Adaptation and validation of the Chinese version of the Service Quality Questionnaire for Internet hospital services in China.

Breastfeeding offers numerous health benefits for women and infants [–]. However, most women in the United States (US) do not meet the American Academy of Pediatrics recommendations for exclusive breastfeeding for the first 6 months and continued breastfeeding until 2 years or beyond, and large socio-economic and racial/ethnic inequities in breastfeeding persist [–]. Strong evidence that in-person and hybrid (in-person and virtual) breastfeeding peer counseling programs improve breastfeeding outcomes among women experiencing breastfeeding inequities have been available for over two decades [–]. In 2025, the National Academies of Sciences, Engineering, and Medicine report on breastfeeding in the US recommended more federal investment in these programs so that they can be scaled to adequately meet the needs of all women and families who wish to breastfeed []. Expanding virtual delivery of breastfeeding peer counseling has the potential to increase access to these services at scale and advance breastfeeding equity. However, little is known about how well fully virtual breastfeeding peer counseling services can be implemented. The COVID-19 pandemic accelerated virtual breastfeeding support services, and virtual delivery models continue to proliferate [–]. Among The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) agencies, counseling sessions by phone rose from 62.4% pre-pandemic to 83.2% by 2022 and video calls jumped from 5.8% to 31.6% []. By 2022, nearly 95% of WIC participants were served by agencies offering virtual breastfeeding services []. Telelactation – virtual breastfeeding support provided by International Board Certified Lactation Consultants (IBCLCs) via video – expanded rapidly during the pandemic, with more than one-third of women in the US using these services in 2020 and 2021 [, ]. Alongside the rapid expansion of virtual breastfeeding support, a growing body of evidence indicates that these virtual models can be effective, feasible to implement, and acceptable. A meta-analysis of randomized controlled trials found that diverse forms of virtual breastfeeding support were associated with higher exclusive breastfeeding rates at 1 month and 6 months postpartum []. Another systematic review and meta-analysis found that remote breastfeeding support can be effective for improving exclusive breastfeeding at 3 months but the quality of the evidence was low []. Improvements in exclusive breastfeeding at 4–8 weeks and 6 months were found when studies at high risk of bias were excluded []. The Telehealth for Mothers to Improve Lactation Confidence (Tele-MILK) digital randomized clinical trial found that telelactation services improved breastfeeding rates among Black parents, though not in the overall population []. Among a subsample of Latina parents who participated in interviews, almost all reported high satisfaction with telelactation due to the convenience of having immediate 24/7 support and not having to leave their homes []. At the same time, some Latina parents believed that telelactation may not be appropriate for all situations, noting that such services might be less helpful for issues like latch and positioning that require observation by IBCLCs []. Similarly, a subsample of Black parents who participated in interviews perceived telelactation as acceptable given that it was easy to use and convenient []. They also described telelactation as less burdensome than in-person support because it requires less time and does not pose challenges such as transportation and traveling with an infant, though the perceived need to look presentable for a video visit was a burden for some []. Additionally, a few Black parents who valued building relationships with IBCLCs did not like that telelactation typically did not allow for support from the same IBCLC across visits [].