Effectiveness of breastfeeding educational interventions to improve breastfeeding knowledge, attitudes, and skills among nursing, midwifery, and medical students: A systematic review and meta-analysis

Background: Breastfeeding education programs are necessary to prepare healthcare students to address the breastfeeding needs of families. Various breastfeeding educational modules have been used in academic settings; however, the effectiveness of breastfeeding educational interventions remains unclear. Objectives: To examine the effectiveness of educational interventions to improve the breastfeeding knowledge, attitudes, and skills of nursing, midwifery, and medical students. Methods: A systematic review was conducted searching academic databases from inception to December 22, 2022. Searches were carried out by two authors independently in PubMed, MEDLINE, Web of Science, Scopus, CINAHL Plus, Embase, Cochrane Library, and ERIC. Joanna Briggs Institute critical appraisal checklist was used. The data were extracted for a random-effects meta-analysis to estimate the standardized mean differences (SMDs) with 95 confidence interval (CI). Subgroup analyses were performed to identify potential moderators. Results: Thirty-three quasi-experimental studies (12 two-group studies and 21 one-group studies), which included 1313 nursing students, 204 midwifery students, and 1066 medical students, were identified. The students who received educational interventions had significantly higher scores in breastfeeding knowledge (SMD: 0.67, 95 CI: 0.46, 0.87 for two-group studies; SMD: 1.42, 95 CI: 0.91, 1.94 for one-group studies), more positive attitudes toward breastfeeding (SMD: 0.43, 95 CI: 0.22, 0.63 for two-group studies; SMD: 0.98, 95 CI: 0.32, 1.63 for one-group studies), and higher scores for breastfeeding skills (SMD: 1.52, 95 CI: 0.46, 2.58 for two-group studies; SMD: 1.33, 95 CI: 0.43, 2.23 for one-group studies) than the control groups. As a teaching method, clinical practicums were a significant moderator of both breastfeeding knowledge (p = .035) and skills (p < .001). Few studies (n = 5) described the educational framework underpinning the program development. Conclusions: Breastfeeding educational interventions effectively improve the breastfeeding knowledge, attitudes, and skills of undergraduate nursing, midwifery, and medical students. Incorporating clinical practicums in interventions is important. Future studies to examine useful teaching strategies for enhancing learning outcomes are warranted.