Promoting recommended infant feeding practices in a low-income sample - randomised controlled trial of a peer support intervention

OBJECTIVES: To assess the effectiveness of a peer support intervention on infant feeding practices. DESIGN: A randomised controlled trial compared nutritional and other outcomes for women offered volunteer support with those for control women who only received standard professional care. Data was collected at baseline when the infants were 10 weeks old, post intervention when the children were 12 months old and 6 months follow up when the sample were 18 months old. The 24-hour multiple pass recall method was used to collect the nutritional data. Mothers were also interviewed at each stage of the study. An intention to treat analysis was conducted to assess differences between the intervention and control groups at the post intervention and follow up stages. In addition, a detailed process evaluation was conducted. SETTING: The sample was recruited at baby clinics located in deprived areas of Camden and Islington, London over a 15-month period from December 2002 to February 2004. SUBJECTS: 312 women were allocated at random to intervention (157) or control group (155). INTERVENTION: A group of local volunteers were recruited and trained to provide nonjudgemental support and practical assistance on infant feeding, and in particular weaning practices. Home-based support was offered over a 9 month period until the infants were 12 months old. In total, 758 home visits were made and the mean length of each visit was 60 minutes. On average each mother in the intervention group received 5 volunteer visits. Mothers in the control group received standard professional care only. MAIN OUTCOME MEASURES: The primary outcome was vitamin C in fruit. Other macro and micro nutrient intakes were also assessed. Secondary outcomes were fruit and vegetable consumption, feeding practices, child growth and health, and use of health services. In addition, information was also gathered on the mother's health, well-being, fruit and vegetable consumption and nutritional knowledge and confidence. RESULTS: The 312 randomised women were well matched by group. Response rates were 77% and 68% at the post intervention and follow up respectively. At post intervention, for the primary outcome, vitamin C in fruit, there was no evidence of difference between the intervention and control group. The other macro and micro-nutrient intakes were also similar in both groups. The food frequency questionnaire data showed that more carrots, boiled potatoes, apples and pears were consumed by the intervention group. At follow up, again no differences were detected in terms of the intakes of vitamin C and other nutrients. However children in the intervention group did consume more boiled potatoes, chips and pears than those in the control group. With feeding practices at post intervention, no differences were found in the duration of breastfeeding between trial arms. Mothers’ in the intervention group were less likely to give their child goats’ or soya milk. Children in the intervention group were more likely to be eating family foods and to be having 3 solid meals per day. At follow up, few differences were evident between the trial arms in terms of feeding practices. However, children in the intervention group were less likely to be still using a bottle than those in the control group. In terms of the child health and growth outcomes, no significant differences in the child's anthropometric measurements were detected between the groups post intervention. At follow up, no significant differences were found in terms of the child's health, use of NHS services or medication use. No significant differences were detected in the mother's health and wellbeing, and their consumption of fruit and vegetables at either the post intervention or follow up. However at the follow up mothers in the intervention group were more knowledgeable about when bottle feeding should be discouraged and were more confident in following health professionals’ recommendations on how best to feed their child. The process evaluation indicated that women in the intervention group were very positive about the volunteers, and greatly appreciated the support provided during the home visits. Evaluation of the volunteer training programme also indicated that the volunteers highly rated their experience of being involved in the study. The study results have been extensively disseminated both locally and at a national level. Across both Camden and, more recently Islington, infant feeding peer support programmes have been established. CONCLUSIONS: The intervention did not achieve a significant change in vitamin C and other macro and micro-nutrient intakes. However, significant benefits were achieved with a range of infant feeding practices and mother's nutritional knowledge and confidence also improved. The process evaluation demonstrated that both the mother's in the intervention group and the volunteer's valued participating in the study