Research team led by Prof Kris Yuet-Wan Lok (2nd from right)Video call–based peer support intervention significantly increases the rate of exclusive breastfeeding at 2 months postpartum and improves maternal breastfeeding self-efficacy, researchers from the University of Hong Kong (HKU) have found.
This randomized clinical trial is the first-of-its-kind in Hong Kong to evaluate video call–based peer support for breastfeeding and one of the first trials globally to rigorously examine the effectiveness of this digital approach in improving breastfeeding outcomes.
The multicentre trial, conducted between January 2021 and June 2024, included first-time mothers with low breastfeeding confidence recruited from four public postnatal wards in Hong Kong. Participants were randomized 1:1 to receive usual postnatal care (control group; n=218; mean age, 32.3 years) consisting of access to lactation consultants and standard breastfeeding information from the Department of Health, or intervention (n=224; mean age, 32.4 years) consisting of usual postnatal care plus at least two video call sessions with trained peer support volunteers at 10 days and 1 month postpartum. [JAMA Netw Open 2026;9:e2614490]
Exclusive breastfeeding at 2 months postpartum (a secondary outcome) was significantly higher in the intervention vs control group (27.1 vs 19.0 percent; p=0.02). “This early success represents a critical achievement in helping mothers establish exclusive breastfeeding – a key covariate associated with longer-term breastfeeding,” noted the authors. The early postpartum period is a critical window during which mothers face substantial challenges to exclusive breastfeeding, including perceived insufficient milk supply, latch difficulties, and fatigue.
“Our findings show that even a modest intervention – just two video calls with a trained peer supporter – can significantly help new mothers continue breastfeeding during the critical early months,” reported leader of the study, Professor Kris Yuet-Wan Lok of the School of Nursing, HKU. “This is especially important given the Chinese cultural practice of ‘sitting the month’ and the reality that many mothers return to work early. The flexibility of video call–based support allows us to reach mothers when and where they need it most,” she noted
Breastfeeding self-efficacy, which is key for early breastfeeding success and another known covariate associated with breastfeeding duration, also showed significantly greater improvement in the intervention group (time × intervention interaction: β, 1.01; p=0.01), with a higher score at 4 months (adjusted β, 4.65; p=0 .01).
However, the primary 6-month outcome did not differ significantly between the two groups, with 20.1 percent in the intervention group vs 15.6 percent in the control group (p=0.15) exclusively breastfeeding at 6 months postpartum. “The attenuation of benefits may relate to waning intervention intensity and the evolving challenge of later infancy, such as returning to work, which the support was not specifically designed to address,” wrote the authors.
“Although the difference in exclusive breastfeeding rates at 6 months was not statistically significant, the improvements seen at 2 months and in maternal confidence are clinically important,” noted Lok. “This model offers a practical, scalable way to integrate peer support into routine postnatal care, particularly in settings where face-to-face visits may be challenging.”
“These findings inform public health policy. Future implementation should focus on optimizing such programmes to provide more adaptable and sustained support, aiming to maintain this critical practice through the first 6 months of life,” concluded the authors.