Effect of a competency-based nurse-led exclusive breastfeeding training program on nurses’ counseling competence and postpartum mothers’ breastfeeding self-efficacy: A quasi-experimental study in Egypt

Abstract

Background: Exclusive breastfeeding (EBF) is a highly cost-effective public health strategy that reduces infant morbidity and mortality and improves maternal health outcomes. However, EBF rates remain below global targets, particularly in low- and middle-income countries (LMICs). Aim: To evaluate the effect of a structured, competency-based nurse-led EBF training program on maternity nurses’ breastfeeding knowledge and counseling competence and to examine its association with postpartum mothers’ breastfeeding self-efficacy and exclusive breastfeeding outcomes. Methods: A quasi-experimental pre–post intervention study was conducted in the postpartum wards of Benha University Hospitals, Egypt. Forty-three maternity nurses were assessed at baseline, immediately post-intervention, and at 3-month follow-up. Postpartum mothers (N = 162) were recruited in three phase-based repeated cross-sectional cohorts (n = 54 per phase). Nurse outcomes included breastfeeding knowledge and observed counseling competence. Maternal outcomes included breastfeeding self-efficacy measured using the Breastfeeding Self-Efficacy Scale–Short Form and exclusive breastfeeding status assessed at 6 months using WHO/UNICEF Infant and Young Child Feeding indicators. Results: Nurses demonstrated significant improvements in breastfeeding knowledge and observed counseling competence immediately post-intervention (p < .001), with gains sustained at 3-month follow-up. Mothers who received counseling after the nurse-led EBF training program demonstrated greater improvements in breastfeeding self-efficacy and maintained exclusive breastfeeding for longer durations compared with mothers counseled during the pre-training phase. Conclusion: A structured competency-based nurse-led exclusive breastfeeding training program improved nurses’ counseling competence and was associated with enhanced maternal breastfeeding self-efficacy and longer exclusive breastfeeding duration. Workforce-strengthening interventions may represent a feasible and scalable strategy to improve postpartum breastfeeding outcomes in LMIC hospital settings.