The peer-professional interface in a community-based, breast feeding peer-support project

Abstract

Objective

to explore key elements of the peer-professional interface within one breast feeding peer-support project.

Design

a descriptive, qualitative study design. Data were generated through focus-group discussions with volunteer peer supporters and health professionals.

Setting

the Breastfriends scheme was a community-based, peer-support project located in Doncaster, a town in the North of England.

Participants

all of the volunteer peer supporters who were involved in the scheme at the time of data collection (n=7). In addition, a convenience sample of health professionals (community midwives and health visitors [n=9]) was also generated.

Analysis

thematic analysis of the data was undertaken. Two key themes that have relevance to understanding the peer-professional interface were derived: benefits of working together, and constraints on enabling working relationships.

Findings

benefits associated with participating in the breast feeding peer-support scheme were highlighted by volunteers and health professionals. Volunteers experienced enhanced social support and increased self-esteem and personal development. Health professionals benefited from being able to ‘spread the load’ of breast feeding support. Some health professionals were also able to learn from volunteers’ specialist experiential and cultural knowledge. Health professionals were concerned about volunteers transgressing (poorly defined) boundaries. Both volunteers and health professionals described gate-keeping activities and surveillance behaviours practised by health professionals in an effort to control aspects of volunteers’ access to, and work with, breast feeding women.

Discussion

as a cohort of peer supporters develops, members may derive benefits from their participation that extend beyond those predicted and planned for in the project. They may also exert a proactive influence upon the evolution of the peer-support project and upon the relationships between volunteers and health professionals. However, midwives and health professionals may also seek to exert influence over the work of peer supporters, preferring the volunteers to work for, rather than with, them as health professionals. It is at the peer-professional interface that any disjuncture between the project ideal and the reality of the group may be most evident and most problematic.

Conclusion and implications for practice

in order to reduce tension at the peer-professional interface, and optimise relationships between volunteers and health professionals, an ongoing process of development involving volunteers and health professionals is essential. Such a process would need to proactively identify and difuse professionals’ concerns while addressing both volunteers’ vulnerabilities and their potential for semi-autonomous development within and beyond the context of the peer-support scheme.

Introduction

Concern about low breast feeding rates is widespread in the developed and, increasingly, developing world (WHO, 2003), and the promotion of breast feeding is recognised as a global health priority. Following the recommendations of the World Health Organization (WHO, 2002), exclusive breast feeding for a period of 6 months is advised in the UK in order to optimise associated health benefits (DoH, 2003). However, the efforts of health professionals to promote breast feeding and to improve breast feeding rates have had limited success. In the systematic review of support for breast feeding mothers undertaken by Sikorski and Renfrew (1999), interventions by health professionals did not show significant improvements in breast feeding outcomes beyond 2 months postpartum. Dennis et al. (2002) reported that this may indicate that professional interventions alone may not be sufficient. Subsequently, interest has been growing in a number of countries in the potential of peer-support programmes to improve breast feeding rates within defined populations (Kistin et al., 1994; Long et al., 1995; Wright, 1996; Arlotti et al., 1998; Humphreys et al., 1998; Morrow et al., 1999; Schafer et al., 1998; Dennis et al., 2002; Haider et al., 2002; Raine, 2003).

Peer support is defined by Dennis et al. (2002) as:

a specific type of social support that incorporates informational, appraisal (feedback) and emotional assistance. This lay assistance is provided by volunteers who are not part of the participant's family or immediate social network; instead, they possess experiential knowledge of the targeted behaviour (i.e. successful breast feeding skills) and similar characteristics (e.g. age, socio-economic status, cultural background, location of residence) (p.24).

However, it is clear from published reports of breast feeding, peer-support projects that patterns of support vary greatly, both within the UK and across the world. Volunteers also vary in the amount of training they receive, and there is further variability in the extent to which volunteers are required to interact with health professionals in the process of providing support to women. With the diversity of processes involved, there is, nevertheless, a growing consensus that the time-limited, beneficial effects that have been demonstrated for professional breast feeding support measures may be bolstered by the more enduring effects of peer support (Kistin et al., 1994; Morrow et al., 1999; Vari et al., 2000; Dennis, 2002; Pugh et al., 2002; Alexander et al., 2003; Sikorski et al., 2003; Dykes, 2005). However, for this potential to be realised, enabling working relationships need to develop between peer supporters and health professionals. Although rarely addressed explicitly, a consistent undertone in many papers that consider the work of peer supporters and health professionals is the importance of the relationship between members of these two groups (Vari et al., 2000; Dykes, 2005).

In this paper, we therefore provide an initial brief description of a specific peer-support project, Breastfriends Doncaster, and then explore key issues of relevance to understanding the dynamics of the peer-professional interface that this project highlighted.