Search

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.

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.

IMPORTANCE Although breastfeeding has a positive effect on an infant’s health and development, the prevalence is low in many communities. The effect of financial incentives to improve breastfeeding prevalence is unknown.OBJECTIVE To assess the effect of an area-level financial incentive for breastfeeding on breastfeeding prevalence at 6 to 8 weeks post partum.DESIGN, SETTING, AND PARTICIPANTS The Nourishing Start for Health (NOSH) trial, a cluster randomized trial with 6 to 8 weeks follow-up, was conducted between April 1, 2015 and March 31, 2016, in 92 electoral ward areas in England with baseline breastfeeding prevalence at 6 to 8 weeks post partum less than 40%. A total of 10 010 mother-infant dyads resident in the 92 study electoral ward areas where the infant’s estimated or actual birth date fell between February 18, 2015, and February 17, 2016, were included. Areas were randomized to the incentive plus usual care (n = 46) (5398 mother-infant dyads) or to usual care alone (n = 46) (4612 mother-infant dyads).INTERVENTIONS Usual care was delivered by clinicians (mainly midwives, health visitors) in a variety of maternity, neonatal, and infant feeding services, all of which were implementing the UNICEF UK Baby Friendly Initiative standards. Shopping vouchers worth £40 (US$50) were offered to mothers 5 times based on infant age (2 days, 10 days, 6-8 weeks, 3 months, 6 months), conditional on the infant receiving any breast milk.MAIN OUTCOMES AND MEASURES The primary outcome was electoral ward area-level 6- to 8-week breastfeeding period prevalence, as assessed by clinicians at the routine 6- to 8-week postnatal check visit. Secondary outcomes were area-level period prevalence for breastfeeding initiation and for exclusive breastfeeding at 6 to 8 weeks.RESULTS In the intervention (5398 mother-infant dyads) and control (4612 mother-infant dyads) group, the median (interquartile range) percentage of women aged 16 to 44 years was 36.2% (3.0%) and 37.4% (3.6%) years, respectively. After adjusting for baseline breastfeeding prevalence and local government area and weighting to reflect unequal cluster-level breastfeeding prevalence variances, a difference in mean 6- to 8-week breastfeeding prevalence of 5.7 percentage points (37.9% vs 31.7%; 95% CI for adjusted difference, 2.7% to 8.6%; P CONCLUSIONS AND RELEVANCE Financial incentives may improve breastfeeding rates in areas with low baseline prevalence. Offering a financial incentive to women in areas of England with breastfeeding rates below 40% compared with usual care resulted in a modest but statistically significant increase in breastfeeding prevalence at 6 to 8 weeks. This was measured using routinely collected data.

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.

The higher education sector in Australia is moving rapidly towards greater accountability in regard to graduate employability outcomes. Currently, data on new graduates' self-reported generic skills and employment status provide the evidence base for universities to make judgements about the effectiveness of curricula in preparing students for employment. This paper discusses alternative sources of evidence, namely the Graduate Employability Indicators (GEI) - a suite of three online surveys designed to supplement current indicators. They are designed to gather and report graduate, employer and course (teaching) team perceptions of the achievement and importance of graduate capabilities within specific degree programs. In 2009 and 2010, the surveys were administered to stakeholder groups associated with Accounting degrees in four Australian universities. In total, 316 graduates, 99 employers and 51 members of the course teaching teams responded to the surveys. This report presents the aggregated results from the trial. These suggest that the fourteen capabilities at the heart of the GEI are considered important, and that both quantitative and qualitative items facilitate the reporting of essential information. Both Accounting employers and teaching staff consider that important capabilities need to be better demonstrated by new graduates. The graduates themselves identified ways in which their courses can be improved to enhance their early professional success. An importance-performance analysis suggests prioritising particular capabilities for immediate attention in particular, work related knowledge and skills, writing clearly and effectively, thinking critically and analytically, solving complex, real-world problems and developing general industry awareness. This paper suggests that an enhanced industry focus might be effected through authentic assessment tasks, and clear identification of the capabilities developed through the curriculum.

