Text messaging interventions for breastfeeding outcomes: A systematic review and meta-analysis

Abstract

<p><strong>Background: </strong>Given the health benefits for infants and mothers, breastfeeding has become a significant public health issue. The global growth of mobile phone usage has created new options for breastfeeding promotion, including through text messaging.</p><p><strong>Objective: </strong>We aimed to evaluate the efficacy of text messaging interventions on breastfeeding outcomes and to identify the efficacy moderators of such interventions.</p><p><strong>Methods: </strong>Ten electronic databases were searched from the inception of databases until 27 October 2022. Studies were included if they used randomized controlled trials or quasi-experimental designs to evaluate the effect of text messaging interventions on breastfeeding outcomes. Two reviewers screened the included studies, assessed the risk of bias, and extracted the data. Pooled results were obtained by the random-effects model, and subgroup analyses were conducted on intervention characteristics to identify potential moderators.</p><p><strong>Results: </strong>Twelve studies were included. Text messaging interventions could improve the exclusive breastfeeding rate (at < 3 months: OR=2.11; 95% CI: 1.52-2.95, <em>P </em>< 0.001; at 3~6 months: OR= 1.37; 95% CI: 1.02-1.84, <em>P</em>=0.04; at ≥ 6 months: OR= 1.87; 95% CI: 1.35-2.61, <em>P</em><0.001), and the breastfeeding self-efficacy (SMD=0.30, 95% CI: 0.14-0.45, <em>P </em>< 0.001). Text messaging interventions that spanned antenatal and postnatal periods, delivered weekly were most effective in improving the exclusive breastfeeding rate.</p><p><strong>Conclusions: </strong>Text messaging interventions may improve breastfeeding practice compared with no or standard health information. We suggest text messaging conducted from the pre- to postnatal periods in a weekly manner can effectively increase exclusive breastfeeding rates and breastfeeding self-efficacy. <br></p>