Can behavioral science advance breastfeeding-friendly primary care? Key findings from an evaluation in Kosovo

作者：Melinda McKay, Hana Bucinca, Wolf Peter-Schmidt, Tanya Marchant, Robert Aunger · 发表于：PLOS Global Public Health · 年份：2025 · DOI：10.1371/journal.pgph.0005276 · 研究领域：Breastfeeding Practices and Influences、Maternal Mental Health During Pregnancy and Postpartum、Infant Development and Preterm Care

Breastfeeding is a cost-effective intervention vital to child health, yet rates remain suboptimal, especially in fragile settings. Primary care providers are critical to improving breastfeeding outcomes but face multilevel barriers. While hospital-based interventions have shown success, adaptations to primary care are limited, and understanding of the mechanisms driving provider behavior change remains insufficient. In Kosovo, where exclusive breastfeeding is declining alongside increasing infant mortality, we piloted a behavioral science intervention to improve primary care provider practices. A before-and-after design (baseline June-July 2019; endline June-July 2021) using mixed-methods assessed changes in provider behavior, maternal experience, and the institutional environment across five municipalities. Validation compared maternal reports with clinical observations. The intervention targeted provider behavior with emotionally engaging activities, job aids and institutional strategies, and was co-designed with system actors. Data sources included direct observation of consultations, exit interviews with mothers, provider interviews and facility assessments. Across 609 consultations with matched exit interviews, we recorded a 14.9 percentage point increase in the mean frequency of breastfeeding-friendly clinical behaviors by providers (95% CI: 6.4-23.4) and a 13.3 percentage point increase in interpersonal behaviors (95% CI: 5.2-21.3) after versus before intervention. Gai...