sahar shafeek mohamed afify
Lecturer
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
Midwifery • 2026
Publication Information
Authors
Elsokary, E. A., Afify, S. S. M., Mohamed, A. Z., Elkady, A. Z., Khalil, M. I. M., & Hassan, M. M.
Keywords
Keywords: exclusive breastfeeding, nurse-led training, counseling competence, breastfeeding self-efficacy, postpartum care, low- and middle-income countries.
Journal
Midwifery
Publisher
Elsevier
Volume
Volume 160
Issue
September 2026
Pages
104890
publication.type
International
Paper Link
Open Link
Supplementary Materials
Not Available
Abstract
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.
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.