Health visitors and breastfeeding support:: influence of knowledge and self-efficacy

Background: Little is known about what influences health visitors' breastfeeding support. The objective was to describe health visitors' breastfeeding experiences, beliefs, knowledge and self-efficacy in breastfeeding guidance and determine the impact of a training course on these factors, and how they were reflected in practice. Methods: A randomized intervention study enrolled 52 health visitors in the intervention group and 57 in the comparison group. The intervention group participated in an 18-hour pre-study training course that focused on knowledge about lactation and how to guide the mother to learn the mechanisms of breastfeeding. Data were collected through self-administered questionnaires before the intervention and after the follow-up period. One hundred and six (97%) health visitors and 1302 (82%) mothers responded. Results: At baseline no substantial differences were seen between the two groups on years since education, own breastfeeding experiences, beliefs or self-efficacy in breastfeeding guidance except that health visitors in the intervention group, who had completed the course, demonstrated significantly higher scores on knowledge questions (P < 0.01). After the intervention health visitors in the intervention group reported significantly higher self-efficacy in guidance on three of five breastfeeding problems (P < 0.01). Mothers in the intervention group reported having received more support than mothers in the comparison group. Conclusion: An interactive course increased the health visitors' knowledge of breastfeeding practice. After the intervention period the health visitors in the intervention group had increased their self-efficacy in helping mothers with common breastfeeding problems. The mothers in the intervention group reported more informational and instrumental breastfeeding support.