Public acceptability of financial incentives for smoking cessation in pregnancy and breast feeding: a survey of the British public Interventions to increase the duration of breastfeeding in obese mothers: the Bassett Improving Breastfeeding Study. A breast feeding education and promotion program: Effects on knowledge, attitudes, and support for breast feeding Healthcare providers’ views on the acceptability of financial incentives for breastfeeding: a qualitative study The GATE frame: critical appraisal with pictures The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. The effect of discharge pack formula and breast pumps on breastfeeding duration and choice of infant feeding method. Influences on breast-feeding by lower-income women: an incentive-based, partner-supported educational program. Dads as breastfeeding advocates: results from a randomized controlled trial of an educational intervention. Comparison of manual and electric breast pumps among WIC women returning to work or school in Hawaii. Effect of discharge samples on duration of breast-feeding. Strategies to reduce attrition in randomised trials Nursing intervention to increase the duration of breastfeeding.
Objective To survey public attitudes about incentives for smoking cessation in pregnancy and for breast feeding to inform trial design . Design Cross-sectional survey . Setting and participants British general public . Methods Seven promising incentive strategies had been identified from evidence syntheses and qualitative interview data from service users and providers . These were shopping vouchers for : ( 1 ) vali date d smoking cessation in pregnancy and ( 2 ) after birth ; ( 3 ) for a smoke-free home ; ( 4 ) for proven breast feeding ; ( 5 ) a free breast pump ; ( 6 ) payments to health services for reaching smoking cessation in pregnancy targets and ( 7 ) breastfeeding targets . Ipsos MORI used area quota sampling and home-administered computer-assisted question naires , with r and omised question order to assess agreement with different incentives ( measured on a five-point scale ) . Demographic data and target behaviour experience were recorded . Analysis used multivariable ordered logit models . Results Agreement with incentives was mixed ( ranging from 34 % to 46 % ) among a representative sample of 1144 British adults .  Mean agreement score was highest for a free breast pump , and lowest for incentives for smoking abstinence after birth . More women disagreed with shopping vouchers than men . Those with lower levels of education disagreed more with smoking cessation incentives and a breast pump . Those aged 44 or under agreed more with all incentive strategies compared with those aged 65 and over , particularly provider targets for smoking cessation . Non-white ethnic groups agreed particularly with breastfeeding incentives . Current smokers with previous stop attempts and respondents who had breast fed children agreed with providing vouchers for the respective behaviours . Up to £ 40/month vouchers for behaviour change were acceptable ( > 85 % ) . Conclusions Women and the less educated were more likely to disagree , but men and women of childbearing age to agree , with incentives design ed for their benefit . Trials evaluating reach , impact on health inequalities and ethnic groups are required prior to implementing incentive interventions . Trial registration number CRD42012001980 OBJECTIVE Maternal obesity is associated with poor breastfeeding outcomes , yet no intervention has been developed to improve them . To ascertain whether increased breastfeeding support or provision of a breast pump is a feasible , effective intervention to improve breastfeeding , we enrolled obese women who intended to breastfeed in two r and omized trials . METHODS In Bassett Improving Breastfeeding Study ( BIBS ) 1 , 40 women received targeted breastfeeding support in the hospital  and via telephone or usual care .  Information regarding breastfeeding was collected via telephone for 7 days after delivery and at 30 and 90 days postpartum . In BIBS 2 , 34 obese mothers received a manual or electric breast pump to use for 10 - 14 days or no pump ; data collection was similar . RESULTS In both experiments , r and omization failed to distribute women of differing postpartum body mass index adequately among the treatment groups . When analyses were adjusted for this , there was no difference in BIBS 1 between targeted and usual care groups and in BIBS 2 among the treatment groups in the proportion of women still breastfeeding at the times studied . CONCLUSIONS In future studies of obese women , stratified r and omization may be necessary . Further development of interventions to help obese women achieve optimal breastfeeding outcomes is required This study was undertaken to determine the effects of a partner-support , incentive-baed educational program on breast feeding knowledge , attitudes and support and to examine the relationship between feeding intentions and feeding behavior among low-income women . Women who expressed a willingness to participate in the intervention were r and omly assigned to “ intervention ” and “ usual breast feeding ” ( control ) groups . Sixty-eight primipara women , with expected due date s between May and December , 1992 , volunteered to participate in the study . Of these , 34 were r and omly assigned to each of the two groups . Approximately 81 percent of the women completed the study , leaving n=29 in the control group and n-26 in the intervention group . The intervention consisted of special incentives ( prizes ) for women and their partners to participate in several breast feeding education and promotion activities . Intervention group women and their partners experienced positive changes in breast feeding knowledge and attitudes . Furthermore , the intervention seemed to have influenced more women in the treatment group to breast feed despite their prenatal feeding intentions . In addition , the partners of intervention group women were perceived to be more supportive of , breast feeding than control group partners . These findings suggest that incentives , such as donated prizes , can be used to attract lower socioeconomic group women and their partners to breast