National Institute of Health Research

HTA - 13/18/05: A novel peer-support intervention using Motivational Interviewing for breastfeeding maintenance: a UK feasibility study

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Project title A novel peer-support intervention using Motivational Interviewing for breastfeeding maintenance: a UK feasibility study
Research type Primary Research
Status Research in progress
Start date September 2014
Publication date

March 2017

This is the estimated publication date for this report, but please note that delays in the editorial review process can cause the forecast publication date to be delayed.

Cost £ 293,310.00
Chief Investigator Professor Shantini Paranjothy
Co-investigators Professor Deborah Fitzsimmons (Swansea University), Professor Billie Hunter (Cardiff University), Dr Julia Sanders (Cardiff University), Dr Aimee Grant (Cardiff University), Dr Michael Robling (Cardiff University), Dr Amy Brown (Swansea University), Dr Rhiannon Phillips (Cardiff University), Professor Stephen Rollnick (Cardiff University), Ms Sally Tedstone (Public Health Wales NHS Trust), Mrs Sian Regan (Involving People)
Contractor Cardiff University
Plain English summary Although 80% of mothers start breastfeeding in the UK, fewer than half breastfeed exclusively after one week and only 1 in 100 breastfeed exclusively to 6 months (3). Most women stop breastfeeding before they had planned. Mothers who are younger (under 20 years), less affluent, and of white British ethnicity are less likely to start or continue to breastfeed (3,4). Evidence from low and middle income countries suggests that breastfeeding peer-support (BFPS) increases the number of mothers who continue breastfeeding, but previous UK-based BFPS studies have not shown similar effects (5-8). Current guidance for health service providers does not specify how to provide effective support to new mothers in the UK to help them continue breastfeeding for longer. We propose to develop a new BFPS intervention that uses a motivational interviewing (MI) approach to help mothers who are young or live in disadvantaged areas to continue breastfeeding for longer. Motivation, confidence and social support are important aspects of changing health behaviour (9). MI is a form of counselling that supports people in changing behaviour by exploring their thoughts and concerns and supporting them in setting their own goals (10). This approach has not previously been used in BFPS but has been successful in other areas, including peer outreach for young people with HIV (11,12). We will train peer-supporters in using an MI-based approach to provide them with skills to communicate effectively with mothers. Our BFPS intervention will include proactive, daily contact by the peer-supporter for at least 2 weeks, starting within 48 hours of birth. We will survey UK service providers to understand how BFPS is currently provided. We will hold focus groups with pregnant women, mothers and peer supporters and interview health professionals and service managers in each area to discuss what mothers require from BFPS; the best way and time for peer-supporters to contact mothers; the type of payment or reward for peer supporters that will be acceptable (e.g. salary, childcare expenses, satisfaction, new skills), the training and on-going support needs of peer-supporters, and how BFPS can be provided alongside existing services. These findings will inform the content and design of our BFPS intervention. We will test whether it is possible to deliver MI-based BFPS in three areas in England and Wales where there are high levels of social and economic deprivation, high rates of teenage pregnancy and low rates of breastfeeding. We will recruit and train between 6 and 9 peer-supporters to provide support to 90 women over six months. Women will be recruited by community midwifery teams. We will assess how many mothers take up the peer-support, whether it can be provided as planned, if it is acceptable particularly to young (<20 years) and first-time mothers, and the cost of providing MI based BFPS. We will obtain views on the intervention using face-to-face interviews with 30 mothers, 6-9 peer-supporters, and 9 health professionals. We will carry out structured telephone interviews with all mothers in the study, and use data collected by Health Visitors or routine NHS data to find out about their health, whether they were breastfeeding at 10 days and 6-8 weeks, and the health of their infants. We will use the findings from this study to make recommendations about a further study to test how effective MI-based BFPS is to help mothers continue breastfeeding for longer.
Scientific summary Design: (i) Rapid evidence review and qualitative research to inform development of a novel breastfeeding peer-support (BFPS) intervention that uses a motivational interviewing (MI) approach for breastfeeding (BF) maintenance, and (ii) a non-randomised multi-site study to test the feasibility of delivering MI based BFPS to mothers living in areas with high levels of social deprivation. Setting: Community maternity services in three areas with high levels of social deprivation and low BF initiation rates in England and Wales. Evidence review strategy: Web-based survey of UK service providers and search of 14 databases to characterise the range of BFPS programmes in current practice, identifying underpinning theoretical models, implementation issues and economic evaluations. Target population: Pregnant women considering BF. Exclusions: Preterm birth (<37 weeks), BF not intitiated clinical reason that precludes BF continuation, inability to consent. Intervention: MI based BFPS, characterised by proactive daily one-to-one peer-supporter led contact for at least 2 weeks, initiated within 48 hours of birth. Peer-supporters are women from a similar locality to the women they support, who have breastfed, completed accredited BFPS training and MI training. Content, optimal timing and methods of contact, training of peer-supporters, and fit with existing services will be informed by focus groups with pregnant women, mothers and peer-supporters, and interviews with midwives, health visitors and service managers. Measurement of costs and outcomes: Quantitative data will describe BFPS uptake, completion of scheduled contacts with peer-supporters according to age-group and parity; recruitment and retention of peer-supporters; and intervention costs from the perspective of the UK NHS, women and their families. We will assess the feasibility of different methods (structured telephone interviews with all mothers, data collected by Health Visitors and routine NHS data from Child Health Systems, Hospital Episode Statistics and General Practice) to collect outcome data (exclusive and partial BF at 10 days and 6-8 weeks, maternal and child health, well-being, satisfaction and healthcare resource utilisation). Peer-supporter structured diaries, audio recorded peer supporter-mother contacts (n=27) and qualitative interviews with mothers (n=30, at least half aged <20), peer-supporters (n=6-9) and health professionals (n=9) will be used to assess acceptability and intervention fidelity. Sample size: 6-9 peer-supporters (2-3 per site) will deliver BFPS to 90 mothers, over a 6-month period. Project timetable including recruitment rate: 24 months. Month (M) 1 8: Rapid evidence review, qualitative stakeholder research, intervention development, set up study sites. M 9 19: Peer-supporter recruitment, training, feasibility study recruitment, intervention delivery and data collection. M 18-24: Analysis and write-up. There are approximately 400 term births per month in the 20% of most deprived areas in the 3 study areas combined. Assuming 55% of women intend to BF, 50% of these consent and 90% go on to initiate BF, the sample size will be achievable in four months. Expertise in team: Multidisciplinary team with expertise in developing and testing complex interventions across multiple sites in community settings, MI, BFPS programmes, public health, epidemiology, qualitative research, midwifery, health visiting, and health economics.
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