Midwifery 69 (2019) 143–149

Contents lists available at ScienceDirect

Midwifery
journal homepage: www.elsevier.com/locate/midw

Evaluating effects of prenatal web-based breastfeeding education for

pregnant mothers in their third trimester of pregnancy: Prospective
randomized control trial
Jamila Abuidhail∗, Lina Mrayan, Dima Jaradat
Faculty of Nursing, Hashemite University, P.O. Box 330133, Zarqa, 13133, Jordan

a r t i c l e i n f o a b s t r a c t

Article history: Background: Education is the cornerstone supporting breastfeeding practices. However, the traditional
Received 9 March 2018 oral education method cannot always satisfy the learning needs of mothers.
Revised 20 November 2018
Objective: to measure the effectiveness of prenatal web-based breastfeeding education program for Jor-
Accepted 28 November 2018
danian pregnant mothers in their third trimester of pregnancy on enhancing knowledge, attitude, and
self-efficacy of breastfeeding after giving birth.
Keywords: Methods: prospective randomized control trial design was used with sample consisted of 112 pregnant
Breastfeeding mothers who were recruited from one antenatal clinic in Irbid Governorate. Data collection instruments
Self efficacy were the infant feeding knowledge and attitudes (IIFAS) and Breastfeeding Self-Efficacy Scale (BSES) were
IIFAS
used to measure self efficacy, knowledge and attitudes regarding breastfeeding.
BSES
Results: Participants of the experimental group were at moderate level of BSES in pre and post inter-
Antenatal education
vention with increasing the number of mothers in the same level post intervention. Participants were
at a neutral level of IIFAS in both groups generally, they were neither positive to breastfeeding nor to
bottle feeding. There was no significant difference between the experimental and control groups on post-
intervention scores on BSES and IIFAS.
Conclusion: This study is considered the first trial to use new teaching methodologies as internet and
website in teaching mothers about breastfeeding. Despite that there were not differences between in-
tervention and control groups, web-based breastfeeding education program may contribute in improving
breastfeeding self efficacy.
Implications: Inclusion prenatal web-based breastfeeding education in antenatal clinics at MCHC centers
of Ministry of Health. Further research is needed to replicate this study in other Jordanian health settings.
© 2018 Elsevier Ltd. All rights reserved.

Introduction of teaching, by informing pregnant mothers about benefits and

Breastfeeding improves intellectual, neurological, psychomotor
and social development. It provides long-term protection as it
lowers the risk of development of many chronic diseases later
in life. In addition, breastfeeding decreases the incidence of
neonatal complications, respiratory problems and other illnesses
(Olang et al., 2009). In order to promote breastfeeding and en-
courage mothers to comply with the recommendations of the
World Health Organization (WHO, 2008), pregnant mothers are
in need for teaching, which is a process used to deliver infor-
mation to the others. Teaching is considered the cornerstone in
enhancing breastfeeding success. However, the traditional methods
∗
Corresponding author.
E-mail addresses: jabuid@hu.edu.jo (J. Abuidhail),
(L. Mrayan), dimanurse@yahoo.com (D. Jaradat).
management of breastfeeding in orally, were not effective enough
to enhance breastfeeding (Huang et al., 2007). In contrast, using
the internet and technology to educate mothers through the ante-
natal period gives better outcomes for mothers and their newborn
infants. This is because the Internet can combine words, pictures,
videos, animations, images and anything related to multi-media
(Huang et al., 2007). The web-based education is a flexible method
of teaching. It allows the learners to find the required information
according to their learning needs (Cheng et al., 2003). Huang et al.,
(2007) found that the web-based breastfeeding education has a
positive effect on breastfeeding rates during follow-up periods.
Huang et al. (2007) study found that, if the health care providers
provide the pregnant women with the effective breastfeeding
education during the third trimester of their pregnancy, the
breastfeeding duration will be prolonged. It was found that the
lina285@gmail.com

