Feasibility and acceptability of a motivational interviewing breastfeeding peer support intervention

Abstract

An uncontrolled study with process evaluation was conducted in three U.K. community maternity sites to establish the feasibility and acceptability of delivering a novel breastfeeding peer-support intervention informed by motivational interviewing (MI;Mam-Kind). Peer-supporters were trained to deliver the Mam-Kind intervention that provided intensive one-to-one peer-support, including (a) antenatal contact, (b) faceto-face contact within 48 hr of birth, (c) proactive (peer-supporter led) alternate day contact for 2 weeks after birth, and (d) mother-led contact for a further 6 weeks.Peer-supporters completed structured diaries and audio-recorded face-to-face sessions with mothers. Semistructured interviews were conducted with a purposive sample of mothers, health professionals, and all peer-supporters. Interview data were analysed thematically to assess intervention acceptability. Audio-recorded peer-support sessions were assessed for intervention fidelity and the use of MI techniques, using the MITI 4.2 tool. Eight peer-supporters delivered the Mam-Kind intervention to 70 mothers in three National Health Service maternity services. Qualitative interviews with mothers (n = 28), peer-supporters (n = 8), and health professionals (n = 12) indicated that the intervention was acceptable, and health professionals felt it could be integrated with existing services. There was high fidelity to intervention content; 93% of intervention objectives were met during sessions. However, peer-supporters reported difficulties in adapting from an expert-by-experience role to a collaborative role. We have established the feasibility and acceptability of providing breastfeeding peer-support using a MI-informed approach. Refinement of the intervention is needed to further develop peer-supporters' skills in providing mother-centred support. The refined intervention should be tested for effectiveness in a randomised controlled trial.

Using the behaviour change wheel to explore infant feeding peer support provision; insights from a North West UK evaluation

“…Many of our findings in regard to how peer support can influence women’s capabilities, motivation and opportunities for breastfeeding parallel the elements of effective breastfeeding peer support described in the realist review by Trickey et al [29], and in other studies [51] or systematic reviews of breastfeeding support [21]. 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].…”

Adapting Breastfeeding Support in Areas of Socio-Economic Deprivation: A Case Study Approach.

“…This juxtaposes to some degree with the ndings of Copeland et al [37], who, in their study, suggest the need for the PSs to maintain the focus of their conversations with mothers upon breastfeeding. Trickey et al [35] found that PSs were more motivated when their work was appreciated, and more responsive to mothers who actively sought their support.…”

Differences in the delivery of motivational interviewing across three countries

“…The MITI is recently refined to reflect the developments in the theory of MI and to improve reliability of the measures (MITI 4) (Moyers et al, 2014). The MITI 4 has been applied in some studies so far supporting the reliability to MI and to some extend the validity (Copeland et al, 2019;Moyers et al, 2016;Owens et al, 2017;Serrano, 2018). The MITI 4 provides information on the technical elements of MI by means of a measure of the therapist's ability to cultivate change talk and soften sustain talk; the relational elements empathy and partnership; in addition, detailed information on MI-adherent therapist behavior (affirmation, seeking collaboration, emphasizing autonomy) and MI-non-adherent therapist adherent (confront and persuade) (Moyers et al, 2014) is collected.…”