ABA-Feed Infant Feeding Training for Peer Supporters and Coordinators: Development and Mixed-Methods Evaluation

The assets-based feeding help before and after birth (ABA-feed) intervention aims to improve breastfeeding rates by offering proactive peer support to first-time mothers, regardless of feeding intention. Based on behaviour change theory and an assets-based approach, the intervention involved training existing peer supporters to become infant feeding helpers (IFHs). A train-the-trainer model was used, with coordinators delivering four 2-h training sessions to IFHs. Training covered a study overview, IFH role, role-play scenarios and signposting to local assets. Due to COVID-19, training was delivered online. Post-training questionnaires were completed by 22/30 (73.3%) coordinators and 119/193 (61.7%) IFHs, and qualitative interviews were conducted with 24 coordinators and 72 IFHs. Researchers observed training at five sites, assessing fidelity, engagement and delivery quality. Questionnaire data were analysed descriptively, and qualitative data were analysed using framework analysis. Findings indicated that coordinators valued the train-the-trainer model, particularly information on formula feeding and antenatal discussions. IFHs found training engaging and felt prepared, though some were apprehensive about formula feeding support. While online training was convenient, challenges included monitoring discussions and role-play in breakout rooms. Most participants favoured a hybrid approach, with in-person sessions for interactive activities. Observations showed high training fidelity, participant engagement and confidence in delivering intervention components. The ABA-feed training was acceptable to coordinators and IFHs and was delivered with fidelity. Future training should adopt a hybrid approach, incorporating diverse resources and prioritising in-person interactive components such as role-play. Trial Registration: ISRCTN17395671.