https://doi.org/10.1016/j.midw.2018.11.015
0266-6138/© 2018 Elsevier Ltd. All rights reserved.
144 J. Abuidhail, L. Mrayan and D. Jaradat / Midwifery 69 (2019) 143–149
prevalence of EBF as recommended by WHO was 1% in Jordan with
one month as an average duration of EBF (Abuidhail et al., 2014).
Perception of self-efficacy is an important indicator to deter-
mine the actions an individual will take or reject. Breastfeed-
ing self-efficacy is the confidence the mother feels pertaining
to breastfeeding (Dennis, 2003). It was determined that moth-
ers with low breastfeeding self-efficacy might discontinue breast-
feeding for their infants earlier than the recommended period by
WHO (2008). While mothers with high breastfeeding self-efficacy
experience fewer problems in starting and maintaining breastfeed-
ing (Dennis, 2003).
Many studies have indicated that the education and training re-
garding breastfeeding have positive effects on the mothers’ will-
ingness to breastfeed, breastfeeding self efficacy and incidence
of breastfeeding problems (Abuidhail et al., 2017; Küçükoğlu and
Çelebioğlu, 2014; Dennis, 2003). If a woman has more knowledge
about breastfeeding and a more positive attitude towards breast-
feeding, she may be more likely to breastfeed her baby and extend
the duration of breastfeeding (Huang et al., 2007).
Antenatal breastfeeding education is an important way to en-
courage and prepare mothers for positive breastfeeding experi-
ences (Rempel and Moore, 2012; McDonald et al., 2010). Further-
more, antenatal education about breastfeeding enhances the rates
and duration of breastfeeding (Su et al., 2007).
In Jordan, using information technology very common. It has
been found that the percentage of households having access to the
internet at home are 69.2% and the percentage of Computer users
age 5 years and above is 36.9% (Department of Statistics (DoS),
2015). Furthermore, the percentage of households having mobile
phones is 98.7%. The percentages of females who have internet ac-
cess and use it according to age groups are: in the age group of
(15–19) is 60.4%, the age group (20–24) is 78%, age group (25–29)
is 71%, and age group (30–34) is 71% (DoS, 2015). On the other
hand, 80% of Jordanian women own smart phones (Ghazal, 2016).
Since Jordanian women have an easy access to the internet and
the computer, we planned to use these technological facilities to
educate pregnant women during their third trimester about breast-
feeding.
Therefore, the current study is the only and the first study in
Jordan that aims to measure the effectiveness of prenatal web-
based breastfeeding education program for Jordanian pregnant
mothers in their third trimester of pregnancy on enhancing knowl-
edge, attitude, and self-efficacy of breastfeeding after giving birth.
Methods
Design
A prospective randomized control trial design was selected for
the purpose of this study to measure the effectiveness of prenatal
web-based breastfeeding education program on enhancing knowl-
edge, attitude and self-efficacy of breastfeeding after giving birth.
Sample
The inclusion criteria for this study was: any pregnant mother
in her third trimester of pregnancy between 29 and 36 weeks ges-
tation, her age ≥18 years old, has not major obstetrical or medical
pregnancy complications, she is planning to breastfeed at the time
of enrollment, she uses the Internet on a daily basis through her
computer or smart phone and giving a consent to participate in
the study - was recruited to this study using a consecutive sam-
pling technique.
The sample size was calculated by using a powerful analysis
method. Hence this study was an experimental design, and to max-
imize the probability of detecting significant finding a statistical
power of 0.9 was used, at the level of significance 0.05. A small ef-
fect size of 0.3 was used because the intervention in this study has
not been tested before. According to power analysis, the sample
size required for this study was 118 pregnant mothers considering
20% of the actual sample to replace withdrawn cases and attrition
rate. This sample was divided into two groups (intervention and
control groups) (Polite and Beck, 2012).
Setting
Antenatal clinic in the Northern Region of Jordan, specifically in
Irbid Governorate were visited to recruit the participants of this
study. Only one antenatal clinic was selected in order to mini-
mize confounding variable that may interfere with the interven-
tion effect. This governorate is considered one of the main gover-
norates in Jordan. It is the second largest governorate in population
(1,77,158) (DOS, 2016).
Ethical issues
The study was presented to the Hashemite University to gain
the Institutional Review Board (IRB) approval for data collection.
The participants in the study signed voluntary an informed con-
sent form if they agreed to participate. All data of the participants
were kept confidential by the principal investigator and was used
for the research and scientific purposes only. The participants have
the choice to withdraw from the study at any time without affect-
ing their health care in the antenatal clinic. The researcher was the
only person who can access the data of the participants. This infor-
mation was annynomus after coding. Then they were deleted upon
finalizing the research study.
Data collection tools
1) The infant feeding knowledge and attitudes (IIFAS): consisted
of a 17-items. It is used to measure knowledge and attitudes
of mothers. Participants respond to equally weighted items
on a 5-point Likert scale ranging from strongly disagree to
strongly agree. The instrument includes both knowledge and at-
titude items. Approximately half the items are worded support-
ing breastfeeding and the remaining items supporting formula
feeding. Items favoring formula feeding are reverse-scored and
a total score is computed by summing all items (de la Mora
et al., 1999). The range of total attitude scores ranges from 17
to 85 with higher scores reflecting attitudes more positive to
breastfeeding. Total scores are divided into three categories: (1)
positive to breastfeeding (70–85), (2) neutral (49–69), and (3)
positive to formula feeding (17–48). Internal consistency of the
IIFAS ranged from 0.79 in Scotland to 0.86 in the US and 0.77
in a Scottish study of fathers’ attitudes (Dungy et al., 2008).
2) Breastfeeding Self-Efficacy Scale (BSES): was initially developed
by Dennis (2003) to assess mothers’ breastfeeding self efficacy.
It was composed of 33 items. However, in 2003, a 14-item
short form of the scale was developed to be used instead of
the original form (Dennis, 2003). Knowing that the lowest point
that can be scored on the scale is 14 and the maximum is 70.
Higher points scored indicate high breastfeeding self-efficacy.
The score of the breastfeeding self-efficacy scale varies from 14
to 70 points. When the respondent obtains between 14 and 32
points, she is considered to have Low efficacy; between 33 and
51, Moderate; and between 52 and 70, High efficacy (Souza and
Fernandes, 2014). The validity and reliability study of the scale
for the Turkish was carried out by Tokat (2009), and its Cron-
bach’s alpha value was found to be 0.86.
 J. Abuidhail, L. Mrayan and D. Jaradat / Midwifery 69 (2019) 143–149 145

