Promoting breastfeeding through digital communication: a longitudinal randomized controlled trial

Introduction Breastfeeding is a key early-life primary prevention behavior; yet, despite consistent recommendations and recent improvements, exclusive breastfeeding rates remain well below target levels. This preregistered longitudinal randomized controlled trial (RCT) tested the effectiveness of two resource-efficient digital communication interventions. Methods Women in the 36th week of pregnancy (N = 467) were randomly assigned to one of six conditions in a 2 × 3 between-participants design. The first intervention consisted of informational messages targeting components of the extended Theory of Planned Behavior (TPB). The second intervention was a drip communication campaign delivered via mobile phone messages: participants in the tips condition received messages aimed at increasing practical breastfeeding knowledge and skills, whereas participants in the implementation intentions condition were additionally prompted to formulate specific if-then plans. Control groups received messages related to healthy eating and physical activity. Participants were followed up until 5 months postpartum. Results The TPB-based intervention exerted indirect effects on both full and any breastfeeding duration by increasing breastfeeding self-efficacy and perceived behavioral control, which in turn enhanced exclusive breastfeeding intentions. For full breastfeeding only, the intention-behavior relationship—and thus the indirect effect of the TPB intervention—was strengthened by both the tips and implementation intentions interventions. Higher levels of self-objectification indirectly reduced breastfeeding duration through weaker identification as a breastfeeding mother and lower intentions. Discussion Delivering simple, resource-efficient digital communication interventions that empower mothers and support the translation of intentions into sustained behavior represents a scalable strategy to promote exclusive breastfeeding.