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Assets-based feeding help Before and After birth (ABA): feasibility study for improving breastfeeding initiation and continuation


To assess the feasibility of delivering a new ABA infant feeding helper intervention within a feasibility randomised controlled trial.


  1. To adapt existing peer support services to provide a new infant feeding helper intervention, underpinned by theory and evidence, with service user and provider input.
  2. To undertake a feasibility RCT of the new feeding helper role compared with usual care (control group) for women living in areas of low breastfeeding prevalence.
  3. To determine levels of uptake and engagement with the intervention; to describe socio-economic/demographic profiles to ascertain reach and explore health inequalities.
  4. To describe care received by the reactive ‘usual care group’ in relation to feeding method.
  5. To assess the fidelity of intervention delivery, any contamination and explore feedback from feeding helpers to improve fidelity if required.
  6. To assess whether women are willing to be recruited and randomised; whether the expected recruitment rate for a subsequent full scale effectiveness RCT is feasible and to identify successful recruitment strategies.
  7. To explore mothers’ and feeding helpers’ perceptions of the intervention, trial participation and processes.
  8. To explore the acceptability and fidelity of the intervention when delivered by paid and volunteer feeding helpers.
  9. To assess acceptability and integration of the intervention to other providers of maternity, postnatal and social care.
  10. To explore the relative value of the individual feeding support versus the community integration elements to inform the design of a future trial.
  11. To provide estimates of the variability in the primary outcome to enable sample size calculation for a definitive trial.
  12. To measure the features of the feeding helper provision and service utilisation which would underpin the cost-effectiveness of the intervention and determine the feasibility of data collection.
  13. To test the components of the proposed RCT to determine the feasibility of the protocol.


Breastfeeding can improve the health of mothers and infants, but the UK has low rates, with marked socio-economic inequalities. Whilst peer support services have been effective in some settings, trials of peer support in the UK have not improved breastfeeding rates. Qualitative research suggests that many women are alienated by the focus on breastfeeding. This feasibility study proposes to change from breastfeeding focussed interactions to respecting a woman’s feeding choices, the inclusion of behaviour change theory, an increased intensity of contacts, particularly in the two weeks after birth when many women cease to breastfeed. This will take place alongside an assets-based approach.  An assets-based approach is about focusing on the positive capability of individuals and communities, rather than solely on their needs, deficits and problems. It is essentially about recognising and making the most of people’s strengths, to ‘redress the balance between meeting needs and nurturing the strengths and resources of people and communities’, with a corresponding shift in focus from the determinants of illness to the determinants of health and wellbeing.  Pat Hoddinott had the original idea for the study, which builds on the findings of the promising FEST pilot trial (Hoddinott P, Craig L, MacLennan G, Boyers D, Vale L. on behalf of the FEST project team.  The FEeding Support Team (FEST) trial of proactive telephone support for breastfeeding women living in disadvantaged areas.  BMJ Open 2012;2:2 e000652 doi:10.1136/bmjopen-2011-000652;  Hoddinott P, Craig L, MacLennan G, Boyers D, Vale L. on behalf of the FEST project team.  Process evaluation for the FEeding Support Team (FEST) trial of proactive telephone support for breastfeeding women living in disadvantaged areas. BMJ Open 2012;2:2 e001039 doi:10.1136/bmjopen-2012-001039).

Principal Investigator: University of Birmingham

NMAHP Research Unit Collaborators: Professor Pat Hoddinott

External Collaborators: Daniels J - University of Birmingham, Dykes F - University of Central Lancaster, Ingram J - University of Bristol,  MacArthur C - University of Birmingham, Roberts T, University of Birmingham, Sitch A - University of Birmingham, Thomson G - University of Central Lancashire, Trickey H - University of Cardiff.

Funder:  NIHR

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