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Dineen TE, Bean C, Jung ME. Successes and Challenges From a Motivational Interviewing-Informed Diabetes Prevention Program Situated in the Community. Health Promot Pract 2024; 25:274-284. [PMID: 36047459 PMCID: PMC10908196 DOI: 10.1177/15248399221115066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To manage the rising prevalence of type 2 diabetes mellitus, sustainable diabetes prevention programs are needed. In this study, a process evaluation was conducted to qualitatively understand perceived successes and challenges of a diabetes prevention program situated in the community. This study took place in the first year of a multiyear project. Semistructured interviews were conducted with a sample of women clients (n = 14) postprogram and trainers (n = 10) 9 months into program implementation. Interviews were audio-recoded, transcribed verbatim, and analyzed using a Template Approach. Data were first analyzed deductively into two categories that aligned with the study's purpose (successes and challenges). Second, an inductive analysis was used to understand program delivery processes within each category. Clients and trainers expressed (a) program successes related to recruitment strategy, outlook on making behavior changes, and communication style used within the program and (b) program challenges surrounding effort of learning and applying the communication strategy, usefulness of program applications and tools, and program fit. This evaluation provides practical implications and future directions for diabetes prevention programs, and has informed tailoring and expansion of the program of focus. Results demonstrate the success of motivational interviewing from both client and trainer perspectives and the impact of community partnerships to increase prediabetes awareness in the community. Overall, the program's diabetes prevention and behavior change strategies coupled with a client-centered approach facilitated women clients in making diet and exercise modifications.
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Affiliation(s)
- Tineke E. Dineen
- The University of British Columbia, Kelowna, British Columbia, Canada
| | - Corliss Bean
- Brock University, St. Catharines, Ontario, Canada
| | - Mary E. Jung
- The University of British Columbia, Kelowna, British Columbia, Canada
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2
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Lucchini-Raies C, Marquez-Doren F, Perez JC, Campos S, Beca P, Lopez-Dicastillo O. A complex intervention to support breastfeeding: A feasibility and acceptability study. Int J Nurs Pract 2023; 29:e13184. [PMID: 37461904 DOI: 10.1111/ijn.13184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 05/30/2023] [Accepted: 06/24/2023] [Indexed: 12/18/2023]
Abstract
AIMS The aims of this study are to assess the acceptability and feasibility of a multicomponent intervention to support breastfeeding women and their families and explore its effectiveness. METHODS A pilot study with control and intervention groups was conducted using the complex intervention framework in two primary healthcare centres. Overall, 44 childbearing women, their partners/relatives and 20 healthcare professionals participated in the study. The intervention's feasibility and acceptability were measured. The percentage of exclusive breastfeeding rates and women's self-efficacy were measured at pre-intervention, at 10 days postpartum, and again at 2, 4 and 6 months postpartum. Postpartum depression risk was measured at 2 and 6 months postpartum. Professional self-efficacy was measured at pre-intervention and 3 months later. RESULTS The intervention was feasible and acceptable. No difference in self-efficacy existed between the intervention and control groups. Preliminary effects of the intervention were found in exclusive breastfeeding percentage and postpartum depression risk in the intervention group. CONCLUSION The intervention is feasible and acceptable. The results are promising not only for breastfeeding maintenance but also for preventing postpartum depression and recovering exclusive breastfeeding during pandemics. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT03944642.
