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class="bkr_bib"><h1 id="_NBK571565_"><span itemprop="name">Formula feeding information and support</span></h1><div class="subtitle">Postnatal care</div><p><b>Evidence review T</b></p><p><i>NICE Guideline, No. 194</i></p><p class="contrib-group"><h4>Authors</h4><span itemprop="author">National Guideline Alliance (UK)</span>.</p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2021 Apr</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-4078-3</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2021.</div></div><div class="bkr_clear"></div></div><div id="niceng194er21.s1"><h2 id="_niceng194er21_s1_">Formula feeding information and support</h2><div id="niceng194er21.s1.1"><h3>Review question</h3><p>This evidence report contains information on 2 qualitative reviews designed to identify what information and support women find useful with formula feeding. The committee anticipated that the relevant studies would have an overlapping focus on information and support in relation to formula feeding. For this reason, they agreed it would be appropriate for the reviews to be analysed and reported together in a single evidence report. The review questions are:
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<ul><li class="half_rhythm"><div>What information on formula feeding do parents find helpful?</div></li><li class="half_rhythm"><div>What support with formula feeding do parents find helpful?</div></li></ul></p><div id="niceng194er21.s1.1.1"><h4>Introduction</h4><p>Breastfeeding is known to have some benefits on mothers and babies, when compared with formula feeding. The benefits include lower rates of infection in the babies and reduced risk of breast cancer in the mothers. However, some mothers choose bottle feeding while others struggle to establish satisfactory breast feeding. This review aims to determine what information and support on formula feeding parents find helpful antenatally and within the first 8 weeks after birth.</p></div><div id="niceng194er21.s1.1.2"><h4>Summary of the protocol</h4><p>See <a class="figpopup" href="/books/NBK571565/table/niceng194er21.tab1/?report=objectonly" target="object" rid-figpopup="figniceng194er21tab1" rid-ob="figobniceng194er21tab1">Table 1</a> for a summary of the Population, (Phenomenon of) Interest, Context (PICo) characteristics of this review.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng194er21tab1"><a href="/books/NBK571565/table/niceng194er21.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figniceng194er21tab1" rid-ob="figobniceng194er21tab1"><img class="small-thumb" src="/books/NBK571565/table/niceng194er21.tab1/?report=thumb" src-large="/books/NBK571565/table/niceng194er21.tab1/?report=previmg" alt="Table 1. Summary of the protocol (PICo table)." /></a><div class="icnblk_cntnt"><h4 id="niceng194er21.tab1"><a href="/books/NBK571565/table/niceng194er21.tab1/?report=objectonly" target="object" rid-ob="figobniceng194er21tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">Summary of the protocol (PICo table). </p></div></div><p>For further details see the review protocol in <a href="#niceng194er21.appa">appendix A</a>.</p></div><div id="niceng194er21.s1.1.3"><h4>Methods and process</h4><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual 2014</a>. Methods specific to this review question are described in the review protocol in <a href="#niceng194er21.appa">appendix A</a>.</p><p>Declarations of interest were recorded according to NICE’s 2014 conflicts of interest policy until March 2018. From April 2018 until June 2019, declarations of interest were recorded according to NICE’s 2018 conflicts of interest policy. From July 2019 onwards, the declarations of interest were recorded according to NICE’s 2019 <a href="https://www.nice.org.uk/about/who-we-are/policies-and-procedures" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">conflicts of interest policy</a>. Those interests declared before July 2019 were reclassified according to NICE’s 2019 conflicts of interest policy (see Register of Interests).