A novel peer-support intervention using motivational interviewing for breastfeeding maintenance: a UK feasibility study

Abstract

Background In total, 81% of women in the UK start breastfeeding, but fewer than half continue beyond 6 weeks. Peer support in the early postnatal period may encourage women to breastfeed for longer. Objective To develop a breastfeeding peer-support intervention based on motivational interviewing (MI) for breastfeeding maintenance and to test the feasibility of delivering it to mothers in areas with high levels of social deprivation. Design Intervention development and a non-randomised multisite feasibility study. Setting Community maternity services in three areas with high levels of social deprivation and low breastfeeding initiation rates in England and Wales. Participants Pregnant women considering breastfeeding. Women who did not plan to breastfeed, who had a clinical reason that precluded breastfeeding continuation or who were unable to consent were excluded. Intervention The intervention Mam-Kind was informed by a survey of infant feeding co-ordinators, rapid literature review, focus groups with service users and peer supporters and interviews with health-care professionals and a Stakeholder Advisory Group. It consisted of face-to-face contact at 48 hours after birth and proactive one-to-one peer support from the Mam-Kind buddy for 2 weeks, followed by mother-led contact for a further 2–6 weeks. Main outcome measures Recruitment and retention of Mam-Kind buddies, uptake of Mam-Kind by participants, feasibility of delivering Mam-Kind as specified and of data collection methods, and acceptability of Mam-Kind to mothers, buddies and health-care professionals. Results Nine buddies were recruited to deliver Mam-Kind to 70 participants (61% of eligible women who expressed an interest in taking part in the study). Participants were aged between 19 and 41 years and 94% of participants were white. Intervention uptake was 75% and did not vary according to age or parity. Most contacts (79%) were initiated by the buddy, demonstrating the intended proactive nature of the intervention and 73% (n = 51) of participants received a contact within 48 hours. Follow-up data were available for 78% of participants at 10 days and 64% at 8 weeks. Data collection methods were judged feasible and acceptable. Data completeness was > 80% for almost all variables. Interviews with participants, buddies and health service professionals showed that the intervention was acceptable. Buddies delivered the intervention content with fidelity (93% of intervention objectives were met), and, in some cases, developed certain MI skills to a competency level. However, they reported difficulties in changing from an information-giving role to a collaborative approach. These findings were used to refine the training and intervention specification to emphasise the focus of the intervention on providing mother-centric support. Health-care professionals were satisfied that the intervention could be integrated with existing services. Conclusions The Mam-Kind intervention was acceptable and feasible to deliver within NHS maternity services and should be tested for effectiveness in a multicentre randomised controlled trial. The feasibility study highlighted the need to strengthen strategies for birth notification and retention of participants, and provided some insights on how this could be achieved in a full trial. Limitations The response rate to the survey of infant feeding co-ordinators was low (19.5%). In addition, the women who were recruited may not be representative of the study sites. Funding The National Institute for Health Research Health Technology Assessment programme.

A realist review of one‐to‐one breastfeeding peer support experiments conducted in developed country settings

“…Our realist review was intended to inform intervention development and an experimental evaluation strategy for a UK‐based one‐to‐one care pathway BFPS intervention for mothers of full‐term babies (Paranjothy et al, , in press). A realist review of community‐based peer support interventions (BFPS being one of the included forms) to increase health literacy and reduce health inequality (addressing a range of health issues) has been conducted (Harris et al, ).…”

An assets-based intervention before and after birth to improve breastfeeding initiation and continuation: the ABA feasibility RCT

“…A recent uncontrolled feasibility trial of breastfeeding peer support, the Mam-Kind study, 31 reported that delivery of that intervention, which included motivational interviewing by paid peer supporters, was feasible and acceptable. A particular strength of the Mam-Kind report was its detailed process evaluation, which enables us to make comparisons with the ABA study's intervention design and findings.…”

“…The Mam-Kind study 31 had a midwife who supervised the peer supporter teams and worked to encourage the hospital midwives to notify the peer supporters about the birth. As a consequence, Mam-Kind contacted 73% of women within 48 hours of birth.…”

“…Our early follow-up rates were similar to that of Mam-Kind. 31 We had data on feeding method within 14 days from 68% of women and Mam-Kind achieved 63% follow-up at 10 days using telephone follow-up. At 8 weeks, ABA obtained 85% follow-up and data on feeding status on an additional 10% of women from health visitor records.…”

“…In comparison with health-care professionals, peer supporters may be considered more approachable and operate as positive role models to whom women can relate because of their direct experience of the challenges of breastfeeding, and in contexts where breastfeeding may not be the social norm. 31 A systematic review 32 of breastfeeding peer support interventions reported a significant increase in breastfeeding initiation in three trials that targeted this support at pregnant women who had decided to breastfeed (relative risk for not initiating breastfeeding 0.64, 95% CI 0.41 to 0.99), but no difference in the three trials that offered universal peer support to all pregnant women (relative risk for not initiating breastfeeding 0.96, 95% CI 0.76 to 1.22). Heterogeneity in the meta-analysis of targeted breastfeeding peer support was high, which might be because of differences in the settings and context where the peer support was offered and the intensity of the interventions.…”