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 foc… Show more
“…For example, Trickey et al [29] and the recent multicentre RUBY (Ringing Up about Breastfeeding Early) trial undertaken in Australia found that repeated contacts in the early postnatal period (a risk period for discontinuation), and proactive support, created important opportunities for breastfeeding support [52]. Furthermore, our findings emphasise how emotionally warm and enabling relationship with the peer support enhanced women’s motivation, similar to the elements of emotional accessibility identified by Trickey et al [29] and others [35, 51]. Our findings support wider literature that emphasises the need for multiple opportunities for women to access support for infant feeding [13, 16].…”
Section: Discussionsupporting
confidence: 82%
“…More simply, this model enables intervention designers to consider a) ‘what behaviours do I want to target?’ (inner layer), b) ‘how am I going to change the behaviour and what elements does the intervention need?’ (second layer), and c) ‘what needs to be in place for the intervention to be delivered?’ (outer layer). The COM-B model has been used to inform and evaluate complex interventions such as a tobacco control strategy [33] and obesity strategy [34] and to develop a motivational interviewing based breastfeeding peer support intervention [35]. Fig.…”
Background
Breastfeeding peer support is advocated in national and international guidelines, but the evidence base is mixed. In the UK, breastfeeding peer support was found to be ineffective in randomised controlled trials, while women report positive impacts on breastfeeding experiences in qualitative studies. A key criticism levied against breastfeeding peer support is the lack of theory underpinning intervention design. Here we use the Behaviour Change Wheel to structure the analysis of evaluation data from an infant feeding peer support service in one area in North West England. We aimed to provide theoretically informed insights into how peer support can be operationalised to influence women’s breastfeeding experiences.
Methods
A 2 year mixed-methods evaluation (2014–2016) comprised surveys and interviews (individual or group) with peer supporters, health and community professionals, project leads and women, and routinely collected infant feeding data. We used the three layers (policies, intervention functions and behaviour-related components) of the Behaviour Change Wheel to structure and interpret the data.
Results
Overall data comprised 23 interviews (n = 14 - individual; n = 9 - group) and 409 completed surveys. The findings are presented in three sections. First, the ‘policies’ (outer) layer of the Behaviour Change Wheel provides insights into the existing context, infrastructure and resources that underpinned peer support delivery. Then the second (intervention functions) and inner (behaviour components) layers of the Behaviour Change Wheel are used to present three themes, ‘developing capabilities for infant feeding’, ‘motivating guidance and support’ and ‘opportunities for support’. These findings highlight that a peer support service delivered in a context of effective interdisciplinary partnerships, Baby Friendly Initiative accreditation, and flexible service planning, with peer support provided via different types of instrumental, social, practical and emotional support was perceived to be highly beneficial on women’s breastfeeding experiences. In the final section key challenges faced by the service are outlined.
Conclusion
While gaps and areas for development were highlighted, the service enhanced women’s capabilities, motivations and opportunities for breastfeeding. These theoretically informed insights into an organic and responsive peer support service help build the evidence base for breastfeeding peer support and to identify positive delivery features for future testing.
“…For example, Trickey et al [29] and the recent multicentre RUBY (Ringing Up about Breastfeeding Early) trial undertaken in Australia found that repeated contacts in the early postnatal period (a risk period for discontinuation), and proactive support, created important opportunities for breastfeeding support [52]. Furthermore, our findings emphasise how emotionally warm and enabling relationship with the peer support enhanced women’s motivation, similar to the elements of emotional accessibility identified by Trickey et al [29] and others [35, 51]. Our findings support wider literature that emphasises the need for multiple opportunities for women to access support for infant feeding [13, 16].…”
Section: Discussionsupporting
confidence: 82%
“…More simply, this model enables intervention designers to consider a) ‘what behaviours do I want to target?’ (inner layer), b) ‘how am I going to change the behaviour and what elements does the intervention need?’ (second layer), and c) ‘what needs to be in place for the intervention to be delivered?’ (outer layer). The COM-B model has been used to inform and evaluate complex interventions such as a tobacco control strategy [33] and obesity strategy [34] and to develop a motivational interviewing based breastfeeding peer support intervention [35]. Fig.…”
Background
Breastfeeding peer support is advocated in national and international guidelines, but the evidence base is mixed. In the UK, breastfeeding peer support was found to be ineffective in randomised controlled trials, while women report positive impacts on breastfeeding experiences in qualitative studies. A key criticism levied against breastfeeding peer support is the lack of theory underpinning intervention design. Here we use the Behaviour Change Wheel to structure the analysis of evaluation data from an infant feeding peer support service in one area in North West England. We aimed to provide theoretically informed insights into how peer support can be operationalised to influence women’s breastfeeding experiences.
Methods
A 2 year mixed-methods evaluation (2014–2016) comprised surveys and interviews (individual or group) with peer supporters, health and community professionals, project leads and women, and routinely collected infant feeding data. We used the three layers (policies, intervention functions and behaviour-related components) of the Behaviour Change Wheel to structure and interpret the data.
