Abstract
BACKGROUND: Breastfeeding provides significant benefits for both mothers and infants, yet its rates remain suboptimal, particularly among women undergoing cesarean sections. Breastfeeding practices are determined by a wide range of socio-environmental, cultural, family and individual factors, but current breastfeeding promotion interventions that integrate these dimensions are limited. This study aimed to evaluate the effectiveness of a breastfeeding intervention based on Theory of Planned Behavior and the Interactive Theory of Breastfeeding in promoting breastfeeding outcomes in women after cesarean section. METHODS: A total of 763 women were recruited and randomly divided into an intervention group (n = 383) and a control group (n = 380). The participants were women scheduled for elective cesarean sections due to medical indications. On the basis of theory, mothers in the intervention group received the breastfeeding promotion program, focusing on enhancing breastfeeding knowledge, fostering positive attitudes, increasing family support, strengthening perceived behavioral control, facilitating the transition from intention to action, and promoting mother-infant interaction through skin-to-skin contact, responsive feeding, and emotional bonding. The control group received routine nursing care. Outcomes were assessed using the Bristol Breastfeeding Assessment Tool and the Chinese Breastfeeding Attrition Prediction Tool, focusing on exclusive breastfeeding rates, breastfeeding frequency, duration, and complications. RESULTS: The exclusive breastfeeding rates in the intervention group were significantly higher on day 1, day 2 And day 3 after cesarean section compared to the control group (P < 0.001). The intervention group exhibited higher Bristol Breastfeeding Assessment Tool and Chinese Breastfeeding Attrition Prediction Tool scores, improved breastfeeding frequency and duration, and a lower incidence of breastfeeding-related complications (P < 0.05). CONCLUSION: A theory-based nursing intervention integrating Theory of Planned Behavior and the Interactive Theory of Breastfeeding significantly enhanced exclusive breastfeeding rates and maternal breastfeeding behaviors in women after cesarean sections. This study highlights the value of combining psychological and contextual factors to design effective breastfeeding interventions, providing evidence for scalable and sustainable strategies to support breastfeeding in postpartum care. TRIAL REGISTRATION: This trial was retrospectively registered with the Chinese Clinical Trial Registry on November 19th, 2024 (ChiCTR2400092869) .