Promoção do aleitamento materno a partir de uma intervenção educativa de longa duração mediada por telefone: ensaio clínico randomizado controlado

Abstract

The aim of this study was to analyze the effects of a long-term telephone educational intervention on the self-efficacy, duration and exclusivity of breastfeeding up to the sixth month of the child's life. It is a Controlled Randomized Clinical Trial in which two groups were evaluated: Control Group (CG) that received standard care (care provided by the hospital routine) and the Intervention Group (IG), which received standard care and educational intervention. The educational intervention was supported by the breastfeeding self-efficacy framework and other relevant literature on the subject, using the motivational interviewing approach. Study developed at Gonzaga Mota de Messejana District Hospital in Fortaleza-CE between October/2016 and July/2017 with a sample of 240 women (CG=120 and IG=120). The study was developed in three phases: 1. Baseline; 2. Intervention (at 7, 30, 90 and 150 days postpartum); 3. Evaluation of the outcomes (at 60, 120 and 180 days postpartum). In the statistical analysis, the chi-square test and Fisher’s exact test were used to compare the categorical variables and the Mann-Whitney U test to compare the numerical variables. Spearman's coefficient was used to correlate sociodemographic, obstetric and self-efficacy scores with the duration and exclusivity of breastfeeding. The research was approved by the Ethics and Research Committee under protocol 42495114.4.0000.5054 and registered in the Brazilian Registry of Clinical Trials (ReBEC) platform. The sample was homogeneous (p> 0.05), except for hours outside the home (p = 0.019). In the intergroup assessment of self-efficacy, it was evident that the CG, despite having started with a higher median score, maintained these scores throughout the outcome evaluations, whereas the IG presented median scores higher than the CG with 60 (p = 0.000), 120 (p = 0.000) and 180 days (p = 0.000). Regarding the rates of BF and EBF, it was observed that at 60 (p = 0.000) and 120 days (p = 0.001) the IG had higher BF rates than the CG, and at 180 days IG presented BF (p = 0.012) and EBF (p = 0.005) higher than CG. In the intergroup evaluation of the BF duration, IG had a final duration of BF (p = 0.000) and EBF (p = 0.000) higher than CG. The self-efficacy scores of 60 and 120-day women showed a positive correlation with duration of BF and EBF, while the 180-day scores correlated only with the EBF duration. Among the factors related to the shorter duration of BF are the practice of physical exercise and the return of women to work and / or studies at two and four months. The factors related to the interruption of EBF were not receiving a home visit, lack of orientation about the BF and return to work and / or study at four months. The number needed to treat (NNT) was 8 women, which justifies the choice of the intervention, since it is necessary to follow a small number of women to avoid that one interrupts the BF. Thus, the data showed that a long-term educational intervention focused on the self-efficacy assumptions and using the telephone-mediated motivational interview approach is effective in increasing maternal self-efficacy for breastfeeding, rates and duration of BF and EBF. It has been shown that the telephone is a viable technology to be used as support for educational practices. In addition, the use of an intervention that works on maternal trust and the mother´s motivation to breastfeed contributes to improving breastfeeding rates