School of Health Sciences, University of Dundee, Dundee, UK.
School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.
Health Soc Care Deliv Res. 2024 Jul;12(20):1-206. doi: 10.3310/DGTP5702.
Breastfeeding impacts positively on multiple health outcomes, but < 50% of UK women breastfeed at 8 weeks. Women with long-term conditions face additional challenges in breastfeeding.
To synthesise global and UK evidence to co-create an implementation and evaluation toolkit for cost-effective breastfeeding support in the NHS.
Evidence syntheses with stakeholder engagement.
Systematic reviews examined effectiveness of breastfeeding support for (1) healthy women and (2) women with long-term conditions using Cochrane Pregnancy and Childbirth Group methods. Mixed-methods systematic reviews synthesised process evaluations of effective breastfeeding support interventions for healthy women and experiences of receiving/providing support for breastfeeding women with long-term conditions. Cross-study synthesis integrated qualitative and quantitative findings. Systematic reviews synthesised evidence on the incremental costs and cost-effectiveness of breastfeeding support following National Institute for Health and Care Excellence guidance. All searches were conducted from May 2021 to October 2022. Stakeholder engagement and toolkit development comprised online discussions, a modified Delphi study, focus groups and four workshops. Participants were 23 stakeholders, 16 parents in the parents' panels, 15 women in the focus groups and 87 stakeholders who attended the workshops.
We found considerably more interventions designed for healthy women (review 1) than aimed at women with long-term conditions (reviews 1 and 4); approximately half of the studies were targeted at groups at higher risk of poor breastfeeding outcomes, and the impact of support may be different in these populations. Despite this, studies from review 2 found that women perceived the provision of support as positive, important and needed. Studies from review 5 echoed a range of suggestions from participants regarding potential strategies to improve breastfeeding support, with the most widely reported being the need to acknowledge the role and influence of other sources of support (e.g. partners, family, friends, peers, external professionals, web-based resources) and involving these sources in the provision of breastfeeding support for women with long-term conditions. In reviews 3 and 6, there was uncertainty about the cost-effectiveness of breastfeeding support interventions due to the limited number of studies and lack of good-quality evidence.
There was a lack of evidence for the effectiveness and cost-effectiveness of breastfeeding interventions in the UK. There was often insufficient information reported about intervention characteristics.
'Breastfeeding only' support probably reduces the number of women stopping any or exclusive breastfeeding. The evidence for 'breastfeeding plus' interventions is less consistent, but these may reduce the number of women stopping exclusive breastfeeding at 4-6 weeks and at 6 months. We found no evidence of differential intervention effects regarding mode of provision or provider. Cost-effectiveness is uncertain due to the lack of good-quality evidence. Key enablers of successful implementation were responsiveness and tailoring of interventions to both women's and supporters' needs. Breastfeeding support as delivered in the included studies probably has little to no effect on breastfeeding outcomes for women with long-term conditions. The mixed-methods synthesis and stakeholder work identified that existing interventions may not address the complex needs of these women. The main study output is a co-produced toolkit to guide implementation and evaluation of breastfeeding support services in the UK.
Evaluation of breastfeeding support for all women, particularly those at risk of poor breastfeeding outcomes (e.g. long-term conditions, deprivation). This could involve tailoring the toolkit to local contexts via implementation and effectiveness studies or using quality improvement studies.
This study is registered as PROSPERO CRD42022337239, CRD42021229769 and CRD42022374509. The reviews of economic evidence were not registered; however, the review protocol can be accessed via the repository held by Queen's University Belfast Research Portal (https://pure.qub.ac.uk/).
This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR130995) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 20. See the NIHR Funding and Awards website for further award information.
母乳喂养对多种健康结果有积极影响，但英国只有不到 50%的女性在 8 周时进行母乳喂养。患有长期疾病的女性在母乳喂养方面面临额外的挑战。
综合全球和英国的证据，为英国国民保健制度中具有成本效益的母乳喂养支持创建实施和评估工具包。
证据综合与利益相关者参与。
系统评价使用 Cochrane 妊娠和分娩组方法，检查了（1）健康女性和（2）患有长期疾病的女性的母乳喂养支持的有效性。混合方法系统评价综合了有效母乳喂养支持干预措施对健康女性的过程评估以及患有长期疾病的母乳喂养女性在接受/提供支持方面的经验。跨研究综合整合了定性和定量发现。系统评价综合了根据国家卫生与保健卓越研究所指南提供母乳喂养支持的增量成本和成本效益的证据。所有搜索均于 2021 年 5 月至 2022 年 10 月进行。利益相关者参与和工具包开发包括在线讨论、改良德尔菲研究、焦点小组和四个研讨会。参与者包括 23 名利益相关者、16 名家长小组的家长、15 名焦点小组的女性和 87 名参加研讨会的利益相关者。
我们发现针对健康女性的干预措施（综述 1）比针对患有长期疾病的女性的干预措施（综述 1 和 4）多得多；大约一半的研究针对的是母乳喂养结果较差风险较高的群体，支持的效果可能在这些人群中有所不同。尽管如此，综述 2 的研究发现，女性认为支持的提供是积极的、重要的和需要的。综述 5 的研究反映了参与者提出的一系列关于改善母乳喂养支持的建议，其中最广泛报道的是需要承认其他支持来源（例如伴侣、家人、朋友、同龄人、外部专业人员、网络资源）的作用和影响，并让这些来源参与为患有长期疾病的女性提供母乳喂养支持。在综述 3 和 6 中，由于研究数量有限且缺乏高质量证据，关于母乳喂养支持干预措施的成本效益存在不确定性。
英国缺乏关于母乳喂养干预措施的有效性和成本效益的证据。关于干预措施特征的信息通常报告不足。
“仅母乳喂养”支持可能会减少停止任何或完全母乳喂养的女性人数。“母乳喂养加”干预措施的证据不太一致，但这些措施可能会减少在 4-6 周和 6 个月时停止纯母乳喂养的女性人数。我们没有发现关于提供方式或提供者的干预效果差异的证据。由于缺乏高质量的证据，成本效益是不确定的。成功实施的关键因素是对女性和支持者的需求的响应和调整。在包括的研究中，母乳喂养支持可能对患有长期疾病的女性的母乳喂养结果几乎没有影响。混合方法综合和利益相关者工作确定，现有的干预措施可能无法满足这些女性的复杂需求。主要研究结果是一个共同制定的工具包，用于指导英国母乳喂养支持服务的实施和评估。
评估所有女性，特别是那些有不良母乳喂养结果风险的女性（例如长期疾病、贫困）的母乳喂养支持。这可能涉及通过实施和有效性研究或使用质量改进研究来调整工具包以适应当地情况。
这项研究是在 PROSPERO（CRD42022337239）、CRD42021229769 和 CRD42022374509 下注册的，经济证据的审查没有注册；然而，审查方案可以通过贝尔法斯特女王大学研究门户（https://pure.qub.ac.uk/）上的存储库获取。
该奖项由英国国家卫生与保健卓越研究所（NIHR）健康和社会保健交付研究计划（NIHR 奖号：NIHR130995）资助，并在 Health and Social Care Delivery Research 中全文发表；第 12 卷，第 20 期。请访问 NIHR 资助和奖项网站，了解更多奖项信息。
