INTRODUCTION

Breastfeeding is a bonding, affection, protection and nutrition strategy for children, and an effective intervention for reducing infant morbidity and mortality indicato= rs.⁽¹⁾ For this purpose, exclusive breastfeeding is defined as breast milk and, wh= en necessary, medication, and is indicated up to six months of age.⁽²⁾

Breastfeeding brings short- and long-term benefits to the child, the mother, and the family. The baby's skin-to-skin contact with the mother helps to form a bond, reduces the risk= of infections, reduces the maternal risk of postpartum hemorrhage, and is an important protective factor against breast cancer. ⁽²⁾ For the family and society, the child who exclusively breastfeeds is less likely to have health problems, which, in turn, will require less medical care, hospitalizations, and expenditure on medications due to health problems. (3)

Even with so many benefits, the r= ate of exclusive breastfeeding in children up to six months worldwide is around 39%. In Brazil, the prevalence is 36%. ⁽⁴⁾ Statistics give visibility to the problem; breastfeeding is not easy for many women. In addition to the biological issue, the act of breastfeeding is linked to sev= eral factors, with different effects on the psychological and social dimensions = of the parties involved. ⁽⁵⁾

Breastfeeding faces some barriers, such as the woman's return to work, psychosocial factors such as insecurity= and fear, in addition to postpartum depression and clinical-hospital separation between mother and baby. ^(6-9) In this aspect, a network of care= and attention directed to women since the prenatal period is a tool that can contribute positively to the self-efficacy of breastfeeding.

Therefore, health professionals m= ust always seek innovations that are close to the identified problems, in order= to create tools that can contribute to overcoming the impasses, performing hea= lth promotion actions from the prenatal to the puerperal visit, using consultat= ions to generate opportunities to encourage the practice of breastfeeding, clarifying doubts and benefits of such practice. ⁽¹⁰⁾

The nurse becomes a facilitator f= or the woman's adaptation to this process, intervening when necessary, in orde= r to ensure that the mother is in good health, physical and emotional conditions, using as a tool the educational technologies in her favor, in order to have= a positive impact on this very important practice, which is breastfeeding. (11)

Health educational technologies a= re the result of scientific knowledge for the production of material goods, or not, used during intervention in practical cases, seeking the resolution of human and structural problems related to health. ⁽¹²⁾

In this context, the aim of the s= tudy is to identify in the scientific literature the educational technologies for breastfeeding self-efficacy and exclusive breastfeeding practice of adult women.

<= span style=3D'font-size:12.0pt;mso-bidi-font-size:11.0pt;line-height:150%;font-f= amily: "Times New Roman",serif'>METHODS

<= span style=3D'font-size:12.0pt;mso-bidi-font-size:11.0pt;line-height:150%;font-f= amily: "Times New Roman",serif'>

This is a scoping review. This study is a scoping review, which s= ought to quickly map the key concepts, the main sources and the types of available evidence, especially for studies where the material is difficult to locate, thus finding gaps in the studies. ⁽¹³⁾ Five steps were followed: identification of the research question; search for relevant studies; selec= tion of studies; data extraction; and grouping, summarizing, and presenting the results. ⁽¹³⁾ The Prefer= red Reporting Items for Systematic Reviews and Meta-Analyzes extensions for Sco= ping Reviews (PRISMA-ScR) was used to guide and report the essential items in this review. ⁽¹⁴⁾=

The construction of the research question was base= d on the PCC strategy (P - population; C - Concept; C - context), in which Population (P): Adult women in exclusive breastfeeding; Concept (C): Educational technologies; Context (C): Nursing care for maternal self-effic= acy.⁽¹⁵⁾In the development of this strategy, the following question was considered: What are the educational technologies used by nurses for breastfeeding self-efficacy and practice of exclusive breastfeeding?

Searches were conducted in the LILACS, BDENF, MEDL= INE, and IBECS databases via the Virtual Health Library (VHL) and PubMed in Janu= ary 2021. In addition to the secondary search in Google Scholar and analysis of= the reference list of the primary studies included, in order to identify other relevant studies that could be retrieved. The literature search process is illustrated using the PRISMA flowchart. ⁽¹⁶⁾ <= /p>

The controlled descriptors used were: P (Breastfeeding, Breastfeeding); C (Educational Technology, Teaching Materia= ls, Validation Study); C (Self Efficacy, Nursing, Self Efficacy, Nursing). The uncontrolled descriptors were: P (Exclusive Breastfeeding; Breastfeeding); C (Educational Technology, Teaching Materials, Validation Study).<= /span>

The strategy to search for studies met the specificities of each database and was composed by the combination of controlled descriptors (indexed in the respective databases) and non-contro= lled descriptors. The controlled descriptors were selected through the Health Sc= iences Descriptors (DeCS) and Medical Subject Headings (MeSH Terms). In order to broaden the search strategy, the controlled and non-controlled descriptors = were combined using the Boolean operators AND OR. The resulting search expressio= ns are presented in Chart 1.

