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Project identifier:Breastfeeding

Topic:Uptake and continuation of breastfeeding

Location:UK

Dates covered:October 1990 to 2012

Overview

An evaluation of the UK Infant Feeding Initiative that covered 79 projects, of which 26 were peer-support breastfeeding programmes (Dykes123_).

Objectives

The aim of the evaluation was to assess if infant feeding projects were successful in increasing the uptake and continuation of breastfeeding; synthesise the key challenges and findings; and make

recommendations on how best to promote breastfeeding and support mothers in socially excluded communities who choose to breastfeed. The review of peer-support programmes focused on the challenges of implementing programmes successfully.

Theoretical models

Dennis’s conceptual model of peer support1_{in a health-care context was used to describe the ultimate aim}

of peer support, but the evaluation itself aimed to contribute to the development of programme theory related to the process of establishing peer-support programmes. Seven common challenges were noted:

l Cultural awareness Conducting some form of local analysis and needs assessment enabled the programme to be based on the needs of the local culture and the knowledge of local people.

l Building on existing infrastructure As a continuation of the needs assessment, identifying existing and related initiatives and linking with them is key.

l Comprehensive planning That includes all key stakeholders, including community members.

l Engaging PSs Creating a training model that provides ongoing support, and that focuses on empowerment by encouraging communities to value their own capacity.

l Peer–professional interface Aim to maintain clear ongoing dialogue between PSs and HPs to ensure understanding of the complementary nature of the roles; give PSs‘foreground’responsibility for facilitation with recourse to professionals as‘background’support.

l Marketing the programme Needs to include ongoing publicity within the community.

l Supportive infrastructure Spanning the hospital–community interface and including multiple access points at accessible venues across the community.

The evaluation noted that women in socially excluded groups in cultures where breastfeeding is

marginalised have negative expectations of breastfeeding, low confidence, and experience embarrassment about breastfeeding in public. Those groups in most need of support are least visible to the health system.

Target population

Women post-partum in socially excluded communities who may be considering breastfeeding. Intervention

Peer-support interventions focused on identifying mothers post-partum who were considering breastfeeding, engaging them in an exchange of information and support, and helping them to problem-solve when encountering challenges with breastfeeding.

Peer-support workers with experience of breastfeeding were engaged, with the help of HPs, to approach women in hospital and community settings and explore their interest in receiving information and support around breastfeeding. Contacts could be made via HPs, who acted as gatekeepers in hospital settings, via midwife liaisons in the community or community nurses. In some projects, peer-support workers also engaged informally, using their local social networks to find women through family and friends.

Women received support while still in hospital, and/or attended group sessions that were held at local community venues, such as places where antenatal classes were being held or well baby clinics. They were offered tips and support on how to breastfeed, as well as discussions about common problems and how to resolve them. The women in the groups also supported each other in terms of wider issues concerning parenting and breastfeeding in public settings and the acceptability of breastfeeding to friends and family. Peer supporter: recruitment

Peer supporters were recruited by community organisations, community midwives and nurses. Peer supporter: training

Peer supporters were offered a short course facilitated by qualified members from one of the voluntary breastfeeding organisations or by HPs.

Evaluation

Action research or qualitative evaluation for developmental studies; some attempts to collect before-and-after data.

Quantitative outcomes

Projects were at the capacity-building and developmental stage at the time of evaluation, which precluded definitive statements about causal relationship between the interventions and breastfeeding outcomes. However, there was a positive trend in most projects towards increased continuation of breastfeeding. Main themes and propositional statements

When the condition or behaviour is seen negatively or stigmatised in society or in the community, this negativity may act as a barrier to participation.

Peer supporters may act as role models who help participants overcome negative social attitudes and increase their willingness to take up healthy behaviours.

A setting’s appropriateness, acceptability, and accessibility can create a sense of security that may increase programme attendance or participation.

The HP–PS interface impacts PSs’confidence and ability to deliver interventions.

Lack of communication and misunderstanding of each other’s roles can be a potential source of conflict for HPs and PSs; this can be minimised when HPs are fully informed of the scheme and involved in providing some form of education and training.

When HPs lack confidence in their own knowledge and skills, they tend to resist or avoid engagement in the projects, adopting a gatekeeping role that makes PSs feel unwelcome.

Health information needs to be offered opportunistically, when participants are interested and ready to receive it.

‘Where the interface aims to control rather than enable interaction, peer supporters are limited in terms of working‘as potential agents of change in their communities’(Curtiset al.2007).

Antecedent

Dykes F.Infant Feeding Initiative: A Report Evaluating the Breastfeeding Practice Projects 1999–2002. London: Department of Health: 2003.

Descendant

Dykes F, Flacking R. Encouraging breastfeeding: a relational perspective.Early Hum Dev2010;86:733–6.131

Cluster references

9196 Condon L, Ingram J. Increasing support for breastfeeding: what can Children’s Centres do? Health Soc Care Commun2011;19:617–25.78

2363 Curtis P, Woodhill R, Stapleton H. The peer–professional interface in a community-based, breast feeding peer-support project.Midwifery2007;23:146–56.108

2467 Dykes F. Government funded breastfeeding peer support projects: implications for practice. Matern Child Nutr2005;1:21–31.123

14798 Gillis DE.Exploring Dimensions of Health Literacy: A Case Study of Interventions to Promote and Support Breastfeeding. PhD thesis. Nottingham: University of Nottingham; 2009.35

312 Schmeid V, Beake S, Sheehan A, McCourt C, Dykes F. Women’s perceptions and experiences of breastfeeding support: a metasynthesis.Birth2011;38:49–60.

2464 Smale M, Renfrew M, Marshall JL, Spiby H. Turning policy into practice: more difficult than it seems. The case of breastfeeding education.Matern Child Nutr2006;2:103–13.

Reference

Dennis C-L. Peer support within a health care context: a concept analysis.Int J Nurs Stud 2003;40:321–32.1