Title: Co-production of an NHS-tailored implementation and evaluation strategy framework to support women in the UK to breastfeed with a focus on reducing health inequities: evidence synthesis with stakeholder engagement.
Funder: Chief Scientist Office, Scotland

Abstract: We know that breastfeeding can improve the health of mothers and babies. However, in the UK, breastfeeding rates are low and disadvantaged women are least likely to breastfeed. Around 80% of women stop breastfeeding before they want to, which can be devastating. Many women say that they do not feel supported by health professionals and that breastfeeding support has been cut._x000D_ We know that support helps women to breastfeed for longer and without needing to give their babies other foods or fluids. There are many different kinds of breastfeeding support, but we don’t know which work best in the UK. There have not been many trials of breastfeeding support in the UK. Also there are many barriers to putting good breastfeeding support into practice in the NHS. We need to know what can be learned from breastfeeding support from other countries that could be transferred to the UK, what good support would cost and what money might be saved through more breastfeeding. In this study we will update the Cochrane review of trials “Support for healthy breastfeeding mothers with healthy term babies” to identify from all over the world, types of support that help women to breastfeed. We will also do a second review to identify all the trials which aim to support women with long-term health conditions to breastfeed. Then, we will identify which of these types of support might be relevant to the UK and the NHS._x000D_ Next, we will look for all types of research available (not just trials) that provide more information about these types of support identified as relevant to the UK. This could include information about what helped and what hindered providing each type of support and when this support might be most effective. We will also estimate the costs of providing these different types of support. This will help the NHS to make decisions about investing in better breastfeeding support._x000D_ We will create NHS guidance to inform commissioning decisions to help more women sustain their decision to breastfeed in the UK. Finally we will learn lessons from this research that might help other researchers carry out similar studies on different topics._x000D_ The study will take 18 months to complete. The project will involve an important element of participation and researchers will work closely with health service staff and breastfeeding women across all the stages of the study. We will create a stakeholder working group which will include health professionals and people from breastfeeding support organisations. We will invite 6-8 parents to form a Parent’s Panel. The Stakeholder working group and the parents’ panel will be involved in all stages of the research and will have three meetings with the researchers. Two of those meetings will be by telephone. We will also conduct three focus groups with disadvantaged women. An extra parents’ panel and stakeholder group will be conducted to help us better understand how we can support women with long-term health conditions. Near the end of the study, we will hold four workshops, one each in England, Scotland, Wales and Northern Ireland. We will invite more stakeholders to the workshops to get their opinions on the findings of the study. This will make sure that the NHS guidance is relevant to women and babies and NHS staff throughout the UK

Lay abstract: This study will provide a UK-relevant implementation framework for breastfeeding support interventions by co-creating a synthesis of global evidence with stakeholders. This will include updating a highly accessed Cochrane review, and synthesising process and economic evaluations, to increase breastfeeding and reduce health inequities. An additional ‘study within a project’ (SWAP) will mirror this work and consider breastfeeding support for women with multiple long-term conditions (MLTCs). _x000D_ Breastfeeding has the greatest known impact of any preventative health intervention, yet the UK has among the lowest breastfeeding rates globally with a marked social gradient. Around 80% of UK women stop breastfeeding before they intended, causing distress. Women report feeling unsupported by healthcare providers and a reduction in breastfeeding support services._x000D_ There is critical need to assess what can be learnt from global evidence that is transferable to the UK context and to understand cost implications and return on investment of breastfeeding support interventions. There is strong global evidence that additional support increases breastfeeding duration and exclusivity. However, interventions tested in trials are heterogeneous and lack underpinning theory that would help assess transferability to the UK context._x000D_ This research will synthesise global and UK evidence to co-create, with key stakeholders, an NHS tailored implementation and evaluation strategy framework to address contextual barriers and inform the transferability, development and evaluation of cost-effective breastfeeding support interventions._x000D_ Objectives_x000D_ 1. Update the Cochrane review “Support for healthy breastfeeding mothers with healthy term babies” to identify effective breastfeeding support interventions;_x000D_ 2. Conduct a theoretically-informed mixed methods synthesis of process evaluations of UK-relevant interventions;_x000D_ 3. Conduct an economic evaluation of interventions to enable women to breastfeed;_x000D_ 4. To conduct a systematic review to identify effective interventions which provide breastfeeding support for women with long-term conditions._x000D_ 5. To conduct a theoretically informed mixed methods synthesis of process evaluations of breastfeeding support interventions for women with long-term conditions;_x000D_ 6. To conduct an economic evaluation of interventions to enable women with long-term conditions to breastfeed;_x000D_ 7. Co-create an NHS-tailored implementation and evaluation strategy framework to address contextual barriers and inform transferability of cost-effective interventions to increase breastfeeding in the UK;_x000D_ 8. Contribute to methodological development on involving stakeholders in co-creation of systematic reviews and synthesising process evaluations to support transferability and applicability of global evidence to local health service contexts._x000D_ The 18-month study comprises evidence synthesis and economic evaluation with embedded stakeholder involvement, including PPI, using principles of co-creation to ensure study outputs are relevant to the NHS context. The study will focus on reducing inequities in breastfeeding by ensuring the NHS-tailored framework is informed by the needs of women and babies from communities that have low breastfeeding rates._x000D_ Stakeholder engagement will be achieved through two stakeholder working groups and two parents’ panels supplemented by focus group discussions with disadvantaged women. Key outputs are: 1) updated Cochrane review “Support for healthy breastfeeding mothers with healthy term babies” to identify effective interventions to enable women to breastfeed; 2; a systematic review of breastfeeding support interventions for women with long-term conditions; 3) two theoretically-informed syntheses of policy and implementation research relating to effective interventions that are relevant to the UK context to produce an integrative review; 4) two syntheses of economic evaluations of breastfeeding interventions; 5) a co-produced NHS-tailored implementation and evaluation strategy framework to inform policy, practice and research in relation interventions to support women and babies in the UK to breastfeed.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH