title: A systematic review of education and evidence-based practice interventions with health professionals and breast feeding counsellors on duration of breast feeding.
abstract: OBJECTIVE
  to examine the effects of training, education and practice change interventions with health professionals and lay breast feeding educator/counsellors on duration of breast feeding.
  
  
  METHODS
  this was part of a series of reviews of interventions that affect duration of breast feeding. Full details of methods used, including search strategy, are reported separately. SELECTION CRITERIA FOR INCLUDED STUDIES: randomised controlled trials, non randomised controlled trials with concurrent controls and before after studies (cohort or cross-sectional), undertaken in a developed country, published between 1980 and 2003 in any language. The primary outcome was duration of breast feeding. Secondary and process outcomes, including attitude, knowledge and behaviour change of participants, were included from papers that also reported breast feeding duration outcomes. STUDY-QUALITY ASSESSMENT: inclusion and exclusion criteria were applied, data extracted and study quality assessments made by one reviewer and independently checked by another, with a third reviewer to resolve differences, as recommended by the NHS Centre for Reviews and Dissemination's guidance for reviews.
  
  
  RESULTS
  the search identified nine papers. All were before after studies that included the education of health professionals; no studies were identified that related to breast feeding counsellors. In six of the studies, the participants were working with mothers and babies in hospitals (three in the UK, two in Italy and one in France); in three studies, the participants were working in community settings (Canada, Spain and the USA). Two UK studies and two non-UK studies (Spain and USA) involved mothers living in disadvantaged areas. Most interventions aimed to increase knowledge and change professional practice in support of breast feeding.
  
  
  CONCLUSIONS
  many of the studies reviewed have methodological limitations. Study settings and contexts vary and lack comparability. Evidence from these studies was insufficient to draw conclusions about overall benefit or harm associated with the interventions. From the studies identified, there seems to be no single way that consistently achieves changes in breast feeding duration. From one of the methodologically more robust studies, it seems that UNICEF/WHO Baby Friendly Hospital Initiative (BFI) training might have the potential to influence breast feeding duration. RECOMMENDATIONS FOR FURTHER RESEARCH: further testing of the BFI initiative within a controlled design. Future research into the education of health-care professionals that relates to the support of breast feeding women should have appropriate theoretical underpinning, describe educational programmes and the context of care delivery comprehensively and use standardised time points in the assessment of the effect of interventions. Intermediate outcomes should also be reported, including those related to the effect on education and practice.
authors.affiliation: Mother and Infant Research Unit, Department of Health Sciences, Area 4, Seebohm Rowntree Building, Heslington, York YO10 5DD, UK. hs507@york.ac.uk
authors.forename: Helen
authors.initials: H
authors.lastname: Spiby
authors.forename: Felicia
authors.initials: F
authors.lastname: McCormick
authors.forename: Louise
authors.initials: L
authors.lastname: Wallace
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Renfrew
authors.forename: Lalitha
authors.initials: L
authors.lastname: D'Souza
authors.forename: Lisa
authors.initials: L
authors.lastname: Dyson
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000523:psychology / Q000706:statistics & numerical data*; D005060:Europe; D019317:Evidence-Based Medicine / Q000706:statistics & numerical data*; D005260:Female; D006266:Health Education / Q000458:organization & administration*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007231:Infant, Newborn; D009035:Mothers / Q000193:education* / Q000706:statistics & numerical data; D009656:North America; D010353:Patient Education as Topic / Q000458:organization & administration*; D011247:Pregnancy; D011369:Professional-Patient Relations; D016032:Randomized Controlled Trials as Topic; D012944:Social Support