Stakeholder and parent co-production within an NHS-tailored evidence synthesis of breastfeeding support in the UK:the Action4Breastfeeding project

BackgroundCo-production in research enhances the quality and relevance of research findings. Stakeholder engagement was integral to the Action4Breastfeeding project. Our approach to stakeholder and parent involvement was ‘active involvement’ (Pollock et al 2018) throughout the process of evidence synthesis including planning, production and dissemination.MethodsEngagement was achieved through a stakeholder working group and a parents’ panel, supplemented by focus group discussions with women from groups least likely to breastfeed. All four UK countries were represented. The stakeholder working group included members of third sector organisations, policymakers, NHS practitioners, and commissioners. The parents’ panel included women who had breastfed a child within the last three years and fathers. Focus group participants were recruited by a peer support organisation working with disadvantaged families. The three groups met separately four times during the study. Co-production activities included: a) discussing priorities for breastfeeding support, b) agreeing criteria to assess transferability of effective interventions from global evidence to the UK setting; c) identifying barriers to implementing breastfeeding support in NHS settings, and d) developing and prioritising strategies to overcome the identified barriers. The online meetings were supplemented with a modified Delphi survey. Focus groups were held online and in-person. Members of the stakeholder working group and parents panel attended in-person workshops held around the UK as the final stage of the project. A project extension for women with multiple long-term conditions mirrored this work.Results/findingsPractical elements of engaging stakeholders and parents in co-creation within an evidence synthesis will be presented, including achieving trust, confidentiality, and good working relations, valuing contributions and maintaining engagement. Examples of diversity and differing priorities within the various stages of the evidence synthesis will be provided. Ways of managing these to produce an NHS-tailored implementation and evaluation strategy framework will be discussed. We plan to continue engagement beyond the funded project to ensure effective knowledge mobilisation (Grindall et al 2022)ConclusionCo-creation was essential to this evidence synthesis and whilst not always easy to achieve, resulted in rich discussions and diverse priorities that will contribute to the development of cost-effective breastfeeding support interventions in the UK

What young people want from health-related online resources: a focus group study

The growth of the Internet as an information source about health, particularly amongst young people, is well established. The aim of this study was to explore young people's perceptions and experiences of engaging with health-related online content, particularly through social media websites. Between February and July 2011 nine focus groups were facilitated across Scotland with young people aged between 14 and 18 years. Health-related user-generated content seems to be appreciated by young people as a useful, if not always trustworthy, source of accounts of other people's experiences. The reliability and quality of both user-generated content and official factual content about health appear to be concerns for young people, and they employ specialised strategies for negotiating both areas of the online environment. Young people's engagement with health online is a dynamic area for research. Their perceptions and experiences of health-related content seem based on their wider familiarity with the online environment and, as the online environment develops, so too do young people's strategies and conventions for accessing it

Lessons for the UK on implementation and evaluation of breastfeeding support: evidence syntheses and stakeholder engagement

Background Breastfeeding impacts multiple health outcomes but less than 50% of UK women breastfeed at 8 weeks. Women with long-term conditions face additional challenges in breastfeeding. Objectives To synthesise global and UK evidence to co-create an implementation and evaluation toolkit for cost-effective breastfeeding support in the NHS. Design Evidence syntheses with stakeholder engagement. Review methods Systematic reviews examined effectiveness of breastfeeding support for i) healthy women, and ii) women with long-term conditions using Cochrane Pregnancy and Childbirth group methods. Mixed methods systematic reviews synthesised process evaluations of effective breastfeeding support interventions for healthy women, and experiences of receiving/providing support for breastfeeding women. Cross-study synthesis integrated qualitative and quantitative findings. Systematic reviews synthesised evidence on the incremental costs and cost-effectiveness of breastfeeding support following NICE guidance. All searches were conducted May 2021 to October 2022. Stakeholder engagement and toolkit development comprised online discussions, a modified Delphi study, focus groups and four workshops. Participants were: 23 stakeholders, 16 parents in the parents panels, 15 women in the focus groups, and 87 stakeholders attended the workshops. Results We found considerably more interventions that were designed for healthy women (Review 1) compared to those aimed at women with long-term conditions (Reviews 1 and 4, approximately half the studies were targeted at groups at higher risk of poor breastfeeding outcomes, and possibly the impact of support may be different in these populations. Despite this, studies from Review 2 found that women perceived the provision of support as positive, important and needed. Studies from Review 5 echoed a range of suggestions from participants regarding potential strategies to improve breastfeeding support, with the most widely reported being the need to acknowledge the role and influence of other sources of support (e.g., partners, family, friends, peers, external professionals, web-based resources) and involving them in the provision of breastfeeding support for women with long-term conditions. In Reviews 3 and 6, there was uncertainty in the cost-effectiveness of breastfeeding support interventions due to the limited number of studies and lack of good quality evidence. Limitations There is lack of evidence for effectiveness and cost-effectiveness of breastfeeding interventions in the UK. There was often insufficient information about intervention characteristics reported. Conclusions ‘Breastfeeding only’ support probably reduces the number of women stopping any or exclusive breastfeeding. The evidence for ‘breastfeeding plus’ interventions is less consistent but may reduce the number of women stopping exclusive breastfeeding at 4-6 weeks and 6 months. We found no evidence of differential intervention effects regarding mode of provision or provider. Cost-effectiveness is uncertain due to the lack of good quality evidence. Key enablers of successful implementation were responsiveness and tailoring of interventions to both women’s and supporters’ needs. Breastfeeding support as delivered in the included studies probably has little to no effect on breastfeeding outcomes for women with long-term conditions. The mixed-methods synthesis and stakeholder work identified that existing interventions may not address the complex needs of these women. The main study output is a co-produced toolkit to guide implementation and evaluation of breastfeeding support services in the UK. Future work Evaluation of breastfeeding support for all women, in particular those at risk of poor breastfeeding outcomes (e.g., long-term conditions, deprivation). This could involve tailoring the toolkit to local contexts via implementation and effectiveness studies or using quality improvement studies

Risk factors for progression from severe maternal morbidity to death: a national cohort study.

Women continue to die unnecessarily during or after pregnancy in the developed world. The aim of this analysis was to compare women with severe maternal morbidities who survived with those who died, to quantify the risk associated with identified factors to inform policy and practice to improve survival

Genomic and molecular analyses identify molecular subtypes of pancreatic cancer recurrence

Pancreatic cancer (PC) remains a highly lethal malignancy, and most patients with localized disease that undergo surgical resection still succumb to recurrent disease. Pattern of recurrence after pancreatectomy is heterogenous, with some studies illustrating that site of recurrence can be associated with prognosis.1 Another study suggested that tumors that develop local and distant recurrence can be regarded as a homogenous disease with similar outcomes.2 Here we investigate novel molecular determinants of recurrence pattern after pancreatectomy for PC