Presentation on theme: "Sheila Knight: Health Visitor"— Presentation transcript:
1Sheila Knight: Health Visitor Hello I am Sheila Knight, a health visitor in an inner city practice in Dundee with a caseload with a high level of deprivation.I was struck in 2002 by the low rate of breast feeding in our practice and even more alarmed when I calculated the number of mothers who gave up breast feeding before leaving hospital before I did my first visit at 10 days and before the baby was 8 weeks old.Sheila Knight: Health VisitorJanet Dalzell: Breast-feeding Coordinator26/04/06
2Breastfeeding Rates Target - 50% at 6 weeks in Scotland by 2005 LocationBreast-feedingat birthAt hospital dischargeAt 6-8 weeksDundee48.8%40.4%22%Mill31.7%21.1%7%Erskine46.3%31.8%13%Arbroath48.3%36.6%23%This slide show the figures, there has been some improvements since then but these were the figures which made me take actionSource: CHSP-PS 2002
3Why telephone peer support? Previously focus was on medical, physical, and demographic reasonsMore recently researcher have been looking at social and confidence reasonsTelephone peer support in middle class CanadaDennis(1999) developed Breast Feeding Self-efficacy Scale to measure maternal confidenceIt use so far has shown a correlation between low antenatal scores and formula feeding at 6 weeksI did some reading and found that the move away from reaach about the medical reason, and problems which make women give up researchers were now looking at breast feeding as a complex process which is affected by social. Psychological and learning aspects I read about RCT to evaluate telephone peer support in Canada, which significantly increased the number of women who breast feed their babies till three months and who breast feed exclusively. Telephone peer support was planned to encourage women, give factual information and boost their confidence through applying an intervention based on social learning theory and how self-efficacy is developed
4Breast-feeding self-efficacy Breast-feeding self-efficacy refers to a mother’sconfidence in her ability to breast-feed her baby and isa significant factor as it predicts;Whether a mother chooses to breast-feed or notHow much effort she will expendWhether she will have self-enhancing or self-defeating thought patternsHow she will respond emotionally to breast-feeding difficulties (Dennis1999)
5Breast-feeding self-efficacy Gaining confidence in breast-feeding isinfluenced by four sources of information:performance accomplishment e.g. previously breast-feed babyvicarious experience e.g. watching other women successfully breast-feedingverbal persuasion e.g. factual information, encouragement from influential others such as family, friends and professionalsphysiological responses e.g. fatigue, stress, anxiety, painThe bosom buddy project like the project in Canada was based on the 3rd source of information for social learning, encouragement from significant others. So Janet and I got together to plan.
6Bosom Buddy ProjectTo investigate the feasibility, acceptability and satisfaction with telephone peer support to lower income women in two Dundee practices and one in ArbroathFunding from Queen’s Nursing Institute of ScotlandApproval from Tayside Committee for Medical EthicsNHS Tayside Policy for VolunteersThe proposal was to find out if it is feasible to recruit volunteers, would women accept this type of support, would they feel satisfied with this type of service. Could this type of support be transferred from middle class Canada to a Scottish city with a high level of deprivation.
7PlanVolunteers, experienced breast feeding mothers from caseloads of practices involvedTelephone contact initiated by supporter before birthUp to eight weeks supportTraining providedEvaluation by interviews and questionnaires (provided by Dennis 2002 study)Training was five hours, crèche provided, was interactive, topics included, confidentiality, listening, being non-judgemental, how breast feeding works, recognising when the woman needed to contact her HV or GP. Information packs were supplied.
8Results Recruiting volunteers In Dundee, 27 asked, 13 said yes, 7 completed training and became volunteersAge Yes NoOverAnd in ArbroathDepcatYesNo1234567The health visitors in the practices involved asked women the knew from visiting , who had breast feed their babies if they would like to provide telephone support to mothers new to breast feeding. Not all free to attend the initial training date planned.Names on waiting list but in the end we did not need to train any more. A good mix of ages, deprivation categories were successfully recruited in DundeeIn Arbroath 4 mothers volunteered, three in depcat 3 and one in 6 and all were between 30 to39 years of age.Figures for anyone who said no are not available
9Recruiting MothersMidwives to provide information during pregnancy, this did not happenOpportunistic recruitmentPlanned antenatal by HV visit to recruit in DundeePlanned postnatal visit to recruit in ArbroathBosom buddies invited to attend antenatal breastfeeding workshops in Arbroath to recruit women.
