Factors influencing the sustainability of volunteer peer support for breast-feeding mothers within a hospital environment: An exploratory qualitative study

Use of volunteers in early years interventions for parents: A scoping review of roles and the extent of evaluation research in this area

Early years interventions, particularly those supporting parents in the first 1001 days of their infants life, support healthy development of infants and prevent adverse experiences that can have long term negative impacts. Volunteers are often used to deliver such interventions. This scoping review aimed to explore the roles and characteristics of volunteers across early years interventions and map the evaluation in this field to identify gaps in the literature. A scoping review was conducted according to the Arksey and O'Malley Framework. Academic databases and grey literature sources were searched to identify literature evaluating volunteer-based interventions for parents in the first 1001 days of their infant's life (conception to aged two). Research conducted in the UK or comparable high-income countries since the year 2000 were identified and data relating to the volunteer role, intervention design and evaluation methods were mapped. Sixty-six articles were eligible for inclusion in the review. Volunteers were commonly involved in interventions to provide peer support for a range of parenting related matters, support breastfeeding and the mental and emotional wellbeing of parents. Volunteer roles were categorised based on their background (peers or non-peer volunteers), their responsibilities (provider of peer support, educator or providers of practical support) and the delivery style of their role (in person one to one support, group leader or remote support). Research most often involved exploring the experiences of those involved in receiving or delivering the interventions and measuring outcomes in relation to breastfeeding and parent mental wellbeing. Volunteers play a large role in the provision of early years interventions. Their varied contribution is presented through a typology that will allow comparisons of roles in future research. Further research exploring the impact on the volunteers and the organisation will support decision making around choosing a volunteer led model within early years services.

Attitudes of mothers and health care providers towards behavioural interventions promoting breastfeeding uptake: A systematic review of qualitative and mixed-method studies

PURPOSE

Recommendations for exclusive breastfeeding are not often adhered to despite the robust evidence of its benefits. This systematic review aims to collate evidence on the attitudes mothers and health care providers have towards breastfeeding interventions to understand what aspects best contribute to acceptability and feasibility.

METHODS

This review further investigates the value of identifiable behaviour change techniques (BCTs) to uncover which components of an intervention are perceived to be most useful and acceptable. The main biomedical databases were searched, and 17 (n = 17) studies met the inclusion criteria.

RESULTS

A total of nine BCTs were identified within the interventions. The thematic analysis produced four main domains: usefulness, accessibility, value and sustainability. Women discussed the importance of the support they received in these interventions and demonstrated a positive view towards three BCTs: 'social support (unspecified)', 'instruction on how to perform behaviour' and 'demonstration of behaviour'. Additionally, women highlighted the benefit of personal, non-clinical and flexible emotional and practical support from peers, lactation consultants and support groups. Health care providers echoed these opinions and specifically highlighted the usefulness of interventions that allowed for continuity of care and more personal breastfeeding support.

CONCLUSIONS

These findings suggest that ongoing practical as well as emotional support is crucial for standard in-hospital support to succeed at increasing breastfeeding rates. Future research would need to better understand the nuances of the interventions among women and providers to enhance their implementation.

Integrating one-to-one peer support into psycho-oncological care in Germany: multi-perspective, mixed-methods evaluation of the isPO onco-guide service

PURPOSE

One-to-one peer supporters called isPO onco-guides (isPO OGs) are an integral part of the new German psycho-oncological form of care 'integrated, cross-sectoral Psycho-Oncology' (isPO), additionally to professional care. The isPO OGs are cancer survivors with experiential knowledge, offering information on local support services and answering questions 'all around cancer' to newly diagnosed cancer patients. We aimed to evaluate the isPO OG service from three perspectives: patients, isPO OGs, and professional service providers.

METHODS

A mixed-methods approach was pursued. We conducted interviews and focus groups with the three person groups, and applied qualitative content analysis on the reported resources, processes and outcomes regarding the isPO OG service. Relations with patients' utilisation and isPO OGs' work satisfaction were identified with regression and correlation analyses of questionnaire and isPO care data. We compared isPO care networks (CN) with X2-tests or ANOVA. Qualitative and quantitative results were integrated during interpretation phase.

RESULTS

Qualitatively, the three person groups agreed on the benefits of the isPO OG service. The implementation's maturity differed between the CN concerning established processes and resource availability. Attitudes of professional service providers appeared to be crucial for patients' utilisation of the isPO OG service. Quantitative results emphasised the differences between the CN.

CONCLUSION

Beyond differences in the CN, the isPO OG service has two psychosocial benefits: providing relevant, reliable, and understandable information; and offering the encouraging example that surviving and living with cancer is possible.

TRIAL REGISTRATION

The study was registered in the German Clinical Trials Register (No. DRKS00015326) on 30.10.2018.

