Hello and welcome!
The winning topic from the poll carried out this week was “peer support + breastfeeding”. We shall be therefore discussing the following systematic review paper this coming Sunday 19th February at 8pm:
- Systematic review of peer support for breastfeeding continuation: metaregression analysis of the effect of setting, intensity, and timing
In order to help prepare for the discussion, below I have provided a brief summary of the paper, explanation of some important concepts (such as ‘systematic review’ and ‘metaregression’) and have outlined some discussion points which will be used during the twitter chat. I hope you find these useful, and do not hesitate to comment or feedback either via this website or on Twitter (@PHTwitJC).
Public Health Relevance: Breastfeeding
Breastfeeding in the UK is a complex issue. On one hand it is clear that breastfeeding has a multitude of benefits to mum and baby (click on NHS Choices for a summary). The acknowledgement of how important breastfeeding is can be seen in national and local policy, initiatives such as the Baby Friendly Initiative and the abundance of healthcare staff whose job roles include commissioning services which are breastfeeding friendly, providing information and support to mums and mums-to-be.
On the other hand, there are many perceptions and stigmas surrounding breastfeeding which are off-putting, as well as varying types and levels of support available. If you could like a light-hearted and entertaining introduction to some of the perceptions around breastfeeding I would recommend watching Cherry Healey’s ‘Is Breast Best’ documentary.
The Infant Feeding Survey takes place every 5 years and provides an indication of UK breastfeeding rates. The latest results (2011) indicate a rise in breastfeeding across the UK, which is encouraging news.
This paper examines the evidence to support a specific type of intervention to encourage the uptake of breastfeeding: this paper aims to examine the effect of setting, intensity, and timing of peer support on breastfeeding. Specifically, two breastfeeding outcomes were considered: 1) any breast feeding at the end of the study follow-up and 2) exclusive breast feeding at the end of the study follow-up.
A Systematic review identified relevant studies and metaregression analysis of randomised controlled trials were conducted to establish risk ratios and 95% confidence intervals. The authors concluded:
- Peer support interventions increases breastfeeding continuation in low or middle income countries (especially exclusive breast feeding),
- This does not seem to apply in high income countries, particularly the United Kingdom, where breastfeeding support is part of routine postnatal healthcare.
- Peer support of low intensity does not seem to be effective.
What is a ‘systematic review’?
“A systematic review draws together the results of several primary research studies. They are used when there is an important clinical question, but many clinical trials, perhaps with conflicting results. A systematic review seeks to provide an overview of the findings of the individual trials, highlighting possible answers, as well as any remaining gaps in knowledge.” (Source: Health Knowledge)
What is ‘metaregression’?
A meta-analysis combines the results of several studies (e.g. identified by systematic review) that address a set of related research hypotheses. Many of the studies included may differ beyond just sampling variation, and these differences (or hetrogeneity) can be addressed using a metaregression model.
Discussion points for Sunday 19th February:
- Were the aims of this study clear? (consider the population, outcome measures, intervention)
- Was the systematic review comprehensive? (consider research designs included, inclusion and exclusion criteria, would all relevant studies have been identified?)
- Were any adjustments made for study size or quality? (if appropriate)
- Do you believe the results? Could anything else explain these findings? (Consider whether the results are due to chance, bias, confounding or the truth?)
- What implications do the findings have for public health practice & policy?