Video-Based Peer Support and Exclusive Breastfeeding and Maternal Self-Efficacy: A Randomized Clinical Trial.

Abstract

Peer support is a promising strategy to improve breastfeeding outcomes, but evidence for online formats is limited. To evaluate whether structured peer support delivered via video calls improves exclusive breastfeeding rates and maternal breastfeeding self-efficacy. This multicenter, randomized clinical trial enrolled first-time mothers with low breastfeeding confidence from 4 public postnatal wards in Hong Kong from January 31, 2021, to June 30, 2024. Participants were randomly assigned (1:1) to intervention or control. The primary analysis was conducted from July 1 to 31, 2024, with final data analysis completed by December 31, 2025. The intervention included usual postnatal care, consisting of access to lactation consultants and standard breastfeeding information from the Department of Health, plus at least 2 video call sessions with trained peer support volunteers at 10 days and 1 month post partum. The primary outcome was the proportion of infants who were exclusively breastfed at 6 months post partum. Secondary outcomes included exclusive breastfeeding at 1, 2, and 4 months post partum and maternal self-efficacy (measured using the Breastfeeding Self-Efficacy Scale-Short Form) at 2 and 4 months. All outcomes were analyzed on an intention-to-treat basis. Among 442 participants, 224 were allocated to the intervention group and 218 were allocated to the control group. The mean (SD) maternal age was 32.4 (4.0) years (32.4 [4.2] years in the intervention group and 32.3 [3.9] years in the control group). The primary 6-month outcome did not differ significantly between groups (37 of 184 [20.1%] vs 29 of 186 [15.6%]; adjusted odds ratio [AOR], 1.57 [95% CI, 0.85-2.89]; P = .15); however, exclusive breastfeeding at 2 months (a secondary outcome) was significantly higher in the intervention group (54 of 199 [27.1%] vs 38 of 200 [19.0%]; AOR, 1.80 [95% CI, 1.08-3.01]; P = .02). Longitudinal analysis confirmed higher odds of exclusive breastfeeding in the intervention group over time, with the largest difference at 2 months. Breastfeeding self-efficacy showed significantly greater improvement in the intervention group (time × intervention interaction: β = 1.01 [95% CI, 0.21-1.81]; P = .01), with a higher score at 4 months (adjusted β, 4.65 [95% CI, 1.60-7.70]; P = .01). In this randomized clinical trial, video call-based peer support did not increase exclusive breastfeeding at 6 months; however, it significantly increased exclusive breastfeeding at 2 months and improved maternal breastfeeding self-efficacy, offering a scalable model for postnatal care integration. ClinicalTrials.gov Identifier: NCT04621266.