Experiences that influence how trained providers support women with breastfeeding: A systematic review of qualitative evidence

INTRODUCTION

There is a need to improve breastfeeding support interventions as although many are evidence-based, a sequential increase in breastfeeding rates is not evident. It is crucial to understand why the implementation of evidence-based guidelines in practice does not always translate to positive experiences for women and improve breastfeeding rates. This systematic review aims to synthesise breastfeeding support experiences of trained support providers and their impact on breastfeeding support practices.

METHODS

A strategy was developed to search seven databases including Medline and CINAHL and grey literature for qualitative studies. Studies eligible for inclusion reported professional and trained peer experiences of supporting women to breastfeed. PRISMA guidelines were followed and included studies were quality appraised using the CASP Qualitative Checklist. A thematic synthesis of included studies was undertaken and confidence in the review findings was assessed using the CERQual tool. The study protocol, registered in the International Prospective Register of Systematic Reviews PROSPERO registration number: CRD42020207380, has been peer reviewed and published.

FINDINGS

A total of 977 records were screened, which identified 18 studies (21 papers) eligible for inclusion comprising 368 participants. Following quality appraisal, all studies were deemed suitable for inclusion. The thematic synthesis resulted in four analytical themes: 1) A personal philosophy of breastfeeding support 2) Teamwork and tensions in practice 3) Negotiating organisational constraints and 4) Encounters with breastfeeding women. Findings demonstrated that a range of experiences influence practice, and practice evolves on continued exposure to such experiences. The potential of each experience to facilitate or inhibit breastfeeding support provision is fluid and context specific.

CONCLUSIONS

Experiences, as named above, are modifiable factors contributing to the development of a philosophy of breastfeeding support based on what the provider believes works and is valuable in practice. Further research is required into the range of factors which underpin context-specific breastfeeding support practice, to improve both women's experiences and intervention effectiveness.

Oncology Volunteers in a Comprehensive Cancer Center: An Observational Study of Compassion and Well-Being

A descriptive, cross sectional design was used to compare perceptions of compassion and well-being of volunteers with and without a personal history of cancer. Most (79%) were >60 years of age, female (63%), married (75%), White (88%), and Non-Hispanic (79%). Thirteen (54%) had a history of cancer; two were still on treatment. Compassion scores were similar between groups. Volunteers with a history of cancer scored higher (p = 0.04) on General Well-being than those without a history of cancer. Understanding volunteer perceptions of compassion and well-being can guide our support structure and psychoeducation. Future studies could examine patient outcomes related to volunteerism.

Infant malnutrition treatment in Kenya: Health worker and breastfeeding peer supporter experiences

Acute malnutrition in infants under 6 months (u6m) is increasingly recognised as a global public health problem. The World Health Organisation (WHO) guidelines for inpatient nutritional rehabilitation of infants u6m is re-lactation: the re-establishment of exclusive breastfeeding. Evidence suggests these guidelines are rarely followed in many low-income settings. Two studies of infant nutritional rehabilitation undertaken in three public hospitals in coastal Kenya employed breastfeeding peer supporters (BFPSs) to facilitate WHO guideline implementation. To explore the acceptability of the strategy to health workers (HWs) and the BFPSs, in-depth interviews were conducted with 20 HWs and five BFPSs in the three study hospitals. The HWs reported that the presence of the BFPSs changed the way infant nutritional rehabilitation was managed, increasing efforts at relactation and decreasing reliance on supplemental milk. BFPSs were said to help address staff shortages and had dedicated time to support and assist the mothers. Key to the success of the BFPSs was the social relationships they were able to establish with the mothers due to the similarity in their experiences and backgrounds. Despite the success of the BFPSs, human resource management and infrastructure challenges remained. BFPSs can successfully be employed to facilitate the implementation of the WHO guidelines for the nutritional rehabilitation of acutely malnourished infants u6m in hospitals in Kenya, establishing supportive social relationships and trust with the mothers of the acutely malnourished infants and helping to address the issue of human resource shortages.

A scoping review of breastfeeding peer support models applied in hospital settings

BACKGROUND

The 2013 updated guidelines on management of severe acute malnutrition in infants and children recommends the support of exclusive breastfeeding. These guidelines are inconsistently applied in low and middle income countries (LMICs) due to barriers including unclear implementation guides, technical support and epidemiological factors. Peer support strategies have been used to offer psychological support to families with infants in NICU and improve mental health outcomes. Breastfeeding peer supporters (BFPS) have been shown to be effective in improving breastfeeding outcomes in community settings however, their success within hospital settings in LMICs is unknown. We conducted a scoping review to explore implementation of breastfeeding peer support strategies as have been applied to hospitalized infants globally and highlight their implementation strategies in order to guide future research and practice.

METHODS

A scoping review of the literature was conducted using the Arksey and O'Malley framework. A search was conducted in five online databases (PubMed, Cochrane library, Hinari, Google Scholar and Open Grey library). Data were extracted and charted in data extraction tables to capture general characteristics, modes of peer support delivery, implementation details and evaluation procedures.

