title: A mixed methods evaluation of peer support in Bristol, UK: mothers', midwives' and peer supporters' views and the effects on breastfeeding.
abstract: 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.
authors.affiliation: Centre for Child and Adolescent Health, School of Social and Community Medicine, Oakfield House, Clifton, Bristol BS8 2BN, UK. jenny.ingram@bristol.ac.uk.
authors.forename: Jenny
authors.initials: J
authors.lastname: Ingram
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D001942:Breast Feeding / Q000523:psychology* / Q000706:statistics & numerical data; D003625:Data Collection; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008880:Midwifery; D009035:Mothers / Q000523:psychology*; D017060:Patient Satisfaction; D010379:Peer Group; D011295:Prenatal Care; D015397:Program Evaluation; D012944:Social Support; D006113:United Kingdom; D055815:Young Adult