The effect of Metaverse- and virtual reality–supported education in the digital breastfeeding museum on mothers’ breastfeeding knowledge level, self-efficacy, and success: a randomized controlled trial

Low breastfeeding rates remain a global public health concern. Global organizations such as WHO and UNICEF recommend prenatal breastfeeding education, and developments in digital health offer new opportunities for breastfeeding education. This study aimed to evaluate the effect of Metaverse and virtual reality-supported education in the digital breastfeeding museum on breastfeeding knowledge level, self-efficacy, and success among third-trimester primiparous pregnant women. This randomized controlled study was conducted between July 2023 and April 2024 with primiparous pregnant women who applied for the first time to the antenatal breastfeeding education classes of three hospitals in Türkiye in their third trimester and had no previous breastfeeding experience. A total of 60 primiparous women were randomized, and data from 53 women (intervention: n = 28; control: n = 25) were included in the final analyses. While the pregnant women in the intervention group received Metaverse- and VR-supported breastfeeding education in the digital breastfeeding museum, the control group received routine antenatal breastfeeding education. Data were collected using the Breastfeeding Self-Efficacy Scale–Short Form (BSES-SF), the LATCH breastfeeding assessment tool, and the breastfeeding knowledge level questionnaire. Data were collected at three time points: pre-, post-intervention, and postpartum. Data were analyzed using IBM SPSS version 29.0.2.0 (α = 0.05). Linear mixed-effects model analysis showed significant main effects of group ( p = 0.003), time ( p < 0.001), and group × time interaction ( p = 0.031) for breastfeeding knowledge. For breastfeeding self-efficacy, significant main effects of group ( p = 0.005) and time ( p < 0.001) were found, whereas the group × time interaction was not significant ( p = 0.100). Breastfeeding knowledge scores were significantly higher in the intervention group than in the control group at both post-intervention (adjusted mean difference: 13.25, 95% CI: 8.74–17.76) and postpartum (8.86, 95% CI: 4.58–13.13). Similarly, breastfeeding self-efficacy scores were significantly higher in the intervention group at post-intervention (adjusted mean difference: 7.08, 95% CI: 3.29–10.87) and postpartum (6.18, 95% CI: 1.53–10.84). Multiple linear regression analysis showed that the intervention group had significantly higher postpartum LATCH breastfeeding success independent of maternal age, birth weight, gestational age, and mode of delivery (adjusted B = 2.206, 95% CI: 1.215–3.198; p < 0.001). In the intervention group, a moderate positive correlation was found between BSES-SF and LATCH scores after training ( r = 0.502; p = 0.006), and a high-level positive correlation was found postpartum ( r = 0.641; p < 0.001). The Metaverse- and VR-supported education intervention delivered through the digital breastfeeding museum contributed to improving breastfeeding knowledge, self-efficacy, and success among primiparous mothers. It is recommended that nurses utilize digital technologies in breastfeeding education. NCT07078825. Registered on 25 July 2025. Retrospectively registered.