RESULTS

From the online search 276 articles were identified, however only 18 met the inclusion criteria for the study. The majority of these articles were reports on in-patient breastfeeding peer support interventions applied in Europe and the United States of America and only two were from LMICs. The articles described peer supporters' identification, training (n = 13) and supervision (n = 14). The majority of the BFPS were employed (n = 10) compared to volunteers (n = 3) and support was mainly one-to-one (n = 11) rather than group support. Process and impact evaluation (n = 13) reported positive breastfeeding outcomes associated with breastfeeding peer support.

CONCLUSION

Breastfeeding peer support strategies are applied in different hospital settings and can be used to improve breastfeeding outcomes. However, to achieve integration, scalability and comparability of impact and outcomes, there is a need to standardize training, develop consistent implementation and supervision plans of in-patient peer supporters' strategies. Further research to assess sustainability and evaluate cost-effectiveness of in-patient breastfeeding peer support strategies will improve uptake and scalability of these potentially lifesaving interventions.

Breastfeeding peer support by telephone in the RUBY randomised controlled trial: A qualitative exploration of volunteers' experiences

BACKGROUND

There is growing evidence that peer support programs may be effective in supporting breastfeeding mothers. A randomised controlled trial (RCT) (the RUBY study) that tested peer support in the Australian context found that infants of first-time mothers who received proactive telephone peer support were more likely to be receiving breastmilk at six months of age.

METHODS

This qualitative sub-study of the RUBY RCT explores the experiences and views of peer volunteers who delivered the intervention. Focus groups were conducted with 17 peers from the RUBY RCT between November 2015 and March 2016. All had provided peer support to at least one mother.

RESULTS

We found that volunteers identified strongly with the mothers' need for support when establishing breastfeeding. Key components of the support were strengthening the mothers' self-belief through affirmation and sharing experiential knowledge. Volunteers found the role rewarding and personally therapeutic although some women reported challenges initiating and maintaining contact with some mothers. Data were analysed using a hybrid approach to thematic analysis combining inductive and deductive techniques.

CONCLUSIONS

Breastfeeding peer support programs are reliant on recruitment of motivated volunteers who can provide empathetic mother-to-mother support. This study provides important information regarding volunteers' experiences that may support the upscaling of breastfeeding peer support for new mothers.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry, ACTRN 12612001024831.

Volunteers' experiences of providing telephone-based breast-feeding peer support in the RUBY randomised controlled trial

OBJECTIVE

The Ringing Up About Breastfeeding earlY (RUBY) randomised controlled trial (RCT) found that a telephone-based peer volunteer support intervention increased breast-feeding duration in a setting with high breast-feeding initiation. This sub-study of the RUBY RCT describes the motivation, preparation and experiences of volunteers who provided the peer support intervention.

DESIGN

An online survey was completed by 154 (67 %) volunteers after ceasing volunteering.

SETTING

Volunteers provided peer support to primiparous women (n 574) who birthed at one of three public hospitals in Melbourne, Australia, between February 2013 and December 2015.

PARTICIPANTS

Volunteers (n 230) had themselves breastfed for at least 6 months and received 4 h of training for the role.

RESULTS

The median number of mothers supported was two (range 1-11), and two-thirds of respondents supported at least one mother for 6 months. Volunteers were motivated by a strong desire to support new mothers to establish and continue breast-feeding. Most (93 %) considered the training session adequate. The majority (60 %) reported following the call schedule 'most of the time', but many commented that 'it depends on the mother'. Overall, 84 % of volunteers were satisfied with the role and reported that the experience was enjoyable (85 %) and worthwhile (90 %). Volunteers agreed that telephone support for breast-feeding was valued by women (88 %) and that the programme would be effective in helping women to breastfeed (93 %).

CONCLUSIONS

These findings are important for those developing similar peer support programmes in which recruiting volunteers and developing training requirements are an integral and recurrent part of volunteer management.

Development of a Breastfeeding Support Scale for Couples

The aim of this study was to develop a Breastfeeding Support Scale for Couples (BSSC) and to examine its reliability and validity. The BSSC was designed to evaluate current state of mutual support necessary for breastfeeding from the perspective of wife as support recipient, and husband as support provider. Subjects were 324 wives who came for their 1-month postpartum checkup and their husbands. Valid responses obtained from 159 husbands (97.0%) and 303 wives (93.5%) were then subjected to analysis. The BSSC for husbands comprised of 10 questions and two factors, and a scale for wives comprised of 14 questions and three factors were ultimately created. Cronbach's alpha reliability coefficient ranged from 0.72 to 0.89 for all factors for both husbands and wives. The internal consistency and criterion-related validity of the scale were also confirmed. The model fitted the data satisfactory. Its reliability and validity were confirmed. The BSSC focused on mutual support among married couples, and may reveal new directions for breastfeeding support by shedding light on the differences in the perception of reciprocity support. The BSSC can evaluate couples and the appropriate support necessary for breastfeeding from the perspective of reciprocity support.