Protocol for a feasibility trial for improving breastfeeding initiation and continuation: Assets-based infant feeding help Before and After birth (ABA)

Introduction: Breastfeeding improves the health of mothers and infants; the UK has low rates, with marked socio-economic inequalities. Whilst trials of peer support services have been effective in some settings, UK trials have not improved breastfeeding rates. Qualitative research suggests many women are alienated by the focus on breastfeeding. We propose a change from breastfeeding focussed interactions to respecting a woman’s feeding choices, inclusion of behaviour change theory and an increased intensity of contacts in the two weeks after birth when many women cease to breastfeed. This will take place alongside an assets-based approach which focuses on the positive capability of individuals, their social networks and communities.
We propose a feasibility study for a multicentre randomised controlled trial of the ABA infant feeding service versus usual care.
Methods and analysis: A two-arm, non-blinded randomised feasibility study will be conducted in two UK localities. Women expecting their first baby will be eligible, regardless of feeding intention. The ABA infant feeding intervention will apply a proactive, assets-based, woman-centred, non-judgemental approach, delivered antenatally and postnatally tailored through face-to face contacts, telephone and SMS texts. Outcomes will test the feasibility of delivering the intervention with recommended intensity and duration to disadvantaged women; acceptability to women, feeding helpers and professionals; and feasibility of a future randomised controlled trial, detailing recruitment rates, willingness to be randomised, follow-up rates at 3 days, 8 weeks and 6 months and level of outcome completion. Outcomes of the proposed full trial will also be collected. Mixed methods will include qualitative interviews with women/partners, feeding helpers and health service staff; feeding helper logs and review of audio-recorded helper-women interactions to assess intervention fidelity.
Ethics and dissemination: Study results will inform the design of a larger multicentre RCT. The National Research Ethics Service Committee approved the study protocol.
Trial registration number: ISRCTN14760978.

STRENGTHS AND LIMITATIONS OF THE STUDY
• This study uses a two-centre randomised controlled trial design to determine the feasibility of a definitive trial.
• The intervention design draws on evidence from best practice to support women who want to breastfeed behavioural change theory and makes use of women’s personal social and community assets.
• A process evaluation will explore reach, fidelity of intervention delivery and the experience of women, feeding helpers and other key stakeholders.
• The success of the study will depend on ability to deliver the intervention with sufficient fidelity.
A definitive trial would be necessary to evaluate the effectiveness of the intervention.