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Alongside a randomized controlled trial testing the effectiveness of offering a cash transfer scheme (shopping vouchers)\ud to mothers in areas with low breastfeeding rates, qualitative interviews were conducted with health care professionals\ud delivering the scheme to explore their experiences. Health care professionals (n = 34; mainly midwives and health visitors)\ud were interviewed in depth. Transcripts from recorded interviews were analyzed using a Framework Analysis approach.\ud There was widespread acceptance of the scheme by health care professionals, with prior concerns regarding bribery and\ud coercion being quickly allayed. Health care professionals reported that the scheme fitted in well with their routine ways of\ud promoting and endorsing breastfeeding. They described their experiences of women’s positive reaction toward the scheme\ud and how the scheme encouraged breastfeeding and gave breastfeeding higher value. Health care professionals reported that\ud the incentives helped them engage women and promote and support breastfeeding in areas with low breastfeeding rates.

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.

ObjectiveTo examine women’s experience of professional support for breast-feeding and health-care professionals’ experience of providing support.DesignWe conducted semi-structured qualitative interviews among women with experience of breast-feeding and health-care professionals with infant feeding roles. Interviews with women were designed to explore their experience of support for breast-feeding antenatally, in hospital and postnatally. Interviews with health-care professionals were designed to explore their views on their role and experience in providing breast-feeding support. Interview transcripts were analysed using content analysis and aspects of Grounded Theory. Overarching themes and categories within the two sets were identified.SettingUrban and suburban areas of North Dublin, Ireland.SubjectsTwenty-two women all of whom had experience of breast-feeding and fifty-eight health-care professionals.ResultsTwo overarching themes emerged and in each of these a number of categories were developed: theme 1, facilitators to breast-feeding support, within which being facilitated to breast-feed, having the right person at the right time, being discerning and breast-feeding support groups were discussed; and theme 2, barriers to breast-feeding support, within which time, conflicting information, medicalisation of breast-feeding and the role of health-care professionals in providing support for breast-feeding were discussed.ConclusionsBreast-feeding is being placed within a medical model of care in Ireland which is dependent on health-care professionals. There is a need for training around breast-feeding for all health-care professionals; however, they are limited in their support due to external barriers such as lack of time. Alternative support such as peer support workers should be provided.

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.

Background Breastfeeding is good for both baby and mother, and the associated health benefits persist. However, in many communities breastfeeding is not the norm. Financial incentives are a potentially powerful method to achieve health-related behaviour change, and these incentives have been used with varying success in a range of settings. The use of financial incentives to promote breastfeeding is controversial, and there has been little research in this area. A street intercept survey with women from areas of low breastfeeding rates showed that financial incentives were acceptable to 80% (95% CI 67–88; n=54) of those sampled. In this study, we aimed to investigate in depth the acceptability of financial incentives for breastfeeding both in principle and in practice among a range of key stakeholders. Our research is part of a wider study to develop and trial a financial incentive scheme for breastfeeding in areas with 6–8-week rates below 40%. Methods We undertook semistructured individual interviews (n=54) and focus groups (n=8) with two stakeholder groups based in south Yorkshire and north Derbyshire: mothers who had breastfed or formula fed, or both (n=38) and health-care staff with infant feeding roles (n=53). A sampling frame was developed to purposively sample for maximum variation in the range of infant feeding preferences and experiences in different age groups. Stakeholders were recruited from children's centres, breastfeeding support groups, parent and toddler groups, and community or hospital maternity services. Health-care staff were midwives, health visitors, breastfeeding peer support workers, children's centre managers, charity or voluntary sector workers, public health leads, and commissioners. Interviews were analysed by thematic analysis, drawing on the principles of framework analysis. NVivo was used to support the analytical process. Interviewer bias was minimised by use of inter-rater reliability, peer debriefing, and reflexivity. Ethics approval for the study was obtained from ScHARR Research Ethics Committee, NHS RD ethical concerns about financial incentives for breastfeeding; potential negative effects; and concerns about the practical implementation of a scheme. Many interviewees felt that financial incentives might encourage more women to attempt breastfeeding. Health-care staff, particularly, felt that a financial incentive might help to normalise breastfeeding in communities with low breastfeeding rates. Some viewed the incentive as being a reward for breastfeeding and that breastfeeding would be perceived as valuable and good. Both groups were concerned about moral implications, perception of incentives as bribery, penalising those unable to breastfeed, and how such interventions would be policed. Many considered the moral implications of how a financial incentive would be spent and whether the incentive should be cash or vouchers. Further, financial incentives could affect women negatively—in particular, if it reduced the intrinsic motivation to breastfeed. Additionally, an incentive could add pressure on the woman to breastfeed and might not help if she ran into difficulties. Both groups made suggestions for the practical implementation of the scheme that would make it more acceptable. There was low acceptability for verification methods that required the mother to perform in order to prove that she was breastfeeding. Interpretation There was difficulty in recruiting primiparous women to the study, which limits the generalisability of these results. Although a wide range of views were expressed within and between stakeholder groups, financial incentives for key stakeholders were broadly acceptable, in principle. Issues were identified that need consideration when implementing a financial incentive scheme in practice. Funding Medical Research Council—National Prevention Research Initiative (MR/J000434/1).