The Effect of Interventions on Breastfeeding Self-efficacy by Using Bandura's Theory in Iranian Mothers: A Systematic Review

Background: Breastfeeding self-efficacy is a psychological effective factor on initiation and duration of breastfeeding, which according to Bandura's theory, is affected by four sources including performance accomplishments, vicarious experiences, verbal persuasion, and the emotional/physiological responses. We aimed to systematically review the effect of interventions using Bandura's self-efficacy theory on breastfeeding self-efficacy in Iranian mothers. Materials and Methods: In this systematic review, all interventional studies from 1990 to May 2019, were searched in Web of Science, Scopus, EMBASE, Cochrane library and Medline databases as International databases and SID, Magiran and Irondoc as National databases by using English and Persian related keywords. Two reviewers studied the full text of the articles and their main findings were extracted and categorized. Quality assessment of studies was checked and verified by two authors independently based on the Effective Public Health Practice Project (EPHPP) tool. Results: Finally, 21 articles (2,661 samples) which met inclusion criteria were investigated and reviewed in 5-domain that include performance accomplishments, vicarious experiences, verbal persuasion, and the emotional/physiological responses as well as interventions by using a combination of the 4 sources. The results of our review showed that mothers in intervention groups had significantly higher breastfeeding self-efficacy score compared to the control group. In addition, interventions by using verbal persuasion (52%, n=1660) are the most common and effective. Conclusion:The results showed that intervention with the use of Bandura's self-efficacy theory improves the breastfeeding self-efficacy. Due to the impact of these interventions on the initiation and duration of breastfeeding, simple and cost-effective, the implementation of theory-based interventions to improve breastfeeding self-efficacy in hospitals and health centers seems to be necessary.