A randomised controlled trial of the effectiveness of a breastfeeding training DVD on improving breastfeeding knowledge and confidence among healthcare professionals in China.

Background: Despite almost all babies being breastfed initially, the rates of exclusive breastfeeding rate at six months is only 30% in China. Improving professionals' knowledge and practical skill is a key government strategy to increase breastfeeding rates. This study aimed to test the effectiveness of a breastfeeding DVD training method for clinicians on improving their knowledge and confidence in breastfeeding support skills of teaching mothers Positioning and Attachment (P & A) and Hand Expression (HE). Methods: A randomised controlled trial was conducted in three hospitals in Zhejiang province, China in 2014. Participants were recruited before their routine breastfeeding training course and randomly allocated to intervention group (IG) and control group (CG). The 15 minute "Breastfeeding: Essential Support Skills DVD" was the intervention for IG and vaginal delivery DVD was used for CG. All participants completed questionnaires of job information, knowledge and confidence in the two skills before (baseline) and immediately after viewing the DVD (post DVD). Results: Out of 210 participants, 191 completed knowledge assessments before and after watching the DVD (IG n=96, CG n=95), with the response rate of 91.0%. At baseline, there are no significant differences in job variables, knowledge scores and confident scores. The total knowledge score significantly increased post-DVD for IG (pre-DVD: M=5.39, SD=2.03; post-DVD: M=7.74, SD=1.71; t (95) =-10.95, p<0.01), but no significant change in total knowledge score for CG between pre- and post-DVD (pre-DVD: M=5.67, SD=1.70; post-DVD: M=5.56, SD=1.63; t (94) =0.85). The total confidence scores were significantly higher post-DVD than pre-DVD in IG (pre-DVD: M=66.49, SD=11.27; post- DVD: M=71.81, SD=9.33; t (68) =-4.92, p<0.01), but no significant difference was seen in CG between pre- and post-DVD total confidence scores (pre-DVD: M=68.33, SD=11.08; post-DVD: M=68.35, SD=11.40; t (65) =-0.25). Personal and job variables did not mediate these effects. Conclusions: The breastfeeding training DVD improved professionals' knowledge and confidence of the two breastfeeding support skills. However, the effect on professionals' practice and on breastfeeding outcomes needs to be examined in the future

Do automated digital health behaviour change interventions have a positive effect on self-efficacy? A systematic review and meta-analysis

© 2019 Taylor & Francis. This is an Accepted Manuscript of an article published by Taylor & Francis in Health Psychology Review on 20/01/2020, available online: https://doi.org/10.1080/17437199.2019.1705873.Self-efficacy is an important determinant of health behaviour. Digital interventions are a potentially acceptable and cost-effective way of delivering programmes of health behaviour change at scale. Whether behaviour change interventions work to increase self-efficacy in this context is unknown. This systematic review and meta-analysis sought to identify whether automated digital interventions are associated with positive changes in self-efficacy amongst non-clinical populations for five major health behaviours, and which BCTs are associated with that change. A systematic literature search identified 20 studies (n=5624) that assessed changes in self-efficacy and were included in a random effects meta-analysis. Interventions targeted: healthy eating (k=4), physical activity (k=9), sexual behaviour (k=3), and smoking (k=4). No interventions targeting alcohol use were identified. Overall, interventions had a small, positive effect on self-efficacy (푔 = 0.190, CI [0.078; 0.303]). The effect of interventions on self-efficacy did not differ as a function of health behaviour type (Qbetween = 7.3704 p = 0.061, df = 3). Inclusion of the BCT ‘information about social and environmental consequences’ had a small, negative effect on self-efficacy (Δ푔= - 0.297, Q=7.072, p=0.008). Whilst this review indicates that digital interventions can be used to change self-efficacy, which techniques work best in this context is not clear.Peer reviewedFinal Accepted Versio

Assessing clinicians' knowledge and confidence to perform kangaroo care and positive touch in a tertiary neonatal unit in England using the Neonatal Unit Clinician Assessment Tool (NUCAT)

Family centred care (FCC) is a guiding principle of the UNICEF Baby-Friendly Hospital Initiative (BFHI) and supports the practice of kangaroo care (KC) and positive touch (PT). We describe how clinicians in a tertiary hospital neonatal unit undertook a training needs analysis using the Neonatal Unit Clinician Assessment Tool (NUCAT), an on line knowledge test with ratings of confidence and knowledge in the practice of KC and PT. Fifty one medical and nursing staff completed NUCAT. Clinicians who spent 75 or more of their working week providing clinical care on the neonatal unit knew more about PT. Clinicians who received training in FCC practices had significantly more confidence in their knowledge and practice of KC and PT. Confidence in knowledge and practice in KC was significantly reduced when clinicians received their knowledge scores. There was no effect of feedback on confidence for PT. Interviews with six neonatal nurses identified a lack of formal training and evidence-based guidelines as impeding confidence of clinicians to implement both KC and PT

Emergence and Persistence of Overweight and Obesity in 7- to 11-Year-Old Children

Aim: After dramatic rises in paediatric obesity, the critical period for obesity onset may now be pre-adolescence. Methods: We monitored adiposity over 4 years in 400 children aged 7-9 years recruited from schools in London. Weight, height, waist circumference (WC) and fat mass were measured annually. Weight status was defined using International Obesity Task Force (IOTF) criteria, and standardised scores and percentiles used British 1990 reference data. Results: BMI, WC and fat mass index all tracked strongly over time (average correlation for BMI = 0.95). Emergence of obesity was relatively uncommon: only 2% of the total sample increased from overweight to obese over the 4-year period, and this was nearly matched by the 1.3% that reduced from obese to overweight. However, more children (6%) moved from healthy weight to overweight than the reverse direction (2%). There were greater absolute gains in adiposity in children with higher baseline weight status, but this was disguised in analyses using standardised scores. Obesity was not an emergent trait in middle childhood, but rates were already high and, in absolute terms, adiposity increased more in overweight and obese than healthy weight children. Conclusion: These results highlight the need for active management of obesity in middle childhood