Title: The effectiveness and cost-effectiveness of Assets-based feeding help Before and After birth (ABA-feed) for improving breastfeeding initiation and continuation
Funder: Department of Health and Social Care

Abstract: OUR AIM_x000D_ To find out whether a promising ‘feeding helper’ service (ABA-feed) that supports women to feed their babies helps them to breastfeed for longer and whether it is good value for money._x000D_ _x000D_ WHY IS THIS RESEARCH IMPORTANT?_x000D_ Breastfeeding can improve the health of mothers and babies, but fewer women breastfeed in the UK compared to other European countries. Many women stop breastfeeding within the first two weeks. Most wish they had breastfed for longer, and would have liked more support to help them continue. Younger mothers and those from lower income homes are less likely to breastfeed. _x000D_ _x000D_ Women value support from other mothers that have breastfed (peer support) but large high quality UK studies of peer support have not increased the numbers of women who breastfeed. This may be because the support was not available when it was most needed, or that the focus on breastfeeding could make women feel guilty if they decided to formula feed their babies. We completed a small study in two places testing a new service which overcame these issues. We found that many women liked the service. _x000D_ _x000D_ WHAT WE PLAN TO DO_x000D_ We will invite women expecting their first baby to take part, approaching them in antenatal clinics or at the 20 week scan. Women can join the study up until they are 34 weeks pregnant. A computer will allocate 2730 mothers by chance to either receive usual care for feeding or the additional new ABA-feed service. _x000D_ _x000D_ ‘Feeding helpers’ will respect women’s feeding choices. They will help mothers identify friends and family who may be able to help and will provide information about local groups, helplines and high-quality websites about infant feeding. They will provide a ‘listening ear’ when women have had their baby. _x000D_ _x000D_ We will train existing peer supporters to become ‘feeding helpers’. They will contact women around 30 weeks of pregnancy and meet to talk about infant feeding; then keep in contact throughout pregnancy. After birth, the feeding helper will contact mothers daily for 2 weeks by text message or phone and refer those with particular difficulties to specialist feeding support. Women will then be offered less frequent texts until their babies are 8 weeks old. We will collect text exchanges between some women and feeding helpers with women’s consent. For women who formula feed, texts and calls will cease when mothers are confident in how to prepare bottles safely and feeding is established._x000D_ _x000D_ At 3 days, 8 and 16 weeks after birth, women will be sent a text/web link which asks how they are feeding their baby and they will receive a voucher at the study end. In order to see if our new ABA-feed intervention works or not, we will compare breastfeeding rates at 8-weeks between women who did/did not receive support from the feeding helpers. We will interview women, feeding helpers and health care professionals about their experience of the service._x000D_ _x000D_ INVOLVEMENT OF MOTHERS _x000D_ Mothers contributed to the design and gave ongoing advice in the previous small study. Three women will help us throughout this study and a wider group of mothers from a Maternity Services Partnership will be involved to discuss recruitment and how to communicate the findings to a wider audience._x000D_ _x000D_ SHARING OUR FINDINGS _x000D_ After the study we will work with mothers, NHS staff, charities and Government to tell people about the work, using social media, local and national events as well as presenting the findings at conferences and in academic journals

Lay abstract: BACKGROUND: Breastfeeding durations in the UK are amongst the shortest worldwide, despite considerable health benefits to both infant and mother associated with breastfeeding. The research team drew on best evidence and behavioural theory to develop the innovative ABA-feed intervention and tested it in a feasibility study. Criteria for progression to a full trial were met._x000D_ _x000D_ RESEARCH QUESTION: To evaluate if the ABA-feed intervention compared with usual care increases any breastfeeding at 8 weeks post delivery, in first-time mothers regardless of their feeding intentions._x000D_ _x000D_ SECONDARY AIMS:_x000D_ 1) To evaluate the effect of the ABA-feed intervention compared to usual feeding care on secondary outcomes including other feeding outcomes. _x000D_ 2) To explore the feasibility of i) modelling longer-term benefits ii) costs and outcomes for a lifetime horizon, using a within trial cost-consequence analysis over 16 weeks post-delivery._x000D_ 3) To investigate how trial conduct and context varies across sites in order to understand any observed differences in outcomes and inform future implementation. _x000D_ _x000D_ METHODS: Randomised controlled trial with 2730 nulliparous women with singleton pregnancy, any feeding intention, recruited from scanning and antenatal clinics and randomised 1.4:1 to intervention or control group (usual feeding care with no proactive peer support). _x000D_ _x000D_ Intervention: Infant feeding helper service applying a proactive, assets-based, woman-centred approach, delivered antenatally and postnatally, tailored through face-to-face contacts, texts and telephone. A face-to-face contact at 30 weeks of pregnancy will be followed by texts/brief calls during pregnancy, daily for 2 weeks after birth, reducing until 8 weeks. _x000D_ _x000D_ Setting: 10-15 UK sites where usual feeding care does not include routine proactive peer supporter contact, including sites of low breastfeeding prevalence and socio-economically disadvantaged populations. _x000D_ _x000D_ Outcome measures: Primary outcome - any breastfeeding at 8 weeks. Secondary outcomes: breastfeeding initiation, any and exclusive breastfeeding, formula feeding practices, anxiety, social support and health care utilisation. _x000D_ _x000D_ Data collection: by text and online questionnaires at 3 days, 8 and 16 weeks postnatal._x000D_ _x000D_ Mixed-methods process evaluation with more detailed case-studies in five sites to explore effect of context on implementation. Qualitative interviews with women, infant feeding helpers and maternity care professionals, fidelity of intervention delivery. _x000D_ _x000D_ Economic evaluation: will explore the feasibility of modelling longer-term benefits, and costs and outcomes for a lifetime horizon, using a within trial cost-consequence analysis over 16 weeks post delivery._x000D_ _x000D_ TIMELINES FOR DELIVERY: Duration 36 months (M). Set-up and training (M1-6); recruitment of women (M7-20); follow-up (M9-30); process evaluation and case studies (M13-31); economic analysis and model (M22-36) and analysis of trial data and report writing (M31-36)._x000D_ _x000D_ ANTICIPATED IMPACT AND DISSEMINATION: The findings will address the effectiveness/cost-effectiveness of the ABA-feed intervention on breastfeeding. If effective, understanding how context impacts on implementation and observed outcomes will inform commissioning guidance and wider-scale roll out. Dissemination of findings will target key stakeholders including media, online forums, patient and public involvement, commissioners and health care professional events, and publications._x000D_ _x000D_ Website: www.birmingham.ac.uk/ABA-feed

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH