Louise Condon

The effects of Baby Friendly Initiative training on breastfeeding rates and the breastfeeding attitudes, knowledge and self-efficacy of community health-care staff

AIM To evaluate the effects of Baby Friendly Initiative (BFI) community training on breastfeeding rates, staff and mothers in a large Primary Care Trust (PCT). BACKGROUND UK Government policy promotes the adoption and implementation of the World Health Organization/United Nations Childrens Fund BFI as the best evidence to raise breastfeeding initiation and prevalence. METHODS A total of 141 health visitors and nursery nurses were trained on mandatory three-day BFI courses during 2008; 137 staff (100 health visitors, 37 nursery nurses) took part in the evaluation. Breastfeeding attitudes, knowledge and staff confidence in helping mothers to breastfeed were measured using a validated Breastfeeding Questionnaire and a self-efficacy tool at three time points before and after training. FINDINGS Breastfeeding rates at eight weeks increased significantly, and a baby born in 2009 was 1.57 times more likely to be breastfed than one born in 2006. Statistically significant improvements in staff breastfeeding attitudes, knowledge and self-efficacy were seen after attending the course, in addition to increases in the appropriate management of breastfeeding problems.Process evaluation interviews with 43 health visitors, nursery nurses and managers explored views of the training and changes in practice. The response to the course was overwhelmingly positive and felt to be extremely worthwhile. It has led to renewed enthusiasm, improved the consistency of advice among team members and raised confidence levels of all staff who help mothers with breastfeeding. Health visitors felt confident about enabling nursery nurses to take a greater role in breastfeeding support. A small survey of mothers reported increases in exclusive breastfeeding and signs of increased breastfeeding self-efficacy. Making the training mandatory across the whole PCT has improved the consistency of breastfeeding advice and confidence of all health-care staff who help breastfeeding mothers.

But Is It a Normal Thing? Teenage Mothers' Experiences of Breastfeeding Promotion and Support.

Aim: To explore teenagers’ experiences of the breastfeeding promotion and support delivered by health professionals. Design: A qualitative study conducted in an English city. Methods: Pregnant teenagers and teenage mothers (n = 29) took part in semi-structured interviews and focus groups between March and July 2009. Results: Breastfeeding is presented by health professionals as incontrovertibly the best choice of feeding method, but teenagers experience an array of conflicting norms which influence their infant feeding choices and behaviours. Conclusions: The social barriers to continuing breastfeeding are insufficiently recognized and addressed by health professionals. It is likely that teenage mothers would breastfeed for longer if they perceived that breastfeeding was a normal way to feed baby in their social milieu.

‘You likes your way, we got our own way’: Gypsies and Travellers’ views on infant feeding and health professional support

Gypsies and Travellers are known to have poor health status and access to health services, even in comparison with other ethnic minority groups. People from this stigmatized ethnic group are rarely consulted about their health needs or health service provision. Optimal infant feeding in the first year of life has the potential to improve lifelong health.

Needles, Jabs and Jags: a qualitative exploration of barriers and facilitators to child and adult immunisation uptake among Gypsies, Travellers and Roma