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Affiliation(s)
- Camila Lucchini-Raies
- School of Nursing, PAHO/WHO Collaborating Center, Pontificia Universidad Católica de Chile, Santiago, Chile
- Alpha Beta Omicron Chapter, Sigma Theta Tau International, Santiago, Chile
| | - Francisca Marquez-Doren
- School of Nursing, PAHO/WHO Collaborating Center, Pontificia Universidad Católica de Chile, Santiago, Chile
- Alpha Beta Omicron Chapter, Sigma Theta Tau International, Santiago, Chile
| | - J Carola Perez
- Faculty of Psychology, Universidad del Desarrollo, Santiago, Chile
| | - Solange Campos
- School of Nursing, PAHO/WHO Collaborating Center, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paulina Beca
- School of Medicine, Family Health Center San Alberto Hurtado ANCORA, Pontificia Universidad Católica de Chile, Santiago, Chile
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Larson E, Jeglum N, Shmays C. Mixed-method evaluation of fidelity of motivational interviewing-based coaching in 5Minutes4Myself Wellness Program for caregivers of children with autism. PEC INNOVATION 2023; 2:100149. [PMID: 37214523 PMCID: PMC10194175 DOI: 10.1016/j.pecinn.2023.100149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/28/2023] [Accepted: 03/20/2023] [Indexed: 05/24/2023]
Abstract
Objective This mixed method analysis examined fidelity of the motivational interviewing (MI) delivered during the 5Minutes4Myself wellness program for caregivers of children with Autism Spectrum Disorders. Methods Coaches used a manualized MI-approach to collaboratively design participants' individualized wellness programs, and then used it in monthly coaching sessions to support goal pursuit. Audio-recorded consultations and post-participation focus groups were transcribed verbatim. Consultation transcripts were rated for MI adherence using Motivational Interviewing Treatment Integrity Code. Focus group data was coded by the team to identify conceptual categories. Results Eighty-seven percent of consultations achieved a beginning (competent) level expert-derived MI standard. Caregivers noted that coaches' MI approach evoked deep emotions and understandings about their lives related to wellness goals, allowed for a permissive flexibility in goal pursuit, and fostered supportive accountability. Conclusion MI was used with high levels of fidelity. Participants described the MI approach as more productive, precise, and useful in addressing their needs compared to other available interventions.
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Affiliation(s)
- Elizabeth Larson
- Department of Kinesiology, University of Wisconsin, Madison, Wisconsin, USA
| | | | - Chloe Shmays
- Providence Child Development Institute, Portland, OR, USA
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Rojas-García A, Lingeman S, Kassianos AP. Attitudes of mothers and health care providers towards behavioural interventions promoting breastfeeding uptake: A systematic review of qualitative and mixed-method studies. Br J Health Psychol 2023; 28:952-971. [PMID: 37060265 DOI: 10.1111/bjhp.12663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 12/19/2022] [Accepted: 03/17/2023] [Indexed: 04/16/2023]
Abstract
PURPOSE Recommendations for exclusive breastfeeding are not often adhered to despite the robust evidence of its benefits. This systematic review aims to collate evidence on the attitudes mothers and health care providers have towards breastfeeding interventions to understand what aspects best contribute to acceptability and feasibility. METHODS This review further investigates the value of identifiable behaviour change techniques (BCTs) to uncover which components of an intervention are perceived to be most useful and acceptable. The main biomedical databases were searched, and 17 (n = 17) studies met the inclusion criteria. RESULTS A total of nine BCTs were identified within the interventions. The thematic analysis produced four main domains: usefulness, accessibility, value and sustainability. Women discussed the importance of the support they received in these interventions and demonstrated a positive view towards three BCTs: 'social support (unspecified)', 'instruction on how to perform behaviour' and 'demonstration of behaviour'. Additionally, women highlighted the benefit of personal, non-clinical and flexible emotional and practical support from peers, lactation consultants and support groups. Health care providers echoed these opinions and specifically highlighted the usefulness of interventions that allowed for continuity of care and more personal breastfeeding support. CONCLUSIONS These findings suggest that ongoing practical as well as emotional support is crucial for standard in-hospital support to succeed at increasing breastfeeding rates. Future research would need to better understand the nuances of the interventions among women and providers to enhance their implementation.
