Peer support intervention (ABA-feed) to improve breastfeeding: UK based, multicentre, parallel group, randomised
Kate Jolly1, Joanne Clarke1, Nicola Crossland2
1Department of Applied Health Sciences, School of Health Sciences, College of Medicine and Health, University of Birmingham, Birmingham B15 2TT, UK.
Insights
The Assets Based Feeding Help Before and After birth (ABA-feed) peer support intervention did not increase breastfeeding rates at eight weeks postpartum. This UK-based trial found no significant differences in breastfeeding outcomes compared to usual care.
Area of Science:
- Public Health
- Maternal and Child Health
- Behavioral Science
Background:
- Breastfeeding peer support interventions aim to improve infant feeding outcomes.
- Assets-based approaches focus on individual capabilities and resources.
- Understanding the effectiveness of proactive, person-centered support is crucial for public health initiatives.
Purpose of the Study:
- To evaluate the impact of the ABA-feed (Assets based feeding help Before and After birth) proactive peer support intervention on breastfeeding rates.
- To compare formula feeding practices and other maternal and infant outcomes between the intervention and usual care groups.
- To assess the effect of assets-based peer support compared to standard breastfeeding support.
Main Methods:
- A multicentre, unblinded, randomised controlled trial involving 2475 nulliparous women in the UK.
- Participants were randomized to either the ABA-feed intervention or usual breastfeeding support.
- The primary outcome was any breastfeeding at eight weeks postpartum, analyzed using the intention-to-treat principle.
Main Results:
- No significant difference in any breastfeeding at eight weeks postpartum between the ABA-feed intervention group (69.8%) and the usual care group (68.8%).
- High breastfeeding initiation rates were observed in both groups (94.2% vs 92.5%).
- The intervention group reported higher social support at eight weeks, but this was not sustained at 16 weeks; no other secondary outcomes differed.
Conclusions:
- The ABA-feed proactive, assets-based peer support intervention did not improve breastfeeding rates at eight weeks postpartum in the UK.
- The findings suggest that this specific type of enhanced peer support may not be more effective than usual care for increasing breastfeeding duration.
- Further research may explore different intervention components or target populations to enhance breastfeeding support effectiveness.
Objective:
To assess the effect of a proactive, assets based, peer support infant feeding intervention in addition to usual care on breastfeeding rates, formula feeding practices, and other outcomes, compared with usual breastfeeding support alone.
Design:
UK based, multicentre, parallel group, unblinded, randomised controlled trial.
Setting:
17 localities in the UK that offered breastfeeding peer support as part of usual care between January 2022 and 30 April 2024.
Participants:
2475 nulliparous women between 20 and 35 weeks of gestation were randomised 1.43:1, to account for potential clustering by peer supporter: 1458 to the ABA-feed (Assets based feeding help Before and After birth-feed) peer support intervention and 1017 to usual care.
Interventions:
The ABA-feed intervention comprised person centred proactive peer support for infant feeding underpinned by an assets based approach (focusing on the capabilities of, and resources available to, participants) and behaviour change theory delivered in person and remotely by text and telephone call. Usual care included universal care from midwives and health visitors and could also include services that provided reactive support such as peer supporters in breastfeeding groups, counselling, helplines, and social media support groups.
Main Outcome Measures:
The primary outcome was any breastfeeding at eight weeks after birth. Secondary outcomes at eight, 16, and 24 weeks after birth included breastfeeding initiation, any and exclusive breastfeeding, formula feeding practices, anxiety, social support, and healthcare utilisation. Analyses were based on the intention-to-treat principle.
Results:
Rates of any breastfeeding at eight weeks did not differ between the intervention group (1013/1452; 69.8%) and usual care group (698/1015; 68.8%); adjusted risk difference 0.01, 95% confidence interval -0.03 to 0.04. Preplanned subgroup analyses showed no interactions between the intervention and age, prespecified feeding intentions, mother's education, index of multiple deprivation fifth, or relationship status. Breastfeeding initiation rates were high (intervention 94.2%; usual care 92.5%). At eight weeks the intervention group reported higher social support, but this was not sustained at 16 weeks. No differences were observed in other secondary outcomes.
Conclusion:
The ABA-feed peer support intervention did not improve breastfeeding rates compared with usual breastfeeding support in a UK context.
Trial Registration:
ISRCTN Registry ISRCTN17395671.
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