BackgroundGypsies, Travellers and Roma (referred to as Travellers) are less likely to access health services including immunisation. To improve immunisation rates, it is necessary to understand what helps and hinders individuals in these communities in taking up immunisations. This study had two aims.1.Investigate the views of Travellers in the UK on the barriers and facilitators to acceptability and uptake of immunisations and explore their ideas for improving immunisation uptake;2.Examine whether and how these responses vary across and within communities, and for different vaccines (childhood and adult).MethodsThis was a qualitative, cross-sectional interview study informed by the Social Ecological Model. Semi-structured interviews were conducted with 174 Travellers from six communities: Romanian Roma, English Gypsy/Irish Travellers (Bristol), English Gypsy (York), Romanian/Slovakian Roma, Scottish Show people (Glasgow) and Irish Traveller (London). The focus was childhood and selected adult vaccines. Data were analysed using the Framework approach.ResultsCommon accounts of barriers and facilitators were identified across all six Traveller communities, similar to those documented for the general population. All Roma communities experienced additional barriers of language and being in a new country. Men and women described similar barriers and facilitators although women spoke more of discrimination and low literacy. There was broad acceptance of childhood and adult immunisation across and within communities, with current parents perceived as more positive than their elders. A minority of English-speaking Travellers worried about multiple/combined childhood vaccines, adult flu and whooping cough and described barriers to booking and attending immunisation. Cultural concerns about antenatal vaccines and HPV vaccination were most evident in the Bristol English Gypsy/Irish Traveller community. Language, literacy, discrimination, poor school attendance, poverty and housing were identified as barriers across different communities. Trustful relationships with health professionals were important and continuity of care valued.ConclusionsThe experience of many Travellers in this study, and the context through which they make health decisions, is changing. This large study identified key issues that should be considered when taking action to improve uptake of immunisations in Traveller families and reduce the persistent inequalities in coverage.Trial registrationCurrent Controlled Trials ISRCTN20019630.

UNderstanding uptake of Immunisations in TravellIng aNd Gypsy communities (UNITING): protocol for an exploratory, qualitative study

Introduction Gypsies, Travellers and Roma (referred to here as Travellers) experience significantly poorer health and have shorter life expectancy than the general population. They are also less likely to access health services including immunisation. To improve immunisation rates, we need to understand what helps and hinders individuals in these communities in taking up immunisations. This study has two aims: (1) Investigate the barriers and facilitators to acceptability and uptake of immunisations among six Traveller communities in the UK; (2) Identify potential interventions to increase uptake in these Traveller communities. Methods and analysis A three-phase qualitative study with six Traveller communities. PHASE 1: In each community, we will explore up to 45 Travellers’ views about the influences on their immunisation behaviours and ideas for improving uptake in their community. PHASE 2: In each community, we will investigate 6–8 service providers’ perspectives on barriers and facilitators to childhood and adult immunisations for Traveller communities with whom they work, and ideas to improve uptake. Interview data will be analysed using the Framework approach. PHASE 3: The findings will be discussed and interventions prioritised in six workshops, each with 10–12 phase 1 and 3–4 phase 2 participants. Ethics and dissemination This research received approval from NRES Committee Yorkshire and The Humber-Leeds East (Ref. 13/YH/02). It will produce (1) findings on the barriers and facilitators to uptake of immunisations in six Traveller communities; (2) a prioritised list of potentially feasible and acceptable interventions for increasing uptake in these communities; and (3) methodological development in undertaking research with diverse Traveller communities. The study has the potential to inform new ways of delivering services to ensure high immunisation uptake. Findings will be disseminated to participants, relevant UK organisations with responsibility for the implementation of immunisation policy and Traveller health/welfare; and submitted for publication in academic journals. Trial registration number ISRCTN20019630.

Using social marketing to encourage teenage mothers to breastfeed

Purpose – This purpose of this paper is to report on a study of the possible role of social marketing in encouraging breastfeeding amongst teenage mothers. UK teenage mothers are particularly prone to low levels of breastfeeding and there has been a lack of response to traditional health education approaches. The purpose of this paper is to report on an in‐depth, qualitative exploration into the use of social marketing to address this problem.Design/methodology/approach – Qualitative interviews were conducted in 2009 with 58 pregnant teenagers, young mothers and their influencers to explore feeding decisions and examine social marketing options. The Theory of Planned Behaviour (TPB) emerged as the most appropriate framework to explain the major influences on breastfeeding. This was used to structure a solution that highlighted three strategic priorities for social marketing based on the TPBs three components: changing attitudes, altering social norms and increasing confidence.Findings – Health benefits o...

