Cuidados respetuosos a través de una intervención de acompañamiento al amamantamientoDiseño y pilotaje del programa criaa

Resumen

This study developed the design and pilot implementation of a multicomponent intervention aimed at supporting mothers and their families based on breastfeeding self-efficacy. The guidelines for the development of complex interventions proposed by the Medical Research Council was used. The theoretical pre-phase, design and development of the intervention (phase I) and feasibility/piloting (phase II) of the intervention were carried out. The theoretical pre-phase included a literature review on the recommendations and policies for breastfeeding promotion and protection and a description of the Chilean situation and health system. In addition, an umbrella review was carried out to synthesized the existing evidence regarding the effectiveness of supporting breastfeeding interventions. In phase I, the methodological foundation that guided the thesis and the analysis of the context where the intervention was carried out were included, allowing the development of the logic model through which the key elements were identified and guided the process of executing the intervention, called the CRIAA Program. For the development of phase II a pilot study was carried out with control and intervention groups to evaluate the intervention feasibility and acceptability and to explore the effects of the intervention on self-efficacy. The study was conducted in two primary healthcare centres with 44 childbearing women (20 control group; 24 intervention group), with their partner/meaningful person and their respective healthcare professionals. Intervention group participants received the intervention: (a) in a breastfeeding workshop during their third trimester of pregnancy; and (b) via virtual breastfeeding support for six months postpartum. Health professionals were trained to deliver the intervention. The control group received standard care in the outpatient clinic. The pilot study helped to determine that the intervention was feasible and acceptable. Data collected pre-intervention, 10-days postpartum and two, four, and six-months postpartum estimated the intervention's preliminary effects on self-efficacy and main outcomes. The intervention had a significant effect on professional self-efficacy, breastfeeding knowledge by professionals and mothers. Preliminary effects on the risk of postpartum depression and breastfeeding recovery were identified. Although breastfeeding self-efficacy increased in both groups participants and was higher in the intervention group, it was not possible to estimate the effects of the CRIAA program on maternal breastfeeding self-efficacy as differences in between intervention groups were not statistically significant. The study produced an original, comprehensive, complex intervention addressing contextual, and organizational factors to promote breastfeeding support using an interdisciplinary and family-based approach. The program evaluation and feasibility study permitted the exploration of the integration of the intervention's novel aspects into the daily work of professionals and revealed how to better use existing resources in a full-scale clinical trial.