A mixed methods evaluation of peer support in Bristol, UK: mothers’, midwives’ and peer supporters’ views and the effects on breastfeeding

BACKGROUND: International studies suggest that breastfeeding interventions in primary care are more effective than usual care in increasing short and long term breastfeeding rates. Interventions that combine pre- and postnatal components have larger effects than either alone, and those that including lay support in a multicomponent intervention may be more beneficial. Despite the mixed reports of the effectiveness of breastfeeding peer support in the UK, targeted peer support services are being established in many areas of the UK. In 2010, NHS Bristol Primary Care Trust commissioned a targeted breastfeeding peer support service for mothers in 12 lower socio-economic areas of the city, with one antenatal visit and postnatal contact for up to 2 weeks. METHODS: Mothers receiving the peer support service were invited to complete an on-line survey covering infant feeding; breastfeeding support; and confidence in breastfeeding (using the Breastfeeding Self-Efficacy Scale). Semi-structured interviews and a focus group explored perceptions of mothers, midwives and peer supporters. The effects of the service on breastfeeding rates were documented and compared. RESULTS: 163 mothers completed the on-line survey; 25 participants were interviewed (14 mothers, 7 peer supporters and 4 maternity health professionals); exclusive and total breastfeeding rates for initiation and at 8 weeks were compared for 12 months before and after the service started. The targeted peer support service was associated with small non-significant increases in breastfeeding rates, (particularly exclusive breastfeeding), compared to the rest of the city. The service was very positively evaluated by mothers, health professionals and peer supporters. Mothers felt that peer support increased their confidence to breastfeed; peer supporters found the contacts rewarding, enjoyable and important for mothers; midwives and maternity support workers were positive about the continuity of an antenatal visit and postnatal support from the same local supporter. CONCLUSIONS: The introduction of a targeted peer support service was associated with psycho-social benefits for mothers, health professionals and peer supporters. Continuity of peer support with an antenatal visit and postnatal support from the same local supporter was also thought to be beneficial

Nebraska School Gardens and the Potential for Science, Technology, Engineering, and Math Learning

School-based growing spaces support student engagement in science, technology, engineering, and mathematics (STEM) learning through authentic agricultural pursuits. We conducted a survey of Nebraska schools to characterize existing school-based growing spaces and to identify challenges limiting garden-based STEM learning. Our findings confirm the use of school-based growing spaces for kindergarten through 12th-grade STEM instruction, especially in the sciences. Opportunities for technology and engineering experiences are currently limited, and additional professional development support is needed to broaden garden-based STEM learning efforts. Our findings are relevant to current and future Extension efforts supporting school gardens, especially in rural agricultural communities

‘Opportunity to bond and a sense of normality’:Parent and staff views of cuddling babies undergoing therapeutic hypothermia in neonatal intensive care: ‘CoolCuddle’

Abstract Background Currently, parents whose sick babies are undergoing three days of cooling therapy for hypoxic–ischaemic encephalopathy in neonatal intensive care units (NICUs) are not permitted to cuddle their cooled babies, due to concerns of warming the baby or dislodging breathing tubes or vascular catheters. Parents want to stay and care for their cooled babies and have reported that bonding is adversely affected when they are not permitted to hold them. Design and Participants Qualitative interviews with 21 parents of cooled babies in NICU (11 mothers and 10 fathers) and 10 neonatal staff (4 consultants and 6 nurses) explored their views and experiences of an intervention to enable parents to cuddle their cooled babies (CoolCuddle). Thematic analysis methods were used to develop the themes and compare them between parents and staff. Results Five themes were produced. Three themes were comparable between parents and staff: Closeness, a sense of normality and reassurance and support. An additional parent theme reflected their mixed feelings about initial participation as they were apprehensive, but felt that it was an amazing opportunity. Parents and staff described the closeness between parents and babies as important for bonding and breastfeeding. Fathers particularly appreciated the opportunity to hold and bond with their infants. Parents valued the reassurance and support received from staff, and the cuddles helped them feel more normal and more like a family at a very stressful time. In a final staff theme, they discussed the skills, number of staff and training needed to undertake CoolCuddle in NICU. Conclusions Parents cuddling their babies during cooling therapy enhanced parent–infant bonding and family‐centred care in NICU and was positively received. Adverse perinatal mental health, impaired mother–infant bonding and their effects on the establishment of breastfeeding may be ameliorated by introducing CoolCuddle. Patient Contribution Our parent advisors contributed to the interview topic guides and endorsed the themes from the analysis

Primary care clinician antibiotic prescribing decisions in consultations for children with RTIs:a qualitative interview study