Prenatal web-based breastfeeding program Table 1

Demographic characteristics of the sample (experimental and control
groups).
Web-based breastfeeding education program: the program can
be visited by the participating mothers through visiting a website Experimental group Control group
Characteristics N % N %
from their own computers or smart phones or any device can be
connected with internet. Participating mothers can visit the web- Educational level
site as much as they need according to their queries during the Primary and secondary 15 27.3 28 50.9
Diploma 4 7.3 3 5.5
time period of education sessions (two weeks prenatally).
BSN 32 58.2 22 40
The web-based breastfeeding education program composed of Master 4 7.3 2 3.6
many topics as: the benefits of breastfeeding, mechanism of lacta- Missing 1 1.8 1 1.8
tion, techniques of breastfeeding, breastfeeding problems and solu- Total 56 100 56 100
Employment status of the mother
tions, contraindications to breastfeeding and human milk storage.
Employed 13 23.6 9 16
Teaching media included texts, animations, pictures, and videos. Housewife 42 76.7 47 84
The education material on this website was evaluated by a certified Parity
lactation consultant and three experts in the field of maternal and Primipara 29 52.7 18 32
child health care nursing. Then it was modified according to their Multipara 27 47.3 38 68
Gender of infant
notes and critique. Therefore the content validity of the education
Male 23 47 30 55.6
material was maintained before its presentation to the mothers. Female 26 53 24 44.4
Mode of delivery
Data collection procedure NVD 24 49 35 67.3
C/S 25 51 17 32.7

