Compassion-Based Breastfeeding Counseling and Its Effects on Self-Compassion, Mindful Breastfeeding, and Self-Efficacy (COMBFED)

April 28, 2026 updated by: Şengül Yaman Sözbir, Gazi University

The Effect of Compassion-Based Breastfeeding Counseling During the Perinatal Period on Self-Compassion, Mindful Breastfeeding, and Breastfeeding Self-Efficacy

This randomized controlled trial aims to evaluate the effects of compassion-based breastfeeding counseling on self-compassion, mindful breastfeeding, and breastfeeding self-efficacy during the perinatal period.

Pregnant women between 24-28 weeks of gestation who meet the eligibility criteria are enrolled. After obtaining informed consent, participants are randomly assigned to either the intervention or control group using simple randomization.

The intervention group receives a total of 6 face-to-face compassion-based breastfeeding counseling sessions between 30-37 weeks of gestation, with follow-up counseling continued until 6 weeks postpartum. The control group receives only routine antenatal care with no additional intervention.

Outcome measures are assessed at three time points: pretest (24-28 weeks of gestation), posttest (36-38 weeks of gestation), and follow-up (6 weeks postpartum). Instruments used include the Self-Compassion Scale, the Breastfeeding Self-Efficacy Scale-Short Form, and the Mindful Breastfeeding Scale.

The study is conducted at Iğdır Dr. Nevruz Erez State Hospital, Türkiye.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Breastfeeding is the most effective intervention for protecting infant and maternal health. Despite its well-documented benefits, breastfeeding continuation rates decline over time due to insufficient support, breastfeeding difficulties, and psychosocial challenges in the postpartum period. Mothers experiencing breastfeeding problems may develop feelings of shame, failure, and inadequacy, which can negatively affect breastfeeding self-efficacy and increase the risk of early weaning.

Self-compassion - defined as treating oneself with kindness, acceptance, and non-judgment in the face of difficulties - has been associated with reduced depressive symptoms, increased psychological flexibility, and stronger mother-infant bonding in the perinatal period. Compassion-based breastfeeding counseling differs from traditional breastfeeding education by integrating emotional support, empathy, and psychosocial care alongside technical knowledge, thereby addressing both the informational and emotional needs of mothers.

This single-center, randomized controlled trial with a pretest-posttest-follow-up design is planned to assess the effectiveness of structured compassion-based breastfeeding counseling. Participants are pregnant women at 24-28 weeks of gestation attending Iğdır Dr. Nevruz Erez State Hospital. Eligible participants are randomly assigned to intervention (n=27) or control (n=27) groups. Sample size was calculated based on a power analysis (G*Power 3.1; repeated measures ANOVA, within-between interaction; partial η²=0.06; α=0.05; power=0.95) with a 20% dropout buffer.

The intervention consists of 6 structured face-to-face compassion-based breastfeeding counseling sessions delivered between 30-37 weeks of gestation, followed by counseling and follow-up support up to 6 weeks postpartum. The control group receives standard antenatal care only.

Outcome measures:

Self-Compassion Scale (Öz-Anlayış Ölçeği; Neff, 2003; Turkish adaptation: Deniz et al., 2008) - 24 items, 5-point Likert scale Breastfeeding Self-Efficacy Scale - Short Form (Dennis & Faux, 1999; Turkish adaptation: Tokat Aluş et al., 2010) - 14 items, 5-point Likert scale Mindful Breastfeeding Scale (Körükcü et al., 2021) - 9 items, 5-point Likert scale

Assessment timepoints:

T0 (Pretest): 24-28 weeks of gestation T1 (Posttest): 36-38 weeks of gestation T2 (Follow-up): 6 weeks postpartum

Randomization is performed by an independent statistician using computer-generated allocation. Data analysis is conducted by a blinded independent statistician. Bias risk is assessed using the Cochrane Risk of Bias Tool (RoB 2). The study is reported in accordance with CONSORT guidelines.

