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Background A cluster randomised controlled trial of a financial incentive for breastfeeding conducted in areas with low breastfeeding rates in the UK reported a statistically significant increase in breastfeeding at 6–8 weeks. In this paper we report an analysis of interviews with women eligible for the scheme, exploring their experiences and perceptions of the scheme and its impact on breastfeeding to support the interpretation of the results of the trial. Methods Semi-structured interviews were carried out with 35 women eligible for the scheme during the feasibility and trial stages. All interviews were recorded and verbatim transcripts analysed using a Framework Analysis approach. Results Women reported that their decisions about infant feeding were influenced by the behaviours and beliefs of their family and friends, socio-cultural norms and by health and practical considerations. They were generally positive about the scheme, and felt valued for the effort involved in breastfeeding. The vouchers were frequently described as a reward, a bonus and something to look forward to, and helping women keep going with their breastfeeding. They were often perceived as compensation for the difficulties women encountered during breastfeeding. The scheme was not thought to make a difference to mothers who were strongly against breastfeeding. However, women did believe the scheme would help normalise breastfeeding, influence those who were undecided and help women to keep going with breastfeeding and reach key milestones e.g. 6 weeks or 3 months. Conclusions The scheme was acceptable to women, who perceived it as rewarding and valuing them for breastfeeding. Women reported that the scheme could raise awareness of breastfeeding and encourage its normalisation. This provides a possible mechanism of action to explain the results of the trial. Trial registration The trial is registered with the ISRCTN registry, number 44898617, https://www.isrctn.com Electronic supplementary material The online version of this article (10.1186/s12884-017-1651-7) contains supplementary material, which is available to authorized users.

Women aged less than 20 years are less likely to initiate and sustain breastfeeding until their baby is 6 weeks and older compared with older mothers, according to the Infant Feeding Survey ( McAndrew et al, 2010 ). The ‘vouchers for breastfeeding’ scheme, which was trialled in 2015–2016 with more than 10 000 women in parts of Yorkshire and Derbyshire, offered mothers shopping vouchers worth up to £200 if they provided breast milk to their baby up to the age of 6 months. Over the period of this large-scale scheme, a parallel small-scale intervention was commissioned and offered by a family nurse partnership (FNP) to first-time young mothers in an adjacent area. This article reports on the evaluation of the initiative within the local FNP service. The results indicate that the scheme was acceptable and deliverable within this setting.

INTRODUCTION: Breast feeding can promote positive long-term and short-term health outcomes in infant and mother. The UK has one of the lowest breastfeeding rates (duration and exclusivity) in the world, resulting in preventable morbidities and associated healthcare costs. Breastfeeding rates are also socially patterned, thereby potentially contributing to health inequalities. Financial incentives have been shown to have a positive effect on health behaviours in previously published studies.METHODS AND ANALYSIS: Based on data from earlier development and feasibility stages, a cluster (electoral ward) randomised trial with mixed-method process and content evaluation was designed. The 'Nourishing Start for Health' (NOSH) intervention comprises a financial incentive programme of up to 6 months duration, delivered by front-line healthcare professionals, in addition to existing breastfeeding support. The intervention aims to increase the prevalence and duration of breast feeding in wards with low breastfeeding rates. The comparator is usual care (no offer of NOSH intervention). Routine data on breastfeeding rates at 6-8 weeks will be collected for 92 clusters (electoral wards) on an estimated 10 833 births. This sample is calculated to provide 80% power in determining a 4% point difference in breastfeeding rates between groups. Content and process evaluation will include interviews with mothers, healthcare providers, funders and commissioners of infant feeding services. The economic analyses, using a healthcare provider's perspective, will be twofold, including a within-trial cost-effectiveness analysis and beyond-trial modelling of longer term expectations for cost-effectiveness. Results of economic analyses will be expressed as cost per percentage point change in cluster level in breastfeeding rates between trial arms. In addition, we will present difference in resource use impacts for a range of acute conditions in babies aged 0-6 months.ETHICS AND DISSEMINATION: Participating organisations Research and Governance departments approved the study. Results will be published in peer-reviewed journals and at conference presentations.TRIAL REGISTRATION NUMBER: ISRCTN44898617; Pre-results.

Breastfeeding rates in Ireland remain among the lowest in Europe, with exclusive breastfeeding rates of 44% at discharge from hospital. The knowledge and attitudes of health professionals are important factors in the promotion and support of breastfeeding. This study was conducted to assess knowledge, attitudes and self-efficacy in breastfeeding in a group of primary health professionals, and the barriers to providing support. Data were collected from 256 primary care professionals (GPs, public health nurses (PHNs) and practice nurses) using a self-administered questionnaire. This study highlights some of the issues for health professionals in providing support for breastfeeding and a need for improved knowledge about the benefits of breastfeeding and how to provide practical support.

PurposeIreland has one of the lowest rates of breastfeeding in Europe with exclusive breastfeeding rates of 44 per cent at discharge from hospital. Increased awareness and debate on breastfeeding and its issues is needed. The purpose of this paper is to describe an evaluation of the piloting of a forum theatre production in increasing awareness of breastfeeding.Design/methodology/approachA mixed methods approach was taken. Research participants were identified through the four organisations in which the play was performed. Approximately 160 people watched a performance of the play. Quantitative data were collected from 110 audience members who completed a postcard survey. Qualitative data were collected from 42 people prior to seeing the play and 47 people after seeing the play, through focus groups and individual interviews.FindingsOver 90 per cent of participants thought the play was a good way of discussing breastfeeding and they thought it was more effective than usual health promotion of giving out leaflets. Qualitative interviews found that the play heightened people's awareness of breastfeeding, highlighted the importance of support and engaged people in discussion and debate around breastfeeding.Originality/valueThe concept of promoting breastfeeding through drama is quite novel and this evaluation shows a potential for using such techniques in health promotion on varied nutrition‐related topics.

Whilst there are clear advantages to breast-feeding, Ireland has one of the lowest rates of breast-feeding in Europe, with rates at discharge from hospital being 44 % (1) . Professional support has been identified as beneficial in promoting and maintaining breast-feeding (2) . Studies worldwide have identified barriers amongst health professionals in providing this support; however, no such research has been undertaken in Ireland. In an effort to better understand the barriers that exist in health professionals in Ireland, qualitative research was conducted amongst a group of healthcare providers. Grounded theory method (3) was used and theoretical sampling guided data collection. Data were collected from face-to-face audiotaped semi-structured individual interviews with midwives, paediatricians, obstetricians, public health nurses, general practitioners and practice nurses in North Dublin. Fifty-eight health professionals participated in the study, fifty-five of whom were female and three male. Interviews were analysed using QSR NVivo 8 software (QSR International Pty Ltd, Doncaster, Victoria, Australia). Data collection and data analysis ran concurrently. Constant comparison of the data revealed core themes that formed the basis of the findings of the research. Barriers that were identified as presenting challenges for health professionals in providing support for breast-feeding included: a lack of time; staffing issues; conflict between health professionals; lack of confidence; conflicting information; being a ‘Jack of all trades’. A lack of time and staff were mentioned by some health professionals as being a source of frustration, as they did not have the time to meet the needs of the women under their care. The issue of conflict between health professionals was also found, most notably in relation to discrepancies in the advice given by doctors and nurses. Some felt that having personal experience of breast-feeding meant they were more confident in advising about breast-feeding and that having this experience gave an authenticity to their advice. Being a ‘Jack of all trades’ was described by some community health professionals. They discussed how their job involves many different facets of care and that this factor in turn can affect how much time they can dedicate towards one particular area, be it training in that area or providing care. These findings suggest that barriers do exist for health professionals in promoting and supporting breast-feeding. In order that an increasing upward trend in breast-feeding rates is observed in Ireland these barriers need to be addressed. Many of the barriers relate to an inadequacy of training in breast-feeding among health professionals and so further analysis of the training needs of healthcare providers would be beneficial.

