Effectiveness of an IMB Model-Based Web Breastfeeding Education Program

This study is designed to evaluate the effectiveness of a Web-Based Breastfeeding Education Program based on the Information-Motivation-Behavioral Skills (IMB) Model among primiparous women. The research aims to assess the program's impact on breastfeeding self-efficacy, maternal motivation, breastfeeding-related problems, and exclusive breastfeeding rates. Background Although breastfeeding is universally recognized as the optimal and natural method of infant nutrition, both global and national rates remain below desired levels. According to the 2018 Turkey Demographic and Health Survey (TDHS), breastfeeding is initiated at high rates within the first hour postpartum; however, continuation of exclusive breastfeeding until six months remains limited. Key barriers include inadequate maternal knowledge, insufficient social support, and limited access to professional counseling. Nurses play a pivotal role in supporting breastfeeding through education and counseling, yet time constraints, limited staff availability, and accessibility challenges restrict face-to-face counseling. With the rapid expansion of digital technologies, web-based interventions have become promising alternatives for delivering breastfeeding education. Prior studies have shown that technology-assisted interventions improve maternal knowledge, motivation, and breastfeeding outcomes. Objectives and Hypotheses The primary objective of this study is to evaluate the effectiveness of a web-based breastfeeding education program structured according to the IMB Model. It is hypothesized that the program will improve maternal breastfeeding knowledge, motivation, self-efficacy, and exclusive breastfeeding rates while reducing breastfeeding-related problems compared to routine care. Study Design The study will be conducted in two phases: Phase 1 - Development of the Breastfeeding Knowledge Test (ASEBT): A 30-item multiple-choice test will be developed to assess breastfeeding knowledge. Test items will be prepared based on literature review, Bloom's cognitive taxonomy, and expert consultation. Content validity will be evaluated through expert review (n=9). The test will be administered to 300 pregnant women meeting the inclusion criteria. Reliability will be assessed using the Kuder-Richardson (KR-20) coefficient; items with KR-20 below 0.60 will be excluded. Phase 2 - Randomized Controlled Trial (RCT): Sample and Randomization: A total of 80 primiparous pregnant women (≥32 weeks gestation, ≥19 years, literate, with access to internet-enabled devices) will be recruited from a university hospital's obstetrics outpatient clinic. Participants will be randomly assigned to intervention (n=35) and control (n=35) groups using a computer-generated randomization schedule. Exclusion criteria include mental or sensory impairments, psychiatric diagnoses, high-risk pregnancies, or prior structured breastfeeding education. Intervention Group: Participants will complete a five-module web-based breastfeeding education program based on the IMB Model, which includes: The Importance of Breastfeeding and Breast Milk Understanding Infant Needs and Breastfeeding Techniques Common Breastfeeding Problems and Management Mother-Infant Bonding and Secure Attachment Stress Management during the Breastfeeding Process The program incorporates interactive educational videos, digital breastfeeding guides, mini knowledge tests, motivational messages, virtual badges, and digital achievement certificates. Modules must be completed sequentially by 37 weeks of gestation. Control Group: Participants will receive routine hospital-based breastfeeding education only. After study completion, the web-based program will be made available to the control group. Follow-Up and Assessments: Baseline (32-34 weeks): Individual Information Form, ASEBT (pre-test), Antenatal Breastfeeding Self-Efficacy Scale, Visual Analog Scale (VAS-Motivation). 37 weeks gestation: ASEBT (post-test), Antenatal Breastfeeding Self-Efficacy Scale, VAS-Motivation. Within 48 hours postpartum: Postnatal Breastfeeding Self-Efficacy Scale, Breastfeeding Motivation Scale, Breastfeeding Problems Assessment Scale, Postpartum Follow-up Form 1. 1 month postpartum: ASEBT, Postnatal Breastfeeding Self-Efficacy Scale, Breastfeeding Motivation Scale, Breastfeeding Problems Assessment Scale, Postpartum Follow-up Form 2, exclusive breastfeeding status. Data Collection Tools Breastfeeding Knowledge Test (ASEBT) - developed in Phase 1. Antenatal and Postnatal Breastfeeding Self-Efficacy Scales Visual Analog Scale (VAS) for Motivation - to measure antenatal motivation. Breastfeeding Motivation Scale - adapted for Turkish mothers Breastfeeding Problems Assessment Scale - validated Turkish version Postpartum Follow-up Forms - developed based on current literature. Statistical Analysis Data will be analyzed using SPSS 22.0. Normality will be tested prior to analysis. Descriptive statistics (mean, SD, frequency, percentage) will be calculated. Independent samples t-tests will be used to compare group means, and Pearson correlation will assess relationships between variables. Results will be evaluated at a 95% confidence interval with a significance level of p\<0.05. Ethical Considerations Ethical approval have been obtained from Ankara Yıldırım Beyazıt University Ethics Committee and institutional permissions have been secured. Permissions for the use of all scales have been requested from the original authors. Participation will be voluntary, and written informed consent will be obtained from all participants. The principles of confidentiality, respect for autonomy, and beneficence/non-maleficence will be strictly observed. Expected Contributions This study is expected to provide evidence on the effectiveness of web-based, IMB model-guided breastfeeding education in improving maternal knowledge, motivation, and self-efficacy while reducing breastfeeding problems. By supporting exclusive breastfeeding practices, the intervention may contribute to improved maternal and child health outcomes. Findings are anticipated to guide the integration of technology-assisted interventions into routine nursing practice and to promote the wider dissemination of digital breastfeeding education programs.