Antenatal peer support workers and initiation of breast feeding: cluster randomised controlled trial
Christine MacArthur, Kate Jolly, Lucy Ingram, Nick Freemantle, Cindy-Lee Dennis, Ros Hamburger, Julia Brown, Jackie Chambers, Khalid Khan, Christine MacArthur, Kate Jolly, Lucy Ingram, Nick Freemantle, Cindy-Lee Dennis, Ros Hamburger, Julia Brown, Jackie Chambers, Khalid Khan
Abstract
Objective: To assess the effectiveness of an antenatal service using community based breastfeeding peer support workers on initiation of breast feeding.
Design: Cluster randomised controlled trial.
Setting: Community antenatal clinics in one primary care trust in a multiethnic, deprived population.
Participants: 66 antenatal clinics with 2511 pregnant women: 33 clinics including 1140 women were randomised to receive the peer support worker service and 33 clinics including 1371 women were randomised to receive standard care.
Intervention: An antenatal peer support worker service planned to comprise a minimum of two contacts with women to provide advice, information, and support from approximately 24 weeks' gestation within the antenatal clinic or at home. The trained peer support workers were of similar ethnic and sociodemographic backgrounds to their clinic population.
Main outcome measure: Initiation of breast feeding obtained from computerised maternity records of the hospitals where women from the primary care trust delivered.
Results: The sample was multiethnic, with only 9.4% of women being white British, and 70% were in the lowest 10th for deprivation. Most of the contacts with peer support workers took place in the antenatal clinics. Data on initiation of breast feeding were obtained for 2398 of 2511 (95.5%) women (1083/1140 intervention and 1315/1371 controls). The groups did not differ for initiation of breast feeding: 69.0% (747/1083) in the intervention group and 68.1% (896/1315) in the control groups; cluster adjusted odds ratio 1.11 (95% confidence interval 0.87 to 1.43). Ethnicity, parity, and mode of delivery independently predicted initiation of breast feeding, but randomisation to the peer support worker service did not.
Conclusion: A universal service for initiation of breast feeding using peer support workers provided within antenatal clinics serving a multiethnic, deprived population was ineffective in increasing initiation rates.
Trial registration: Current Controlled Trials ISRCTN16126175.
Conflict of interest statement
Competing interests: RH, JB, JC are from the Heart of Birmingham Primary Care Trust and were involved in the employment and management of the peer support workers.
Figures
References
- Cattaneo A, Yngve A, Koletzko B, Ruiz Guzman L, on behalf of the promotion of breastfeeding in Europe project. Protection, promotion and support of breast-feeding in Europe: current situation. Public Health Nutr 2005;8:39-46.
- Bolling K, Grant C, Hamlyn B, Thornton A. Infant feeding survey 2005. Leeds: NHS Information Centre, 2007.
- Hamlyn B, Brooker S, Oleinikova K, Wands S. Infant feeding 2000. London: Stationery Office, 2002.
- Dyson L, McCormick F, Renfrew MJ. Interventions for promoting the initiation of breastfeeding. Cochrane Database Syst Rev 2005;(2):CD001688.
- Fairbank L, O’Meara S, Renfrew MJ, Woolridge M, Sowden AJ, Lister-Sharp D. A systematic review to evaluate the effectiveness of interventions to promote the initiation of breastfeeding. Health Technol Assess 2000;4(25):1-171.
- Guise J-M, Palda V, Westhoff C, Chan B, Helfand M, Lieu T. The effectiveness of primary care-based interventions to promote breastfeeding: evidence review; meta-analysis for US Preventive Services Task Force. Ann Fam Med 2003;1:70-8.
- Britton C, McCormick FM, Renfrew MJ, Wade A, King SE. Support for breastfeeding mothers. Cochrane Database Syst Rev 2007;(1):CD001141.
- Muirhead PE, Butcher G, Rankin J, Munley A. The effect of a programme of organised and supervised peer support on the initiation and duration of breastfeeding: a randomised trial. Br J Gen Pract 2006;56:191-7.
- Taylor B, Newall D. Maternity, mortality and migration: the impact of new communities. Edgbaston, Birmingham: Heart of Birmingham Teaching NHS Primary Care Trust, 2008. .
- MacArthur C, Winter HR, Bick DE, Knowles H, Lilford R, Henderson C, et al. Effects of redesigned community postnatal care on womens’ health 4 months after birth: a cluster randomised controlled trial. Lancet 2002;359:378-85.
- Donner A, Birkett N, Buck C. Randomisation by cluster. Sample size requirements and analysis. Am J Epidemiol 1981;114:906-14.
- Collet D. Modelling binary data. London: Chapman and Hall, 1991.
- Dyson L, Renfrew M, McFaden A, McCormick F, Herbert G, Thomas J. Promotion of breastfeeding initiation and duration. Evidence into practice briefing. London: National Institute for Health and Clinical Excellence, Jul 2006.
- Graffy J, Taylor J, Williams A, Eldridge S. Randomised controlled trial of support from volunteer counsellors for mothers considering breast feeding. BMJ 2004:328;26-31.
- Chapman DJ, Damio G, Young S, Perez-Escamilla R. Effectiveness of breastfeeding peer counseling in a low-income, predominantly Latina population. Arch Pediatr Adolesc Med 2004;158:897-902.
- Anderson AK, Damio G, Young S, Chapman DJ, Perez-Escamilla R. A randomized trial assessing the efficacy of peer counseling on exclusive breastfeeding in a predominantly Latino low-income community. Arch Pediatr Adolesc Med 2005;159:836-41.
- Haider R, Ashworth A, Kabir I, Huttly KRA. Effect of community-based peer counsellors on exclusive breastfeeding practices in Dhaka, Bangladesh: a randomised controlled trial. Lancet 2000;356:1643-7.
- Morrow AL, Guerrero L, Shults J, Calva JJ, Lutter C, Bravo J, et al. Efficacy of home-based peer counselling to promote exclusive breastfeeding: a randomised controlled trial. Lancet 1999;353:1226-31.
Source: PubMed