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Affiliation(s)
- Antonio Rojas-García
- Mental Health Policy Research Unit, Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7BN, UK
- Department of Psychiatry, Faculty of Medicine, University of Granada, Granada, Spain
- Institute of Neurosciences, Biomedical Research Centre (CIBM), University of Granada, Granada, Spain
| | - Sabrina Lingeman
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Angelos P Kassianos
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
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Cui H, Chen H, Gao W, Shi S, Li Y, Li H, Shen B. Quarantine experience of healthcare workers in close contact with COVID-19 patients in China: a qualitative study. BMJ Open 2023; 13:e073868. [PMID: 37865408 PMCID: PMC10603403 DOI: 10.1136/bmjopen-2023-073868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 09/22/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND This study investigated the experiences of front-line healthcare workers who had been in close contact with COVID-19 patients and had been quarantined in order to provide guidance on quarantine measures with more humanistic care when dealing with future public health emergencies. METHODS We conducted a qualitative study using semistructured, qualitative, in-depth interviews between April and June 2022. The interviews were recorded and transcribed, followed by a thematic analysis. The study followed the Standards for Reporting Qualitative Research. RESULTS This study identified the following four themes: (1) personal psychological changes, (2) increased reflection on life and work during quarantine, (3) the important role of others' support and (4) different types of demands during quarantine and isolation. Each theme is supported by several subthemes that further illustrate the participants' experiences. CONCLUSIONS Quarantine of close contacts is necessary to prevent outbreaks. Front-line doctors and nurses are at a greater risk of COVID-19 infection than others. The results showed the psychological reactions of ordinary close contacts, and the unique feelings and experiences of doctors and nurses during the epidemic. Therefore, future research should cooperate with multiple departments to assess their needs, provide them with individualised care and love and give them incentives in order to reduce their psychological burden, improve their quality of life and allow them to engage in healthcare with a healthy mind.
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Affiliation(s)
- Hengmei Cui
- Department of Nursing, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Haoyang Chen
- Department of Nursing, The Second People's Hospital of Nantong, Jiangsu, China
| | - Wei Gao
- School of Nursing, Jiangsu Vocational College of Medicine, Jiangsu, China
| | - Songsong Shi
- Department of Nursing, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yunyun Li
- Department of Nursing, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Huiling Li
- School of Nursing, Soochow University, Suzhou, China
| | - Biyu Shen
- Department of Nursing, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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Leeming D, Marshall J, Hinsliff S. Self-conscious emotions and breastfeeding support: A focused synthesis of UK qualitative research. MATERNAL AND CHILD NUTRITION 2021; 18:e13270. [PMID: 34651437 PMCID: PMC8710115 DOI: 10.1111/mcn.13270] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/09/2021] [Accepted: 09/01/2021] [Indexed: 11/26/2022]
Abstract
Research on women's experiences of infant feeding and related moral discourse suggests that self‐conscious emotions may be highly relevant to breastfeeding support interactions. However, the emotional impact of receiving support has not been fully explored. The aim of this review is to re‐examine qualitative UK research on receiving breastfeeding support, in order to explore the role of self‐conscious emotions and related appraisals in interactions with professional and peer supporters. From 2007 to 2020, 34 studies met criteria for inclusion. Using template analysis to identify findings relevant to self‐conscious emotions, we focused on shame, guilt, embarrassment, humiliation and pride. Because of cultural aversion to direct discussion of self‐conscious emotions, the template also identified thoughts about self‐evaluation, perceptions of judgement and sense of exposure. Self‐conscious emotions were explicitly mentioned in 25 papers, and related concerns were noted in all papers. Through thematic synthesis, three themes were identified, which suggested that (i) breastfeeding ‘support’ could present challenges to mothering identity and hence to emotional well‐being; (ii) many women managed interactions in order to avoid or minimise uncomfortable self‐conscious emotions; and (iii) those providing support for breastfeeding could facilitate women's emotion work by validating their mothering, or undermine this by invalidation, contributing to feelings of embarrassment, guilt or humiliation. Those supporting breastfeeding need good emotional ‘antennae’ if they are to ensure they also support transition to motherhood. This is the first study explicitly examining self‐conscious emotions in breastfeeding support, and further research is needed to explore the emotional nuances of women's interactions with supporters.
