Rapid Mixed-Methods Assessment and Institutional Co-Design of Breastfeeding Support to Enhance Maternal Confidence in a Teaching Hospital in North India.

BACKGROUND: Despite strong policy support, many Indian mothers discontinue breastfeeding early. Maternal confidence, rather than knowledge alone, predicts breastfeeding success, yet institution-based approaches to building confidence remain limited. We employed rapid mixed-methods research to identify barriers and co-design feasible support interventions within a teaching hospital. RESEARCH AIMS: To identify barriers influencing breastfeeding confidence, quantify barrier prevalence and associations with maternal confidence, and co-design and pilot-test an institutionally feasible intervention through participatory stakeholder engagement. METHODS: This was a sequential mixed-methods study (November 2024-April 2025) at a teaching hospital in north-western India. Phase 1: Qualitative assessment (n = 47) through interviews and focus groups. Phase 2: Cross-sectional survey (n = 232) measuring breastfeeding self-efficacy (BSES-SF), barriers, social support, and depressive symptoms. Phase 3: Participatory co-design and micro-pilot (n = 26) of intervention integrated into hospital workflows. RESULTS: Qualitative analysis identified four barrier domains: early experiences (70%), social/family influences (62%), healthcare interactions (55%), and emotional well-being (48%). Survey findings: 63% reported milk supply concerns, 58% pain, 49% conflicting family advice. Mean BSES-SF = 46.2 (SD 9.8); 32% scored low confidence. Early difficulties (β = -5.8, p < 0.001), low social support (β = -4.1, p < 0.001), depression (β = -3.6, p < 0.001), and primiparity (β = -2.3, p = 0.005) were independently associated with lower confidence (R2 = 0.41). Stakeholders prioritized three components: peer support (94% endorsement), provider communication tools (89%), and family counseling (83%). The micro-pilot demonstrated high acceptability (88%) and feasibility (median delivery time 7 min) with no additional staffing. CONCLUSION: Teaching hospitals can rapidly identify breastfeeding confidence barriers and co-design contextually appropriate, low-cost interventions. This model offers a scalable pathway for strengthening breastfeeding support in resource-constrained settings.