A mixed methods evaluation of the breastfeeding memory aide CHINS

Lynette Shotton, Tracy Collins, Reinie Cordier, Fadzai Chikwava, Mary Steen

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Abstract

Introduction
Breastfeeding is a key public health priority; however, rates remain persistently low in the United Kingdom (UK) despite the wide-scale rollout of UNICEF Baby Friendly Initiative training and accreditation. Here, memory aides such as Close, Head free, In-line, Nose to Nipple and Sustainable (CHINS) designed to help structure theory concerning principles of positioning could help practitioners remember, recall, and apply breastfeeding theory in their routine practice. This paper presents the first UK evaluation of CHINS. Breastfeeding is a key public health priority; however, rates remain persistently low in the United Kingdom (UK) despite the wide-scale rollout of UNICEF Baby Friendly Initiative training and accreditation. As such, more must be done to ensure breastfeeding practitioners can provide effective support. The memory aide CHINS (Close, Head free, In-line, Nose to Nipple and Sustainable) could help practitioners remember, recall, and apply breastfeeding theory in their routine practice but has not, until now, been subject to formal evaluation. This paper presents the first UK evaluation of CHINS.

Methods
A concurrent, convergent mixed methods approach was adopted using an overarching framework based on the four Normalisation Process Theory (NPT) constructs. An online survey was developed to target breastfeeding practitioners and academics from across the United Kingdom. A sub-set of survey respondents took part in qualitative focus groups. The survey data was subjected to descriptive and inferential statistical analysis, and the focus group data was analysed by drawing on the four NPT constructs of coherence, cognitive participation, collective action, and reflexive monitoring.

Results
In total, 115 participants from a range of practice-based and academic backgrounds completed the survey, and 16 of them took part in the focus group strand of the study. The findings demonstrate that CHINS has become a widely used feature of breastfeeding education and practice largely because of its simplicity and ease of integration in everyday practice, as well as its sustained inclusion in UNICEF Baby Friendly Initiative training. CHINS has introduced a standardised approach to the principles of positioning for effective breastfeeding. Doing so has helped address inconsistencies and poor practice in this area, and CHINS plays a role in assisting practitioners in building confidence in their breastfeeding practice.

Conclusion
There is a need to ensure the breastfeeding workforce develops and maintains skills in supporting breastfeeding practice, and more work needs to be done to consider how best this can be achieved, including the role of memory aides such as CHINS in supporting this.
Original languageEnglish
JournalMaternal & Child Nutrition
DOIs
Publication statusAccepted/In press - 2 Jul 2024

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