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Affiliation(s)
- Dawn Leeming
- Department of Psychology, School of Human & Health Sciences, University of Huddersfield, Queensgate, Huddersfield, UK
| | - Joyce Marshall
- Division of Maternal Health, School of Human & Health Sciences, University of Huddersfield, Queensgate, Huddersfield, UK
| | - Sophie Hinsliff
- Division of Maternal Health, School of Human & Health Sciences, University of Huddersfield, Queensgate, Huddersfield, UK
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Grant A. Breasts and the city: an urban ethnography of infant feeding in public spaces within Cardiff, United Kingdom. Int Breastfeed J 2021; 16:37. [PMID: 33926506 PMCID: PMC8082607 DOI: 10.1186/s13006-021-00384-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Internationally, women report challenges breastfeeding in public spaces. This study aimed to investigate the social-spatial aspects of public spaces in one UK city, Cardiff, in order to suggest possible barriers and facilitators to breastfeeding in public spaces. METHODS The study observation location guide prioritised places that had been reported as hostile to breastfeeding or breastfeeding friendly in the existing literature. Data were collected between April and September 2018 at various times of day, in several areas of the city, and included transport (n = 4), transport hubs (n = 3), high streets (n = 4), cafes (n = 2), a large city centre shopping complex, comprising of three joined shopping malls and a large city centre department store containing a third café. Low inference field notes were written on an encrypted smart phone and expanded soon after. Data were analysed thematically using deductive codes based on the observation schedule. Additional inductive codes relating to places were added. RESULTS Overall, public transport and the city centre were inhospitable environments for those who might need to breastfeed, and even more so for those who need to express breastmilk. The core barriers and facilitators across locations were the availability of appropriate seating coupled with either high privacy or politely unimposing strangers (civil inattention). The one variation to this model arose from the department store café, where civil inattention was not performed and there was low privacy, but breastfeeding occurred anyway. CONCLUSIONS This research highlights the physical and social barriers to breastfeeding within one urban city centre in the UK and its associated transport links. It is clear that there is an urgent need for change in urban city centres and public transport if countries are to meet their aims in relation to increasing breastfeeding rates. Interventions will need to be multifaceted, accounting for social norms relating to infant feeding as well as changes to the physical environment, policy and potentially legal change. Further research should be undertaken in other countries to examine the extent to which hostile environments exist, and if correcting these could facilitate breastfeeding and reduce gender-based violence.
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Affiliation(s)
- Aimee Grant
- Centre for Lactation, Infant Feeding and Translational Research, Swansea University, Swansea, UK.
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Hunt L, Thomson G, Whittaker K, Dykes F. Adapting breastfeeding support in areas of socio-economic deprivation: a case study approach. Int J Equity Health 2021; 20:83. [PMID: 33743718 PMCID: PMC7980580 DOI: 10.1186/s12939-021-01393-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/21/2021] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND There are inequalities in breastfeeding initiation and continuation rates, whereby socio-economically disadvantaged mothers are least likely to breastfeed. Breastfeeding peer support (BPS) interventions are recommended as a solution, and in the UK non-profit organisations are commissioned to deliver BPS services in areas of socio-economic deprivation. BPS interventions have a mixed evidence base, offering limited knowledge about the interaction between context and intervention and how this affects women's experiences. METHODS This interpretive study used a case study methodology to explore how and why two BPS services developed their services in socio-economically deprived contexts. Methods aimed to generate holistic understanding of BPS service development. Data collected across both cases comprised; observation (n = 1), and semi-structured interviews with: mothers who had (n = 10) and had not (n = 9) engaged with the BPS services, peer supporters (PSs) (n = 9), community health professionals (n = 5), infant feeding co-ordinators (n = 2), non-profit organisation managers (n = 3), and public health commissioners (n = 2). Inductive grounded theory analytic techniques of open coding and constant comparisons, followed by cross case comparisons, were used to analyse the data. RESULTS The over-arching theme - 'the transcending influence of society' - offers insights into the underlying context and drivers impacting service development. It reflects how funding and data sharing arrangements determined service operation and the peer's access to women. Four underpinning themes explain how: peer supporters were resourceful in adapting their services ('adapting and modifying the support'); BPS organisations worked to enable women's access to supportive breastfeeding environments, but did not necessarily focus service development on the needs of women living in areas of deprivation ('supporting women's journeys to access'); the BPS-professional connections for supporting access and how BPS could result in more supportive community environments ('embedding within healthcare practice'); and how management practices precluded meaningful use of data to provide context led service development ('ways of using knowledge'). CONCLUSIONS Findings suggest that while PSs are commissioned to focus on those most in need, there is limited discussion, collection, or use of knowledge about women's lives to develop needs-led service delivery. The key recommendation is the development of a social ecological tool to facilitate the use and application of contextual knowledge.