Results
Overall data comprised 23 interviews (n = 14 - individual; n = 9 - group) and 409 completed surveys. The findings are presented in three sections. First, the ‘policies’ (outer) layer of the Behaviour Change Wheel provides insights into the existing context, infrastructure and resources that underpinned peer support delivery. Then the second (intervention functions) and inner (behaviour components) layers of the Behaviour Change Wheel are used to present three themes, ‘developing capabilities for infant feeding’, ‘motivating guidance and support’ and ‘opportunities for support’. These findings highlight that a peer support service delivered in a context of effective interdisciplinary partnerships, Baby Friendly Initiative accreditation, and flexible service planning, with peer support provided via different types of instrumental, social, practical and emotional support was perceived to be highly beneficial on women’s breastfeeding experiences. In the final section key challenges faced by the service are outlined.
Conclusion
While gaps and areas for development were highlighted, the service enhanced women’s capabilities, motivations and opportunities for breastfeeding. These theoretically informed insights into an organic and responsive peer support service help build the evidence base for breastfeeding peer support and to identify positive delivery features for future testing.
“…There has been a growth in research using the COM-B to undertake a behavioural analysis in a range of behaviours [17][18][19][20]. Fewer studies have undertaken the full BCW process to design and test an intervention.…”
Purpose: Sedentary behaviour is any waking behaviour in sitting, lying or reclining postures with low energy expenditure. High sedentary behaviour levels, common after stroke, are associated with poor health and higher levels of mobility disability. The aim of this study was to undertake a behavioural diagnosis of sedentary behaviour in the early phase after stroke to inform interventions that may reduce sedentary behaviour and associated disability. Methods and materials: Independently mobile stroke survivors were interviewed three months after stroke. The topic guide was informed by the central layer of the Behaviour Change Wheel to explore three components: capability, opportunity and motivation. This model recognises that behaviour is the consequence of an interacting system of these components. Interviews were transcribed verbatim and analysed using The Framework Method. Results: Thirty one people were interviewed (66.7 years; 16 male). The perception of diminished capability to reduce sedentary behaviour due to physical tiredness/fatigue, and pain/discomfort acting as both a motivator and inhibitor to movement, were discussed. Environmental barriers and the importance of social interaction were highlighted. Perceived motivation to reduce sedentary behaviour was influenced by enjoyment of sedentary behaviours, fear of falling and habitual nature of sedentary behaviours. Conclusions: This information will inform evidence-based sedentary behaviour interventions after stroke. ä IMPLICATIONS FOR REHABILITATION Higher levels of sedentary behaviours are associated with poor health and stroke survivors are highly sedentary. Stroke survivors have complex reasons for spending time in sedentary behaviours including fatigue, pain, fear of falling and environmental barriers. Future interventions should educate stroke survivors on the health consequences of sedentary behaviours and encourage an increased awareness of time spent sedentary. Supporting stroke survivors to identify enjoyable and achievable activities that involve standing and movement, and ideally social interaction, is recommended.
“…Future research should be focused on the development and the evaluation of breastfeeding community support programmes which aim to enhance maternal breastfeeding self-e cacy. These programmes could include both formal and peer mother-tomother support groups [57][58][59]. A number of intervention studies have been designed based on self-e cacy theory and/or investigated the effect of breastfeeding education and/or support programmes explicitly through the enhancement of self-e cacy.…”
Section: Implications For Research and Practicementioning
Background: Breastfeeding self-efficacy (BSES) is an important modifiable determinant of BF initiation, duration and exclusivity. The use of valid measurement tools of BSES is important in clinical and community practice. Thus, we aimed to assess the properties of the Breastfeeding Self-Efficacy Scale (BSES-SF) to measure the self-efficacy of mothers in Cyprus and its association with BF and EBF up to the sixth month.Methods: A cross-sectional and longitudinal descriptive study with a nationwide consecutive sample of 586 mother-infant dyads, recruited from all state maternity wards and 24 (of 30) private clinics within 24-48 hours of birth and followed up by telephone up to the 6 th month postpartum. BSES was assessed at the clinic and at the first month with the Greek version of the 14-item 5-point Likert BSES-SF scale. Information on infant feeding practices was collected at all four time points. The association between self-efficacy and breastfeeding outcomes was estimated in logistic regression models. Results: With Mean=3.55 (SD=0.85), BSES was only moderate, and lower among Cypriot women, primiparas, those who delivered by C/S and did not intent to breastfeed exclusively. There was good internal consistency across the 14 items (alpha coefficient=0.94). While higherlevels of self-efficacy were not strongly associated with the likelihood of breastfeeding initiation, there was a stepwise association with exclusivity. The association between in-hospital assessment of self-efficacy and long-term EBF persisted in multivariable models adjusting for socio-demographic characteristics. Women in the upper quartile of BSES at 48 hours were more likely to breastfeed exclusively at the 1 stand at the 4 th month. Similar, if not stronger, associations were observed between self-efficacy at the 1 st month and BF outcomes at subsequent time-points. High BSES at the first month (>3.96) had 58.9% positive and 79.6% negative predictive value for breastfeeding at 6 months.Conclusions: The Greek version of the BSES-SF showed good metric properties. The generally low prevalence of breastfeeding among mothers in Cyprus, suggests a need for policy, educational and community support interventions, including the systematic use of BSES scale as a screening tool to identify those at higher risk for premature BF discontinuation.
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