Qualitative data
The global theme to emerge from the qualitative data was 'incentives as connectors'. Two organising themes are presented, 'facilitating connections' and 'facilitating relationships and wellbeing'. The themes and associated sub-themes are detailed in Table
4. These themes explore how the incentives and opportunities to develop connected relationships provided tangible and intangible benefits for women and peer supporters.
Table 4
Global, organising and basic themes
Incentives as Connectors
|
Facilitating Connections
| Encouraging access |
| | Connecting to self and others |
| | Relating to outside world |
|
Facilitating Relationships and Wellbeing
| Being on the journey together |
| | Encouraging sensitive dialogues and opportunities for support |
| | Being rewarded |
Facilitating connections
This theme explores how the provision of, and quality of the gifts were 'encouraging access' between the peer supporters and mothers; how the gifts enabled 'connections to self and others' and how the gifts facilitated mothers 'relating to the outside world'.
Encouraging access
The Star Buddies reported how gifts enabled them to gain a 'foot in the door' into the women's homes and lives. Whilst women in receipt of the 'usual' programme were generally happy to receive on-going breastfeeding support via text or phone, face-to-face contact was often limited until a specific breastfeeding problem emerged. However, delivering the gifts facilitated repeated face to face contact with women:
‘I suppose the thing about the gift scheme is you're signed up to see them every week, to have contact with them every week...' (Mary).
The actual quality of the gifts was identified as enabling regular access to women. Highly positive comments were made regarding the gift variety, their appropriateness, the targeted discussions they stimulated, and the thought and care that had gone into their selection:
‘It was a really, really nice touch I thought and the gift themselves were very, very well thought out, in the way that they gave like the healthy snacks and the magazine, which is great to have when you're breastfeeding. Every gift that I received was really appropriate and I've enjoyed every one, it's been really good' (Rose).
The quality of the gifts meant that the Star Buddies were more willing to impart the presents; 'we were happy to hand them over'. Pleasure was obtained through accounts and observations of the gifts being utilised, and from women's comments:
‘...What was lovely was seeing the picture frames getting the picture in and being on the mantle.....
...'I had a couple go swimming and they've been really pleased' (Peer Supporters).
The gift-giving enabled peer supporters to provide regular proactive weekly support to mothers identified as difficult to access, e.g. multi-parous, younger and vulnerable mothers:
‘I'm glad I ended up [seeing the Star Buddies] because I don't have loads of people come to my house, I'm quite a private person....... but overall, if I did have questions, she was there and she'd reassure me, so I'd feel reassured rather than panicking and thinking, oh I don't know what's what' (Nicky).
Connecting to self and others
A recurrent message to emerge across all the narratives was how the gifts were tailored towards them and the families. Women repeatedly cited how the gifts reminded them of their individuality. As mothers can lose their identity as they adjust to the parenting role, these gifts were considered to re-connect them to their sense of self:
‘I think it reminds you of you being an individual. I've been constantly like X (son) on the breast and sorting the kids out and she came with a gift and it's like, oh yes, this is for me.....who am I again? It reminds you that you need to look after yourself as well sort of thing' (Nicky).
Peer supporters and the mothers frequently reflected how the birth of a baby can leave mothers feeling overwhelmed and preoccupied in adapting to their new role. These gifts therefore often provided women with the feeling of being cared for and the need for self-care:
‘It was nice we got, I think on the second or the third week, I can't remember, they give you .....I think it was a pamper set, like body scrub and bath stuff, that was really nice, because I felt like I'm not paying any attention to myself since she was born, so that was nice' (Claire)
Furthermore, the nature and quality of the gifts, and associated discussions with peer supporters could motivate women to initiate quality time with their partner, families and babies:
‘Even a simple gift like a cup of coffee and a voucher, it seems like giving us, me and my husband, time to spend outside' (Nadia).