feeding promotion interventions . Participation in such interventions can produce positive changes in breast feeding knowledge , attitudes , and support , and can have a dramatic effect in promoting breast feeding 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 r and omised controlled trial . Methods Fifty – three healthcare providers were interviewed about their views on financial incentives for breastfeeding . Participants were purposively sample d 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 design ing 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 Epidemiological evidence about the accuracy of diagnostic tests , the power of prognostic markers , and the efficacy and safety of interventions is the cornerstone of evidence -based health care.1 Practitioners of evidence -based health care require critical appraisal skills to judge the validity of this evidence . The Evidence -Based Medicine ( EBM ) Working Group members are international leaders in teaching critical appraisal skills , and their users ’ guides for appraising the validity of the healthcare literature 2 have long been the basis of teaching programmes worldwide . However , we found that many of our students took a reductionist “ paint by numbers ” approach when using the Working Group ’s guides . Students could answer individual appraisal questions correctly but would have difficulty assessing overall study quality . We believe this is due to a poor underst and ing of epidemiological study design . So over the past 15 years of teaching critical appraisal we have modified the EBM Working Group approach and developed the Graphic Appraisal Tool for Epidemiological studies ( GATE ) frame to help our students conceptualise the whole study as well as its component parts . GATE is a visual framework that illustrates the generic design of all epidemiological studies ( figure 1 ) . We now teach critical appraisal by “ hanging ” studies and the EBM Working Group ’s appraisal questions on the GATE frame . Figure 1 The GATE frame . This editorial outlines the GATE approach to critical appraisal , illustrated throughout using the Heart and Estrogen/progestin Replacement Study ( HERS ) , a r and omised , double blind , placebo controlled trial of the effect of daily oestrogen plus progestin on coronary heart disease ( CHD ) death in postmenopausal women.3 A detailed critical appraisal of HERS using a GATE-based checklist is available online.4 The GATE frame incorporates a triangle , circle , square , and arrow ( figure 1 ) , labelled with the acronym PECOT ( or PICOT ) . The triangle ( figure 2 ) represents the population studied : “ P ” for population or Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity BACKGROUND A study of breastfeeding mothers was conducted from October 1993 through July 1994 in the western United States to determine the influence of components of hospital discharge packs on the duration of breastfeeding . METHOD On discharge from the hospital , over 1600 breastfeeding mothers were given one of four free discharge packs , identical in all ways except that one contained a can of powdered formula , one a manual breast pump , one both formula and pump , and one neither . During the following 6 months , mothers were interviewed by telephone three times by an independent research firm to determine how and what they were feeding their infants . Analysis of the independent and interactive effects of both formula and pump was performed , and the moderating effects of age , ethnicity , marital and insurance status , prebirth feeding plan , and the effect of returning to outside employment or school were examined . RESULTS Across the entire sample , the contents of the discharge packs had a negligible effect on feeding method and breastfeeding duration . Examination of select subgroups revealed modest discharge pack effects , wherein the presence of discharge pack formula increased the likelihoof2p4 introducing supplementation during the first 6 weeks whereas receipt of pumps prolonged full breastfeeding . Even in these select groups , however , no effect was observed on the overall duration of breastfeeding . CONCLUSION Relative to other known influences on the choice of feeding method and on breastfeeding duration , discharge pack contents do not merit great concern OBJECTIVE To determine the effects of a partner-supported , incentive-based educational program on rates and duration of breast-feeding among low-income women . DESIGN Women who expressed a willingness to participate in the breast-feeding educational program  were r and omly assigned to one of two groups : an intervention group and a control group who received usual breast-feeding education . SETTING Clinics of the Special Supplemental Food Program for Women , Infants , and Children in Flagstaff , Ariz. SUBJECTS Sixty-eight primiparous pregnant women with expected due date s between May 1992 and December 1992 were willing to participate in the study . Of these , 34 were r and omly assigned to the intervention group and 34 to the control group . Approximately 81 % of the women completed the study : 29 in the control group and 26 in the intervention group . INTERVENTION The intervention consisted of special incentives ( prizes ) for women and their partners to participate in a breast-feeding class for expectant couples and an educational series on childbirth . Women were also encouraged to use a breast-feeding support program in which peers serve as role models . MAIN OUTCOME MEASURES The primary outcome measure was infant feeding method . Data were collected from mothers in both groups at the time of discharge from the hospital and at 2 weeks , 6 weeks , and 3 months postpartum . STATISTICAL ANALYSES PERFORMED Binomial proportional analyses of the feeding data were performed . RESULTS Women in the intervention group reported a higher percentage of breast-feeding at all measurement times . APPLICATIONS These findings suggest that incentives , such as donated prizes , can be used to attract primiparous women from lower socioeconomic groups , along with their partners , to participate in educational interventions design ed to promote breast-feeding . Participation by couples in breast-feeding promotion activities