Enhancing Breastfeeding Self-Efficacy and Breastfeeding Outcomes in Primiparous Women Through a Midwifery-Led Mobile Health Intervention: A Randomized Controlled Trial

Introduction: Maternal confidence is essential for initiating and maintaining breastfeeding. Although professional breastfeeding support is important, traditional face-to-face counseling may be constrained by limited time, workforce, and accessibility. Information and communication technologies (ICTs), including mobile health (mHealth) applications, offer accessible, flexible, and timely support that can complement routine midwifery care. This study aimed to develop a midwifery-led mobile application grounded in self-efficacy theory and to evaluate its effects on breastfeeding self-efficacy and outcomes among primiparous women. Methods: A randomized controlled trial was conducted from September 2022 to August 2023 at four family health centers in Eskişehir, Türkiye. The mobile application was developed collaboratively by midwives and software experts, integrating educational modules, reminders, and self-monitoring features based on self-efficacy principles. Eighty-six primiparous women in their third trimester were randomly assigned to an intervention group ( n = 44) using the application or a control group ( n = 42) receiving standard care. Data were collected through a sociodemographic form, the Breastfeeding Self-Efficacy Scale–Short Form, breastfeeding follow-up records, and an app-use satisfaction questionnaire. Statistical analyses were conducted using SPSS. Results: Participants in the intervention group had significantly higher breastfeeding self-efficacy scores at the second and third follow-ups than controls ( p = 0.008 and p = 0.001, respectively). Within-group analyses showed consistent increases in self-efficacy over time among app users ( p < 0.001). Exclusive breastfeeding rates and continuation at 6 months postpartum were also significantly greater in the intervention group ( p < 0.001 and p = 0.001, respectively). Discussion: The midwifery-led mobile application improved breastfeeding self-efficacy and increased exclusive and sustained breastfeeding. These findings support integrating structured digital tools into routine midwifery care to strengthen early lactation outcomes and enhance maternal–infant health during the critical postpartum period.