</p></div><div id="niceng194er21.s1.1.4"><h4>Clinical evidence</h4><div id="niceng194er21.s1.1.4.1"><h5>Included studies</h5><p>Fourteen qualitative studies were included in this review (with 8 included for the information question and 9 included for the support question, although these were not always mutually exclusive with 3 papers reporting data on both). Eleven studies collected data from interviews or focus groups (<a class="bibr" href="#niceng194er21.s1.1.ref3" rid="niceng194er21.s1.1.ref3">Hoddinott 2000</a>, <a class="bibr" href="#niceng194er21.s1.1.ref2" rid="niceng194er21.s1.1.ref2">Hoddinott 1999</a>, <a class="bibr" href="#niceng194er21.s1.1.ref4" rid="niceng194er21.s1.1.ref4">Hoddinott 2012</a>, <a class="bibr" href="#niceng194er21.s1.1.ref5" rid="niceng194er21.s1.1.ref5">Hughes 1997</a>, <a class="bibr" href="#niceng194er21.s1.1.ref6" rid="niceng194er21.s1.1.ref6">Keely 2015</a>, <a class="bibr" href="#niceng194er21.s1.1.ref7" rid="niceng194er21.s1.1.ref7">Lagan 2014</a>, <a class="bibr" href="#niceng194er21.s1.1.ref8" rid="niceng194er21.s1.1.ref8">Martyn 1997</a>, <a class="bibr" href="#niceng194er21.s1.1.ref9" rid="niceng194er21.s1.1.ref9">Murphy 2000</a>, <a class="bibr" href="#niceng194er21.s1.1.ref12" rid="niceng194er21.s1.1.ref12">Sherriff 2009</a>, <a class="bibr" href="#niceng194er21.s1.1.ref13" rid="niceng194er21.s1.1.ref13">Stewart-Knox 2003</a>, <a class="bibr" href="#niceng194er21.s1.1.ref14" rid="niceng194er21.s1.1.ref14">Williamson 2012</a>); 2 studies collected data from surveys with open ended questions (<a class="bibr" href="#niceng194er21.s1.1.ref1" rid="niceng194er21.s1.1.ref1">Graffy 2005</a>, <a class="bibr" href="#niceng194er21.s1.1.ref10" rid="niceng194er21.s1.1.ref10">Redshaw 2012</a>); and 1 study collected data from interviews or focus groups and surveys with open ended questions (<a class="bibr" href="#niceng194er21.s1.1.ref11" rid="niceng194er21.s1.1.ref11">Roberts 2009</a>). It is likely that <a class="bibr" href="#niceng194er21.s1.1.ref3" rid="niceng194er21.s1.1.ref3">Hoddinott 2000</a> and <a class="bibr" href="#niceng194er21.s1.1.ref2" rid="niceng194er21.s1.1.ref2">Hoddinott 1999</a> are presenting qualitative data from the same 21 women, however since there is limited information on study dates, this cannot be confirmed. Each study presents different themes, therefore there are no concerns with duplicating information. The studies have been presented as separate publications.</p><p>One study (<a class="bibr" href="#niceng194er21.s1.1.ref11" rid="niceng194er21.s1.1.ref11">Roberts 2009</a>) assessed the feasibility and acceptability of future infant feeding video support after hospital discharge and investigated general views on the potential of other communication technology in rural Scotland. Since this study was assessing infant feeding, the themes from this study appear in both the breastfeeding and formula feeding reviews.</p><p>Three studies specifically evaluated formula feeding (<a class="bibr" href="#niceng194er21.s1.1.ref7" rid="niceng194er21.s1.1.ref7">Lagan 2014</a>, <a class="bibr" href="#niceng194er21.s1.1.ref8" rid="niceng194er21.s1.1.ref8">Martyn 1997</a>, <a class="bibr" href="#niceng194er21.s1.1.ref5" rid="niceng194er21.s1.1.ref5">Hughes 1997</a>), 6 studies evaluated infant feeding which included both breastfeeding and formula feeding (<a class="bibr" href="#niceng194er21.s1.1.ref2" rid="niceng194er21.s1.1.ref2">Hoddinott 1999</a>, <a class="bibr" href="#niceng194er21.s1.1.ref3" rid="niceng194er21.s1.1.ref3">Hoddinott 2000</a>, <a class="bibr" href="#niceng194er21.s1.1.ref4" rid="niceng194er21.s1.1.ref4">Hoddinott 2012</a>, <a class="bibr" href="#niceng194er21.s1.1.ref9" rid="niceng194er21.s1.1.ref9">Murphy 2000</a>, <a class="bibr" href="#niceng194er21.s1.1.ref10" rid="niceng194er21.s1.1.ref10">Redshaw 2012</a>, <a class="bibr" href="#niceng194er21.s1.1.ref11" rid="niceng194er21.s1.1.ref11">Roberts 2009</a>) and 5 studies primarily evaluated breastfeeding but formula feeding was also discussed (<a class="bibr" href="#niceng194er21.s1.1.ref1" rid="niceng194er21.s1.1.ref1">Graffy 2005</a>, <a class="bibr" href="#niceng194er21.s1.1.ref6" rid="niceng194er21.s1.1.ref6">Keely 2015</a>, <a class="bibr" href="#niceng194er21.s1.1.ref12" rid="niceng194er21.s1.1.ref12">Sherriff 2009</a>, <a class="bibr" href="#niceng194er21.s1.1.ref13" rid="niceng194er21.s1.1.ref13">Stewart-Knox 2003</a>, <a class="bibr" href="#niceng194er21.s1.1.ref14" rid="niceng194er21.s1.1.ref14">Williamson 2012</a>). These latter 5 breastfeeding studies were all identified from review S examining the breastfeeding information and support that parents find helpful.