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


Lead investigator
S Paranjothy
Background

Co-contributors: M Robling, D Fitzsimmons, B Hunter, J Sanders, A Grant, A Brown, R Phillips, S Rollnick, S Tedstone, S Regan

Although 80% of mothers start breastfeeding in the UK, fewer than half breastfeed exclusively after one week and only 1 in 100 breastfeed exclusively to 6 months (3). Most women stop breastfeeding before they had planned. Mothers who are younger (under 20 years), less affluent, and of white British ethnicity are less likely to start or continue to breastfeed (3,4). Evidence from low and middle income countries suggests that breastfeeding peer-support (BFPS) increases the number of mothers who continue breastfeeding, but previous UK-based BFPS studies have not shown similar effects (5-8). Current guidance for health service providers does not specify how to provide effective support to new mothers in the UK to help them continue breastfeeding for longer. We propose to develop a new BFPS intervention that uses a motivational interviewing (MI) approach to help mothers who are young or live in disadvantaged areas to continue breastfeeding for longer. Motivation, confidence and social support are important aspects of changing health behaviour (9). MI is a form of counselling that supports people in changing behaviour by exploring their thoughts and concerns and supporting them in setting their own goals (10). This approach has not previously been used in BFPS but has been successful in other areas, including peer outreach for young people with HIV (11,12). We will train peer-supporters in using an MI-based approach to provide them with skills to communicate effectively with mothers. Our BFPS intervention will include proactive, daily contact by the peer-supporter for at least 2 weeks, starting within 48 hours of birth. We will survey UK service providers to understand how BFPS is currently provided. We will hold focus groups with pregnant women, mothers and peer supporters and interview health professionals and service managers in each area to discuss what mothers require from BFPS; the best way and time for peer-supporters to contact mothers; the type of payment or reward for peer supporters that will be acceptable (e.g. salary, childcare expenses, satisfaction, new skills), the training and on-going support needs of peer-supporters, and how BFPS can be provided alongside existing services. These findings will inform the content and design of our BFPS intervention. We will test whether it is possible to deliver MI-based BFPS in three areas in England and Wales where there are high levels of social and economic deprivation, high rates of teenage pregnancy and low rates of breastfeeding. We will recruit and train between 6 and 9 peer-supporters to provide support to 90 women over six months. Women will be recruited by community midwifery teams. We will assess how many mothers take up the peer-support, whether it can be provided as planned, if it is acceptable particularly to young (<20 years) and first-time mothers, and the cost of providing MI based BFPS. We will obtain views on the intervention using face-to-face interviews with 30 mothers, 6-9 peer-supporters, and 9 health professionals. We will carry out structured telephone interviews with all mothers in the study, and use data collected by Health Visitors or routine NHS data to find out about their health, whether they were breastfeeding at 10 days and 6-8 weeks, and the health of their infants. We will use the findings from this study to make recommendations about a further study to test how effective MI-based BFPS is to help mothers continue breastfeeding for longer.
Further information & publications

http://www.nets.nihr.ac.uk/projects/hta/131805

Start date
September 2014
End date
October 2017
Funders

NIHR

Amount
£281,062.12