Table 2 - Records included by the scope review, according to title, journal and country of origin. Teresina, PI, Brazil, 2021.

Title of article=	Short title of journal=	Country	Year
Meeting The Challenge Of Delivering High-Quality Breastfeeding Training For All.<= o:p>	Pract Midwife	Europe	2011
Discussion Of The Health Benefits Of Breastfeeding Within Small Groups.	Community Pract	Europe	2011
Validation of a Serial Album for Breastfeeding	Acta Paul Enferm.	Brazil	2012
Serial Album About Breastfeeding: Educational Intervention With Nursing Mothers = In The Immediate	Rev Enferm Ufpe On Line	Brazil	2013
Validation of a serialized album for promotion of breastfeeding self-efficacy	Acta paul. enferm	Brazil	2013
Construction and validation of an educational manual for breastfeeding promotion.=	Rev. RENE =	Brazil	2013
Evaluation of an Educational Technology in the modality Cordel Literature on Breastfeeding	Rev Esc Enferm USP	Brazil	2013
An experimental study of an educational intervention to promote maternal self-efficacy in breastfeeding.	Latin American Journal of Nursing (Online)	Brazil	2015
Efficacy of e‐technologies in improving breastfeeding outcomes among perinat= al women: a meta‐analysis	Maternal and child nutrition	Singapore	2015
Postnatal counseling on exclusive breastfeeding using video - experience from a tertiary care teaching hospital, South India	J Matern Fetal Neonatal Med	India	2017
Effects of an Educational Technology on Breastfeeding Self-Efficacy and Exclusive Breastfeeding Practice	Rev Esc Enferm USP	Brazil	2018
Assistive technology on breastfeeding for visually impaired people: a comparison Br= azil and Portugal	Texto & contexto enferm	Brazil	2018
Educational technology for maternal empowerment in breastfeeding self-efficacy.<= /o:p>	Rev. enferm. UFPE on line	Brazil	2019
The Philani MOVIE study: a clusterrandomized controlled trial of a mobile vid= eo entertainment-education intervention to promote exclusive breastfeeding in South Africa	Health Services Research	South Africa	2019
Construction and Validation of an Educational Primer for a Breastfeeding Support Room<= o:p>	Rev Min Enferm=	Brazil	2020
Construction and Validation of na Educational Primer for Mobile Devices on Breastfeedi= ng	Texto & contexto enferm	Brazil	2020

Source: The authors

Chart 3 - Synthesis of the review articles, according to study objective, educational technology, and outcome. Teresina, PI, Brazil, 2021