Study Type

Interventional

Enrollment (Actual)

54

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Turkey (Türkiye)
    • Ankara
      • Ankara, Ankara, Turkey (Türkiye), 06000
        • Gazi University Institute of Health Sciences, Ankara, Ankara 06000

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Literate or above
  • Primigravida
  • Between 18-35 years of age
  • Between 24-28 weeks of gestation
  • Spontaneous conception
  • Owns a smartphone

Exclusion Criteria:

  • Diagnosed with any psychiatric disorder (self-reported)
  • High-risk pregnancy (preeclampsia, gestational diabetes mellitus, placenta previa, chronic disease, fetal anomaly, multiple pregnancy, Rh incompatibility, obesity)
  • Previously attended any compassion or mindfulness-based training
  • Communication barriers (inability to speak Turkish, hearing/speech impairment, or intellectual disability)

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Supportive Care
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Intervention Group
Receives 6 face-to-face compassion-based breastfeeding counseling sessions between 30-37 weeks of gestation, with follow-up counseling continued until 6 weeks postpartum.
Behavioral: Compassion-Based Breastfeeding Counseling
A structured, compassion-based breastfeeding counseling program consisting of 6 face-to-face sessions delivered between 30-37 weeks of gestation. Each session integrates self-compassion practices (based on Neff's self-compassion model), mindfulness-based breastfeeding techniques, and evidence-based breastfeeding education. Sessions address emotional barriers to breastfeeding, strengthen breastfeeding self-efficacy, and promote mindful mother-infant interaction. Follow-up counseling is continued until 6 weeks postpartum.
No Intervention: Control Group
Receives routine antenatal care only, with no additional intervention.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Breastfeeding Self-Efficacy
Time Frame: Baseline (24-28 weeks gestation), post-intervention (36-38 weeks gestation), and follow-up (6 weeks postpartum)
Measured by the Breastfeeding Self-Efficacy Scale-Short Form (Turkish adaptation, Tokat Aluş et al., 2010). 14-item, 5-point Likert scale; scores range 14-70. Higher scores indicate greater self-efficacy.
Baseline (24-28 weeks gestation), post-intervention (36-38 weeks gestation), and follow-up (6 weeks postpartum)
Self-Compassion
Time Frame: Baseline (24-28 weeks gestation), post-intervention (36-38 weeks gestation), and follow-up (6 weeks postpartum)
Measured by the Self-Compassion Scale (Turkish adaptation, Deniz et al., 2008). 24-item, 5-point Likert scale; scores range 24-120. Higher scores indicate greater self-compassion.
Baseline (24-28 weeks gestation), post-intervention (36-38 weeks gestation), and follow-up (6 weeks postpartum)
Mindful Breastfeeding
Time Frame: Baseline (24-28 weeks gestation), post-intervention (36-38 weeks gestation), and follow-up (6 weeks postpartum)
Measured by the Mindful Breastfeeding Scale (Körükcü et al., 2021). 9-item, 5-point Likert scale; scores range 9-45. Higher scores indicate greater mindfulness during breastfeeding.
Baseline (24-28 weeks gestation), post-intervention (36-38 weeks gestation), and follow-up (6 weeks postpartum)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Gazi University

Investigators

  • Principal Investigator: ŞENGÜL YAMAN SÖZBİR, PhD, Gazi University, Faculty of Health Sciences, Department of Nursing

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

May 1, 2025

Primary Completion (Actual)

December 1, 2025

Study Completion (Actual)

December 1, 2025

Study Registration Dates

First Submitted

April 28, 2026

First Submitted That Met QC Criteria

April 28, 2026

First Posted (Actual)

May 5, 2026

Study Record Updates

Last Update Posted (Actual)

May 5, 2026

Last Update Submitted That Met QC Criteria

April 28, 2026

Last Verified

April 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 2025 - 1341

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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