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Affiliation(s)
- Louise Hunt
- Maternal and Infant Nutrition and Nurture Unit (MAINN). School of Community Health and Midwifery, University of Central Lancashire (UCLan), Preston, PR12HE, UK.
| | - Gill Thomson
- Maternal and Infant Nutrition and Nurture Unit (MAINN). School of Community Health and Midwifery, University of Central Lancashire (UCLan), Preston, PR12HE, UK
| | | | - Fiona Dykes
- Maternal and Infant Nutrition and Nurture Unit (MAINN). School of Community Health and Midwifery, University of Central Lancashire (UCLan), Preston, PR12HE, UK
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Kramer Schmidt L, Andersen K, Søgaard Nielsen A. Differences in the delivery of motivational interviewing across three countries. J Ethn Subst Abuse 2020; 21:823-844. [PMID: 33032500 DOI: 10.1080/15332640.2020.1824838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We do not know if the delivery of Motivational Interviewing (MI) differs across countries. In an international study targeting Elderly people with Alcohol Use Disorder, The Elderly Study, MI was part of the treatment applied. Treatment delivery was measured by means of the Motivational Interviewing Treatment Integrity code version 4 (MITI 4). Mixed effects models explored potential differences in delivery of MI between the countries. Delivery of MI differed significantly between participating countries: Denmark, Germany and the US. These findings are important to consider when comparing measures of MI integrity across studies from different cultures.
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Affiliation(s)
- Lotte Kramer Schmidt
- University of Southern Denmark, Odense, Denmark.,Region of Southern Denmark, Odense, Denmark
| | | | - Anette Søgaard Nielsen
- University of Southern Denmark, Odense, Denmark.,Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
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Ingram J, Thomson G, Johnson D, Clarke JL, Trickey H, Hoddinott P, Dombrowski SU, Jolly K. Women's and peer supporters' experiences of an assets-based peer support intervention for increasing breastfeeding initiation and continuation: A qualitative study. Health Expect 2020; 23:622-631. [PMID: 32198797 PMCID: PMC7321743 DOI: 10.1111/hex.13042] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/12/2019] [Accepted: 02/07/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND AND CONTEXT Breastfeeding peer support is valued by women, but UK trials have not demonstrated efficacy. The ABA feasibility trial offered proactive peer support underpinned by behaviour change theory and an assets-based approach to women having their first baby, regardless of feeding intention. This paper explores women's and infant feeding helpers' (IFHs) views of the different components of the ABA intervention. SETTING AND PARTICIPANTS Trained IFHs offered 50 women an antenatal meeting to discuss infant feeding and identify community assets in two English sites-one with a paid peer support service and the other volunteer-led. Postnatally, daily contact was offered for the first 2 weeks, followed by less frequent contact until 5 months. METHODS Interviews with 21 women and focus groups/interviews with 13 IFHs were analysed using thematic and framework methods. RESULTS Five themes are reported highlighting that women talked positively about the antenatal meeting, mapping their network of support, receiving proactive contact from their IFH, keeping in touch using text messaging and access to local groups. The face-to-face antenatal visit facilitated regular text-based communication both in pregnancy and in the early weeks after birth. Volunteer IFHs were supportive of and enthusiastic about the intervention, whereas some of the paid IFHs disliked some intervention components and struggled with the distances to travel to participants. CONCLUSIONS This proactive community assets-based approach with a woman-centred focus was acceptable to women and IFHs and is a promising intervention warranting further research as to its effect on infant feeding outcomes.
