Still feeding that baby: a cluster randomised controlled trial, with training of general practice nurses, to examine motivational support for ongoing breastfeeding

Abstract

AIM: To increase exclusive breastfeeding and any breastfeeding of infants aged four months and six months compared to controls, and to evaluate trial processes. INTRODUCTION: Despite its known importance, continuation of breastfeeding in Australia is lower than recommended. Cross-disciplinary research identifies the dilemma that mothers face: they are questioned regarding when, where, how and why they are breastfeeding. Protection and promotion of breastfeeding are inadequate. This complex interpersonal behaviour needs more support. Systematic literature review suggests that training in breastfeeding management and counselling skills, within a theoretical framework, are needed for effective health professional support. METHOD: Using a motivational interviewing framework The Conversation Tool flowchart was developed. Ten hours of training prepared the intervention practice nurses to deliver the Conversation Tool intervention during infant immunisation appointments, in a cluster randomised controlled trial. Independent mail recruitment and telephone data collection for breastfeeding outcomes were conducted with mothers. Statistical analysis was conducted in STATA, adjusted for clustering. Periodic telephone contact with practice nurses enabled mentoring and mixed methods process evaluation RESULTS: The trial involved 15 general practices, 19 intervention practice nurses, and 330 mothers. Training improved practice nurse breastfeeding knowledge (t 7.27(14), p<0.001 2-tailed) and attitudes (t 6.25(14), p<0.001 2-tailed). Full breastfeeding OR 1.95 (95%CI 1.03-3.69) p=0.041 and exclusive breastfeeding OR 1.88 (95%CI 1.01-3.50) p=0.047 were increased at four months (24 hour recall) compared to control, adjusted for return to work/study plans. Duration of breastfeeding was not significantly different from controls. Process evaluation included 43 practice nurse interviews; despite community resistance, workplace restrictions, and their own learning curves, support for ongoing breastfeeding was satisfying for practice nurses and mostly non-threatening. DISCUSSION AND RECOMMENDATIONS: This successful clinical translational research demonstrates a rural preventive health intervention and improved breastfeeding outcomes. The motivational interviewing framework and this training model are appropriate. Policy commitment to address structural barriers is needed. Future research is awaited on support for ongoing breastfeeding with women from disadvantaged groups and on improved maternal access to support.