Seeking the views of service users: From impossibility to necessity

When I was a graduate student nurse in the early 1980s, one assessment was to devise a research project—I suggested asking patients for their views on the care they had received in hospital. Sadly, when I proposed this topic, I was told that asking patients for their views was far too risky and certainly could not be carried out in my training hospital. Imagine my delight therefore at being an editor of Health Expectations journal which seeks to represent and explore the views of service users and the ways in which they can be involved in research and service development. Evaluating patients’ experiences is now considered a vital component of assessing the quality of health care,1,2 and in this edition Smirnova et al. report on their validation of the Consumer Quality Index (CQI) questionnaire as a standardized measure for evaluating inpatient experiences in Dutch hospitals. A limitation in using questionnaires to measure patient experience is that survey response rates are notoriously low, and the authors recommend exploring reasons for nonresponse to ensure an adequate sample size and optimal use of resources. This edition of HEX presents a variety of studies in which service user voice adds to our understanding of how we can provide better health services. Communication with patients is the theme of four papers. Chevalier et al. used communication accommodation theory (CAT) to improve communication between pharmacists and patients to avoid medicationrelated problems (MRPs). In accommodative communication, speakers complement their speech patterns (e.g. rate, volume, tone), modulate language and word use to maximize understanding, take turns and respond to nonverbal cues. In this study, most pharmacists used CAT strategies, but nonaccommodation occurred when pharmacists spoke too quickly, used unfamiliar terms and did not involve patients in agenda setting. Chou et al. analysed oncologists’ discussion of prognosis with African American patients diagnosed with cancer; their findings highlight the need to improve clinical communication with people from minority ethnic backgrounds who have advanced cancer. In a mixed methods study, Eassey et al. explored the MRPs experienced by Australian patients (n = 506) on discharge from hospital. A third of respondents experienced problems such as unwanted sideeffects and being given unfamiliar medication which resulted in confusion and anxiety. Patients would have liked more information about the medications they were prescribed and emphasized the need for better collaboration and communication (“I have nine specialists, they need to swap notes!”). Finally, communication emerged as a priority in Lawn et al.’s investigation into ‘what cancer survivors want?’ When care is shared between hospital specialists and primary care participants want to be at the centre of care, for instance, having shared electronic health records, and to be prepared for selfmanagement. Shared decision making (SDM) is central to patientcentred care and closely related to the protection of patients’ rights. A clusterrandomized trial of SDM in patients with type 2 diabetes (Ouden, Vos and Rutten) gave strong indications that SDM improved treatment outcomes, while PeresteloPerez et al.’s randomized trial of the effectiveness of a decision aid for patients with depression showed improved knowledge and reduced decisional conflict. In a qualitative study of patients with a newly acquired spinal cord injury, ScheelSailer et al. identified a challenge for health professionals in balancing patients’ need for autonomy with their reduced ability to participate in decision making in the early months postinjury. The authors suggest providing adequate information is an important way to address this conflict. Health information is the topic of studies by Cusack et al., Learmouth et al. and Brady et al. McKenna et al. stress the importance of context (e.g., quality of communication with the healthcare provider, family medical history) in understanding service users’ health literacy skills. A group of papers explore service development and service users’ views on “doing things differently.” Imison3 commented in 2009 that, despite the skills and employment challenges facing the health sector, traditional patterns of working and service provision have changed little in the UK since the inception of the NHS in 1948. The physician associate (PA) is a new role developed in the United States in the 1960s to provide clinical services which may be a substitute for, or delegated, from doctors, and now introduced in the UK. In a qualitative study, Halter et al. found that as with nurse substitutes for doctors, trust is a crucial factor, and that patients responded more favourably to PAs when the role was clearly explained to them. Willingness to consult a PA again was linked to patients’ opinions on the severity of their condition, as well as to experience of care and treatment. Two studies focused on service users’ roles in caring for themselves. Williams et al. explored women’s perspectives on selfsampling for HPV (human papillomavirus), as this test is likely to be introduced into the UK cervical screening programme, with selfsampling a possibility. Selfmanagement of type 2 diabetes (such as taking medication, eating well and taking exercise, caring for feet and attending health checks) is a vital part of keeping healthy,