</p><p>Some studies focused on participants’ experiences up to 10 weeks postpartum. It was agreed with the committee that this threshold was close enough to the 8 weeks’ threshold and that the population was similar to that of interest in the review, so these studies were checked to see if they would add any additional themes to the review or if they should be excluded based on data saturation. Four studies (<a class="bibr" href="#niceng194er21.s1.1.ref2" rid="niceng194er21.s1.1.ref2">Hoddinott 1999</a>, <a class="bibr" href="#niceng194er21.s1.1.ref3" rid="niceng194er21.s1.1.ref3">Hoddinott 2000</a>, <a class="bibr" href="#niceng194er21.s1.1.ref8" rid="niceng194er21.s1.1.ref8">Martyn 1997</a>, <a class="bibr" href="#niceng194er21.s1.1.ref6" rid="niceng194er21.s1.1.ref6">Keely 2015</a>) covered a period up to the first 10 weeks and were included because they contributed to the review with new themes. Moreover, some studies interviewed women later than 8 weeks after birth, but referred to the time period of interest and so were included. These studies were: Sherriff 2018, which interviewed fathers with young babies between 6 weeks and 11 months of age, <a class="bibr" href="#niceng194er21.s1.1.ref4" rid="niceng194er21.s1.1.ref4">Hoddinott 2012</a>, which interviewed women every 4 weeks over a period of 6 months, <a class="bibr" href="#niceng194er21.s1.1.ref7" rid="niceng194er21.s1.1.ref7">Lagan 2014</a> which interviewed women who were 4 to 8 months postpartum, <a class="bibr" href="#niceng194er21.s1.1.ref9" rid="niceng194er21.s1.1.ref9">Murphy 2000</a> which conducted interviews antenatally and at 5 intervals over the following two years and <a class="bibr" href="#niceng194er21.s1.1.ref10" rid="niceng194er21.s1.1.ref10">Redshaw 2012</a> whose questionnaire was returned by women whose infants were a mean age of 15.5 weeks old (range 13 to 28 weeks). In all cases, data were extracted in relation to their experiences of antenatal information and support, as this time period is relevant to this review.</p><p>One study (<a class="bibr" href="#niceng194er21.s1.1.ref11" rid="niceng194er21.s1.1.ref11">Roberts 2009</a>) specifically evaluated the response to an intervention or proposed intervention. <a class="bibr" href="#niceng194er21.s1.1.ref11" rid="niceng194er21.s1.1.ref11">Roberts 2009</a> evaluated women’s opinions on whether a video support service would be well received.</p><p>One study only included fathers (<a class="bibr" href="#niceng194er21.s1.1.ref12" rid="niceng194er21.s1.1.ref12">Sheriff 2009</a>), and 1 study included women and their significant others (<a class="bibr" href="#niceng194er21.s1.1.ref4" rid="niceng194er21.s1.1.ref4">Hoddinott 2012</a>), the remaining 12 studies only included mothers.</p><p>Four studies did not report the age of the participants (<a class="bibr" href="#niceng194er21.s1.1.ref8" rid="niceng194er21.s1.1.ref8">Martyn 1997</a>, <a class="bibr" href="#niceng194er21.s1.1.ref9" rid="niceng194er21.s1.1.ref9">Murphy 2000</a>, <a class="bibr" href="#niceng194er21.s1.1.ref12" rid="niceng194er21.s1.1.ref12">Sherriff 2009</a> and <a class="bibr" href="#niceng194er21.s1.1.ref13" rid="niceng194er21.s1.1.ref13">Stewart-Knox 2003</a>) the remaining studies recruited women typically from 16 years to 40’s.</p><p>One study mentioned a participant who had given birth to twins (<a class="bibr" href="#niceng194er21.s1.1.ref5" rid="niceng194er21.s1.1.ref5">Hughes 1997</a>), but no themes or papers specific to twins or triplets were identified.