Dear editor

I read with great interest the study by Thepha et al on the effectiveness of a Facebook-based exclusive breastfeeding (EBF) support program for husbands during the COVID-19 pandemic.¹ While this research provides valuable insights, there are some limitations that warrant discussion.

The study’s quasi-experimental design limits causal inferences. A randomized controlled trial would provide stronger evidence for the program’s efficacy.² Additionally, the small sample size (n=72) may limit generalizability. A larger, more diverse sample could enhance external validity.

The authors report significant improvements in husbands’ EBF knowledge but not in attitudes or behaviors. This raises questions about the program’s ability to translate knowledge gains into meaningful behavioral change. Future research should explore strategies to more effectively influence attitudes and behaviors, perhaps by incorporating elements of behavior change theories.³

The study’s reliance on self-reported measures introduces potential bias. Objective measures of breastfeeding outcomes (eg, infant weight gain, breastfeeding duration) would strengthen the findings.⁴ Moreover, the short follow-up period (1 month) may not capture long-term effects. A longitudinal design could provide insights into the program’s sustained impact.

While the Facebook platform offers accessibility, it may exclude participants without internet access or digital literacy. Exploring alternative delivery methods could enhance inclusivity. Additionally, the potential for misinformation spread on social media platforms warrants careful consideration in health education interventions.⁵

Despite these limitations, this study contributes valuable knowledge to the field of breastfeeding support, particularly in the context of the COVID-19 pandemic. The authors’ innovative use of social media to engage fathers in breastfeeding education is commendable. Future research building on this work could significantly impact breastfeeding rates and maternal-child health outcomes.

In conclusion, while this study provides promising initial evidence for a Facebook-based EBF support program, addressing the noted limitations in future research will strengthen the evidence base for such interventions.