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Process evaluation for the FEeding Support Team (FEST) randomised controlled feasibility trial of proactive and reactive telephone support for breastfeeding women living in disadvantaged areas
  1. Pat Hoddinott1,
  2. Leone Craig2,
  3. Graeme MacLennan1,
  4. Dwayne Boyers3,
  5. Luke Vale4 On behalf of the NHS Grampian and the University of Aberdeen FEST project team
  1. 1Health Services Research Unit, University of Aberdeen, Aberdeen, UK
  2. 2Public Health Nutrition Research Group, University of Aberdeen, Aberdeen, UK
  3. 3Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
  4. 4Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
  1. Correspondence to Dr Pat Hoddinott; p.hoddinott{at}


Objective To assess the feasibility, acceptability and fidelity of a feeding team intervention with an embedded randomised controlled trial of team-initiated (proactive) and woman-initiated (reactive) telephone support after hospital discharge.

Design Participatory approach to the design and implementation of a pilot trial embedded within a before-and-after study, with mixed-method process evaluation.

Setting A postnatal ward in Scotland.

Sample Women initiating breast feeding and living in disadvantaged areas.

Methods Quantitative data: telephone call log and workload diaries. Qualitative data: interviews with women (n=40) with follow-up (n=11) and staff (n=17); ward observations 2 weeks before and after the intervention; recorded telephone calls (n=16) and steering group meetings (n=9); trial case notes (n=69); open question in a telephone interview (n=372). The Framework approach to analysis was applied to mixed-method data.

Main outcome measures Quantitative: telephone call characteristics (number, frequency, duration); workload activity. Qualitative: experiences and perspectives of women and staff.

Results A median of eight proactive calls per woman (n=35) with a median duration of 5 min occurred in the 14 days following hospital discharge. Only one of 34 control women initiated a call to the feeding team, with women undervaluing their own needs compared to others, and breast feeding as a reason to call. Proactive calls providing continuity of care increased women's confidence and were highly valued. Data demonstrated intervention fidelity for woman-centred care; however, observing an entire breast feed was not well implemented due to short hospital stays, ward routines and staff–team–woman communication issues. Staff pragmatically recognised that dedicated feeding teams help meet women's breastfeeding support needs in the context of overstretched and variable postnatal services.

Conclusions Implementing and integrating the FEeding Support Team (FEST) trial within routine postnatal care was feasible and acceptable to women and staff from a research and practice perspective and shows promise for addressing health inequalities.

Trial registration ISRCTN27207603. The study protocol and final report is available on request.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • To cite: Hoddinott P, Craig L, MacLennan G, et al. Process evaluation for the FEeding Support Team (FEST) randomised controlled feasibility trial of proactive and reactive telephone support for breastfeeding women living in disadvantaged areas. BMJ Open 2012;2:e001039. doi:10.1136/bmjopen-2012-001039

  • Contributors PH had the idea for the study, and all the people acknowledged were involved in the design of the study. GM conducted the statistical analysis; DB and LV led the health economic data analysis with PH and LC contributing to the analysis of relevant qualitative data. LC and Karen Arnold conducted interviews with women participants. LC, Dale Sherriff and PH conducted interviews with staff. All authors had access to anonymised data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. PH wrote the first draft of the paper, and all authors made important intellectual contributions to the content and approved the final version.

  • Funding This study was funded by NHS Grampian through the Scottish Government: nutrition of women of childbearing age, pregnant women and children under five in disadvantaged areas—funding allocation 2008–2011, NHS Health Scotland ( NHS Grampian and the University of Aberdeen worked in partnership to implement the study. PH is employed by the University of Aberdeen and as a General Practitioner with NHS Grampian. All evaluation was conducted by University of Aberdeen employees.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval North of Scotland Research Ethics Committee approved this study on 19 April 2010, ref: 10/S0801/22.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The study protocol and final report are available on request.

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