Abstract
The UK has low breastfeeding rates, with socioeconomic disparities. The Assets‐based feeding help Before and After birth (ABA) intervention was designed to be inclusive and improve infant feeding behaviours. ABA is underpinned by the behaviour change wheel and offers an assets‐based approach focusing on positive capabilities of individuals and communities, including use of a Genogram. This study aimed to investigate feasibility of intervention delivery within a randomised controlled trial (RCT). Nulliparous women ≥16 years, (n = 103) from two English sites were recruited and randomised to either intervention or usual care. The intervention – delivered through face‐to‐face, telephone and text message by trained Infant Feeding Helpers (IFHs) – ran from 30‐weeks' gestation until 5‐months postnatal. Outcomes included recruitment rates and follow‐up at 3‐days, 8‐weeks and 6‐months postnatal, with collection of future full trial outcomes via questionnaires. A mixed‐methods process evaluation included qualitative interviews with 30 women, 13 IFHs and 17 maternity providers; IFH contact logs; and fidelity checking of antenatal contact recordings. This study successfully recruited women, including teenagers, from socioeconomically disadvantaged areas; postnatal follow‐up rates were 68.0%, 85.4% and 80.6% at 3‐days, 8‐weeks and 6‐months respectively. Breastfeeding at 8‐weeks was obtained for 95.1% using routine data for non‐responders. It was possible to recruit and train peer supporters to deliver the intervention with adequate fidelity. The ABA intervention was acceptable to women, IFHs and maternity services. There was minimal contamination and no evidence of intervention‐related harm. In conclusion, the intervention is feasible to deliver within an RCT, and a definitive trial required.
Highlights
Despite the benefits of breastfeeding for infants and mothers (Victora et al, 2016), the UK experiences a high drop off in breastfeeding in the two weeks following birth, very low proportions of babies exclusively breastfed to four or six months, and marked socio‐economic inequalities in breastfeeding (McAndrew et al, 2012).There is strong systematic review evidence that providing additional support to women who want to breastfeed increases breastfeeding duration (McFadden et al, 2017)
Proactive contact was found to be effective when delivered by peer supporters (Dennis, Hodnett, Gallop, & Chalmers, 2002; Forster et al, 2019), and promising in a feasibility study of an infant feeding team (Hoddinott, Craig, Britten, & McInnes, 2012c; Hoddinott, Craig, Maclennan, et al, 2012a)
Our results indicate that (1) we were successful in recruiting women from areas of socioeconomic disadvantage and teenagers, with adequate follow up rates; (2) it was feasible to recruit and train existing peer supporters to the new ABA role, and they were able to deliver the intervention with satisfactory fidelity, incorporating the delivery of core Behaviour Change Techniques (BCTs) in line with behavioural theory and a woman‐centred approach; (3) the intervention was acceptable to women, Infant Feeding Helpers (IFHs) and maternity services; and (4) there were no harms associated with the intervention, and contamination was low
Summary
Despite the benefits of breastfeeding for infants and mothers (Victora et al, 2016), the UK experiences a high drop off in breastfeeding in the two weeks following birth, very low proportions of babies exclusively breastfed to four or six months, and marked socio‐economic inequalities in breastfeeding (McAndrew et al, 2012).There is strong systematic review evidence that providing additional support to women who want to breastfeed increases breastfeeding duration (McFadden et al, 2017). Evidence suggests more intensive contact (Jolly et al, Jolly et al, 2012b, McFadden et al, 2017) and early contact postnatally (Hoddinott, Craig, Maclennan, Boyers, & Vale, 2012a; Ingram, MacArthur, Khan, Deeks, & Jolly, 2010) are important characteristics of effective breastfeeding support. Woman‐centred rather than breastfeeding‐focussed support may improve acceptability to women (Hoddinott, Craig, Britten, & McInnes, 2012c; Trickey & Newburn, 2014) In cultures such as the UK, where mixed feeding is common, inclusion of help with formula feeding in peer support may be important to reduce the risk of alienating women and improve reach and retention of any intervention (Thomson, Ebisch‐Burton and Flaking, 2015; Trickey & Newburn, 2014). The assets‐based approach informed the style and principles of intervention delivery, and the Behaviour Change Wheel informed intervention content in the form of specific Behaviour Change Techniques (BCTs) based on behavioural theory
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