BACKGROUND: Respiratory tract infections (RTIs) are a major primary care challenge in children because they are common and costly, there is uncertainty regarding their diagnosis, prognosis, and management, and the overuse of antibiotics leads to illness medicalisation and bacterial resistance. AIM: To investigate healthcare professional (HCP) diagnostic and antibiotic prescribing decisions for children with RTIs. DESIGN AND SETTING: Semi-structured interviews conducted with 22 GPs and six nurses. HCPs were recruited from six general practices and one walk-in centre, serving a mix of deprived and affluent areas. METHOD: Interviews were audiorecorded, transcribed, imported into NVivo 9, and analysed thematically. RESULTS: HCPs varied in the symptom and clinical examination findings used to identify children they thought might benefit from antibiotics. Their diagnostic reasoning and assessment of perceived clinical need for antibiotics used a dual process, combining an initial rapid assessment with subsequent detailed deductive reasoning. HCPs reported confidence diagnosing and managing most minor and severe RTIs. However, residual prognostic uncertainty, particularly for the intermediate illness severity group, frequently led to antibiotic prescribing to mitigate the perceived risk of subsequent illness deterioration. Some HCPs perceived a need for more paediatrics training to aid treatment decisions. The study also identified a number of non-clinical factors influencing prescribing. CONCLUSION: Prognostic uncertainty remains an important driver of HCPs’ antibiotic prescribing. Experience and training in recognising severe RTIs, together with more evidence to help HCPs identify the children at risk of future illness deterioration, may support HCPs’ identification of the children most and least likely to benefit from antibiotics

Maternal vaccines during the Covid-19 pandemic:A qualitative interview study with UK pregnant women

BACKGROUND: There is suboptimal uptake of recommended maternal vaccines (pertussis and influenza) during pregnancy in the UK. The Covid-19 pandemic has impacted healthcare services, and potentially vaccine coverage, and brought the need for new vaccines to be tested and rolled out. OBJECTIVES: : To explore: i) the impact of the Covid-19 pandemic on pregnant women's access to, and attitudes towards, routine maternal vaccines and; ii) women's attitudes towards testing Covid-19 vaccines on pregnant women and their personal willingness to take part in such a trial. DESIGN: Qualitative interview study with pregnant women in the Bristol and surrounding area (UK). METHODS: Semi-structured telephone/videoconference interviews were conducted (following a topic guide), transcribed verbatim and subjected to thematic analysis. RESULTS: Thirty-one pregnant women (selected for demographic range) were interviewed in April/May 2020. Participants felt the pandemic had elevated the importance of routine maternal vaccines, though women were concerned about safety management around appointment attendance. Women were wary of receiving a new Covid-19 vaccine, with most perceiving it as riskier than Covid-19 itself. CONCLUSIONS: It is important to maximise the safety and efficiency of maternity appointments to encourage uptake of routine maternal vaccines, and to communicate this well. For pregnant women to gain a new vaccine or participate in a vaccine trial, they need to be convinced that the risk posed by the virus is greater than any risk of receiving a new vaccine

Self-efficacy in teaching mathematics and the use of effective pedagogical practices in New Zealand primary schools

This study explored teachers’ self-efficacy in teaching mathematics (SETM) as related to their teaching profile and pedagogical practices. Using data from 327 New Zealand primary teachers, a multilevel structural equation model was constructed and analyzed that looked at the relationships among SETM and effective pedagogical practice scales and included characteristics related to the teachers and their schools. No significant gender, year level, or school socioeconomic differences were found with teachers’ SETM. Experienced teachers had significantly higher SETM scores than their inexperienced colleagues. Teachers who were self-efficacious in their mathematics teaching reported pedagogical practices known to be effective in the mathematics classroom in contrast to their low self-efficacy colleagues

The development of a tongue assessment tool to assist with tongue-tie identification

AIM: To produce a simple tool with good transferability to provide a consistent assessment of tongue appearance and function in infants with tongue-tie. METHODS: The Bristol Tongue Assessment Tool (BTAT) was developed based on clinical practice and with reference to the Hazelbaker Assessment Tool for Lingual Frenulum Function (ATLFF). This paper documents 224 tongue assessments using the BTAT. There were 126 tongue assessments recorded using the BTAT and ATLFF tools to facilitate comparisons between them. Paired BTAT assessments were obtained from eight midwives who were using the new assessment tool. RESULTS: There was acceptable internal reliability for the four-item BTAT (Cronbach's α=0.708) and the eight midwives who used it showed good correlation in the consistency of its use (ICC=0.760). The BTAT showed a strong and significant correlation (0.89) with the ATLFF, indicating that the simpler BTAT could be used in place of the more detailed assessment tool to score the extent of a tongue-tie. Midwives found it quick and easy to use and felt that it would be easy to teach to others. CONCLUSIONS: The BTAT provides an objective, clear and simple measure of the severity of a tongue-tie, to inform selection of infants for frenotomy and to monitor the effect of the procedure