More than just information: A qualitative evaluation of an online peer support program to build breastfeeding self-efficacy among Hong Kong mothers

BACKGROUND: Exclusive breastfeeding rates in Hong Kong are low, highlighting a challenge in sustaining the practice. The COVID-19 pandemic accelerated the shift to digital health, yet the mechanisms of online peer support remain poorly understood. OBJECTIVE: To conduct a process evaluation of an online breastfeeding peer support program, exploring participant experiences to understand how the intervention works, using Social Cognitive Theory as a framework. METHODS: A qualitative descriptive study nested within an randomized control trial in Hong Kong. Semi-structured online interviews were conducted with 25 mothers and 13 peer supporters. Data from interviews and 50 observed support meetings were analyzed using inductive thematic analysis and interpreted through Social Cognitive Theory. RESULTS: Four themes emerged. 1) Breastfeeding Challenges: Mothers faced barriers (e.g., anxiety, pain) that undermined confidence (self-efficacy). 2) Limitations of Professional Support: Clinical support was valued for skills but perceived as rushed and impersonal for ongoing needs. 3) Power of Online Peer Support: The intervention acted as a "lighthouse" (guidance), "shelter" (emotional safety), and "cheer team" (camaraderie), enhancing self-efficacy through observational learning. 4) Expectations of Support: Effective support required credible peers with lived experience and a convenient online format. CONCLUSION: Online peer support bridges the gap between clinical instruction and lived experience by addressing Social Cognitive Theory constructs like self-efficacy and environmental barriers. Peers provide unique, empathetic, and practical support, making them a crucial component of strategies to promote sustained breastfeeding.