{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T20:12:12Z","timestamp":1784751132316,"version":"3.55.0"},"reference-count":269,"publisher":"National Institute for Health and Care Research","license":[{"start":{"date-parts":[[2024,7,1]],"date-time":"2024-07-01T00:00:00Z","timestamp":1719792000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002001","name":"Health and Social Care Delivery Research (HSDR) Programme","doi-asserted-by":"publisher","award":["NIHR130995"],"award-info":[{"award-number":["NIHR130995"]}],"id":[{"id":"10.13039\/501100002001","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journalslibrary.nihr.ac.uk"],"crossmark-restriction":false},"short-container-title":["Health Soc Care Deliv Res"],"abstract":"Background<\/jats:title>\nBreastfeeding impacts positively on multiple health outcomes, but < 50% of UK women breastfeed at 8 weeks. Women with long-term conditions face additional challenges in breastfeeding.<\/jats:p>\n<\/jats:sec>\nObjectives<\/jats:title>\nTo synthesise global and UK evidence to co-create an implementation and evaluation toolkit for cost-effective breastfeeding support in the NHS.<\/jats:p>\n<\/jats:sec>\nDesign<\/jats:title>\nEvidence syntheses with stakeholder engagement.<\/jats:p>\n<\/jats:sec>\nReview methods<\/jats:title>\nSystematic reviews examined effectiveness of breastfeeding support for (1) healthy women and (2) women with long-term conditions using Cochrane Pregnancy and Childbirth Group methods. Mixed-methods systematic reviews synthesised process evaluations of effective breastfeeding support interventions for healthy women and experiences of receiving\/providing support for breastfeeding women with long-term conditions. Cross-study synthesis integrated qualitative and quantitative findings. Systematic reviews synthesised evidence on the incremental costs and cost-effectiveness of breastfeeding support following National Institute for Health and Care Excellence guidance. All searches were conducted from May 2021 to October 2022. Stakeholder engagement and toolkit development comprised online discussions, a modified Delphi study, focus groups and four workshops. Participants were 23 stakeholders, 16 parents in the parents\u2019 panels, 15 women in the focus groups and 87 stakeholders who attended the workshops.<\/jats:p>\n<\/jats:sec>\nResults<\/jats:title>\nWe found considerably more interventions designed for healthy women (review 1) than aimed at women with long-term conditions (reviews 1 and 4); approximately half of the studies were targeted at groups at higher risk of poor breastfeeding outcomes, and the impact of support may be different in these populations. Despite this, studies from review 2 found that women perceived the provision of support as positive, important and needed. Studies from review 5 echoed a range of suggestions from participants regarding potential strategies to improve breastfeeding support, with the most widely reported being the need to acknowledge the role and influence of other sources of support (e.g. partners, family, friends, peers, external professionals, web-based resources) and involving these sources in the provision of breastfeeding support for women with long-term conditions. In reviews 3 and 6, there was uncertainty about the cost-effectiveness of breastfeeding support interventions due to the limited number of studies and lack of good-quality evidence.<\/jats:p>\n<\/jats:sec>\nLimitations<\/jats:title>\nThere was a lack of evidence for the effectiveness and cost-effectiveness of breastfeeding interventions in the UK. There was often insufficient information reported about intervention characteristics.<\/jats:p>\n<\/jats:sec>\nConclusions<\/jats:title>\n\u2018Breastfeeding only\u2019 support probably reduces the number of women stopping any or exclusive breastfeeding. The evidence for \u2018breastfeeding plus\u2019 interventions is less consistent, but these may reduce the number of women stopping exclusive breastfeeding at 4\u20136 weeks and at 6 months. We found no evidence of differential intervention effects regarding mode of provision or provider. Cost-effectiveness is uncertain due to the lack of good-quality evidence. Key enablers of successful implementation were responsiveness and tailoring of interventions to both women\u2019s and supporters\u2019 needs. Breastfeeding support as delivered in the included studies probably has little to no effect on breastfeeding outcomes for women with long-term conditions. The mixed-methods synthesis and stakeholder work identified that existing interventions may not address the complex needs of these women. The main study output is a co-produced toolkit to guide implementation and evaluation of breastfeeding support services in the UK.<\/jats:p>\n<\/jats:sec>\nFuture work<\/jats:title>\nEvaluation of breastfeeding support for all women, particularly those at risk of poor breastfeeding outcomes (e.g. long-term conditions, deprivation). This could involve tailoring the toolkit to local contexts via implementation and effectiveness studies or using quality improvement studies.<\/jats:p>\n<\/jats:sec>\nStudy registration<\/jats:title>\nThis study is registered as PROSPERO CRD42022337239, CRD42021229769 and CRD42022374509. The reviews of economic evidence were not registered; however, the review protocol can be accessed via the repository held by Queen\u2019s University Belfast Research Portal (https:\/\/pure.qub.ac.uk\/).<\/jats:p>\n<\/jats:sec>\nFunding<\/jats:title>\nThis award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR130995) and is published in full in Health and Social Care Delivery Research<\/jats:italic>; Vol. 12, No. 20. See the NIHR Funding and Awards website for further award information.<\/jats:p>\n<\/jats:sec>","DOI":"10.3310\/dgtp5702","type":"journal-article","created":{"date-parts":[[2024,7,26]],"date-time":"2024-07-26T07:45:08Z","timestamp":1721979908000},"page":"1-206","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Lessons for the UK on implementation and evaluation of breastfeeding support: evidence syntheses and stakeholder engagement"],"prefix":"10.3310","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3750-2445","authenticated-orcid":true,"given":"Anna","family":"Gavine","sequence":"first","affiliation":[{"name":"School of Health Sciences, University of Dundee, Dundee, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8970-6146","authenticated-orcid":true,"given":"Albert","family":"Farre","sequence":"additional","affiliation":[{"name":"School of Health Sciences, 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