Strengthening health visitors’ breastfeeding support – results from a cluster randomised study

Abstract

Background and Intervention : Health professionals are key in supporting breastfeeding women but studies report gaps in health professionals’ breastfeeding support competencies. In an intervention study, we aimed to strengthen the breastfeeding support of families to improve breastfeeding rates. Health visitors received an interactive training programme to enhance their breastfeeding support self-efficacy, action competence and knowledge, including e-learning and a two-day course of lectures, role plays, and discussions. Objectives To assess the effect of the training programme on three constructs of health visitors’ breastfeeding support: self-efficacy, action competence and knowledge. Furthermore, we aimed to confirm the factor structure of these three constructs. Design and Methods : Pre- and post-test study in a cluster randomised trial with Danish municipal health visiting programmes as cluster units, randomised by stratifying for region and annual births per cluster. Health visitors from 21 clusters (11 intervention, 10 control) participated. The self-efficacy, action competence and knowledge were assessed in self-reported questionnaires before and after training (n = 368; intervention n = 176, control n = 196). To analyse the effects, the intention-to-treat principle and linear mixed models were applied. Confirmatory Factor Analysis was used to confirm the factor structures of the hypothesised self-efficacy, action competence and knowledge constructs. Results 158 health visitors in the control arm and 157 in the intervention arm completed the baseline questionnaire and were analysed in intention-to-treat analyses. 125 and 116, respectively, completed the follow-up questionnaire and were analysed in sensitivity analyses. Health visitors in both trial arms had high levels of self-efficacy and action competence at baseline. Mean treatment effect of the training programme was 2.4 points (CI95% 1.6–3.3) for self-efficacy, 1.4 points (CI95% 0.7-2.0) for action competence, and 0.5 points (CI95% 0.1–0.8) for knowledge. The factor structure of the items used to measure self-efficacy, action competence and knowledge were confirmed. Conclusions The training programme improved the self-reported breastfeeding support self-efficacy, action competence and knowledge of health visitors. The factor structures of the instruments used to measure effects were confirmed by confirmatory factor analysis. Trial registration : Clinical Trials: NCT05311631. Date of first recruitment of health visitors: Dec 01, 2021.

Implementation of a community-based breastfeeding support intervention to prolong duration of and reduce social inequality in exclusive breastfeeding: a mixed-methods systematic process evaluation in a cluster-randomised trial

“…According to Chesnel et al (30), the opportunity to discuss support practices with colleagues is an important part of breastfeeding education, but frequent discussions may, if the breastfeeding support is outdated, impede the entire teams' provision of breastfeeding support. We recently established that the training programme was effective on health visitors' self-reported self-e cacy and action competence and somewhat on knowledge (9). The health visitors in present study highlighted that having gained knowledge was one of the major bene ts of the intervention.…”

“…An additional hypothesis proposed that delivering a higher dose of the intervention through proactive telephone calls (termed: 'intensi ed intervention') to families with young mothers and/or low educational attainment could help reduce social inequality in breastfeeding. In a pre-and post-test study we have documented that the training programme enhanced health visitors' knowledge, action competence, and self-e cacy related to breastfeeding support (9). The present study is a mixed-methods systematic process evaluation of the Breastfeeding Trial prior to the trial effectiveness evaluation.…”

“…1). The intervention has been described in detail elsewhere (8), as has the training programme (9). The four key messages in the intervention: 1) breastfeeding as a joint parenting task, 2) skin-to-skin contact, 3) proper breastfeeding positioning and 4) frequent breastfeeding, are evidencebased and have previously produced results in the 'Less is More' trial carried out in Danish maternity wards (15,16).…”

“…In the Breastfeeding Trial, health visitors in the intervention arm (n = 11 clusters) received training to provide individualised breastfeeding support to new families, based on current evidence and theories such as self-e cacy, tailoring, and attributional retraining (9), and aligned with the breastfeeding support implemented at hospital level (10). The aim of the intervention was to strengthen breastfeeding support and increase the proportion of women accomplishing their breastfeeding duration goals.…”