From a peer supporter perspective, the increased opportunities for home visits enabled identification of worries or concerns, which subsequently brought the Star Buddies into closer contact with other health professionals to try and resolve them. These occasions helped to raise awareness of the Star Buddies programme, promoted extended contact between the peer supporters and health professionals and facilitated the development of more collaborative relationships:
‘I've had a lot more contact phoning midwives and health visitors to say mum's worried about this and she's asked me to speak to you and.....they've also contacted us. We have had more contact with health visitors and things' (Peer Supporters).
Relating to the outside world
Women's regular contact with the Star Buddies provided them with a 'life-line' to the outside world. Women looked forward to the visits which helped to safeguard against maternal isolation:
‘Because when you're sitting in your house on your own and your other half is at work, and it's just you day after day after day at home with your child, you begin to feel very isolated and you begin to feel very on your own. And having her coming every Friday, you know, it's a colossal difference' (Erica).
The gift(s) and associated discussions encouraged women to breastfeed outside the home environment and promoted access to wider support networks. Peer supporters reported that the number of women accessing the breastfeeding groups increased over the incentive programme. Moreover, as some of the women preferred contact at community locations, these opportunities encouraged women to gain access to additional social occasions and activities:
‘Because we've got them into lots of groups, they all come to baby groups, baby massage, baby yoga. Because they're here and they know us all and then they join the centre and do other stuff, it's like a community almost' (Peer Supporters).
Facilitating relationships and wellbeing
This theme reports on how the provision of gifts and repeated contacts with women facilitated meaningful relationships through 'being on the journey together'; 'encouraging sensitive dialogues and opportunities for support' and how the incentive intervention provided rewards for women as well as the peer supporters.
Being on the journey together
The peer supporters considered that regular face-to-face access to women, couched within the provision of gifts enabled a more meaningful and connected relationship to be forged:
‘We had real relationships, rather than the actual giving of the gift, though that was nice, you had a way to get in the door and once you're in the door you could build on all sorts of things' (Peer Supporters).
Whilst 'friendships' being forged between peer supporters and mothers was evident, the incentive scheme created continuity and a situation in which the peer supporters 'were with them along their journey'. Repeated contacts enabled the supporters to monitor the on-going health of the woman and infant and to be cognisant of women's and families values and beliefs:
‘With X (Star Buddy), knowing that he was a placid baby and then suddenly changing into this crazy, screaming banshee that he was. And the fact that she rang the health visitor and said, look, no he's not himself, you know, he's being different, I think that really helped' (Shona).
Previously Star Buddies felt pressured to impart as much information whenever opportunities for contact arose. The weekly home visits provided sustained and prolonged contact allowing peer supporters to target discussions over the support period, and choose when it was most appropriate to discuss a particular issue:
‘You'd move on to feeding out and about because you're part of that with them, they'd be going out and experiencing that and then you'd be part of, you know, growth spurts as you'd see them at that time' (Peer Supporters).
In turn, the peer supporter's insider knowledge of their families and lives, and 'friendship' led to women feeling 'cared about', 'comfortable' and 'easy' to raise issues with peer supporters. Star Buddies also highlighted how these women were more likely to perform more intimate tasks in front of them, e.g. expressing milk. Furthermore, whilst Star Buddies have always encouraged women to maintain contact after the period of support, these instances were far more prevalent amongst the women who received incentives:
‘...And I've found the women I've discharged, a lot of them are still getting in touch with me.
....There's loads of that, it's never happened before, yes.
....You know, further questions throughout the journey, are coming back to me' (Peer Supporters).
Encouraging sensitive dialogues and opportunities for support
As the incentives created opportunities to meet up when no specific concerns were identified, the discussions often delved into a whole host of wider breastfeeding and non-breastfeeding issues. More emotive topics were raised such as bed-sharing, smoking, alcohol consumption, acquiring a tattoo and managing breastfeeding during formal occasions. Women and peer supporters referred to how the repeated contacts enabled trust to be forged within their relationships. Moreover, the trust in their peer supporters led women to seek out their opinion on personal or family issues (e.g. relationship issues, mental health concerns); maintain contact when on holiday and 'open up' more than within their personal networks:
‘He (husband) was getting a bit frustrated, so I couldn't really vent as much to him. So as soon as X (Star Buddy) came round I was like, just let rip. So yes, I definitely did look forward to it' (Lucille).
