Motivational interviewing improves exclusive breastfeeding in an Australian randomised controlled trial

Elliott-Rudder, Megan; Pilotto, Louis; McIntyre, Ellen; Ramanathan, Shanthi

doi:10.1111/apa.12434

Cited by 33 publications

(32 citation statements)

References 19 publications

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“…A few studies have examined the effectiveness of BMIs to promote breastfeeding and have reported different findings. One study showed a significant increase in EBF rates at the fourth month (65% intervention group vs. 56% control group; odds ratio (OR): 1.9, 95% confidence interval (95% CI): 1.01–3.5, p = .047; Elliott‐Rudder, Pilotto, McIntyre, & Ramanathan, ). In contrast, two studies showed a duration of breastfeeding of only 8–18 days longer in the intervention groups without statistical significance (Wilhelm, Aguirre, Koehler, & Rodehorst, ; Wilhelm, Stepans, Hertzog, Rodehorst, & Gardner, ).…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of a brief motivational intervention to increase the breastfeeding duration in the first 6 months postpartum: Randomized controlled trial

Franco‐Antonio

Calderón‐García

Santano‐Mogena

et al. 2019

Journal of Advanced Nursing

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Aims To evaluate the effectiveness of a brief motivational intervention to increase the breastfeeding duration in the first 6 months postpartum in mothers who began breastfeeding in the first hour after birth and to explore the role of general and breastfeeding self‐efficacy in this relationship. Design A multi‐centre randomized controlled clinical trial. Methods Data were collected from February 2018 ‐ March 2019. Women were randomly assigned to an intervention group that received a brief motivational intervention (N = 44) or a control group that was offered standard education on breastfeeding (N = 44). Survival analysis techniques were carried out with a follow‐up of 6 months. In addition, the roles of breastfeeding and general self‐efficacy in the association between BMI and breastfeeding duration were explored through mediation/moderation analysis. Results Among 88 randomized patients (mean age, 32.82 years), 81 (92.04%) completed the trial. The survival analyses of exclusive breastfeeding and breastfeeding (exclusive and non‐exclusive) showed reductions in the risk of abandonment in the intervention group of 63% (aHR: 0.37 [0.22–0.60] p < .001) and 61% (aHR: 0.39 [0.20–0.78] p = .008), respectively. We found that self‐efficacy acted as a moderator of the effect of brief motivational intervention on breastfeeding self‐efficacy. A discrete indirect effect of brief motivational intervention through increased breastfeeding self‐efficacy was found on breastfeeding duration, with an index of moderated mediation of 0.08 (95% CI: 0.02–0.19). Greater positive variations in the breastfeeding self‐efficacy scores during follow‐up predicted exclusive and non‐exclusive breastfeeding duration. Conclusion A brief motivational intervention conducted in the immediate postpartum period increases breastfeeding and exclusive breastfeeding duration in the first 6 months. Although breastfeeding self‐efficacy seems to moderate the effect of brief motivational intervention on the increase in breastfeeding duration, other factors may influence its effectiveness. Further studies could focus on exploring how brief motivational intervention works and whether it also works for pregnant mothers who have not yet decided whether to breastfeed. Impact Brief motivational intervention could be introduced as part of routine care of women who begin breastfeeding to improve the low rates of exclusive breastfeeding at 6 months postpartum. Trial registration Unique Protocol ID: Moti003; https://ClinicalTrials.gov ID: NCT03357549.

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Section: Introductionmentioning

confidence: 99%

Effectiveness of a brief motivational intervention to increase the breastfeeding duration in the first 6 months postpartum: Randomized controlled trial

Franco‐Antonio

Calderón‐García

Santano‐Mogena

et al. 2019

Journal of Advanced Nursing

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“…Two of these RCTs 53,54 found no significant effect of MI. The other RCT 55 found statistically significant effects of MI on breastfeeding status at 2 and 4 months but not at 6 months post birth. In all three RCTs, it was difficult to disentangle the effects of MI from the other aspects of the intervention.…”

