Increasing breastfeeding initiation and duration in women with a body mass index ≥ 30 kg/m2: developing an intervention from theory to acceptability

Abstract

Background. Breastfeeding has many health benefits for both mother and child, but rates of initiation and duration amongst women with a BMI ≥30 kg/m2 are low. Few interventions aiming to increase breastfeeding in this group have been successful; likely because existing interventions do not target psychological factors. Therefore, this study aimed to design and explore the acceptability of a newly developed psychological intervention to increase breastfeeding initiation and duration in women with a BMI ≥30 kg/m2. Methods. The Medical Research Council’s Complex Intervention Development Framework was followed to design the intervention. A ‘breastfeeding workbook’ was developed, based on literature and psychological theory, and filled with tailored information and activities. A Patient and Public Involvement group of women with a BMI ≥30 kg/m2 who had breastfed, health professionals and researchers were consulted throughout the process, selecting the intervention content, format and delivery methods. Thirteen women with a BMI ≥30 kg/m2 then reviewed the workbook and took part in in-depth qualitative interviews to assess its acceptability. Thematic analysis was conducted, informed by the Theoretical Framework of Acceptability version 2. Results. The findings reveal the intervention is acceptable to the target population; women believe the intervention shows promise for increasing breastfeeding initiation and duration, is representative of their experiences, is accessible, and aligns with their belief system. They valued that the intervention provided realistic expectations of breastfeeding, options to overcome the challenges of breastfeeding in the real-world and supported them to breastfeed without inducing stigma or shame regarding their weight or infant feeding practices. Suggestions for improvement are also included, such as incorporating audio and video content as alternatives to written text and translation options. Conclusions. An acceptable, psychological intervention was developed to increase breastfeeding initiation and duration in women with BMIs ≥30 kg/m2. These findings can inform maternity and breastfeeding care, future research directions and intervention development.