Telephone Peer Counseling of Breastfeeding Among WIC Participants: A Randomized Controlled Trial

Abstract

OBJECTIVE: The US Surgeon General has recommended that peer counseling to support breastfeeding become a core service of the Supplemental Nutrition Program for Women, Infants, and Children (WIC). As of 2008, 50% of WIC clients received services from local WIC agencies that offered peer counseling. Little is known about the effectiveness of these peer counseling programs. Randomized controlled trials of peer counseling interventions among low-income women in the United States showed increases in breastfeeding initiation and duration, but it is doubtful that the level of support provided could be scaled up to service WIC participants nationally. We tested whether a telephone peer counseling program among WIC participants could increase breastfeeding initiation, duration, and exclusivity. METHODS: We randomly assigned 1948 WIC clients recruited during pregnancy who intended to breastfeed or were considering breastfeeding to 3 study arms: no peer counseling, 4 telephone contacts, or 8 telephone contacts. RESULTS: We combined 2 treatment arms because there was no difference in the distribution of peer contacts. Nonexclusive breastfeeding duration was greater at 3 months postpartum for all women in the treatment group (adjusted relative risk: 1.22; 95% confidence interval [CI]: 1.10–1.34) but greater at 6 months for Spanish-speaking clients only (adjusted relative risk: 1.29; 95% CI: 1.10–1.51). The likelihood of exclusive breastfeeding cessation was less among Spanish-speaking clients (adjusted odds ratio: 0.78; 95% CI: 0.68–0.89). CONCLUSIONS: A telephone peer counseling program achieved gains in nonexclusive breastfeeding but modest improvements in exclusive breastfeeding were limited to Spanish- speaking women.

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

“…29,34,35,[37][38][39][80][81][82][83][84][85][86][87][88][89] Nine interventions were delivered in the USA, all associated with the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). [80][81][82][83][84][85][86][87]89 Five papers related to UK-based interventions 34,35,[37][38][39]88 and one intervention was delivered in Canada. 29 Studies were included if they pertained to a model of BFPS that included planned one-to-one contact between a mother and a peer supporter, reported breastfeeding rates (initiation, continuation or exclusivity) as an outcome measure and if they had been delivered in a developed country setting.…”

“…Eleven studies were RCTs, 29,34,35,37,80,81,84,[86][87][88][89] three were area-based controlled studies 38,82,83 and two were natural experiments. 39,85 Applying Cochrane risk of bias criteria, 91 we found that only three studies had a low risk of bias.…”

“…39,85 Applying Cochrane risk of bias criteria, 91 we found that only three studies had a low risk of bias. 34,81,86 Six of the evaluations were at a risk of selection bias, 29,38,39,82,83,85 attrition may have affected six evaluations 35,37,80,83,87,88 and one evaluation 89 was at a risk of detection bias. Implementation issues affected 11 of the 15 evaluations.…”

“…Implementation issues affected 11 of the 15 evaluations. 34,35,[37][38][39]80,84,[86][87][88][89] Among the five UK studies, there were difficulties in achieving the intended number of contacts 34,38,39,88 and in ensuring intervention fidelity. 35,37,88. Of the nine studies of US-based cases, four reported significant implementation problems.…”

“…35,37,88. Of the nine studies of US-based cases, four reported significant implementation problems. 80,86,87,89 Heterogeneity between studies…”