The FEeding Support Team (FEST) randomised, controlled feasibility trial of proactive and reactive telephone support for breastfeeding women living in disadvantaged areas

Pat Hoddinott, Leone Craig, Graeme Maclennan, Dwayne Boyers, Luke Vale, On behalf of the NHS Grampian and the University of Aberdeen FEST project team

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Abstract

OBJECTIVE: To assess the feasibility of implementing a dedicated feeding support team on a postnatal ward and pilot the potential effectiveness and cost-effectiveness of team (proactive) and woman-initiated (reactive) telephone support after discharge. DESIGN: Randomised controlled trial embedded within a before-and-after study. Participatory approach and mixed-method process evaluation. SETTING: A postnatal ward in Scotland. SAMPLE: Women living in disadvantaged areas initiating breast feeding. METHODS: Eligible women were recruited to a before-and-after intervention study, a proportion of whom were independently randomised after hospital discharge to intervention: daily proactive and reactive telephone calls for =14 days or control: reactive telephone calls = day 14. Intention-to-treat analysis compared the randomised groups on cases with complete outcomes at follow-up. MAIN OUTCOME MEASURES: Primary outcome: any breast feeding at 6-8 weeks assessed by a telephone call from a researcher blind to group allocation. Secondary outcomes: exclusive breast feeding, satisfaction with care, NHS costs and cost per additional woman breast feeding. RESULTS: There was no difference in feeding outcomes for women initiating breast feeding before the intervention (n=413) and after (n=388). 69 women were randomised to telephone support: 35 intervention (32 complete cases) and 34 control (26 complete cases). 22 intervention women compared with 12 control women were giving their baby some breast milk (RR 1.49, 95% CI 0.92 to 2.40) and 17 intervention women compared with eight control women were exclusively breast feeding (RR 1.73, 95% CI 0.88 to 3.37) at 6-8 weeks after birth. The incremental cost of providing proactive calls was £87 per additional woman breast feeding and £91 per additional woman exclusively breast feeding at 6-8 weeks; costs were sensitive to service organisation. CONCLUSIONS: Proactive telephone care delivered by a dedicated feeding team shows promise as a cost-effective intervention for improving breastfeeding outcomes. Integrating the FEeding Support Team (FEST) intervention into routine postnatal care was feasible. TRIAL REGISTRATION NUMBER: ISRCTN27207603. The study protocol and final report are available on request.
Original languageEnglish
Article numbere000652
JournalBMJ Open
Volume2
Issue number2
DOIs
Publication statusPublished - 2012

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Vulnerable Populations
Breast Feeding
Telephone
Randomized Controlled Trials
Costs and Cost Analysis
Postnatal Care
Intention to Treat Analysis
Scotland
Human Milk
Cost-Benefit Analysis
Research Personnel
Parturition
Organizations

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The FEeding Support Team (FEST) randomised, controlled feasibility trial of proactive and reactive telephone support for breastfeeding women living in disadvantaged areas. / Hoddinott, Pat; Craig, Leone; Maclennan, Graeme; Boyers, Dwayne; Vale, Luke; On behalf of the NHS Grampian and the University of Aberdeen FEST project team.

