Breastfeeding is the best source of nutrition for infants; it is also the most important factor in preventing infant infectious diseases and allergies, especially in the first six months of life [1]. Despite the known benefits of breastfeeding for both mother and infant, various factors can influence the mother's decision to initiate and continue breastfeeding. These include maternal knowledge of the benefits of breastfeeding, support systems, socioeconomic status, and breastfeeding self-efficacy [7]. It can be said that self-efficacy is the confidence that makes a person perform a certain behavior successfully and expects the results to be achieved [8]. Thus, breastfeeding self-efficacy is one of the modifiable and effective variables in early termination of lactation and can affect the rate and duration of lactation [9,10]. Breastfeeding may be thought to be a natural process and every mother should be able to do so without prior assistance, but it should be noted that in low-grade mammals, genes control the time, duration, and mode of breastfeeding. While in higher-level mammals like humans, all of these require a model and training [6]. Therefore, the choice of teaching method is a very important factor for effective education. In this context, educational content on breastfeeding is available through various educational methods [11]. In this regard, virtual networks can be optimally used for educational purposes.

 

This experimental study was conducted with two groups of experimental and control. The study was performed on nulliparous women taking part in Semnan province birth preparation classes in Shahrood in 2018. The sample size was 31 individuals in each group [15]. Therefore, the study population consisted of all primiparous women attending birth preparation classes in Shahroud; randomly, two centers were selected from Shahroud health centers and then approximately, 65 patients were divided into two groups of experimental and control (2 mothers from the experimental group and 3 mothers from the control group left the study for personal reasons). Inclusion criteria were being primiparous, normal neonates (normal weight, full gestational age and malformations), familiarity with cyberspace, internet and mobile access, no medical prohibition for breast-feeding for mothers and newborns, previous abstinence from similar periods. The study subjects were excluded if they were absent for more than one session in the training sessions.
Data gathering tools were demographic questionnaires and Lactation Self-efficacy Scale.
For the experimental group, educational steps (starting from 28 to 32 weeks of gestation and lasting until four months of infancy; also before and after the training sessions individuals studied and completed the questionnaires) including 7-step 60- 45 minutes training sessions were held for primiparous women from 28 to 32 weeks (Table 1). This tutorial included topics such as the benefits of breastfeeding.
The seven steps presented to the participants were: (a) The first step included the topics presented in the clinic in person, including the members' acquaintances and their problems in the clinic; Step 2 includes pre-test (filling out questionnaires) from the test and control group; (c) Step 3 includes expressing the benefits of breastfeeding and breastfeeding training to 28-32 weeks pregnant women; (d) Step four was submitting in virtual groups (in the multimedia training group, the participants' cellphones were checked for software availability and in the absence of software, required training was provided on how to use the software.) (E) Step 5, including initiating breastfeeding training through cyberspace groups (sharing information with researchers and answering questions on a regular basis). Group A; (f) Step 6 includes training and answering breastfeeding questions through the Virtual Group; and (g) Step Seven: summarizing past issues and providing solutions to follow up on learning (Table 1).

Table 1- Stages of training sessions

 

No sessions were held for the control group and they only received routine center training. At the end of the training sessions (four months after the birth of infants), the breastfeeding self-efficacy questionnaire was completed again by the experimental and control groups. At the time of completing the questionnaire, the researchers were present along with the study subjects to answer any questions. Also, neonates were weighed at birth and at four months of age in both experimental and control groups.

Independent t-test did not show a significant difference between the experimental and control groups before intervention (P=0.1), but post-intervention t-test showed a significant difference (P<0.01). Self-efficacy was higher in the experimental group. Also, the covariance test revealed a significant difference (P<0.01) between the two groups in terms of lactation self-efficacy (P<0.01), with 0.28 post-test effects due to training.

In the present study, the level of breastfeeding self-efficacy was significantly different in the experimental group compared to the control group. Thus, based on the findings, cybersecurity training is effective on increasing the self-efficacy of primiparous mothers. According to the results of this study based on mean inequality in the pre-test and post-test, it can be deduced that the difference between the scores of the test and control groups was due to the educational information delivered through the virtual space for the test group. The results of the study by Kazemi Majd et al. showed that using mobile SMS service enhances self-efficacy and improves adherence to treatment for patients with epilepsy [17]. In the study of Karimian Kakolaki et al., training through the virtual network improved women's self-efficacy in preventing osteoporosis in the intervention group compared to pre-study and post-training self-efficacy was higher in the intervention group than in the control group [18]. A study by Azhari et al. showed that face-to-face breastfeeding instruction was associated with increased breastfeeding self-efficacy at 8 weeks postpartum [19]. This finding is in line with the results of the present study. The present study, not only highlighted the benefits of breastfeeding for primiparous women, also gave these mothers the opportunity of talking to a specialist with 28 years of work experience if they had a question. This was an advantage of the present study with Azhari's study.
Limitations of this study were the small sample size, the unwillingness of some mothers to participate in the research (given that most mothers were employed, perhaps one of the reasons for their unwillingness was their work). Since these limitations may adversely affect the generalizability of the findings and limit the findings, future research with larger sample size and other supportive methods is suggested. Educational interventions for inexperienced and primiparous mothers can also be seriously considered in health policy making.

 

This study is based on the Master's Degree in Pediatric Nursing with Code of Ethics IR.IAU.CHALUS.REC.1397.005 and Clinical Trial Code IRCT20181208041889N1, approved by the Islamic Azad University of Chalus. We are grateful to the directory of Shahroud University of Medical Sciences and the Shahroud Maternity Preparation Centers which contributed to this study.

 

No conflict of interest was declared.