A trained research assistant contacted the pregnant mothers

during the prenatal visits in a selected private antenatal clinic
in Irbid governorate. The research assistant informed the moth-
ers about the study nature and its purpose. If a mother agreed to
participate, she would receive a letter clarifying the study. Then
she would sign the consent form. After that, she completed the
pretest about breastfeeding knowledge, attitude and self- efficacy.
Each participant in the experimental group would be given an ac-
cess to the website of the education program. Each mother in
the control group would be remained without any access to the
website. So they would be dealing with breastfeeding according
to the knowledge and information from their experience or rela-
tives. Their physician and the nurse in the selected clinic did not
offer breastfeeding support educational sessions. Further, the in-
tervention was blinded to the women at the control group. After
three days, participants were reminded to use mobile text mes-
sages to read the website information and watch videos and im-
ages about breastfeeding. Two weeks after the expected date of
delivery, each mother either in experimental or control group was
communicated by phone to complete the post intervention as-
sessment about breastfeeding knowledge, attitude, and self-efficacy
and to ask the mothers about their experience with the website
education. Telephone contact was used to ask the participating
mothers about the duration of breastfeeding at two weeks post-
partum. Two weeks after the giving birth is a crucial period of
breastfeeding because of emerging difficulties. Such problems are
the insufficiency of milk, the swelling of breasts, the baby’s refusal
of drinking milk, and the tiredness of the woman (Huang et al.,
2007).
Data analysis
The data were analyzed using SPSS version 17. Descriptive
statistics were obtained to describe the sample characteristics.
An ANCOVA test was used to determine the differences between
the intervention and control group in order to measure the ef-
fectiveness of the web-based breastfeeding education program at
(p < 0.05).
Results
The total sample was 118 pregnant mothers who enrolled in
this study. After allocating them randomly to experimental and
control groups at the beginning of the study, six mothers withdrew
from the study after completing the pre- intervention assessment.
So the sample size became 112 pregnant mothers in both groups
(Fig. 1).
The randomization process was done using an online Ran-
domizer. The total sample in the intervention group was (n = 56,
50%) and a comparison group was (n = 56, 50%). The mean age
of the participants was (27.7, SD = 4.9), their age varied between
17 and 39 years old. Most of the participants were multiparous
(n = 63, 56.8%) and nulliparous were (n = 48, 43.2%). The house-
hold income of the participants ranged between $140 and $1400
(mean = $406, SD = $276.3) monthly. Around half of participating
mothers educated to bachelor degree level (n = 54, 49%), and 80.2%
of them were housewives (n = 89). Fifty eight percent of the sam-
ple (n = 59) gave birth through normal vaginal delivery (Table 1).
The above mentioned demographics (age, parity, gender of the
infant, income level, education level and working status) were in-
cluded in the analysis to find if any of them is different between
intervention and control group. However, after assessing the data
there were no differences between the two groups in terms of the
demographics, which means the results were not skewed.
Breastfeeding self efficacy scale (BSES)
The participating mothers in this study were assigned randomly
to experimental and control group with allocation ratio 1:1. After
both groups have completed pre intervention and post interven-
tion of BSES, the results showed that most of the participants were
at the moderate level of self efficacy in both groups. Participants
of the experimental group at the moderate level of BSES in the
pre intervention was (n = 36, 64.3%) and in post intervention was
(n = 45, 80.4%). However, the participants in the control group at
the moderate level of BSES in the pre intervention (n = 38, 67.9%)
and post intervention (n = 39, 69.6%). Although a number of the
participants in the experimental group at a moderate level after
exposing to the intervention increased more than the participants
in the control group after they exposed to routine care, none of
them reached the level of high of BSES (n = 11, 19.6% in pre inter-
vention; n = 10, 17.9% in post intervention) (Table 2).
The infant feeding knowledge and attitudes (IIFAS)
The results also showed that the participants were at a neutral
level of IIFAS in both groups generally, they were neither pos-
itive to breastfeeding nor to bottle feeding. Participants of the
146 J. Abuidhail, L. Mrayan and D. Jaradat / Midwifery 69 (2019) 143–149

Fig. 1. CONSORT 2010 flow diagram.

Table 2 ever, the participants in the control group who were neutral in
Description BSES scores between experimental and control groups.
the pre intervention was (n = 51, 91.1%) and post intervention was
Pre test assessment Post test assessment (n = 55, 98.2%). Although a number of the neutral participants in
N % N % the control group were slightly more than the participants in the
Experimental group experimental group after they exposed to the intervention, none
Low BSES (14–32) 9 16.1 1 1.8 of them have positive attitude towards breastfeeding (Table 3).
Moderate BSES (33–52) 36 64.3 45 80.4
High BSES (34–70) 11 19.6 10 17.9
Analysis of covariate (ANCOVA)
Control group:
Low BSES (14–32) 4 7.1 – –
Moderate BSES (33–52) 38 67.9 39 69.6 A one-way ANCOVA between-group analysis of covariance
High BSES (34–70) 14 25.00 17 30.4 was conducted to compare the effectiveness web-based antena-
Total 112 100 112 56
tal breastfeeding program designed to increase the self efficacy
of breastfeeding of pregnant mothers after giving birth. The in-
dependent variable was the type of group either the experimen-
experimental group who were neutral in the pre intervention was tal group or control group. The dependent variable was the total
(n = 50, 89.3%) and in post intervention was (n = 54, 96.4%). How- score of BSES post introducing the intervention to the experimental
 J. Abuidhail, L. Mrayan and D. Jaradat / Midwifery 69 (2019) 143–149 147

Table 3
Description IIFAS scores between experimental and control groups.

