Effects of digital interventions on breastfeeding-related outcomes: a systematic review and network meta‑analysis

Addressing suboptimal global breastfeeding adherence via digital interventions (DIs) to enhance breastfeeding self-efficacy has become a key clinical research focus. This study evaluates the impact of DI strategies on exclusive breastfeeding, self-efficacy, and breastfeeding effectiveness, providing an evidence-based foundation for optimizing maternal and child health management. Embase, PubMed, Cochrane Library, and Web of Science were comprehensively searched. The risk of bias was independently assessed using the Cochrane tool, RoB 2. The primary outcome was exclusive breastfeeding rate, while secondary outcomes were breastfeeding self‑efficacy and LATCH score. A fixed‑ effects model or a random‑effects model under a Bayesian framework was employed for the network meta-analysis (NMA), and mean differences (MDs) and risk ratios (RRs) were calculated with 95% credible intervals (CrIs). The surface under the cumulative ranking curve (SUCRA) was computed to rank the probabilities of different interventions. R (version 4.4.1) was used for all statistical analyses. In total, 44 studies were included. The NMA revealed that, in comparison with other interventions, web‑based health education combined with mobile application-based health education (WHE+MAE) was the highest-ranked intervention for raising the exclusive breastfeeding rate at 3 months after delivery (RR = 1.7, 95% CrI: 1.4–2.3; SUCRA = 91.4%), whereas telephone support combined with printed educational material (TE+PEM) ranked highest at 6 months after parturition (RR = 21.0, 95% CrI: 9.0–73.0; SUCRA = 99.7%). In terms of breastfeeding self‑efficacy, TE+F2F ranked highest at 3 months after delivery (MD = 13.0, 95% CrI: 7.3–19.0; SUCRA = 97.4%), while mobile application-based health education combined with short message service (MAE+SMS) ranked highest at 6 months after parturition (MD = 8.8, 95% CrI: 1.5–16.0; SUCRA = 87%). For breastfeeding effectiveness (LATCH score), TE+SMS was the highest-ranked intervention (MD = 2.4, 95% CrI: 1.8–3.1; SUCRA = 99.9%). Digital nursing interventions show time-dependent effects on breastfeeding outcomes. Multimodal strategies—integrating mHealth, multimedia, and face-to-face guidance—are more effective than single-component interventions for enhancing maternal feeding confidence and quality. Future high-quality trials are needed to validate stage-specific, personalized support for postpartum women. Not applicable.