The paper by Muirhead and colleagues1 is one of three lay support intervention studies in Britain to report no significant effect on breastfeeding duration.2,3
However, it would be premature to conclude that lay support interventions are ineffective. The studies suggest several reasons for lack of effectiveness: low uptake for a variety of reasons; strong cultural barriers to breastfeeding that could not be overcome by lay support; and a lack of commitment to lay support by local health professionals. Evaluation of 35 UK peer support schemes have identified the need for sensitive negotiation of the boundaries and relationships between health professionals and lay supporters, to aid cross referral and avoid ‘dumping’ on volunteers.4,5
All three studies evaluate a model where training, varying in amount, content and style, enables lay supporters to develop some breastfeeding ‘expertise’, over and above their defining characteristic of having breastfed a baby. Although central to the intervention, the authors do not discuss the effect of different training, and there is a need to evaluate theoretical models underpinning peer support training. An action research model of health professionals working together with untrained breastfeeding mothers to offer peer coaching, mainly through groups, was effective in improving breastfeeding rates.6
In the current climate it is tempting to see lay interventions as a solution to health service shortfalls rather than opportunities for partnership to improve the quality of care. These process issues deserve more investigation and are likely to arise in other expert patient and lay initiatives.
- © British Journal of General Practice, 2006.
