Abstract
BackgroundMany women in the UK stop breastfeeding before they would like to, and earlier than is recommended by the World Health Organization (WHO). Given the potential health benefits for mother and baby, new ways of supporting women to breastfeed for longer are required. The purpose of this study was to develop and characterise a novel Motivational Interviewing (MI) informed breastfeeding peer-support intervention.MethodsQualitative interviews with health professionals and service providers (n = 14), and focus groups with mothers (n = 14), fathers (n = 3), and breastfeeding peer-supporters (n = 15) were carried out to understand experiences of breastfeeding peer-support and identify intervention options. Data were audio-recorded, transcribed, and analysed thematically. Consultation took place with a combined professional and lay Stakeholder Group (n = 23). The Behaviour Change Wheel (BCW) guided intervention development process used the findings of the qualitative research and stakeholder consultation, alongside evidence from existing literature, to identify: the target behaviour to be changed; sources of this behaviour based on the Capability, Opportunity and Motivation (COM-B) model; intervention functions that could alter this behaviour; and; mode of delivery for the intervention. Behaviour change techniques included in the intervention were categorised using the Behaviour Change Technique Taxonomy Version 1 (BCTTv1).ResultsBuilding knowledge, skills, confidence, and providing social support were perceived to be key functions of breastfeeding peer-support interventions that aim to decrease early discontinuation of breastfeeding. These features of breastfeeding peer-support mapped onto the BCW education, training, modelling and environmental restructuring intervention functions. Behaviour change techniques (BCTTv1) included social support, problem solving, and goal setting. The intervention included important inter-personal relational features (e.g. trust, honesty, kindness), and the BCTTv1 needed adaptation to incorporate this.ConclusionsThe MI-informed breastfeeding peer-support intervention developed using this systematic and user-informed approach has a clear theoretical basis and well-described behaviour change techniques. The process described could be useful in developing other complex interventions that incorporate peer-support and/or MI.
Highlights
Many women in the UK stop breastfeeding before they would like to, and earlier than is recommended by the World Health Organization (WHO)
Qualitative interviews and focus groups The purpose of the focus groups and interviews was to inform the design of the intervention by helping us to understand the functions and acceptability of Motivational Interviewing (MI)-based breastfeeding peer-support, and explore potential issues associated with implementation
Qualitative findings Behaviour change wheel stage 1: Understanding behaviour Using our qualitative findings, we compiled a list of potentially modifiable sources of behaviour for breastfeeding continuation, and mapped these against the elements of the COM-B model (Table 1)
Summary
Many women in the UK stop breastfeeding before they would like to, and earlier than is recommended by the World Health Organization (WHO). Given the health benefits of breastfeeding during the first two years of a child’s life (and beyond) for mothers and their infants [6, 7], new approaches are required to support mothers to breastfeed for longer. Four UK based randomised controlled trials have not found breastfeeding peer-support to be effective in improving breastfeeding maintenance [13,14,15,16] These UK studies tested low intensity breastfeeding peer-support interventions, whereas breastfeeding peer-support is more likely to be effective if it is intensive, delivered face-to-face, and starts early in the postnatal period, and it is unlikely to be effective if only offered to women who actively seek help [2, 17], as this may prevent the intervention from reaching the women who are most at risk of stopping breastfeeding
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