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Affiliation(s)
- Jenny Ingram
- Centre for Academic Child HealthUniversity of BristolBristolUK
| | - Gill Thomson
- Maternal and Infant Nutrition and Nurture Unit (MAINN)University of Central LancashirePrestonUK
| | - Debbie Johnson
- Centre for Academic Child HealthUniversity of BristolBristolUK
| | - Joanne L. Clarke
- Institute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Heather Trickey
- DECIPHERDepartment of Social MedicineCardiff UniversityCardiffUK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research UnitUniversity of StirlingStirlingUK
| | - Stephan U. Dombrowski
- Faculty of KinesiologyUniversity of New BrunswickFrederictonNBCanada
- Division of PsychologyUniversity of StirlingStirlingUK
| | - Kate Jolly
- Institute of Applied Health ResearchUniversity of BirminghamBirminghamUK
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Clarke JL, Ingram J, Johnson D, Thomson G, Trickey H, Dombrowski SU, Sitch A, Dykes F, Feltham M, MacArthur C, Roberts T, Hoddinott P, Jolly K. The ABA intervention for improving breastfeeding initiation and continuation: Feasibility study results. MATERNAL AND CHILD NUTRITION 2019; 16:e12907. [PMID: 31793233 PMCID: PMC7038877 DOI: 10.1111/mcn.12907] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 09/09/2019] [Accepted: 09/30/2019] [Indexed: 11/30/2022]
Abstract
The UK has low breastfeeding rates, with socioeconomic disparities. The Assets-based feeding help Before and After birth (ABA) intervention was designed to be inclusive and improve infant feeding behaviours. ABA is underpinned by the behaviour change wheel and offers an assets-based approach focusing on positive capabilities of individuals and communities, including use of a Genogram. This study aimed to investigate feasibility of intervention delivery within a randomised controlled trial (RCT). Nulliparous women ≥16 years, (n = 103) from two English sites were recruited and randomised to either intervention or usual care. The intervention - delivered through face-to-face, telephone and text message by trained Infant Feeding Helpers (IFHs) - ran from 30-weeks' gestation until 5-months postnatal. Outcomes included recruitment rates and follow-up at 3-days, 8-weeks and 6-months postnatal, with collection of future full trial outcomes via questionnaires. A mixed-methods process evaluation included qualitative interviews with 30 women, 13 IFHs and 17 maternity providers; IFH contact logs; and fidelity checking of antenatal contact recordings. This study successfully recruited women, including teenagers, from socioeconomically disadvantaged areas; postnatal follow-up rates were 68.0%, 85.4% and 80.6% at 3-days, 8-weeks and 6-months respectively. Breastfeeding at 8-weeks was obtained for 95.1% using routine data for non-responders. It was possible to recruit and train peer supporters to deliver the intervention with adequate fidelity. The ABA intervention was acceptable to women, IFHs and maternity services. There was minimal contamination and no evidence of intervention-related harm. In conclusion, the intervention is feasible to deliver within an RCT, and a definitive trial required.
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Affiliation(s)
- Joanne L Clarke
- Institute of Applied Health Research, University of Birmingham, UK
| | - Jenny Ingram
- Centre for Academic Child Health, University of Bristol, UK
| | - Debbie Johnson
- Centre for Academic Child Health, University of Bristol, UK
| | - Gill Thomson
- Maternal and Infant Nutrition and Nurture Unit (MAINN), University of Central Lancashire, UK
| | - Heather Trickey
- DECIPHER, Department of Social Medicine, Cardiff University, UK
| | - Stephan U Dombrowski
- Faculty of Kinesiology, University of New Brunswick, Canada.,Division of Psychology, University of Stirling, UK
| | - Alice Sitch
- Institute of Applied Health Research, University of Birmingham, UK.,NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, UK
| | - Fiona Dykes
- Maternal and Infant Nutrition and Nurture Unit (MAINN), University of Central Lancashire, UK
| | - Max Feltham
- Birmingham Clinical Trials Unit, University of Birmingham, UK
| | | | | | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, UK
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12
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Thomson G, Crossland N. Using the behaviour change wheel to explore infant feeding peer support provision; insights from a North West UK evaluation. Int Breastfeed J 2019; 14:41. [PMID: 31548846 PMCID: PMC6749647 DOI: 10.1186/s13006-019-0236-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 09/10/2019] [Indexed: 12/15/2022] Open
Abstract
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.
