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Review question/objective The review question is ‘how effective are and what is the level of maternal satisfaction with interventions supporting breast-feeding establishment for women considered “disadvantaged” due to socio-demographic characteristics?’ Specific quantitative and qualitative objectives are: Describe the interventions available to support the establishment of breast-feeding for women from disadvantaged groups Assess the effectiveness of support interventions for women from disadvantaged groups as determined by the establishment of breast-feeding in the early postnatal period Explore the maternal satisfaction of women from disadvantaged groups in relation to their views and perceptions of the usefulness and acceptability of interventions supporting the establishment of breast-feeding in the early postnatal period Operational definitions: Breast-feeding: establishment of breast-feeding will be defined as feeding an infant by breast or predominantly feeding expressed breast milk by gastric feeding tube. Postnatal period: for this review the early postnatal period will be considered as up to seven days following delivery. 1 This is to coincide with the expected establishment of lactogenesis. Disadvantaged groups: for the purpose of this review disadvantaged groups will be classified as populations who are at increased risk of health inequalities due to specific socio-demographic characteristics. 2 These are determined as residing in areas of socio-economic deprivation; low income; under 20 years of age; substance dependent or eligible for the special supplementary nutrition program for Women, Infant and Child (WIC) in the United States of America (USA). Support: any intervention provided to women from disadvantaged groups to facilitate establishment of breast-feeding/lactation and may include but not limited to practical, motivational, informative or educational assistance. Inclusion criteria Types of participants The quantitative and qualitative components of this review will consider studies that include disadvantaged women who have elected to breastfeed. Eligible studies are those researching women who would be considered disadvantaged due to socio-economic-demographic characteristics. These include women who are of low income, from areas of socio-economic deprivation, under 20 years of age, substance dependent or eligible for the special supplementary nutrition program for WIC in the USA. Studies which include disadvantaged groups in their research on the general population of breast-feeding women, but they are not the explicit focus of the study, shall be excluded due to the potential moderating effect on the reported data. Subgroups with low breastfeeding initiation due to ethnic, cultural or specific religious practices, and therefore not representational of other disadvantaged women, shall be excluded. Types of intervention(s)/phenomena of interest The quantitative components of the review will consider studies that evaluate the effectiveness of professionally led practices designed to support breast-feeding establishment during the early postnatal period for women from disadvantaged groups. The phenomena of interest for the qualitative component of the review will be the perceptions and experiences of women from disadvantaged groups of professionally led breast-feeding support provision and their expressed level of satisfaction with the intervention. Breast-feeding support interventions may include or take the form of: - informative and /or educational - practical - motivational. The intervention may be either a combination of all/some of the support elements or delivered as a single intervention. The intervention will be professionally led and delivered in an in-hospital setting by one or more of the following: -  midwife -  midwifery support worker -  nurse/neonatal nurse - breast-feeding support worker - lactation consultant. Interventions delivered by peer/lay counselors or requiring continued support/supervision outside the early postnatal period will be excluded. Types of outcomes This review will consider studies that include the following outcome measures: (1) Effectiveness of the intervention to support the establishment of breast-feeding/lactation within the early postnatal period, as determined as fully fed at the breast or receiving predominantly breast milk by gastric feeding tube.  (2) Level of maternal satisfaction as determined by the views and perceptions of disadvantaged women on the usefulness and acceptability of the intervention to support breast-feeding establishment in the early postnatal period.

jbi database of systematic reviews and implementation reports

The effectiveness and maternal satisfaction of interventions supporting the establishment of breast-feeding for women from disadvantaged groups: a comprehensive systematic review protocol