Strengthening health visitors’ breastfeeding support: Results from a cluster randomised study

Aims: To assess the effect of the education programme on three constructs of health visitors’ breastfeeding support: knowledge, self-efficacy and action competence. Furthermore, the study aimed to confirm the factor structure of these three constructs. Background: Health professionals are key in supporting breastfeeding women but studies report gaps in health professionals’ breastfeeding support knowledge and competences. The present intervention study aimed to strengthen the breastfeeding support of families to improve breastfeeding rates. Health visitors received an interactive education programme to enhance their breastfeeding support knowledge, self-efficacy and action competence, including e-learning and a two-day course of lectures, role plays and discussions. Design: A pre- and post-test study was applied in a cluster randomised trial Methods: Cluster units were Danish municipal health visiting programmes, randomised by stratifying for region and annual births per cluster. Health visitors from 21 clusters (11 intervention, 10 control) participated. The knowledge, self-efficacy and action competence were assessed in self-reported questionnaires before and after education (n=368; intervention n=176, control n=196). To analyse the effects, the intention-to-treat principle and linear mixed models were applied. Confirmatory Factor Analysis was used to confirm the factor structures of the hypothesised knowledge, self-efficacy and action competence constructs. Results: 158 health visitors in the control arm and 157 in the intervention arm completed the baseline questionnaire and were analysed in intention-to-treat analyses. 125 and 116, respectively, completed the follow-up questionnaire and were analysed in sensitivity analyses. Health visitors in both trial arms had high levels of self-efficacy and action competence at baseline. Mean treatment effect of the education programme was 0.5 points (CI95 % 0.1–0.8) for knowledge, 2.4 points (CI95 % 1.6–3.3) for self-efficacy and 1.4 points (CI95 % 0.7–2.0) for action competence. The factor structure of the items used to measure knowledge, self-efficacy and action competence were confirmed. Conclusions: The education programme improved the self-reported breastfeeding support knowledge, self-efficacy and action competence of health visitors. The factor structures of the instruments used to measure effects were confirmed by confirmatory factor analysis. Trial registration: Clinical Trials: NCT05311631. First posted April 5, 2022.