{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T09:47:48Z","timestamp":1785232068842,"version":"3.55.0"},"reference-count":21,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Peer support is a promising strategy to improve breastfeeding outcomes, but evidence for online formats is limited.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate whether structured peer support delivered via video calls improves exclusive breastfeeding rates and maternal breastfeeding self-efficacy.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This multicenter, randomized clinical trial enrolled first-time mothers with low breastfeeding confidence from 4 public postnatal wards in Hong Kong from January 31, 2021, to June 30, 2024. Participants were randomly assigned (1:1) to intervention or control. The primary analysis was conducted from July 1 to 31, 2024, with final data analysis completed by December 31, 2025.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n The intervention included usual postnatal care, consisting of access to lactation consultants and standard breastfeeding information from the Department of Health, plus at least 2 video call sessions with trained peer support volunteers at 10 days and 1 month post partum.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was the proportion of infants who were exclusively breastfed at 6 months post partum. Secondary outcomes included exclusive breastfeeding at 1, 2, and 4 months post partum and maternal self-efficacy (measured using the Breastfeeding Self-Efficacy Scale\u2013Short Form) at 2 and 4 months. All outcomes were analyzed on an intention-to-treat basis.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 442 participants, 224 were allocated to the intervention group and 218 were allocated to the control group. The mean (SD) maternal age was 32.4 (4.0) years (32.4 [4.2] years in the intervention group and 32.3 [3.9] years in the control group). The primary 6-month outcome did not differ significantly between groups (37 of 184 [20.1%] vs 29 of 186 [15.6%]; adjusted odds ratio [AOR], 1.57 [95% CI, 0.85-2.89];\n P<\/jats:italic>\n \u2009=\u2009.15); however, exclusive breastfeeding at 2 months (a secondary outcome) was significantly higher in the intervention group (54 of 199 [27.1%] vs 38 of 200 [19.0%]; AOR, 1.80 [95% CI, 1.08-3.01];\n P<\/jats:italic>\n \u2009=\u2009.02). Longitudinal analysis confirmed higher odds of exclusive breastfeeding in the intervention group over time, with the largest difference at 2 months. Breastfeeding self-efficacy showed significantly greater improvement in the intervention group (time\u2009\u00d7\u2009intervention interaction: \u03b2\u2009=\u20091.01 [95% CI, 0.21-1.81];\n P<\/jats:italic>\n \u2009=\u2009.01), with a higher score at 4 months (adjusted \u03b2, 4.65 [95% CI, 1.60-7.70];\n P<\/jats:italic>\n \u2009=\u2009.01).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this randomized clinical trial, video call\u2013based peer support did not increase exclusive breastfeeding at 6 months; however, it significantly increased exclusive breastfeeding at 2 months and improved maternal breastfeeding self-efficacy, offering a scalable model for postnatal care integration.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT04621266<\/jats:ext-link>\n <\/jats:p>\n 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