■母乳喂养对多种健康结果产生积极影响,但<50%的英国女性母乳喂养8周。患有长期疾病的妇女在母乳喂养方面面临额外的挑战。
■综合全球和英国的证据,共同创建一个实施和评估工具包,用于在NHS中提供具有成本效益的母乳喂养支持。
■与利益相关者参与的证据综合。
系统评价使用Cochrane妊娠和分娩组方法检查了母乳喂养支持对(1)健康妇女和(2)长期疾病妇女的有效性。混合方法系统综述综合了对健康妇女的有效母乳喂养支持干预措施的过程评估,以及为长期条件的母乳喂养妇女接受/提供支持的经验。交叉研究综合整合了定性和定量结果。根据国家健康与护理卓越研究所的指导,系统评价综合了有关母乳喂养支持的增量成本和成本效益的证据。所有搜索均在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,修改后的德尔菲研究,焦点小组和四个讲习班。与会者是23个利益攸关方,父母小组中有16位父母,焦点小组中有15名妇女和87名利益攸关方参加了讲习班。
我们发现,针对健康女性(综述1)的干预措施比针对长期疾病女性(综述1和4)的干预措施多得多;大约一半的研究针对母乳喂养结局不良风险较高的人群。在这些人群中,支持的影响可能不同。尽管如此,综述2的研究发现,女性认为提供支持是积极的,重要的和需要的。综述5的研究回应了参与者关于改善母乳喂养支持的潜在策略的一系列建议。最广泛报道的是需要承认其他支持来源的作用和影响(如合作伙伴、家庭,朋友,同行,外部专业人士,基于网络的资源),并使这些资源参与为有长期状况的妇女提供母乳喂养支持。在综述3和6中,由于研究数量有限且缺乏高质量的证据,母乳喂养支持干预措施的成本效益存在不确定性。
■在英国,缺乏母乳喂养干预措施的有效性和成本效益的证据。关于干预特征的信息报告往往不足。
■\'仅母乳喂养\'支持可能会减少停止任何或完全母乳喂养的妇女人数。“母乳喂养加干预”的证据不太一致,但这些可能会减少在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不同干预效果的证据。由于缺乏高质量的证据,成本效益是不确定的。成功实施的关键推动者是对妇女和支持者需求的响应和定制干预措施。纳入的研究中提供的母乳喂养支持可能对长期条件妇女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的工作确定,现有的干预措施可能无法解决这些妇女的复杂需求。主要研究结果是共同制作的工具包,用于指导英国母乳喂养支持服务的实施和评估。
■评估所有妇女的母乳喂养支持,特别是那些有母乳喂养结局不良风险的人(例如,长期条件,剥夺)。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根据当地情况调整工具包。
■本研究注册为PROSPEROCRD4202237239、CRD42021229769和CRD42022374509。对经济证据的审查没有登记;然而,可以通过女王大学贝尔法斯特研究门户(https://pure)持有的存储库访问审查协议。qub.AC.英国/)。
■该奖项由国家健康与护理研究所(NIHR)健康与社会护理提供研究计划(NIHR奖参考:NIHR130995)资助,并在健康与社会护理提供研究中全文发表。12号20.有关更多奖项信息,请参阅NIHR资助和奖励网站。
我们知道母乳喂养有利于母亲和婴儿的健康,然而,许多母亲经历了困难,并在他们想要之前停止母乳喂养。这在生活在母乳喂养率低的贫困地区的妇女中很明显。良好的支持可以帮助女性克服困难,以便她们能够继续母乳喂养。患有糖尿病和抑郁症等慢性疾病的妇女在母乳喂养方面面临额外的挑战。我们想了解如何改善对英国女性的母乳喂养支持。我们汇集了以前的科学研究来了解什么是有效的。我们还与父母和服务提供商进行了交谈。我们将所有发现整合到一个工具包中,以帮助NHS改善对女性的母乳喂养支持。我们发现,对于健康的女性来说,某些形式的母乳喂养支持可能有助于减少停止母乳喂养的妇女人数,并帮助她们完全母乳喂养。对于患有慢性病的女性来说,我们发现,研究中使用的支持类型可能无法帮助女性进行母乳喂养.大多数证据并非来自英国。我们确定了为所有女性提供母乳喂养支持的障碍,尤其是那些处于不利地位的人。我们确定了可以帮助NHS克服这些障碍的策略。缺乏证据表明,这些干预措施与常规护理相比的成本效益如何,但是父母和提供者看到了支付母乳喂养支持费用的价值。给予女性有针对性的母乳喂养支持将有助于她们进行母乳喂养;然而,我们需要测试这种支持在NHS中是否有效。我们还需要为患有慢性病的妇女提供更多服务。NHS可以利用我们的发现,通过确定特定的障碍并使用基于证据的策略来克服这些障碍,来改善对所有母乳喂养妇女的支持。
UNASSIGNED: 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.
UNASSIGNED: To synthesise global and UK evidence to co-create an implementation and evaluation toolkit for cost-effective breastfeeding support in the NHS.
UNASSIGNED: Evidence syntheses with stakeholder engagement.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: \'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.
UNASSIGNED: 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.
UNASSIGNED: 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/).
UNASSIGNED: 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.
We know that breastfeeding is good for the health of mothers and babies, yet many mothers experience difficulties and stop breastfeeding before they want to. This is noticeable among women living in disadvantaged areas where there are low rates of breastfeeding. Good support may help women overcome difficulties so that they can continue to breastfeed. Women with chronic illnesses such as diabetes and depression face additional challenges in breastfeeding. We wanted to understand how to improve breastfeeding support for UK women. We brought together previous scientific studies to learn about what works. We also spoke with parents and service providers. We combined all our findings into a toolkit to help the NHS improve breastfeeding support for women. We found that, for healthy women, some forms of breastfeeding support can probably help reduce the number of women stopping breastfeeding and help them breastfeed exclusively. For women with chronic illnesses, we found that the types of support used in the studies probably did not help women to breastfeed. Most of the evidence did not come from the UK. We identified barriers to providing breastfeeding support for all women, especially those who are disadvantaged. We identified strategies that could help the NHS overcome these barriers. There was a lack of evidence on how cost-effective these interventions are compared with usual care, but parents and providers saw the value of paying for breastfeeding support. Giving women targeted breastfeeding support will help them to breastfeed; however, we need to test if this support works in the NHS. We also need to develop additional services for women with chronic illnesses. The NHS could use our findings to improve support for all breastfeeding women by identifying specific barriers and using evidence-based strategies to overcome them.