Category (Educational Technology)	Author, Year	Country	Goal	Outcome
Serialized album	JAVORSKI et al., 2018 ⁽¹⁶⁾	Brazil	To evaluate the effects of using a serialized album on maternal breastfeeding self-efficacy and its repercussions on exclusive breastfeeding (EBF) in t= he first 2 months of a child's life.	The serialized album worked positively on the self-efficacy index of exclusive breastfeeding.
Educational primer for mobile devices.	MELLO et al., 2020⁽¹⁷⁾	Brazil	To validate an educational booklet for use in mobile devices on breastfeeding for family members and caregivers of newborns and infants.	The educational booklet was validated, and had satisfactory scores, being considered a support technology for health professionals in order to reinforce teachings about breastfeeding.
Educational primer for the breastfeeding support room	LIMA et al., 2020⁽¹⁸⁾	Brazil	To build and validate an educational booklet for the breastfeeding support r= oom.	The booklet was validated and had satisfactory indexes, and can be used by he= alth professionals and by family members and caregivers of newborns and infants aiming at promoting breastfeeding and, consequently, reducing early weani= ng rates.
Cordel Literature	DE OLIVEIRA et al., 2013⁽¹⁹⁾	Brazil	To describe the evaluation of an educational technology, regarding the aspec= ts of content and cordel literature on breastfeeding.	Positive results were observed, since this technology was built and evaluated in t= he theoretical pole regarding its content and the cordel literature format, according to the Psychometrics Model
Serialized album	DODT et al., 2012⁽²⁰⁾	Brazil	To validate a serialized album about breastfeeding self-efficacy in terms of content and appearance	The album can be used in several nursing fields, including in the rooming-in setting.
Serialized album	DODT et al., 2013 ⁽²¹⁾	Brazil	To report the experience of using a serialized album about breastfeeding in = an educational intervention with nursing mothers.	It facilitated the communication between health professionals and nursing mothers, favoring the learning process based on the nursing mothers' need= s.
Tool called Breastfeeding Treasure Box	CLARCKSON, DU PLESSIS et al.,2011 ⁽²²⁾	Europe	To examine the usefulness of an interactive group session designed to explore the health benefits of breastfeeding.	There is potential for further development of the tool to reflect the specific health benefits identified by the Baby Friendly Initiative, although mess= ages about the benefits of breastfeeding still need to be reinforced at every opportunity using other resources.
Workbook and DVD	WALLACE et al., 2011 ⁽²³⁾	Europe	= Offer high-quality breastfeeding training for all	Participants welcomed the program as a wa= y to ensure that staff consistently used evidence-based practice
Flip-chart	DODT et al., 2015 ⁽²⁴⁾ = ;	Brazil	= To construct, validate, and evaluate an educational intervention using the f= lip chart entitled "I can breastfeed my child"	The intervention was beneficial because mothers in the intervention group had higher self-efficacy scores, more mothers continued breastfeeding, and mothers had longer duration of exclu= sive breastfeeding at both hospital discharge and the second month postpartum, with statistically significant associations
Cordel Literature	DE OLIVEIRA et al., 2018 ⁽²⁵⁾	Brazil	= To describe the results of the apparent and content validation of t= he assistive technology "Breastfeeding in action", with visually impaired pe= ople from two realities, Portugal and Brazil.	There were excellent evaluations with some topics analyzed differently in the two countries. The participants liked = the Assistive Technology, but to validate it using the synthesizer, time was needed, and even then it was often complex.
Educational manual	COSTA et al, 2013 ⁽²⁶⁾	Brazil	= To construct and validate an educational manual for breastfeeding promotion.	The use of this manual during both the prenatal and puerperal periods will facilitate nursing practice.
Flip-chart	RODRIGUES et al, 2013 ⁽²⁷⁾	Brazil	= To validate the content and appearance of a flipchart entitled &quo= t;I can breastfeed my child" among puerperal women admitted to an obstet= rics ward.	All illustrations were found to be clear = and comprehensive. However, picture 6 had a relevance of 85.7% compared to 90= % to 100% for the other pictures.
Explanatory folder	FRANCO et al, 2019 ⁽²⁸⁾	Brazil	= To describe the experience of developing and applying an educational technology as a way to promote maternal self-efficacy in breastfeeding in= the postpartum period.	By means of the educational technology, a favorable environment for the empowerment of postpartum women was provide= d. The folder "Every woman is able to breastfeed!" was used, which promoted interactivity, knowledge, and debate about maternal self-efficac= y to breastfeed, creating a favorable environment for dialogue about factors t= hat can negatively interfere in the establishment and maintenance of breastfeeding in the postpartum period.
Educational video	ADHISIVAM et al, 2017 ⁽²⁹⁾	India	= To eval= uate the impact of a postnatal video-based health education program on promoti= ng exclusive breastfeeding among primiparous mothers.	Improved knowledge about exclusive breastfeeding among primiparous mothers postnatally, better than with rou= tine lactation counseling alone.
Educational video	ADAM et al, 2019 ⁽³⁰⁾	South Africa	= To meas= ure the causal effect ed a video-based intervention, developed using human-centered design principles, on infant feeding behaviors in under-resourced South African communities.	Intended to support capacity building for= a "next generation" of digital, maternal and child health educati= on, a generation of innovative educational tools rooted in the needs and cont= exts of the audiences they are intended to serve.
Educational video	LAU et al, 2016 ⁽³¹⁾	Singapore	= Synthesize the best available evidence by performing a meta-analysi= s to assess whether electronic technologies had any effect on improving breastfeeding outcomes among perinatal women.	Improved knowledge about exclusive breastfeeding among primiparous mothers
Source: The authors

DISCUSSION

This literature review revealed that the technolog= ies developed for health education for breastfeeding self-efficacy were mainly videos ^(29-31), serial albums ^{(16, 20-21),}educational primers ^(17-18), and folders ⁽²⁸⁾. But other types of technology were also identified. Thus, it is possible to realize that the a= ct of breastfeeding is not so simple, which stimulates some researchers in the search for research and methods to assist in breastfeeding in a safe and relaxed manner.