The purpose of this pilot study was to determine whether using dimensional analysis as the method of mathematical computation could reduce nursing medication calculation errors. The sample for this study consisted of second-year baccalaureate nursing students in a required clinical skills course. Students in the control group were taught medication calculations using the traditional math method during one semester, whereas students in the experimental group were taught the same material using dimensional analysis during the next semester. Analysis of the collected data from a medication dosage calculation examination revealed the dimensional analysis group scored with greater accuracy than the traditional math group.AUTHORSReceived: December 9, 2004Accepted: April 1, 2005Dr. Greenfield and Ms. Cohn are Assistant Professors, and Ms. Whelan is Adjunct Faculty, Adelphi University, School of Nursing, Garden City, New York.Address correspondence to Sue Greenfield, PhD, RN, Assistant Professor, Adelphi University, School of Nursing, Alumnae Hall, Room 208, 1 South Avenue, PO Box 701, Garden City, NY 11530-0701; e-mail: greenfi2@adelphi.edu.

Background The UK has one of the lowest breastfeeding rates (duration and exclusivity) in the world. Moreover, breastfeeding is strongly socially patterned, with young women in areas of high deprivation being less likely to breastfeed than women in areas of low deprivation. This study tested the feasibility of a financial incentive intervention to increase breastfeeding in areas with 6–8 week breastfeeding rates of 40% or less. Methods The intervention was the offer of a structured financial incentive scheme to women with babies aged up to 6 months old. If women were breastfeeding their baby, they could claim vouchers, at five different timepoints—ie, when their baby reached 2 days, 10 days, 6 weeks, 3 months, and 6 months old. Breastfeeding was verified by signed statements from the mother and health-care professional. Vouchers were for supermarkets and high street shops, to the value of £40, up to a maximum of £200. Starting in November, 2013, the scheme was offered to women with babies born during a 16-week period resident in three neighbourhoods in Derbyshire and South Yorkshire, UK, all of whom had historically persistent low 6–8 week breastfeeding rates, ranging from 21% to 29%. The feasibility (acceptability and deliverability) of the incentive scheme and the study design to key stakeholder groups was assessed with quantitative and qualitative methods, in advance of undertaking a full randomised controlled trial. 36 health-care providers and 18 women gave semi-structured interviews. Findings Relevant approvals for the study were obtained. Women learnt about the scheme from their midwife or the media (print, radio, social media), or both. Of a total of 108 women eligible for the scheme, 58 (53·7%) joined the scheme, 48 (44·4%) claimed 2-day vouchers, 45 (41·7%) claimed 10-day vouchers, and 37 (34·3%) claimed 6–8 week vouchers. 3-month and 6-month data are still accruing. 53 health-care providers cosigned claim forms. Satisfaction with the scheme (including the method used to verify breastfeeding) was high among both mothers and health-care staff participating in the scheme. Interpretation The scheme was both deliverable and acceptable to mothers and health-care staff in this field study. The scheme was extended (and will continue until at least December, 2014) in all three areas. A randomised controlled trial testing the effectiveness of the scheme is now planned. Funding Medical Research Council National Prevention Research Initiative (MR/J000434/1).

Severe infection of infants with respiratory syncytial virus (RSV) is a leading cause of morbidity in the developed world and mortality in the developing world. Prophylaxis using palivizumab in infants at risk for severe RSV disease reduces the rate of hospitalisation in this population of children. To ensure complete prophylaxis, infants must receive monthly doses over the winter season. To improve parental convenience, the Synacare® programme was implemented in Ireland and the Netherlands. Synacare® is now a longstanding programme in which palivizumab is administered in the home setting by skilled nurses. Protocols and procedures described here illustrate the efficiency and acceptability of the home delivery service of RSV disease prophylaxis. Post-administration surveys have indicated a high level of parental satisfaction with the programme. At-home paediatric programmes like Synacare® may serve as an alternative to burdensome monthly hospital visits and may lead to enhanced clinical outcomes.