can dramatically increase the rate and duration of breast-feeding OBJECTIVE Recognizing that an expectant father may influence a mother 's decision to breast- or formula-feed , we tested the effectiveness of a simple , educational intervention that was design ed to encourage fathers to advocate for breastfeeding and to assist his partner if she chooses to breastfeed . STUDY DESIGN We conducted a r and omized controlled trial in which expectant fathers ( n = 59 ) were assigned r and omly to attend either a 2-hour intervention class on infant care and breastfeeding promotion ( intervention ) or a class on infant care only ( control group ) . The classes , which were led by a peer-educator , were interactive and informal and utilized different media to create an accessible environment for participants . Couples were recruited during the second trimester from a university obstetrics practice . RESULTS Overall , breastfeeding was initiated by 74 % of women whose partners attended the intervention class , as compared with 41 % of women whose partners attended the control class ( P = .02 ) . CONCLUSION Expectant fathers can be influential advocates for breastfeeding , playing a critical role in encouraging a woman to breastfeed her newborn infant INTRODUCTION The Women , Infants , and Children ( WIC ) branch of the Hawaii Department of Health encourages and assists mothers in breastfeeding . A study was done to determine whether an electric breast pump ( vs. a manual pump ) would increase breastfeeding duration in those returning to work or school full-time . MATERIAL S AND METHODS During 2002 - 2003 , a r and omized trial was conducted among 280 women , with the duration of breastfeeding analyzed in 229 of these women . Descriptive analyses and a multivariate logistic regression analysis assessed factors associated with breastfeeding at 6 months . Unadjusted and adjusted survival analyses were performed to estimate the duration of breastfeeding . RESULTS In all , 76.8 % of women using the manual breast pump and 72.3 % of those using the electric breast pump breastfed for at least 6 months . This difference did not reach statistical significance . In the survival analysis adjusted for pump assignment , maternal age , race/ethnicity , marital status , and parity , women with at least some college education breastfed for a 38 % shorter time than women with a high school or lower education . CONCLUSIONS Our findings suggest that the manual breast pump may work as well as the electric breast pump when breastfeeding is encouraged and supported among women returning to work or school full-time . Particular attention should be given to examining reasons why women with greater education breastfed for a shorter duration . Further research is needed to vali date these results to better inform breastfeeding women returning to work or school The breast-feeding patterns of 146 women who initiated breast-feeding during their hospital stay were evaluated to determine whether those women who received a  hospital discharge package containing a manual breast pump breast-fed their infants for a longer period of time than did women who received a discharge package containing an infant formula . Women were r and omly assigned to receive either a specially prepared pack containing a manual breast pump but no infant formula or a commercially available infant formula package . The women were interviewed in the hospital and by computer-assisted telephone interviews at 2 , 4 , 6 , and 8 weeks postdischarge . Information obtained included infant-feeding practice s , sociodemographic characteristics , and attitudinal data . Follow-up interviews were completed for nearly 85 % of eligible women at each time period . Women who received a discharge pack containing a breast pump but no infant formula continued exclusive breast-feeding for a greater number of weeks ( mean = 4.18 weeks ) than did women receiving infant formula in their discharge package ( mean = 2.78 weeks ) ( P less than .05 ) . Also , women who indicated that ease of nighttime feeding was an important consideration were more likely to breast-feed over the entire 8-week period if they received the breast pump rather than infant formula ( P less than .05 ) . The conclusion is that an easily implemented , low-cost intervention , the inclusion of a breast pump in discharge packages , may increase the duration of breast-feeding This is a protocol for a Cochrane Review ( Methodology ) . The objectives are as follows : To quantify the effect of strategies to reduce attrition in r and omised trials . To investigate if there is a variation in effect by type of strategy , trial setting and disease area T HE U.S. DEPARTMENT OF HEALTH and Human Services ( 1994 ) published the Healthy People 2000 guidelines as a statement of national concerns regarding health in the U.S. One Healthy People 2000 objective is to increase the percentage of women who continue to breastfeed for the first 6 months of their infant 's life . The American Academy of Pediatrics recommends that women breastfeed their infant 's for the first year of life ( Gartner , 1997 ) . An intervention that increases the duration of breastfeeding in low-income women offers health benefits to mothers and babies ( Krebs & Murtaugh , 1997 ) . The benefits of breastfeeding are well established . Women who breastfeed are less likely to develop osteoporosis and some forms of cancer ( Cummings , Kelsey , & Nevitt , 1985 ; Michels et al. , 1996 ; Schneider , 1987 ) . Furthermore , breastfeeding is empowering for low-income minority women ( Locklin & Naber , 1993 ) . Infants who are breastfed for at least 4 months are less likely to die of
BACKGROUND AND OBJECTIVES : Few women in industrialized countries achieve the World Health Organization ’s recommendation to breastfeed exclusively for 6 months .
Governments are increasingly seeking new interventions to address this problem , including the use of incentives .
The goal of this study was to assess the evidence regarding the effectiveness of incentive interventions , delivered within or outside of health care setting s , to individuals and /or their families seeking to increase and sustain breastfeeding in the first 6 months after birth .