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.

The NOSH (Nourishing Start for Health) three-phase research study is testing whether offering financial incentives for breastfeeding improves six-eight-week breastfeeding rates in low-rate areas. This article describes phase one development work, which aimed to explore views about practical aspects of the design of the scheme. Interviews and focus groups were held with women (n = 38) and healthcare providers (n = 53). Overall both preferred shopping vouchers over cash payments, with a total amount of £200-250 being considered a reasonable amount. There was concern that seeking proof of breastfeeding might impact negatively on women and the relationship with their healthcare providers. The most acceptable method to all was that women sign a statement that their baby was receiving breast milk: this was co-signed by a healthcare professional to confirm that they had discussed breastfeeding. These findings have informed the design of the financial incentive scheme being tested in the feasibility phase of the NOSH study.

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.

Background Despite a gradual increase in breastfeeding rates, overall in the UK there are wide variations, with a trend towards breastfeeding rates at 6–8 weeks remaining below 40% in less affluent areas. While financial incentives have been used with varying success to encourage positive health related behaviour change, there is little research on their use in encouraging breastfeeding. In this paper, we report on healthcare providers’ views around whether using financial incentives in areas with low breastfeeding rates would be acceptable in principle. This research was part of a larger project looking at the development and feasibility testing of a financial incentive scheme for breastfeeding in preparation for a cluster randomised controlled trial. Methods Fifty–three healthcare providers were interviewed about their views on financial incentives for breastfeeding. Participants were purposively sampled to include a wide range of experience and roles associated with supporting mothers with infant feeding. Semi-structured individual and group interviews were conducted. Data were analysed thematically drawing on the principles of Framework Analysis. Results The key theme emerging from healthcare providers’ views on the acceptability of financial incentives for breastfeeding was their possible impact on ‘facilitating or impeding relationships’. Within this theme several additional aspects were discussed: the mother’s relationship with her healthcare provider and services, with her baby and her family, and with the wider community. In addition, a key priority for healthcare providers was that an incentive scheme should not impact negatively on their professional integrity and responsibility towards women. Conclusion Healthcare providers believe that financial incentives could have both positive and negative impacts on a mother’s relationship with her family, baby and healthcare provider. When designing a financial incentive scheme we must take care to minimise the potential negative impacts that have been highlighted, while at the same time recognising the potential positive impacts for women in areas where breastfeeding rates are low.

His name was David. He was large of heart, slow to speak, a salt-of-the-earth kind of man. I happened to know that he’d been widowed years before and left with six children to care for, so his marriage to Clare was easy to understand. Being an army man, raising a family on his own would be

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).

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).

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.

The Assurance of Learning for Graduate Employability framework is a quality assurance model for curriculum enhancement for graduate employability, enabling graduates to achieve "the skills, understandings and personal attributes that make [them] more likely to secure employment and be successful in their chosen occupations to the benefit of themselves, the workforce, the community and the economy" (Yorke, 2006). Of particular note is the framework's dependence on three foundations, including easy access to integrated and accessible tools for staff and student self-management. In other words, this approach to curriculum quality depends on staff and student access to tools that enable them to self-manage their learning. This paper examines two aspects which informed the design of a student e-portfolio system, iPortfolio, intended for students' self-management of their learning, particularly recording evidence of their achievement of capabilities. The paper focuses on two particular considerations in the design of theiPortfolio: adoptability and learning analytics. Adoptability means the phase preceding adoption, whether students have the devices, platforms and technology skills to be able to use such an innovation. The iPortfolio also facilitates learning analytics: it has the capability to gather data related to learning indicators for course quality assurance purposes. Both adoptability and analytics are very dynamic fields: new devices, platforms and applications constantly spark changes in user habits, and policy changes mean institutions need to be able to provide new data, often at short notice. In the conclusion, the paper suggests how tools such as the iPortfolio can be designed for 'future proofing' and sustainability.