Pre test assessment Post test assessment

N % N %

Experimental group
Positive to breastfeeding (70–85) 4 7.1 1 1.8
Neutral (49–69) 50 89.3 54 96.4
Positive to formula feeding (17–48) 2 3.6 1 1.8
Control group
Positive to breastfeeding (70–85) 1 1.8 – –
Neutral (49–69) 51 91.1 55 98.2
Positive to formula feeding (17–48) 4 7.1 1 1.8
Total 112 100 112 56

Table 4
Evaluation of participating mothers in the experimental group who had an access to the website.

What is your opinion about What is your opinion about What is your opinion about images
knowledge of the website? presentation methods of the website? and videos on the website?
Answers
N % N % N %

Excellent 5 9 8 14.3 11 25.1

Beneficial 12 21.8 N.A N.A 8 14.3
Good 20 34 25 44.7 21 37.5
Interesting and 1 1.8 12 21.5 2 3.6
organized
Did not read or 17 30.4 11 19.7 14 25
use it
Difficult to 1 1.8 0 0 0 0
understand

group and the routine care control group. Participants’ scores
pre intervention administration of BSES as covariate. Preliminary
checks were conducted to ensure that there was no violation of
the assumptions. After adjusting for pre- intervention scores, there
was no significant difference between the experimental and con-
trol groups on post- intervention scores on BSES [F(1,109 ) = 1.5,
p = 0.22, partial eta squared = 0.014].
A one-way ANCOVA between-group analysis of covariance
was conducted to compare the effectiveness web-based antena-
tal breastfeeding program designed to increase the knowledge and
attitude regarding breastfeeding of pregnant mothers after giving
birth. The independent variable was the type of group either the
experimental group or control group. The dependent variable was
the total score of IIFAS post introducing the intervention to the
experimental group and the routine care control group. Partici-
pants’ scores pre intervention administration of IIFAS as covari-
ate. Preliminary checks were conducted to ensure that there was
no violation of the assumptions. After adjusting for pre- interven-
tion scores, there was no significant difference between the exper-
imental and control groups on post- intervention scores on IIFAS
[F(1,109 ) = 0.243, p = 0.62, partial eta squared = 0.002].
Web site evaluation
During follow up phone interviews with participating mothers
of the experimental group, they were asked to complete post in-
tervention assessment and to evaluate the website that was used
in the intervention. The results showed that (n = 17, 30.4%) of the
participating mothers did not read the knowledge in the web-
site, which has been described as long articles to be read. Further,
(n = 14, 25%) of the participating mothers did not watch or take use
of images and videos on the website. On the other hand (n = 20,
34%) of them described knowledge as ‘good’ and around 40%
(n = 21) evaluated images and videos as ‘good’ (Table 4). Fewest
number of participating mothers evaluated the knowledge of the
website, images and videos as ‘excellent’.
Discussion
The purpose of this study was to measure the effectiveness of
prenatal web-based breastfeeding education program for Jordanian
pregnant mothers in their third trimester of pregnancy on enhanc-
ing knowledge, attitude, and self-efficacy of breastfeeding after giv-
ing birth. To our knowledge, this study was the first and the only
one to assess the effectiveness of web-based breastfeeding educa-
tion as an intervention in antenatal care practice and the website
is the first one of its kind that is in Arabic language and specialized
in topics of breastfeeding only.
As the results indicated the effectiveness of the prenatal web-
based breastfeeding education program enhanced the breastfeed-
ing self efficacy of the participating mothers in the experimental
group after giving birth (post intervention) to moderate level. Al-
though most of the participating mothers in the this group were in
the moderate level pre intervention, the number of mothers in this
level increased from (n = 36, 64.3%) pre-intervention assessment to
(n = 45, 80.4%) post intervention assessment during the postpar-
tum period. However, participating mothers of the control group
in the moderate level were the same in the pre and post interven-
tion assessments. Similarly, knowledge and attitudes of the partic-
ipating mothers in the intervention group were neutral before and
after intervention. However the number of mothers who were neu-
tral increased from (n = 50, 89.3%) pre-intervention assessment to
(n = 54, 96.4%) post intervention assessment in the experimental
group.
Self efficacy of participating mothers in the experimental group
had not reached the desired level as hypothesized in this study.
The results of this study were similar to Huang et al. (2007)
results who found that using web-based breastfeeding education
can initiate the learning process of the pregnant woman then
she learn the knowledge of breastfeeding through self-study. So
enough understanding and confidence of woman’s self in breast-
feeding can be strengthened (Huang et al., 2007). This is because
the effect of maternal confidence on breastfeeding outcomes as
Ertem et al. (2001) revealed that pregnant women who have low
148 J. Abuidhail, L. Mrayan and D. Jaradat / Midwifery 69 (2019) 143–149
level of confidence in their ability to breastfeed were more likely
to stop breastfeeding before two weeks postpartum.
