N09016: Promoting recommended infant feeding practices in a low-income sample - randomised controlled trial of a peer education intervention

Study Duration: University College London

Contractor: March 2002 to September 2006

There is evidence from the literature that peer-led education has been used successfully in a number of settings such as drugs or smoking cessation amongst young people. The limited published evidence of the use of peer-led educators in promoting healthy eating is mainly from international sources, but indicates that it can be effective, particularly with hard to reach groups such as adults on low incomes and ethnic minority communities.

This project aims to:

• Assess the impact of peer educators on nutritional and other health and social outcomes in low income mothers compared with standard professional care.
• Assess the sustainability and feasibility of using peer-led support and education.
• Assess the cost effectiveness of a peer-led support intervention.
• Develop a practical resource on the best means of conducting peer-led infant feeding interventions.

Study population

• first-time mothers
• infants aged 3 months
• living Camden & Islington
• disadvantaged areas – Sure Start
• ability to speak English as first/second language

Study design

• randomised controlled trial
• individual peer support
• process evaluation
• outcome measures at 3, 12 and 18 months

Outcome measures

1. Primary outcome:

• vitamin C from fruit

2. Secondary outcomes:

• total Kcals % energy from NMES
• other nutrients
• feeding practices
• anthropometric measures
• other's knowledge
• level of social support and mental health status

So far, appropriate measurement tools have been developed and measures pilot tested. Local partnerships have also been established. This study will use a volunteer training programme.

Recruitment of subjects began in January 2003 and staggered training of peer educators is planned for March/April 2003.

End of second year interim report

The researchers of the project have written a report of the initial stages of the project. The report highlights practical experiences and insights from the process of recruiting, training and supporting a group of volunteer peer educators. If you would like to see a copy of this report contact: Mr Jamie Blackshaw, Room 808C Aviation House, 125 Kingsway, London WC2B 6NH. Fax: 020 7276 8935
Email: jamie.blackshaw@foodstandards.gsi.gov.uk

The aim of this project was to design, implement and evaluate a peer-support intervention to promote recommended infant feeding practices to mothers and infants living in deprived communities. Local volunteers were recruited and trained to make home visits and give non-judgemental peer support and practical assistance on infant feeding, particularly weaning practices, to a group of mothers when their infants were between three and twelve months old (intervention group). A comparable group of mothers did not receive such support (control group). Both groups of families had normal access to standard health and other services.

The study demonstrated that it was possible to recruit, train and support a group of volunteers over an 18-month period. The comprehensive training programme was highly rated by the volunteers who gained a range of benefits from participating in the project. Mothers in the intervention group valued the support given and were highly satisfied with volunteer visits.

At the end of the study there was no evidence of overall macro- or micro-nutritional differences between the two groups of children. However mothers in the intervention group were more knowledgeable about when to discourage bottle feeding and were more confident in following health professionals’ recommendations on infant feeding than mothers in the control group.

As a result, infants in the peer-support group were less likely than those in the control group to have been introduced to cows’ milk before the age of 6 months; and aged 12 months they were more likely to be eating fruits and vegetables and were significantly more likely to be eating family foods and three solid meals a day. At 18 months of age, children in the intervention group were still consuming more fruit and vegetables, and were significantly less likely to be still using a bottle than those in the control group. These positive outcomes have important potential longer term health and developmental benefits.

Publications:
Watt, R.G. and McGlone, P. and Russell, J.J. and Tull, K.I. and Dowler, E. (2006) The process of establishing, implementing and maintaining a social support infant feeding programme. Public Health Nutrition, 9 (6). pp. 714-721.

Resources

Copies of the resources developed for the recruitment, training and support of volunteers is available on a CD which may be obtained from vivien.lund@foodstandards.gsi.gov.uk.

The final report is available from the Agency’s Information Centre.
To obtain a copy, please contact the Enquiry Desk, Information Services, Food Standards Agency (tel: 020 7276 8181/8182 or email: infocentre@foodstandards.gsi.gov.uk)

For any enquiries concerning this research project, please contact the relevant Programme contact or email: science@foodstandards.gsi.gov.uk