Background

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 (1). 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 (1,2).

Breastfeeding peer-supporters are mothers who have experience of breastfeeding and are able to support other local mothers. Evidence from low and middle income countries suggests that breastfeeding peer-support increases the number of mothers who continue breastfeeding, but previous UK-based breastfeeding peer-support studies have not shown similar effects (3-6). 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 breastfeeding peer-support intervention that uses a Motivational Interviewing approach to help mothers who are young or live in disadvantaged areas to continue breastfeeding for longer.

How will we develop the intervention?

We will survey UK service providers to understand how breastfeeding peer-support is currently provided. We will also be looking at the evidence from previous studies on peer-support for breastfeeding and the use of Motivational Interviewing approaches by peer-supporters (or peer outreach workers).

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 breastfeeding peer-support; 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 breastfeeding peer-support can be provided alongside existing services. These findings will inform the content and design of our breastfeeding peer-support intervention.

Can the intervention be delivered?

We will test whether it is possible to deliver Motivational Interviewing based breastfeeding peer-support 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 Motivational Interviewing based breastfeeding peer-support. 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 Motivational Interviewing based breastfeeding peer-support is to help mothers continue breastfeeding for longer.

Who is organising and funding the study?

This study is being organised by the Institute of Primary Care and Public Health, Cardiff University, in collaboration with Swansea University, Public Health Wales NHS Trust and Involving People. This research is funded by the National Institute of Health Research Health Technology Assessment (project number 13/18/05). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Health Technology Assessment, NIHR, NHS or the Department of Health.

Further information

For further information, please contact mi-bfps@cardiff.ac.uk or visit www.mi-bfps.co.uk

References

1. Health & Social Care Information Centre. Infant Feeding Survey - UK, 20102012 November 2012. Available from: http://www.esds.ac.uk/doc/7281/mrdoc/pdf/7281_ifs-uk-2010_report.pdf
2. Renfrew MJ, Pokhrel S, Quigley M, McCormick F, Fox-Rushby J, Dodds R, et al. Preventing disease and saving resources: the potential contribution of increasing breastfeeding rates in the UK. London: UNICEF, 2012.
3. Jolly K, Ingram L, Freemantle N, Khan K, Chambers J, Hamburger R, et al. Effect of a peer support service on breast-feeding continuation in the UK: A randomised controlled trial. Midwifery. 2012;28(6):740-5.
4. Graffy J, Taylor J, Williams A, Eldridge S. Randomised controlled trial of support from volunteer counsellors for mothers considering breast feeding. British Medical Journal.2004;328(7430):26-9.
5. Watt RG, Tull KI, Hardy R, Wiggins M, Kelly Y, Molloy B, et al. Effectiveness of a social support intervention on infant feeding practices: randomised controlled trial. Journal of Epidemiology and Community Health. 2009;63(2):156-62.
6. Muirhead PE, Butcher G, Rankin J, Munley A. The effect of a programme of organised and supervised peer support on the initiation and duration of breastfeeding: a randomised trial. British Journal of General Practice. 2006;56(524):191-7.
7. Michie S, van Stralen M, West R. The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science. 2011;6(1):42.
8. Miller WR, Rollnick S. Motivational Interviewing: Helping people change. . Third ed. New York: The Guilford Press; 2012.
9. Naar-King S, Outlaw A, Green-Jones M, Wright K, Parsons JT. Motivational interviewing by peer outreach workers: a pilot randomized clinical trial to retain adolescents and young adults in HIV care. Aids Care-Psychological and Socio-Medical Aspects of Aids/HIV. 2009;21(7):868-73.
10. Outlaw AY, Naar-King S, Parsons JT, Green-Jones M, Janisse H, Secord E. Using Motivational Interviewing in HIV Field Outreach With Young African American Men Who Have Sex With Men: A Randomized Clinical Trial. American Journal of Public Health. 2010;100:S146-S51.

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