Knowledge and attitudes of participating mothers in the exper-
imental group had not been enhanced to the positive attitudes to-
wards breastfeeding. However, participating mothers in the exper-
imental group kept neutral. This means they are not supporting
breastfeeding nor bottle feeding, both were at the same level for
them. Further, no significant differences were found between ex-
perimental and control group after providing the education mate-
rial via the web-based education to the experimental group. These
results could be explained by the evaluation of the mothers in the
experimental group (Table 4). Around one third of them did not
read the knowledge in the website and one quarter of them did
not watch or take use of images and videos on the website. One
third also of the mothers in the experimental group evaluated the
web site’s knowledge as ‘good’ and around 40% (n = 21) evaluated
images and videos as ‘good’. Fewest number of participating moth-
ers (n = 5, 11%) evaluated the knowledge of the website as ‘excel-
lent’ and (n = 11, 25%) evaluated the images and videos as ‘excel-
lent’.
So the participating mothers did not read the knowledge effec-
tively where most of the discussions about breastfeeding benefits,
positions and problems, and how to manage problems were writ-
ten. Images and videos, illustrated the process of breastfeeding and
the sucking process by the infant to prevent problems. This gives
the authors a hint that the Jordanian mothers do not read a lot,
but they watch images or videos more than reading information.
Although they are using the internet and smart phones, they use
them for social media more than using them for seeking informa-
tion or reading articles about health topic. This has been supported
by Ghazal (2016) who reported that 80% of Jordanian women own
smart phones and they are as other Jordanians very active on so-
cial networking sites. It has been found that 84% of Jordanians use
social websites such as Facebook and Twitter (Ghazal, 2016). More
recently, it has been reported that 91% of Jordanian population are
using smart phones for social media (DoS, 2016). The results of our
study reflected the actual social situation among Jordanian people
because Jordan is ranked the 2nd in the Arab world in Internet us-
age, which is due to the high Internet and smartphone penetration
(Ghazal, 2016).
The results of this study indicated that the effectiveness of web-
based education program for breastfeeding mothers should be at-
tractive enough to encourage mothers to use it effectively. Further,
social media can be used rather than specified website that is sep-
arate from social media. Adding short messages, images or videos
within social media may be more effective in delivering the educa-
tion than we-based education. Although our website was evaluated
favorably by mothers, it was used by more than half of participat-
ing mothers in the intervention group, but was not associated with
better breastfeeding outcomes.
Our results were congruent with Labarère et al. (2011) who
found the same results, but by using CD-ROM to introduce the ed-
ucation material about breastfeeding. However, Ahmed and Ouz-
zani (2013) found that using interactive web-based breastfeeding
monitoring system was effective, feasible and acceptable among
breastfeeding mothers to enhance breastfeeding outcomes. On the
other hand, attitudes of the participating mothers that were at
neutral level gave the researcher an indication that health educa-
tion and health promotion regarding breastfeeding is not effective
enough to change mothers’ attitudes towards breastfeeding.
Limitations
One of the limitations in this study was the sample that was
selected from one governorate in Notheren of Jordan and from
private antenatal clinic, which limited the generalization to other
pregnant mothers in Jordan. A second limitation was the follow
up interviews to complete the post intervention assessment, were
conducted by phones not face to face interviews.
Conclusion
This study is considered the first trial to use new teaching
methodologies as internet and website in teaching mothers about
breastfeeding. Despite that there were not differences between in-
tervention and control groups, web-based breastfeeding education
program may contribute in improving breastfeeding self efficacy,
knowledge and attitude. Therefore, there is a great need for ad-
justing the website and the educational material and connect them
with social media to be feasible and attractive for pregnant moth-
ers or lactating mothers. Then further research is needed to repli-
cate this study in other Jordanian governorates and among differ-
ent samples of participants and different settings.
Funding sources
This research received no specific grant from any funding
agency in the public, commercial, or not for-profit sectors.
Conflict of interest
Authors declare no conflict of interest.
Ethical approval
The study was ethically approved by the Institutional Review
Board (IRB) of the Ministry of Health and the Hashemite University
for data collection (IRB number (2014/2015/2/2/16).
Clinical trial registry and registration
Not applicable.
Acknowledgments
The authors of this study would like to thank the participating
mothers for their cooperation and the proofreader for their efforts.
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