Nilsson Ingrid, Busck-Rasmussen Marianne, Villadsen Sarah Fredsted
Danish Committee for Health Education, Classensgade 71, 5, Copenhagen, 2100, Denmark.
Section of Social Medicine, Department of Public Health, University of Copenhagen, CCS, Øster Farimagsgade 5A, Copenhagen, 1353, Denmark.
Arch Public Health. 2024 Oct 2;82(1):174. doi: 10.1186/s13690-024-01401-6.
Breastfeeding is the ideal nutrition for infants and protects infants and mothers from a range of adverse health outcomes during their lifespan. In Denmark, while the breastfeeding initiation rate is high, only 14% of mothers meet the World Health Organization's recommendation of exclusive breastfeeding at six months. Furthermore, a notable social inequity exists among those who achieve this recommendation. Knowledge of effective interventions to reduce breastfeeding inequity is limited. A previous hospital-based intervention succeeded in increasing breastfeeding duration. However, most breastfeeding support is provided in Danish municipalities by health visitors. This called for adapting the intervention to the health visiting program and developing an intensified intervention addressing the social inequity in breastfeeding. This article describes the adaptation and development process of a municipality-based intervention.
During a 15-month period in 2020-21, the municipal intervention was iteratively developed using a three-stage framework for developing complex health interventions described by Hawkins et al. The three stages were 1) need assessment and stakeholder consultation, 2) co-production and 3) prototyping. The process was inspired by O'Cathain et al.'s principles for a user-centred, co-created and theory- and evidence-based approach, involving parents and health visitors.
In stage 1, we identified the needs and priorities of the target groups of the intervention. In stage 2, the intervention was developed through action research design and inspired by Duus' 'learning cycles' as the method to enhance motivation and ownership and to strengthen the implementation process by creating a joint room for learning and reflection with health visitors and developers. In stage 3, the intervention was tested for feasibility and usefulness during a 2.5-month period accompanied by monthly dialogue meetings with health visitors and developers. In this period, the intervention was refined based on the gathered experiences and was subsequently prepared for evaluation.
The description of the development of this complex intervention, aimed at increasing breastfeeding duration and reducing inequity, offers breastfeeding practitioners and researchers a transparent foundation for continuously improving breastfeeding support and a methodology for complex intervention development.
Registered at Clinical Trials NCT05311631.
母乳喂养是婴儿的理想营养方式，可保护婴儿和母亲在其生命周期内免受一系列不良健康后果的影响。在丹麦，虽然母乳喂养启动率很高，但只有14%的母亲在六个月时达到世界卫生组织纯母乳喂养的建议。此外，在达到这一建议的人群中存在明显的社会不平等。关于减少母乳喂养不平等的有效干预措施的知识有限。先前一项基于医院的干预措施成功地延长了母乳喂养时间。然而，丹麦各市镇的母乳喂养支持大多由健康访视员提供。这就需要使干预措施适应健康访视计划，并制定一项强化干预措施来解决母乳喂养方面的社会不平等问题。本文描述了一项基于市镇的干预措施的调整和开发过程。
在2020 - 21年的15个月期间，使用霍金斯等人描述的用于开发复杂健康干预措施的三阶段框架，对市镇干预措施进行迭代开发。这三个阶段分别是：1）需求评估和利益相关者咨询，2）共同生产，3）原型设计。该过程受到奥凯欣等人以用户为中心、共同创建且基于理论和证据的方法原则的启发，涉及家长和健康访视员。
在第一阶段，我们确定了干预目标群体的需求和优先事项。在第二阶段，通过行动研究设计开发干预措施，并以杜斯的“学习循环”为灵感，作为增强动机和主人翁意识以及通过与健康访视员和开发者创建共同学习和反思空间来加强实施过程的方法。在第三阶段，在为期2.5个月的时间里对干预措施进行了可行性和实用性测试，并每月与健康访视员和开发者举行对话会议。在此期间，根据收集到的经验对干预措施进行了完善，随后准备进行评估。
对这项旨在延长母乳喂养时间和减少不平等的复杂干预措施开发过程的描述，为母乳喂养从业者和研究人员持续改进母乳喂养支持提供了一个透明的基础，以及一种复杂干预措施开发的方法。
在临床试验NCT05311631注册。
