title: Multiprofessional training for breastfeeding management in primary care in the UK.
abstract: BACKGROUND
  Increasing breastfeeding initiation and duration rates is one of the UK Department of Health national targets for improving the health of the population. One reason contributing to the high rates of breastfeeding discontinuation may be that primary care teams may not have sufficient knowledge to help mothers overcome problems experienced in the early days and may also give conflicting advice. Previous studies have shown that general practitioners are happy to participate in practice-based educational sessions and have expressed a need for breastfeeding education. This study was carried out as part of the training to achieve 'UNICEF UK Baby Friendly Initiative in a community health care setting' status. It aimed to improve the breastfeeding expertise and advice about the management of breastfeeding problems within the primary care team using a CD-ROM breastfeeding learning package, and to assess the usefulness and acceptability of this educational intervention.
  
  
  METHODS
  Six UK general practitioner (GP) practices were involved in a questionnaire survey of multiprofessional groups before and after an interactive training session. This focussed on managing and solving problems, particularly mastitis and nipple thrush. The questionnaire included 20 questions on attitudes to and knowledge of breastfeeding, and eight multiple-choice questions on breastfeeding management. Non-parametric statistics (Mann-Whitney, Kruskal-Wallis and Wilcoxon tests) were used to compare the groups and to explore changes in knowledge after training.
  
  
  RESULTS
  Fifty primary care health professionals (29 GPs, 18 health visitors, 3 midwives) attended the sessions. There was an increase in scores relating to knowledge about breastfeeding after training, especially for the GPs and for those who did not have their own children. Health visitors improved their scores on recognition of the symptoms of poor attachment at the breast, and GPs showed greatest improvement in resolving sore nipples and recognising nipple thrush.Changes in practice were reported and positive comments made about involving GPs and health visitors together in practice-based education.
  
  
  CONCLUSIONS
  Using an electronic teaching resource is feasible for updating the knowledge of the primary care team. It can help to improve breastfeeding expertise and advice about breastfeeding problem management.
authors.affiliation: Centre for Child & Adolescent Health, Department of Community-based Medicine, University of Bristol, Hampton House, Cotham Hill, Bristol BS6 6JS, UK. jenny.ingram@bristol.ac.uk.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ingram