Table 2 Characteristics and outcomes of included studies

Ekstrom 2005 [23] and Ekstrom 2015 [27]

2-arm cluster-randomised

10 municipalities in South-Western Sweden

Midwives (n = 28) and postnatal nurses (n = 53).

Process-orientated training programme. Consisted of seven sessions, including discussions on counselling skills and reflection on personal breastfeeding experiences. Participants were encouraged to develop a common breastfeeding policy between the antenatal clinic and the receiving child-health centres. N = 36.

Breastfeeding attitudes at 1 year post training through 4 sub-scales: regulating, facilitating, disempowering and breastfeeding antipathy.

Usual approaches to training and care. No further detail provided. N = 45

Kronborg 2008 [24]

2-arm cluster-randomised

22 municipalities in Western Denmark

Health visitors (n = 52)

18 h training ‘Breastfeeding Promotion and Support in a Baby-friendly Hospital’ course by the WHO. Included oral presentations, video presentations, exercises and role play. N = 52

Breastfeeding knowledge (including management of breastfeeding practices), indirect measures of attitudes (self-efficacy, subjective norms, behavioural intent and evaluation of importance) and BFHI stage 5 all measured immediately after programme.

Usual practice and then received the programme at the end of the study. N = 57.

Rea 1999 [25]

2-arm individual randomised trial

Maternity hospital in a low income metropolitan area of Sao Paulo, Brazil.

Healthcare professionals working in maternity services (n = 60)

WHO/UNICEF 40 h breastfeeding counselling training course. Delivered as 33 sessions over 40 h and included theoretical and clinical aspects of breastfeeding and training on counselling skills. N = 20

Breastfeeding knowledge by a multiple choice test^a immediately after the intervention. Observation of clinical and counselling^a skills specific to breastfeeding.

Usual training/care provision – no other details specified. N = 40

Westphal 1995 [26] and Taddei [28]

2-arm cluster-controlled trial

8 hospitals in a metropolitan area of wider Sao Paulo, Brazil.

Healthcare professionals (obstetricians, paediatricians, nurses) in maternity hospitals (n = 12)

3 week programme delivered by Santos Lactation Centre based on the Wellstart^TM San Diego programme. Covered theoretical and practical aspects of breastfeeding. 66% of time was lectures and remainder was practical sessions. N = 4 (cluster level).

Breastfeeding knowledge post-intervention^a.

Compliance of the hospital with the BFHI ten steps measured by structured observations by a researcher and a questionnaire based on staff and mother’s reports in the institutional questionnaire^a

No detail provided on comparator. N = 4 (cluster level).