Section: Motivational Interviewingmentioning

confidence: 87%

“…There have been at least 12 systematic reviews that have found statistically significant effects of MI in relation to health outcomes [41][42][43][44][45][46][47][48][49][50][51][52] and three RCTs 53-55 examining MI and breastfeeding support. A health educator, 53 a research nurse 54 and a practice nurse 55 delivered the MI in the RCTs. Two of these RCTs 53,54 found no significant effect of MI.…”

Section: Motivational Interviewingmentioning

confidence: 99%

“…Two of the interventions were MI-based interventions, in which only elements of MI were delivered. 53,55 None of the RCTs was based in the UK. It is possible that MI has a role in helping women to continue breastfeeding by increasing their intrinsic motivation to breastfeed, but there is limited evidence available on the effectiveness of MI in this context.…”

Section: Motivational Interviewingmentioning

confidence: 99%

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

Paranjothy

Copeland

Merrett

et al. 2017

Health Technol Assess

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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.

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“…Assuming an effect size like those of previous studies (Elliott-Rudder et al, 2014;Pollard, 2011;Wilhelm et al, 2015Wilhelm et al, , 2006 and with common alpha risk of 0.05, beta risk of 0.20, and estimated loss to follow-up of 10%, a sample of n = 44 participants in each group will be required using a log-rank survival test. Assuming an effect size like those of previous studies (Elliott-Rudder et al, 2014;Pollard, 2011;Wilhelm et al, 2015Wilhelm et al, , 2006 and with common alpha risk of 0.05, beta risk of 0.20, and estimated loss to follow-up of 10%, a sample of n = 44 participants in each group will be required using a log-rank survival test.…”

Section: Sample Size Determinationmentioning

confidence: 99%

A randomized controlled trial to evaluate the effectiveness of a brief motivational intervention to improve exclusive breastfeeding rates: Study protocol

Franco‐Antonio

Calderón‐García

Vilar-López

et al. 2019

Journal of Advanced Nursing

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Aims To estimate the effectiveness of a brief motivational intervention (BMI) in increasing the duration of exclusive breastfeeding in the first 6 months postpartum. A complementary aim was to examine a potential mediating role of breastfeeding self‐efficacy in the effectiveness of the BMI. Background Breastfeeding is associated with benefits for babies and mothers’ health. Among the pool of techniques used to encourage healthy behaviours, BMI is highlighted based on the principles of motivational interviewing. One of the main components of these interventions is the promotion of self‐efficacy, which, in fact, is a key factor for breastfeeding success. Design A multi‐centre randomized controlled clinical trial of parallel groups. Methods Women who begin to breastfeed in the first hour after birth will be randomly assigned to the intervention group (receiving a BMI at immediate postpartum plus a telephone booster at the 1st and 3rd month postpartum) or the control group (receiving standard breastfeeding education at the same time). Outcome measures include the following: breastfeeding, breastfeeding self‐efficacy, general self‐efficacy, and postnatal depression. Data will be collected before the intervention and at the 1st, 3rd, and 6th month after birth. The study protocol has been approved by Badajoz Ethics Committee of Clinical Research in October 2017. Discussion This study will identify the effectiveness of BMI in improving exclusive breastfeeding rates. The findings will give useful evidence to health professionals about how to support breastfeeding. Impact This study will address the low‐exclusive breastfeeding rates, that in our country are far lower than World Health Organization's recommendation.

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Motivational interviewing improves exclusive breastfeeding in an Australian randomised controlled trial

Abstract: A motivational interviewing intervention by primary care health professionals who have undertaken a replicable training programme is feasible and effective in increasing exclusive breastfeeding and full/predominant breastfeeding at 4 months.

Cited by 33 publications

References 19 publications

Effectiveness of a brief motivational intervention to increase the breastfeeding duration in the first 6 months postpartum: Randomized controlled trial

Effectiveness of a brief motivational intervention to increase the breastfeeding duration in the first 6 months postpartum: Randomized controlled trial

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

A randomized controlled trial to evaluate the effectiveness of a brief motivational intervention to improve exclusive breastfeeding rates: Study protocol

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