Co-production of an NHS-tailored implementation and evaluation strategy framework to support women in the UK to breastfeed with a focus on reducing health inequities: evidence synthesis with stakeholder engagement.

This study will provide a UK-relevant implementation framework for breastfeeding support interventions by co-creating a synthesis of global evidence with stakeholders. This will include updating a highly accessed Cochrane review, and synthesising process and economic evaluations, to increase breastfeeding and reduce health inequities. An additional ‘study within a project’ (SWAP) will mirror this work and consider breastfeeding support for women with multiple long-term conditions (MLTCs).

Breastfeeding has the greatest known impact of any preventative health intervention, yet the UK has among the lowest breastfeeding rates globally with a marked social gradient. Around 80% of UK women stop breastfeeding before they intended, causing distress. Women report feeling unsupported by healthcare providers and a reduction in breastfeeding support services.

There is critical need to assess what can be learnt from global evidence that is transferable to the UK context and to understand cost implications and return on investment of breastfeeding support interventions. There is strong global evidence that additional support increases breastfeeding duration and exclusivity. However, interventions tested in trials are heterogeneous and lack underpinning theory that would help assess transferability to the UK context.

This research will synthesise global and UK evidence to co-create, with key stakeholders, an NHS tailored implementation and evaluation strategy framework to address contextual barriers and inform the transferability, development and evaluation of cost-effective breastfeeding support interventions. Objectives

1. Update the Cochrane review “Support for healthy breastfeeding mothers with healthy term babies” to identify effective breastfeeding support interventions; 2. Conduct a theoretically-informed mixed methods synthesis of process evaluations of UK-relevant interventions; 3. Conduct an economic evaluation of interventions to enable women to breastfeed;

4. To conduct a systematic review to identify effective interventions which provide breastfeeding support for women with long-term conditions.

5. To conduct a theoretically informed mixed methods synthesis of process evaluations of breastfeeding support interventions for women with long-term conditions; 6. To conduct an economic evaluation of interventions to enable women with long-term conditions to breastfeed;

7. Co-create an NHS-tailored implementation and evaluation strategy framework to address contextual barriers and inform transferability of cost-effective interventions to increase breastfeeding in the UK;

8. Contribute to methodological development on involving stakeholders in co-creation of systematic reviews and synthesising process evaluations to support transferability and applicability of global evidence to local health service contexts.

The 18-month study comprises evidence synthesis and economic evaluation with embedded stakeholder involvement, including PPI, using principles of co-creation to ensure study outputs are relevant to the NHS context. The study will focus on reducing inequities in breastfeeding by ensuring the NHS-tailored framework is informed by the needs of women and babies from communities that have low breastfeeding rates.

Stakeholder engagement will be achieved through two stakeholder working groups and two parents’ panels supplemented by focus group discussions with disadvantaged women. Key outputs are: 1) updated Cochrane review “Support for healthy breastfeeding mothers with healthy term babies” to identify effective interventions to enable women to breastfeed; 2; a systematic review of breastfeeding support interventions for women with long-term conditions; 3) two theoretically-informed syntheses of policy and implementation research relating to effective interventions that are relevant to the UK context to produce an integrative review; 4) two syntheses of economic evaluations of breastfeeding interventions; 5) a co-produced NHS-tailored implementation and evaluation strategy framework to inform policy, practice and research in relation interventions to support women and babies in the UK to breastfeed.