnant women/ 4.8%	Partners of an American non-governmental organization in partnership with four community organizations	Up to the sixth month postpartum	Instruments used: Posters and leaflets on BF during the sessions. Aspects considered: Recommendations for the early onset of BF and for EBF, benefits of BF, breastfeeding techniques and time for introducing other foods. Compared to the use of the telephone: 1) Group that received counseling sessions on BF during microcredit meetings; 2) Group that received text and voice messages recorded and sent by phone about matters discussed in the sessions; and 3) Group who received songs and dramatizations created by the participants. Assessment of BF and EBF: EBF and its duration at 1, 3 and 6 months were evaluated; the initiation of breastfeeding within 1 hour after delivery and the use of colostrum or breast milk exclusively during the first 3 days of the child’s life.
Pugh et al., 2010⁽³³33. Pugh LC, Serwint JR, Frick KD, Nanda JP, Sharps PW, Spatz DL, et al. A randomized controlled community-based trial to improve breastfeeding rates among urban low-income mothers. Acad Pediatr [Internet]. 2010 [cited 2016 July 12];10(1):14-20. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2818063/ https://www.ncbi.nlm.nih.gov/pmc/article... ⁾	328 puerperal women/ 29%	Support group formed by nurses and lactation consultants and advising peers	Up to the sixth month postpartum	Instrument used: Intervention Protocol created by the principal investigator. Aspects considered: Strengthening of maternal competence with the commitment to breastfeeding, parental education on breastfeeding, identification of social support, ways to reduce breast issues and information regarding the health services that facilitate the process of BF. Compared to the use of the telephone: 1) Group that received the routine service. 2) Group that received the routine service plus an intervention, which initially consisted of daily hospital visits of the support group up to hospital discharge, twice at home during the first week, and a third visit up to 4 weeks postpartum. Mothers subsequently received phone calls scheduled at every 2 weeks up to the sixth month. Assessment of BF and EBF: BF at 6, 12 and 24 weeks postpartum was evaluated.

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[1] Corresponding author: Hilana Dayana Dodou. Rua Alexandre Baraúna, 1115, Rodolfo Teófilo CEP 60430-160 – Fortaleza, CE, Brazil. hilanadayana@yahoo.com.br