These dialogues encouraged tailored support to be provided; together with referrals into appropriate services:
‘I was supporting a muslin lady who felt really isolated but I don't think she'd have ever told me that if she hadn't have built up a relationship. There was sort of racial abuse every time she set out of her door. So we got an ethnic inclusion worker and they're supporting her with a house move ......but to me that was way more than breastfeeding. I don't think she would have trusted me if I hadn't been seeing her so regular' (Peer Supporter).
Finally, home contacts enabled peer supporters to regularly access women's personal networks including partners and family members providing opportunities to harness their support and encouragement:
‘Then you can spend time telling the dads ways to support the mums and showing them what to look for' (Peer Supporters).
Being rewarded
Overall, the majority of women reported how the gifts per se did not alter their decision or intention to breastfeed:
‘It's (gifts) been really, really nice but breastfeeding is so important to me that I can't imagine stopping .....I already know that I'm breastfeeding for a year minimum and that's it. So .....I wasn't going to be persuaded by gifts but they were very lovely all the same and I'm very grateful' (Sandy).
These gifts did however provide intangible incentives through the pleasure they provided. Women considered the gifts as to be an 'instant encouragement', a 'treat', a 'bonus' and something to 'look forward to':
‘It was fantastic, it was such a treat to get something. I mean I was just so happy to be getting her time and her advice, the fact that I was getting like a magazine and so many little treats to go along with it, was just a massive bonus really' (Rose).
Fundamentally, the actual support the women received via the peer supporters was considered to be crucial to their breastfeeding success; 'I definitely would have given up without their support'. Almost all of the women perceived that on-going support from the programme had enabled them to breastfed for longer. However, as breastfeeding was often experienced as arduous and difficult, on-going receipt of the gifts re-enforced and recognised their breastfeeding achievements:
‘When you're doing something that's painful and hard work and exhausting and pins you to a sofa for hours and hours of a day and means that you're the only one who can get up and feed in the middle of the night, then I suppose it's nice to get something that's thanking you almost, telling you you're doing a good job and that you deserve to be treated' (Lucia).
Peer supporters identified how incentives had provided them with personal and professional rewards. The in-depth nature of the relationships forged between the supporters and women led to in-depth insider knowledge of women's lives and to gain a more authentic consideration of new motherhood:
‘I think we only generally see women the first couple of weeks, husbands are at home, everything's still euphoric, baby's brilliant....men go back to work and then women tend to find they're struggling....and generally they're the times they drop off and you wouldn't necessarily be able to contact them. Whereas now because you're in, you can see it, and I was really shocked by the amount of women, by about week four or five were sort of hitting rock bottom' (Peer Supporters).
Peer supporters were also more frequently challenged by the new and/or unfamiliar breastfeeding issues being raised, and this developed their breastfeeding knowledge and skills:
‘We can't get through the door for many reasons, so I was feeling a bit jaded that actually my skills......sat at a phone just going through how many times your baby's weed and pooed and is everything going OK.....whereas this, it's sort of put a bit of blood in our.... it gave us a bit..... oh I'm using loads of my skills now' (Peer Supporters).
Whilst the development of professional-based and person-centred capacities had been an unexpected feature of the incentives, the Star Buddies greatly appreciated the 'buzz' it had created. The incentive intervention was considered to have harnessed the peer supporters enthusiasm and motivation for their role; enabling them to be the supporters they had envisioned:
‘It's just doing what we're meant to do and what we're trained to do in a really valuable, meaningful way. Face to face makes all the difference, that's what it is' (Peer Supporters).