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Affiliation(s)
- Gill Thomson
- Maternal and Infant Nutrition and Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, PR1 2HE UK
- School of Education, Health and Social Studies, Dalarna University, Högskolegatan 2, Falun, Sweden
| | - Nicola Crossland
- Maternal and Infant Nutrition and Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, PR1 2HE UK
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Grant A, Morgan M, Mannay D, Gallagher D. Understanding health behaviour in pregnancy and infant feeding intentions in low-income women from the UK through qualitative visual methods and application to the COM-B (Capability, Opportunity, Motivation-Behaviour) model. BMC Pregnancy Childbirth 2019; 19:56. [PMID: 30744581 PMCID: PMC6371518 DOI: 10.1186/s12884-018-2156-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 12/17/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Health behaviours during pregnancy and the early years of life have been proven to affect long term health, resulting in investment in interventions. However, interventions often have low levels of completion and limited effectiveness. Consequently, it is increasingly important for interventions to be based on both behaviour change theories and techniques, and the accounts of pregnant women. This study engaged with pregnant women from deprived communities, to understand their subjective experiences of health in pregnancy. METHODS The study adopted a women-centred ethos and recruited a purposive sample of ten pregnant women, who lived in deprived areas and were on low incomes. Participants engaged with three creative techniques of visual data production (timelines, collaging and dyad sandboxing), followed by elicitation interviews. One participant only engaged in the initial activity and interview, resulting in a total of 28 elicitation interviews. This in-depth qualitative approach was designed to enable a nuanced account of the participants' thoughts, everyday experiences and social relationships. Data were deductively coded for alcohol, smoking and infant feeding and then mapped to the COM-B model (Capability, Opportunity, Motivation - Behaviour). RESULTS Five participants had experience of smoking during pregnancy, four had consumed alcohol during pregnancy, and all participants, except one who had exclusively formula fed her child, disclosed a range of infant feeding experiences and intentions for their current pregnancies. Considerable variation was identified between the drivers of behaviour around infant feeding and that related to abstinence from tobacco and alcohol during pregnancy. Overall, knowledge and confidence (psychological capability), the role of partners (social opportunity) and support from services to overcome physical challenges (environmental opportunity) were reported to impact on (reflective) motivation, and thus women's behaviour. The role of the public in creating and reinforcing stigma (social opportunity) was also noted in relation to all three behaviours. CONCLUSIONS When designing new interventions to improve maternal health behaviours it is important to consider the accounts of pregnant women. Acknowledging pregnant women's subjective experiences and the challenges they face in negotiating acceptable forms of motherhood, can contribute to informed policy and practice, which can engage rather than isolate potential user groups.
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Affiliation(s)
- Aimee Grant
- Centre for Trials Research, Cardiff University Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK Wales
| | - Melanie Morgan
- Centre for Trials Research, Cardiff University Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK Wales
| | - Dawn Mannay
- School of Social Sciences, Cardiff University, Glamorgan Building, King Edward VII Avenue, Cardiff, CF10 3WT UK
| | - Dunla Gallagher
- Centre for Public Health, Institute of Clinical Sciences, Queens University Belfast, Belfast, UK Ireland
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Kramer Schmidt L, Andersen K, Nielsen AS, Moyers TB. Lessons learned from measuring fidelity with the Motivational Interviewing Treatment Integrity code (MITI 4). J Subst Abuse Treat 2019; 97:59-67. [DOI: 10.1016/j.jsat.2018.11.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/12/2018] [Accepted: 11/18/2018] [Indexed: 11/26/2022]
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Copeland L, Merrett L, McQuire C, Grant A, Gobat N, Tedstone S, Playle R, Channon S, Sanders J, Phillips R, Hunter B, Brown A, Fitzsimmons D, Robling M, Paranjothy S. Feasibility and acceptability of a motivational interviewing breastfeeding peer support intervention. MATERNAL AND CHILD NUTRITION 2018; 15:e12703. [PMID: 30246923 DOI: 10.1111/mcn.12703] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/11/2018] [Accepted: 09/12/2018] [Indexed: 11/29/2022]
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) face-to-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.
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Affiliation(s)
- Lauren Copeland
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Laura Merrett
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Cheryl McQuire
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Aimee Grant
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Nina Gobat
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Sally Tedstone
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - Rebecca Playle
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Sue Channon
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Julia Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Rhiannon Phillips
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Billie Hunter
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Amy Brown
- Department of Public Health, Policy and Social Sciences, Swansea University, Swansea, UK
| | - Deborah Fitzsimmons
- Department of Public Health, Policy and Social Sciences, Swansea University, Swansea, UK
| | | | - Shantini Paranjothy
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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