1. Conclusions Clinical staff confidence in knowledge and practice was found to be associated with objectively assessed knowledge, with expected associations to prior training, though not associated with years experience. It is not known if improving staff knowledge will increase staff confidence. Feedback of objectively assessed knowledge may be an important motivator for uptake of training where there is evidence of over or under confidence and of inaccurate knowledge in key practice areas. Training can be targeted at individuals and staff groups accurately with this type of assessment. Organisational training and policy interventions, such as those developed by Yorkshire & Humberside HIEC and the Best Beginnings Small Wonders Programme can be evaluated by using this type of assessment before and after implementation. Assessing the knowledge and confidence of neonatal unit clinicians to support breastfeeding and the practices to support parents care of their baby using the Neonatal Unit Clinician Assessment Tool (NUCAT) in England. Wallace LM 1., Law SM 2., Higman W 1, Kehal I 1., Anwar K 1., Jackson BR 1., Bayley J 1., Watson J 3., Renfrew, M 3. 1 Applied Research Centre in Health & Lifestyle Interventions, Coventry University 2 Coventry University 3 Yorkshire & Humber HIEC Aims 1.To assess which areas of knowledge and practice clinicians are confident in, and objectively assess clinicians’ actual knowledge. 2.To examine the relationships between confidence and knowledge. 3.To examine the relationship between both prior training and years of experience with knowledge. Background Breast milk feeding of infants on neonatal units has been shown to be associated with reductions in infection, necrotising enterocolitis, cognitive impairment, procedural pain and to lead to earlier discharge (Renfrew et al. 2009). Skin-to-skin contact has been shown to be associated with improved IQ and cognitive development, and increased brain maturity in premature and sick babies. Yet breastfeeding rates in UK neonatal units remain low. In order to ensure clinicians provide support for parental engagement and breastfeeding, it is important to ascertain what clinical knowledge and confidence in practices clinicians have within their current working environment. Method Six neonatal units / special care baby units enrolled their clinicians to undertake the on line assessment – the Neonatal Unit Clinician Assessment (NUCAT). Clinicians rated their confidence from 1 = ‘no confidence’ to 10 = ‘very confident’ using a standard self efficacy protocol for both knowledge and practices. Knowledge is assessed using 40 multiple choice items covering Knowledge (physiology of lactation, benefits of breastfeeding) and Practices (supporting breastfeeding, breast milk expression, kangaroo care, positive touch). Contact: Prof Louise Wallace – Applied Research Centre in Health & Lifestyle Interventions, Coventry University, Priory Street, Coventry, CV1 5FB. Tel: + 44 2476 88 8718 Email: l.wallace@coventry.ac.uk Results 1. 79 clinicians took part; half of them were neonatal nurses. Other job roles included midwives, neonatologists, and nursery nurses. Confidence ratings ranged from 1 to 10 on all items. There was no significant difference between confidence in knowledge and confidence in practice [F (1, 78) = 1.91, p=0.16], although median scores indicated clinicians higher confidence. Objectively assessed knowledge scores (out of 40) varied from below chance (scores of below 10, <25% correct) to more than 75% correct, in total scores and across all sub scales. For total scores, one person achieved less than chance score, a further three scored less than half, 44 scored 50-75%, and 31 above 75% correct. Overall, 61% achieved less than 75% correct (Fig. 1 ). Practices of positive touch and kangaroo care sub scales had most high scorers and breastfeeding related areas least high scorers. 2. Confidence in all areas, with the exception of positive touch, significantly correlates with actual knowledge in those areas (Fig. 2). 3. ANOVA indicated a significant difference of training on total knowledge score. [F (4, 74) = 3.76, p=0.008]. Tukey post-hoc tests revealed those that have never had any BF training scored significantly lower than those that have, irrespective of how recent the training (Fig. 3; never vs 0-6 months p=.03; never vs 6-12 months p=.01; never vs 1-2 years p=.01; never vs 2-5 years p=.02). There was no relationship between years of experience and knowledge [F (4, 73) = 1.81, p=0.14]. ItemMeanSD How much do you feel you know about positive touch for sick and premature babies? 6.192.16 How much do you feel you know about supporting Kangaroo Care? 6.922.12 How much do you feel you know about supporting women to breastfeed? 7.222.10 How much do you feel you know about breast milk expression?6.962.31 How much do you feel you know about the benefits of breast milk feeding for babies and mothers? 7.761.71 ItemMeanSD How confident are you in your use of positive touch with sick and premature babies? 6.012.49 How confident are you in supporting parents to do Kangaroo Care? 6.872.36 How confident are you to support women to breastfeed?7.152.30 How much do you feel you know about the physiology of breast milk production, expression and breastfeeding? 6.432.25 Confidence in Knowledge rsig Positive Touch0.190.09 Kangaroo Care0.29*0.01 BF support0.55**0.00 Expression0.56**0.00 Physiology0.55**0.00 Benefits0.47**0.00 Confidence in Practice Positive Touch0.120.31 Kangaroo Care0.25*0.23 BF support0.49**0.00 Figure 1. Percentage of 79 clinicians whose knowledge falls in each quartile Figure 2. Correlations of confidence with actual knowledge per related area Figure 3. Total knowledge score & recency of breastfeeding training Table 1. Mean scores in confidence in knowledge & practice % correct score Best Beginnings and Coventry University have collaboratively developed the Neonatal Unit Clinician Assessment Tool (NUCAT), an online clinical assessment tool which objectively assesses neonatal and midwifery staff knowledge, and measures the subjectively assessed confidence in their knowledge of breast milk expression, breastfeeding and kangaroo care and positive touch for premature babies. Best Beginnings commissioned Coventry University and Health Behaviour Research Limited to create NUCAT as part of a larger evaluation that Best Beginnings commissioned Coventry University to do of the Small Wonders Change Programme (see http://www.bestbeginnings.org.uk/small-wonders for further details). NUCAT is jointly owned by Best Beginnings and Health Behaviour Research Limited.http://www.bestbeginnings.org.uk/small-wonders Total score 1. Renfrew, M. J., Craig, D., Dyson, L., McCormick, F., Rice, S., King, S. E., Misso, K., Stenhouse, E., & Williams, A.F. (2009). Breastfeeding promotion for infants in neonatal units: a systematic review and economic analysis. Health Technology Assessment, 13 (40)