Breast is best? A small-scale study exploring knowledge, attitudes, and training amongst community pharmacists about breastfeeding
Authors: Kamdar D , El Kout Oustah Y , Elbashir M 
Published: November 2023

Abstract

Introduction
The United Kingdom (UK) has one of the lowest breastfeeding rates in Europe, with the last Infant Feeding Survey showing a reduction from 81% of mothers initiating breastfeeding to 0.5% still breastfeeding at 12 months.1 It provides multiple health benefits for mothers and infants, and promoting breastfeeding is an important public health strategy, impacting the future health of the population. Community pharmacists are accessible and trusted healthcare professionals, giving expert advice on medication use and public health. Previous research has found a lack of knowledge and training on medicines use during lactation and breastfeeding-related conditions, often leading to unnecessary cessation of breastfeeding.2

Aim
To explore breastfeeding knowledge, attitudes, and training amongst community pharmacists.

Methods
Following ethical approval from Kingston University and a pilot study, a paper questionnaire comprising 24 mixed-style questions was distributed to community pharmacists in the London boroughs of Ealing and Brent. The Raosoft online calculator was used to calculate the sample size of 110 pharmacists at 95% confidence interval. Semi-structured interviews were conducted using a validated interview guide. Analyses were performed using SPSS software alongside thematic analysis for interview responses.

Results
Response rate was 75% (n=82/110) and 9 pharmacists participated in the interviews. 47.6% (n=39/82) pharmacists rated their current breastfeeding knowledge as neither poor nor good or lower. Only 11% (n=9/82) pharmacists stated the duration of breastfeeding should be greater than 2 years. 27.2% (n=12/44) pharmacists felt slightly or not confident providing over-the-counter medicines to breastfeeding patients compared to 61.4% (n=27/44) when making recommendations for breastfeeding-related conditions such as mastitis or nipple thrush. Thematic analysis highlighted the need for further research into medication use safety during lactation as pharmacists lacked confidence to make recommendations based on Summary of Product Characteristics (SPC).
50% (n=41/82) pharmacists stated their knowledge was obtained from personal experience. 100% (n=82/82) of participants agreed that more education and training must be provided, and thematic analysis showed pharmacists would prefer a spiralled approach starting at university level, through foundation year training and post-registration.

Discussion/Conclusion
The majority of pharmacists showed somewhat or high confidence advising patients about over-the-counter medication safety during lactation, but this was reversed when confronted with breastfeeding-related conditions, in contrast to findings from Byerley2 where the majority of pharmacists were not confident about medicines advice. Pharmacists have a positive attitude towards breastfeeding with all desiring further training. Changes to pharmacy education and training are needed to develop pharmacists’ understanding on breastfeeding generally and medicines safety with the need for robust evidence from clinical trials to improve pharmacist’s confidence to advise appropriately,3 or at least to educate pharmacists about specialised resources such as the Drug and Lactation Database or Breastfeeding Network.
Study strengths included providing information about an area with limited literature and a reasonable response rate. Limitations included a small sample size in a small geographical area. Only community pharmacists were surveyed but with evolving roles, it would benefit surveying primary care pharmacists.

References
1. Unicef. Breastfeeding in the UK [Internet]. [Place unknown]: Unicef; [date unknown] [cited 2023 Mar 11]. Available from: https://www.unicef.org.uk/babyfriendly/about/breastfeeding-in-the-uk/
2. Byerley EM, Perryman DC, Dykhuizen SN, Haak JR, Grindeland CJ, Williamson JDM. Breastfeeding and the Pharmacist’s Role in Maternal Medication Management: Identifying Barriers and the Need for Continuing Education. J Pediatr Pharmacol Ther [Internet]. 2022 Feb [cited 2023 Mar 10]; 27(2):102-108. Available from: https://www.researchgate.net/publication/358489674_Breastfeeding_and_the_Pharmacist%27s_Role_in_Maternal_Medication_Management_Identifying_Barriers_and_the_Need_for_Continuing_Education
3. Hussainy SY, Dermele N. Knowledge, attitudes and practices of health professionals and women towards medication use in breastfeeding: A review. Int Breastfeed J [Internet]. 2011 Aug [cited 2023 May 16]; 6(1):1-16. Available from: https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/1746-4358-6-11