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Outcome Measures in Interventions That Enhance Breastfeeding Initiation, Duration, and Exclusivity

A Systematic Review

Wood, Natsuko K., PhD, RN; Woods, Nancy F., PhD, RN, FAAN

MCN: The American Journal of Maternal/Child Nursing: November/December 2018 - Volume 43 - Issue 6 - p 341–347
doi: 10.1097/NMC.0000000000000472

Objective: The purpose of this review was to examine outcome measures used in interventions focusing on enhancement of breastfeeding initiation, duration, and exclusivity.

Methods: A literature search guided by search terms on outcome measures of breastfeeding interventions was conducted using PubMed, CINAHL Plus, & PsycINFO databases on publications between 2006 and 2017.

Results: Nine studies were included in this review, using PRISMA guidelines. Rates of breastfeeding initiation, duration, and exclusivity were measured during specific points in time. Data collection methods involve interviews, self-report, observations, and/or feeding logs. Although breastfeeding types (exclusive breastfeeding, predominant breastfeeding, and complementary breastfeeding) were measured, methods of infant feeding (breastfeeding and bottle feeding) were rarely assessed, ignoring significant mediators or moderators of breastfeeding.

Conclusions: There were methodological limitations to the reviewed studies: (1) a 24-hour recall bias, (2) misclassification of breastfeeding categories, (3) lack of consistency in breastfeeding definitions, and (4) few reports of the reason for breastfeeding discontinuation. Future studies should focus on the modifiable cause of the problem: outcome measures attributed to the targets of the intervention, followed by breastfeeding initiation, duration, and/or exclusivity.

This systematic review highlights gaps in the literature on interventions to promote breasting. Without a core set of measures that are consistently used by breastfeeding researchers, it is challenging to identify and design interventions that help new mothers meet their breastfeeding goals.

Natsuko K. Wood is an Assistant Professor, College of Nursing, Washington State University, Spokane, WA. The author can be reached via e-mail at

Nancy F. Woods is a Professor Emerita, School of Nursing, University of Washington, Biobehavioral Nursing and Health Systems, Seattle, WA.

The authors declare no conflicts of interest.

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