The development of educational technologies struct= ured based on a theoretical framework enables the use of principles and theories that support and reach the expected educational goal. Among the studies analyzed, it was noticed that only one of the works describes the theoretic= al framework used: the psychometric model. Psychometrics represents an importa= nt form of objective assessment of psychological phenomena that have been structured in the development of clinical research since the 19th century. = ⁽³²⁾ Thus, the need for studies to clearly describe the theoretical framework th= at guides the development of the method is emphasized.

All studies included in this review used at least = one type of educational technology as a tool for the educational care method wi= th mothers who were or will be going through the breastfeeding process, aiming= to foster learning in health in a meaningful way.

In the category educational booklets, two articles described the use of this technology. ^(17-18) One of the studies reported on the importance of the booklet for the breastfeeding support roo= m. Work is one of the reasons that most lead to early weaning, thus the breastfeeding support room at the workplace is important, as well as the booklet as a way to clarify possible doubts and enhance the encouragement of this very important practice in the life of the child and the mother. ^=
(18) The other study addressed the importance of the educational booklet for mob= ile devices. The study was validated both by judges and the target audience and approved as a relevant theme, since technology, especially mobile devices, = is one of the means in which there is most demand for information. ⁽¹⁷⁾

Compared to other studies that also had the educational booklet as a tool, it was noticed that this model is self-explanatory, due to the presence of images, which favors the teaching-learning process, and can be used by various health professionals,= not only nurses. Thus, it is a simple and low cost material, which has shown results. ⁽³³⁾

There is the breastfeeding education manual. It was considered relevant and highly relevant, and because it had many illustrati= ons, it attracted even more attention from the public. The manual presented the = most common doubts among women, thus collaborating with the nurses' role in the = need to provide breastfeeding self-efficacy to nursing mothers. ⁽²⁶⁾ = The tool becomes playful, because it is visibly illustrative and exposes in a detailed manner all the aspects and difficulties that breastfeeding mothers experience. It is of paramount importance to create methods that facilitate breastfeeding self-efficacy, thus improving the rates of exclusive breastfeeding up to six months of age.

Another category is the serial album. The construc= tion of the "I can breastfeed my child" album was described in three of the papers that make up the sample of the present study, being an experience report, a methodological research, and the validation study. ^(20,21,27=
) Both articles approached the album as a technology of easy access and understanding. It is seen as something with attractive content, because it = is composed of illustrations and important points on the subject, clarifying m= any doubts and facilitating educational dialogue among nursing mothers.

We also highlight the use of the explanatory folder aimed at promoting maternal self-efficacy in breastfeeding in the postpartum period; the folder was used individually by women who had recently started breastfeeding and were in rooming-in. The outcome of the use was positive, = as it created a favorable environment for the empowerment of postpartum women, besides opening a space for debate on maternal breastfeeding self-efficacy.= ⁽²⁸⁾The use of various types of technology can benefit the nursing woman = in order to have a variety of options and much easier access to information, so the use of the folder, for example, together with the use of educational vi= deos can bring this confidence more broadly.

The flip-chart technology model was described in t= wo studies. The technology was effective, as it was identified that participat= ing mothers obtained higher self-efficacy scores, continued to breastfeed, and exhibited lasting exclusive breastfeeding, both at the time of hospital discharge and in the second month postpartum. ^(24,27)=

In the Cordel Literature category, one of the stud= ies sought to describe the evaluation of the use of cordel literature on breastfeeding among breastfeeding women, finding positive results, such as = its playful resource, role as a didactic tool, besides being a means of health communication and a facilitator of the teaching-learning process. ⁽³⁴⁾⁼ It was seen that the cordel can be a technology that can provide the bond of these mothers, so that they can read together and thus obtain the necessary information, however, the technology should be evaluated on the issue of si= ze, and should not be so long. ⁽¹⁹⁾

Another study also chose the cordel literature mod= el, in the context of visually impaired participants, men and women, of differe= nt age groups and education, with the purpose of assessing the knowledge of th= ese people about breastfeeding. It was carried out with the use of computers as= a voice synthesizer and a computer screen reading system for the blind, and it was a validation study, whose objective was to describe the result of the apparent and content validation of the assistive technology. Positive resul= ts were obtained, because the participants of the study showed they liked the method of the study, resulting in excellent evaluations. However, it is reported that more time is needed to effectively validate the study. ^(=
19)