G325(P) Understanding uptake of immunisations in travelling and gypsy communities

Aims To investigate the barriers and facilitators to acceptability and uptake of immunisation among Gypsy/Traveller communities in the UK. Methods We interviewed 174 Gypsy/Travellers from five communities: Romanian/Slovakian Roma, English Gypsy, Irish Travellers, English Roma, Scottish Showpeople, in four UK cities: Interviews gathered views about the influences on their immunisation behaviours (childhood, adult flu and pertussis vaccines) and ideas for improving uptake in their community. Interview data were analysed using the framework approach. The Social Ecological Model provided the theoretical framework. Results General acceptance of immunisation based on social norms and trust in health professionals was expressed by approximately half of the participants from the English Roma and London Irish Traveller communities in two cities; three quarters of the English Gypsy/Irish Traveller community and Scottish Showpeople; and almost all of the Romanian/Slovakian Roma participants. Concerns about specific vaccines were evident for particular communities e.g. pertussis vaccine in pregnancy for the English/Irish Traveller community in one city, MMR for the Scottish Showpeople. A belief that having the HPV vaccination would imply that Traveller girls are promiscuous was evident for a minority of Travellers in four communities (not Scottish Showpeople). Romanian/Slovakian Roma communities identified language barriers to accessing immunisation services and low literacy across all communities resulted in people being unable to read immunisation leaflets or letters/texts about appointments and struggling to make sense of conversations with health professionals. Relationships with health professionals appeared to be very important. Recall and reminder systems (letters, texts, phone calls) were seen as effective for the majority of participants including those who regularly travel. Most did not appear to have problems with attending appointments for immunisations although some talked about the difficulty of registering with a GP practice without a fixed address and being unable to get an appointment within two weeks. Conclusion Although these Travellers’ accounts of the barriers and facilitators to immunisation have consistency with the wider population, there are some important differences between communities. Immunisation services need to be aware of Gypsy/Traveller communities in their area and tailor services accordingly.

G626 Keeping pre-school children healthy: A qualitative study of the experiences of parents who have migrated to the UK

Aim of abstract This abstract presents the findings of a study exploring the views of migrant parents on maintaining the health of pre-school children in the United Kingdom (UK). Background There is evidence that the health behaviours of immigrants deteriorate over time, with a decrease in breastfeeding and taking exercise, and an increase in eating higher fat foods and smoking (Hawkins et al 2008, Jayaweera and Quigley 2010). This has a consequent impact upon the health of dependent children in the short and long term. Children of migrant parents are a growing group in the UK population with 25% of births in 2013 to mothers born abroad (ONS 2014). Methods Five focus groups were held with parents of children aged 0–5 years who had migrated to the UK within the last ten years. Parents originated from Romania, Poland, Somalia and Pakistan, with one group made up of Roma parents. Data collection took place January–March 2015. Participants (n = 28) were selected purposively, using local link workers to aid recruitment. Interpreters were provided for all groups, but the Polish group chose to speak English. Focus groups were audiotaped, and data fully transcribed. NVivo10 was used to facilitate thematic analysis. Results Improving children’s life chances was a factor motivating migration; however, once in the UK differences in lifestyle challenged parents’ ability to keep children healthy. All groups apart from the Roma perceived their children’s play, exercise and nutrition to be less healthy post-migration. Conclusion This qualitative study indicates the challenges faced by migrant parents in maintaining children health in the UK. Health in the early years sets the course of lifelong health so it is important child health professionals support parents to retain positive health behaviours post-migration. References Hawkins, S. S., Lamb, K., Cole, T. J. and Law, C. Influence of moving to the UK on maternal health behaviours: prospective cohort study. BMJ Online 336. 2008;7652:1052–55 Jayaweera, H. and Quigley, M. A. Health status, health behaviour and healthcare use among migrants in the UK: evidence from mothers in the Millennium Cohort Study. Social Science and Medicine, 2010;71:1002–10 Office for National NS (2014) http://www.ons.gov.uk