The effectiveness of motivational interviewing on breastfeeding outcomes among lactating mothers: a systematic review and meta-analysis

Background Breast milk is essential for newborns up to six months, yet exclusive breastfeeding rates worldwide remain below the 50% targeted by the World Health Organization. The mother’s motivation is a significant intrinsic factor in achieving exclusive breastfeeding (EBF). Motivational interviewing (MI) is an effective strategy to increase individual motivation. It could be used to help mothers resolve ambivalence and increase intrinsic motivation to overcome barriers to breastfeeding. This study aims to evaluate the effectiveness of MI in improving breastfeeding success compared with standard lactation care. Methods A systematic search was conducted in May 2023 and updated in August 2026 across multiple databases, including CINAHL Complete, Cochrane, PubMed, ProQuest, ScienceDirect, Google Scholar, Thai Journal Online, one gray literature source (Mahidol e-thesis), and reference lists. Eligible studies included randomized controlled trials and quasi-experimental studies evaluating the effectiveness of motivational interviewing on breastfeeding outcomes. Two reviewers independently assessed methodological quality using the Joanna Briggs Institute (JBI) critical appraisal checklists. Data were extracted using the JBI form and analyzed with the Review Manager 5. The meta-analysis was conducted using random-effects models for all outcomes. Relative risk (RR) was used for binary outcomes, while mean difference (MD) was used for continuous outcomes. Effect sizes are reported with 95% confidence intervals (CIs). Statistical significance was set at p < 0.05. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Thirteen eligible reports included 1,795 participants. These studies evaluated at least one of these BF outcomes: EBF rate, duration, and BF self-efficacy. Meta-analysis revealed that MI significantly improved the EBF rate compared to standard care (RR 1.35, 95% CI [1.16, 1.58], p = 0.0002) with moderate heterogeneity (I² = 48%). MI significantly prolonged the duration of EBF (MD 27.95, 95%CI [15.85, 40.05], p < 0.0001) with no heterogeneity (I² = 0%) and increased BF self-efficacy (MD 5.45, 95%CI [4.36, 6.53], p < 0.00001) with moderate heterogeneity (I² = 45%), suggesting substantial differences across studies. Therefore, the overall effect on EBF rate and breastfeeding self-efficacy may not be entirely reliable and should be interpreted with caution. Conclusions MI may be a potentially beneficial approach for improving EBF outcomes. Healthcare providers should consider integrating the MI strategy into BF support services to improve EBF outcomes. Systematic review registration number This systematic review has been registered in the International Prospective Register of Systematic Reviews (PROSPERO), ID: CRD42023431886