In South Africa, exclusive breastfeeding rates rem= ain low and breastfeeding promotion is a national health priority, so video has proven to be an effective alternative in this context. It could be inferred that the group that had both breastfeeding support methodologies had satisfactory results in self-efficacy for exclusive breastfeeding up to six months of age. The video was designed as an entertainment intervention and developed based on the principles of human-centered designer and community.= As the study unfolded, the development of the capacity for the formation of "a new generation" of digital education in maternal and child hea= lth was perceived, generating innovative educational tools tied to the needs of= the public context. ⁽³⁰⁾

Tools also used, considered traditional teaching resources, were the book and the DVD. The women answered a questionnaire wi= th 50 questions about the theme, then participated in a brief discussion on the subject and watched a video to fix the content. The study was approved by t= he ethics committee and aimed to provide services that support breastfeeding a= nd work on self-efficacy at this important time. ⁽²³⁾

Video is a widely used technology. However, it is observed that the identified results show little significant improvement wh= en compared to mothers who had only an educational dialogue with the health professional. ⁽²⁹⁾In view of this, the combination of dialogue = and technology is considered essential, in order to enhance knowledge and incre= ase the number of people who perform exclusive breastfeeding until the child is= six months old.

Another study on construction and validation of an educational video for teaching cardiopulmonary resuscitation for deaf people revealed that the technology was evaluated by the participating audience as= a tool that encourages learning and may result in lives saved at a given time= . ⁽³⁵⁾

The use of group tools, such as the treasure box, = is also described. The technology was used in an interactive group session designed to explore the health benefits of breastfeeding. However, there wa= s a perceived need for further development of the tool to reflect specific heal= th benefits, such as reinforcing messages about the benefits of breastfeeding = at every opportunity using other resources. ⁽²²⁾ Thus, the need for association of one or more intervention alternatives is evidenced.

CONCLUSION

The study met the proposed objective of identifying educational technologies to promote breastfeeding self-efficacy. These are various materials, printed and digital, used, individually or in associatio= n, for individual consultation or group care. The great majority of the studies were about the construction and validation of the technology that proved the effectiveness of its use and highlighted alternatives that enhance the management of the technology for maternal self-efficacy for breastfeeding.<= o:p>

The scarc= ity of studies that describe the theoretical framework used for construction and validation are pointed out as gaps, since this gives consistency and reliability to the research. The valorization of the theme is suggested as a way to increase the knowledge of nursing mothers about breastfeeding, provi= ding them with self-efficacy and thus obtaining exclusive breastfeeding until the age of six months, with technologies being an ally to encourage this very i= mportant practice. Therefore, the investment in studies that provide the creation of= new tools in order to encourage and assist the practice of breastfeeding is a relevant and necessary point in order to reach satisfactory levels in the breastfeeding process.

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= Corresponding author: Thayse Gabrielle Viana Lima, = rua delegado felix dias, número 7527, bairro loteamento porto alegre Cep: 64039= -050, 86 9572-3813 e thaysegabriell= e0@gmail.com

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Submission: 2021-08-03

Approval: 2021-09-07<= /span>

	LILACS, BDENF, MEDLINE e IBECS via BVS	(("Breastfeeding") OR ("exclusive breastfeeding") OR ("Breast Feeding")) AND (("Educati= onal Technology")) AND ((self-efficacy) OR (nursing) OR ("Self Effic= acy nursing"))
(("Breastfeeding") OR ("exclusive breastfeeding") OR ("Breast Feeding")) AND ((teaching materials) OR (teaching materials))) AND ((self-efficacy) OR (nursing) OR ("Self Efficacy nursing"))
(("Breastfeeding") OR ("exclusive breastfeeding") OR ("Breast Feeding")) AND (("Validat= ion Study") OR ("Validation Study")) AND ((self-efficacy) OR (nursing) OR ("Self Efficacy nursing"))
(("Breastfeeding") OR ("exclusive breastfeeding") OR ("Breast Feeding"))= AND (("Educational Technology") OR ("Teaching Materials")= OR ("Validation Study")) AND ((self-efficacy) OR (nursing) OR ("Self Efficacy nursing"))
PUBMED	(("Breast Feeding"[MeSH Terms]) AND ((("Educational Technology"[MeSH Terms]) OR ("Teaching Materials"[MeSH Terms])) OR ("Valida= tion Study"[MeSH Terms]))) AND (("Self Efficacy"[MeSH Terms]) OR (Nursing[MeSH Terms]))=