10Recruiting mothers 16 mothers were recruited 10 were prims and 6 had previous children13 were had not previously breast feed at all3 had breast fed for a short time before
11Being a volunteer Very enthusiastic about breast feeding Clearly understood the support roleClear understanding of the difference of professional problem solving roleEnjoyed contacts once establishedReplacement buddy neededOverall positive experience for the buddy, would do it againKeen to support other womenSmall group discussionIndividual interview with volunteersDiary sheets
12Training and Information Pack All said that training was adequateBit about being non-judgmental was goodPack used for checking information
13Telephone contacts:Diary sheets showed evidence of the buddies giving positive feedback to mothersGood rapport being establishedBosom buddies checking usefulness of contact with the mothersMobile phones in Dundee were usefulNo contact; 2 mothers decided to bottle feedOne changed her phone number and the service was unaware of thisOne bosom buddy tried to contact the mother about 30 time over two weeks and when contact was made the mother had changed to bottle feedingOne was reluctant to talk and it was clear she had changed her mind about having a bosom buddyMobile phones allowed land line to be free for other family members, used for leaving messages, used at work by one mother, could be used for text messaging to mothers
14No contact established Two mothers decided to formula feed their babies, both before hospital dischargeOne mother changed her phone number and the service was unaware of thisOne bosom buddy telephoned the mother around thirty times over a two to three week period and got no replies but when contact was made the mother had started formula feedingOne mother was reluctant to talk and it was clear to the bosom buddy that she had changed her mind about taking part.
15ContactsDiary entries showed that there was a wide range of contacts and length of calls;the number of contacts per mother ranged from 2 to 11length of individual calls in minutes ranged from 3 to 90 minutestotal contact time per mother ranged from 15 to 195minutesno replies to calls ranged from 2 to 30mother initiated calls were four from three mothers in Arbroath, none in Dundee
16Satisfaction with Infant Feeding Scores ranged from 12 to 59,Mean 50.313 intend to breastfeed next baby13 found experience enjoyable14 recommend to friends4 unhappy with feeding method at 8 weeks (formula feeding)All but 3 scored over 50 out of a possible 60.
17Maternal satisfaction with Peer Support Comments from 14 mothers who completed the evaluation and questionnairesQuestionnaire Scores ranged from 33 to 50,and the mean was 46.57 said it extended the length of breast feeding11 said helped to reach goals, kept me focused12 said they would like a bosom buddy the next time7 said she helped me continue breastfeeding11 said all new mothers should have one12 said they had enough contact
18Breastfeeding Self-efficacy Feeding at 8 weeksMean scoresBefore project(range)After project%increaseBreastfeeding110(77-136)144.5( )31.3Bottle Feeding113.4(91-135)118.6(77-137)4.5Breastfeeding self-efficacy measurement tool produced by Dennis et al and trialled by Blythe et al in Australia and recommended to be piloted in more disadvantaged populations. Under 130 low score and over 140 high scoreAntenatal Breastfeeding scores increase significantly by 30% but bottle feeders lees confident 4.5% increaseMuch less difference antenatally
19Breastfeeding Questionnaire at 8 weeks 8 of the14 babies still receiving breast milkFrom data interpretation 5 of the 6 not breastfeeding at 8 weeks did not fully establish breastfeeding.
20Reasons given by mothers for giving formula feed Never attached successfully (2)Painful cracked nipples mastitis (1)Did not like breastfeeding (1)Baby feeding too long, too hungry(3)And did not have enough milk(2)Not planned to evaluate the effectiveness in increasing duration of feeding but to test the feasibility of providing this type of support
21Conclusion Feasibility Recruiting volunteers successful Volunteers positive and highly enthusiasticMobile phones useful and added versatilityExperience of breast feeding and 5 hours training gave volunteers enough confidenceWomen keen to support other breast feeding mothers
22Conclusion Acceptability Over half the mothers who were asked, accepted the offer of a buddyMay have been more if not a research projectMothers found telephone contact acceptableBuddies viewed it as a worthwhile thing to do
23Conclusion Satisfaction Volunteers rated highly by mothers Mothers satisfied by experience of the projectMothers thought everyone should have oneWould have buddy again with next babyBuddies happy with training and support
24ConclusionTelephone peer support cannot provide the intensive pre and post natal education guidance and support needed by mothers to establish breast feedingBut when breast feeding is established it may be effective in increasing duration and exclusivity ratesVolunteers need support, up-dating and deputy
25RecommendationsAn RCT is needed to evaluate the effectiveness of telephone peer support in extending duration of breastfeeding.Comparison of areas of high and low deprivation, and urban and rural areas would be useful in the evaluation of the effectiveness of this intervention