In: BMJ Open, Vol. 2, No. 2, e000652, 2012.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVE: To assess the feasibility of implementing a dedicated feeding support team on a postnatal ward and pilot the potential effectiveness and cost-effectiveness of team (proactive) and woman-initiated (reactive) telephone support after discharge. DESIGN: Randomised controlled trial embedded within a before-and-after study. Participatory approach and mixed-method process evaluation. SETTING: A postnatal ward in Scotland. SAMPLE: Women living in disadvantaged areas initiating breast feeding. METHODS: Eligible women were recruited to a before-and-after intervention study, a proportion of whom were independently randomised after hospital discharge to intervention: daily proactive and reactive telephone calls for =14 days or control: reactive telephone calls = day 14. Intention-to-treat analysis compared the randomised groups on cases with complete outcomes at follow-up. MAIN OUTCOME MEASURES: Primary outcome: any breast feeding at 6-8 weeks assessed by a telephone call from a researcher blind to group allocation. Secondary outcomes: exclusive breast feeding, satisfaction with care, NHS costs and cost per additional woman breast feeding. RESULTS: There was no difference in feeding outcomes for women initiating breast feeding before the intervention (n=413) and after (n=388). 69 women were randomised to telephone support: 35 intervention (32 complete cases) and 34 control (26 complete cases). 22 intervention women compared with 12 control women were giving their baby some breast milk (RR 1.49, 95{\%} CI 0.92 to 2.40) and 17 intervention women compared with eight control women were exclusively breast feeding (RR 1.73, 95{\%} CI 0.88 to 3.37) at 6-8 weeks after birth. The incremental cost of providing proactive calls was £87 per additional woman breast feeding and £91 per additional woman exclusively breast feeding at 6-8 weeks; costs were sensitive to service organisation. CONCLUSIONS: Proactive telephone care delivered by a dedicated feeding team shows promise as a cost-effective intervention for improving breastfeeding outcomes. Integrating the FEeding Support Team (FEST) intervention into routine postnatal care was feasible. TRIAL REGISTRATION NUMBER: ISRCTN27207603. The study protocol and final report are available on request.",
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N2 - OBJECTIVE: To assess the feasibility of implementing a dedicated feeding support team on a postnatal ward and pilot the potential effectiveness and cost-effectiveness of team (proactive) and woman-initiated (reactive) telephone support after discharge. DESIGN: Randomised controlled trial embedded within a before-and-after study. Participatory approach and mixed-method process evaluation. SETTING: A postnatal ward in Scotland. SAMPLE: Women living in disadvantaged areas initiating breast feeding. METHODS: Eligible women were recruited to a before-and-after intervention study, a proportion of whom were independently randomised after hospital discharge to intervention: daily proactive and reactive telephone calls for =14 days or control: reactive telephone calls = day 14. Intention-to-treat analysis compared the randomised groups on cases with complete outcomes at follow-up. MAIN OUTCOME MEASURES: Primary outcome: any breast feeding at 6-8 weeks assessed by a telephone call from a researcher blind to group allocation. Secondary outcomes: exclusive breast feeding, satisfaction with care, NHS costs and cost per additional woman breast feeding. RESULTS: There was no difference in feeding outcomes for women initiating breast feeding before the intervention (n=413) and after (n=388). 69 women were randomised to telephone support: 35 intervention (32 complete cases) and 34 control (26 complete cases). 22 intervention women compared with 12 control women were giving their baby some breast milk (RR 1.49, 95% CI 0.92 to 2.40) and 17 intervention women compared with eight control women were exclusively breast feeding (RR 1.73, 95% CI 0.88 to 3.37) at 6-8 weeks after birth. The incremental cost of providing proactive calls was £87 per additional woman breast feeding and £91 per additional woman exclusively breast feeding at 6-8 weeks; costs were sensitive to service organisation. CONCLUSIONS: Proactive telephone care delivered by a dedicated feeding team shows promise as a cost-effective intervention for improving breastfeeding outcomes. Integrating the FEeding Support Team (FEST) intervention into routine postnatal care was feasible. TRIAL REGISTRATION NUMBER: ISRCTN27207603. The study protocol and final report are available on request.

AB - OBJECTIVE: To assess the feasibility of implementing a dedicated feeding support team on a postnatal ward and pilot the potential effectiveness and cost-effectiveness of team (proactive) and woman-initiated (reactive) telephone support after discharge. DESIGN: Randomised controlled trial embedded within a before-and-after study. Participatory approach and mixed-method process evaluation. SETTING: A postnatal ward in Scotland. SAMPLE: Women living in disadvantaged areas initiating breast feeding. METHODS: Eligible women were recruited to a before-and-after intervention study, a proportion of whom were independently randomised after hospital discharge to intervention: daily proactive and reactive telephone calls for =14 days or control: reactive telephone calls = day 14. Intention-to-treat analysis compared the randomised groups on cases with complete outcomes at follow-up. MAIN OUTCOME MEASURES: Primary outcome: any breast feeding at 6-8 weeks assessed by a telephone call from a researcher blind to group allocation. Secondary outcomes: exclusive breast feeding, satisfaction with care, NHS costs and cost per additional woman breast feeding. RESULTS: There was no difference in feeding outcomes for women initiating breast feeding before the intervention (n=413) and after (n=388). 69 women were randomised to telephone support: 35 intervention (32 complete cases) and 34 control (26 complete cases). 22 intervention women compared with 12 control women were giving their baby some breast milk (RR 1.49, 95% CI 0.92 to 2.40) and 17 intervention women compared with eight control women were exclusively breast feeding (RR 1.73, 95% CI 0.88 to 3.37) at 6-8 weeks after birth. The incremental cost of providing proactive calls was £87 per additional woman breast feeding and £91 per additional woman exclusively breast feeding at 6-8 weeks; costs were sensitive to service organisation. CONCLUSIONS: Proactive telephone care delivered by a dedicated feeding team shows promise as a cost-effective intervention for improving breastfeeding outcomes. Integrating the FEeding Support Team (FEST) intervention into routine postnatal care was feasible. TRIAL REGISTRATION NUMBER: ISRCTN27207603. The study protocol and final report are available on request.

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