Effectiveness of a theory-based educational intervention on enhancing milk donation behavior: a cluster randomized controlled trial.

Background: This study aims to assess the impact of an educational intervention based on the theory of planned behavior (TPB) on breastfeeding mothers' knowledge, attitude, subjective norms, perceived behavioral control regarding donor human milk (DHM), intention to donate milk and milk donation behavior.

Method: This cluster randomized controlled trial (CRT) was performed on 67 breastfeeding mothers (intervention, n = 33; control, n = 34) in health centers affiliated to Tehran University of Medical Sciences (TUMS) from April 2023 to October 2023. Four weekly 60-min educational sessions were conducted based on the TPB through lectures, group discussions, psychodrama method, videos and pictures display for mothers in the intervention group, while the control group received only routine care. The data collection tool was a researcher-made questionnaire based on the TPB. It assessed breastfeeding mothers' knowledge, attitudes, subjective norms, perceived behavioral control regarding milk donation, intention to donate milk, and actual milk donation behavior. The questionnaire was completed by participants in both groups before, immediately and three months after the intervention.

Results: The findings indicated that both the intervention and control groups were similar in terms of demographic and obstetrics variables. Additionally, before the intervention, there were no significant differences between the two groups regarding knowledge (P = 0.552), attitude (P = 0.734), subjective norms (P = 0.813), perceived behavioral control (P = 0.453), intention to donate milk (P=0.476) and actual milk donation behavior (P = 0.105). However, the intervention group showed significant improvements in the mean score of noted variables immediately and three months after the intervention (P < 0.05). Moreover, regarding the frequency of milk donations, three months after the intervention, eight mothers in the intervention group had donated milk, whereas none of the mothers in the control group had done so (P = 0.002).

Conclusion: Our findings showed that the TPB-based educational intervention significantly enhanced milk donation behavior among breastfeeding mothers. Given that donor mothers are crucial for the establishment and sustainability of human milk banks (HMBs), such programs should be implemented to increase milk donation rates and support the development of HMBs.

Trial registration: irct.ir (IRCT20230124057203N1) registered February 14, 2023.