Adapting breastfeeding support in areas of socio-economic deprivation: a case study approach.
Adapting breastfeeding support in areas of socio-economic deprivation: a case study approach.
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DOI：
10.1186/s12939-021-01393-7
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发表时间：
2021-03-20
影响因子：
4.8
通讯作者：
Dykes F
中科院分区：
文献类型：
--
作者：
Hunt L;Thomson G;Whittaker K;Dykes F
在母乳喂养开始率和继续喂养率方面存在不平等，即社会经济上处于不利地位的母亲最不可能进行母乳喂养。建议将母乳喂养同伴支持(BPS)干预作为一种解决方案，在英国，非营利性组织被委托在社会经济贫困地区提供BPS服务。BPS干预有一个复杂的证据基础，提供了关于背景和干预之间的相互作用以及这如何影响妇女体验的有限知识。这项解释性研究使用案例研究方法来探讨两个BPS服务如何以及为什么在社会经济贫困的情况下发展其服务。旨在产生对BPS服务开发的整体理解的方法。在两个案例中收集的数据包括：观察(n= 1)，以及对以下对象的半结构化访谈：有(n= 10)和没有(n= 9)参与的母亲、同伴支持者(n = 9)、社区卫生专业人员(n= 5)、婴儿喂养协调员(n= 2)、非营利组织经理(n= 3)和公共卫生专员(n = 2)。数据分析采用开放编码、常量比较、交叉比较的归纳扎根理论分析技术。最重要的主题--“社会的超越影响”--提供了对影响服务发展的潜在背景和驱动因素的洞察。它反映了资金和数据共享安排如何决定服务运作和同龄人接触妇女的机会。四个基本主题解释了如何：同行支持者在调整其服务方面足智多谋(“调整和修改支持”)；BPS组织努力使妇女能够获得支持性母乳喂养环境，但不一定将服务发展重点放在生活在贫困地区的妇女的需求上(“支持妇女的获取途径”)；BPS--支持获得支持的专业联系以及BPS如何能够产生更具支持性的社区环境(“嵌入医疗实践”)；以及管理做法如何排除了有意义地使用数据来提供背景导向的服务发展(“利用知识的方式”)。调查结果表明，虽然PSS被委托专注于最有需要的人，但关于妇女生活的知识的讨论、收集或使用有限，以发展以需求为导向的服务交付。主要建议是开发一种社会生态工具，以促进使用和应用背景知识。
There are inequalities in breastfeeding initiation and continuation rates, whereby socio-economically disadvantaged mothers are least likely to breastfeed. Breastfeeding peer support (BPS) interventions are recommended as a solution, and in the UK non-profit organisations are commissioned to deliver BPS services in areas of socio-economic deprivation. BPS interventions have a mixed evidence base, offering limited knowledge about the interaction between context and intervention and how this affects women’s experiences. This interpretive study used a case study methodology to explore how and why two BPS services developed their services in socio-economically deprived contexts. Methods aimed to generate holistic understanding of BPS service development. Data collected across both cases comprised; observation (n = 1), and semi-structured interviews with: mothers who had (n = 10) and had not (n = 9) engaged with the BPS services, peer supporters (PSs) (n = 9), community health professionals (n = 5), infant feeding co-ordinators (n = 2), non-profit organisation managers (n = 3), and public health commissioners (n = 2). Inductive grounded theory analytic techniques of open coding and constant comparisons, followed by cross case comparisons, were used to analyse the data. The over-arching theme - ‘the transcending influence of society’ – offers insights into the underlying context and drivers impacting service development. It reflects how funding and data sharing arrangements determined service operation and the peer’s access to women. Four underpinning themes explain how: peer supporters were resourceful in adapting their services (‘adapting and modifying the support’); BPS organisations worked to enable women’s access to supportive breastfeeding environments, but did not necessarily focus service development on the needs of women living in areas of deprivation (‘supporting women’s journeys to access’); the BPS-professional connections for supporting access and how BPS could result in more supportive community environments (‘embedding within healthcare practice’); and how management practices precluded meaningful use of data to provide context led service development (‘ways of using knowledge’). Findings suggest that while PSs are commissioned to focus on those most in need, there is limited discussion, collection, or use of knowledge about women’s lives to develop needs-led service delivery. The key recommendation is the development of a social ecological tool to facilitate the use and application of contextual knowledge.
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