</p><p>Five studies recruited primiparous mothers (<a class="bibr" href="#niceng194er21.s1.1.ref2" rid="niceng194er21.s1.1.ref2">Hoddinott 1999</a>, <a class="bibr" href="#niceng194er21.s1.1.ref3" rid="niceng194er21.s1.1.ref3">Hoddinott 2000</a>, <a class="bibr" href="#niceng194er21.s1.1.ref5" rid="niceng194er21.s1.1.ref5">Hughes 1997</a>, <a class="bibr" href="#niceng194er21.s1.1.ref9" rid="niceng194er21.s1.1.ref9">Murphy 2000</a>, <a class="bibr" href="#niceng194er21.s1.1.ref14" rid="niceng194er21.s1.1.ref14">Williamson 2012</a>). Seven studies recruited a mixture of primiparous and multiparous mothers (<a class="bibr" href="#niceng194er21.s1.1.ref1" rid="niceng194er21.s1.1.ref1">Graffy 2005</a>, <a class="bibr" href="#niceng194er21.s1.1.ref4" rid="niceng194er21.s1.1.ref4">Hoddinott 2012</a>, <a class="bibr" href="#niceng194er21.s1.1.ref7" rid="niceng194er21.s1.1.ref7">Lagan 2014</a>, <a class="bibr" href="#niceng194er21.s1.1.ref8" rid="niceng194er21.s1.1.ref8">Martyn 1997</a>, <a class="bibr" href="#niceng194er21.s1.1.ref10" rid="niceng194er21.s1.1.ref10">Redshaw 2012</a>, <a class="bibr" href="#niceng194er21.s1.1.ref11" rid="niceng194er21.s1.1.ref11">Roberts 2009</a>, <a class="bibr" href="#niceng194er21.s1.1.ref13" rid="niceng194er21.s1.1.ref13">Stewart-Knox 2003</a>,). One study did not report whether the mothers were primiparous or multiparous (<a class="bibr" href="#niceng194er21.s1.1.ref6" rid="niceng194er21.s1.1.ref6">Keely 2015</a>). The study that recruited fathers (<a class="bibr" href="#niceng194er21.s1.1.ref12" rid="niceng194er21.s1.1.ref12">Sheriff 2009</a>), recruited a mixture of first-time fathers and fathers with previous children.</p><p>Four studies specifically recruited participants from socially deprived areas or recruited only working class women (<a class="bibr" href="#niceng194er21.s1.1.ref2" rid="niceng194er21.s1.1.ref2">Hoddinott 1999</a>, <a class="bibr" href="#niceng194er21.s1.1.ref3" rid="niceng194er21.s1.1.ref3">Hoddinott 2000</a>, <a class="bibr" href="#niceng194er21.s1.1.ref4" rid="niceng194er21.s1.1.ref4">Hoddinott 2012</a>, <a class="bibr" href="#niceng194er21.s1.1.ref5" rid="niceng194er21.s1.1.ref5">Hughes 1997</a>). One study did not report on the socio-economic status, employment or education of their participants (<a class="bibr" href="#niceng194er21.s1.1.ref8" rid="niceng194er21.s1.1.ref8">Martyn 1997</a>). The remaining 9 studies (<a class="bibr" href="#niceng194er21.s1.1.ref1" rid="niceng194er21.s1.1.ref1">Graffy 2005</a>, <a class="bibr" href="#niceng194er21.s1.1.ref6" rid="niceng194er21.s1.1.ref6">Keely 2015</a>, <a class="bibr" href="#niceng194er21.s1.1.ref7" rid="niceng194er21.s1.1.ref7">Lagan 2014</a>, <a class="bibr" href="#niceng194er21.s1.1.ref9" rid="niceng194er21.s1.1.ref9">Murphy 2000</a>, <a class="bibr" href="#niceng194er21.s1.1.ref10" rid="niceng194er21.s1.1.ref10">Redshaw 2012</a>, <a class="bibr" href="#niceng194er21.s1.1.ref11" rid="niceng194er21.s1.1.ref11">Roberts 2009</a>, <a class="bibr" href="#niceng194er21.s1.1.ref12" rid="niceng194er21.s1.1.ref12">Sherriff 2009</a>, <a class="bibr" href="#niceng194er21.s1.1.ref13" rid="niceng194er21.s1.1.ref13">Stewart-Knox 2003</a>, <a class="bibr" href="#niceng194er21.s1.1.ref14" rid="niceng194er21.s1.1.ref14">Williamson 2012</a>) either reported that participants came from a mixed socio-economic background or reported the participants’ education level and/or their employment level, from which we have assumed participants came from a mixed socio-economic background.</p><p>Three studies recruited all White participants (<a class="bibr" href="#niceng194er21.s1.1.ref2" rid="niceng194er21.s1.1.ref2">Hoddinott 1999</a>, <a class="bibr" href="#niceng194er21.s1.1.ref3" rid="niceng194er21.s1.1.ref3">Hoddinott 2000</a> and <a class="bibr" href="#niceng194er21.s1.1.ref14" rid="niceng194er21.s1.1.ref14">Williamson 2012</a>). Three studies recruited a population that was majority White with a small proportion of other ethnicities or countries of origin (<a class="bibr" href="#niceng194er21.s1.1.ref6" rid="niceng194er21.s1.1.ref6">Keely 2015</a>, <a class="bibr" href="#niceng194er21.s1.1.ref7" rid="niceng194er21.s1.1.ref7">Lagan 2014</a>, <a class="bibr" href="#niceng194er21.s1.1.ref9" rid="niceng194er21.s1.1.ref9">Murphy 2000</a>). <a class="bibr" href="#niceng194er21.s1.1.ref1" rid="niceng194er21.s1.1.ref1">Graffy 2005</a> and <a class="bibr" href="#niceng194er21.s1.1.ref10" rid="niceng194er21.s1.1.ref10">Redshaw 2012</a> were the only studies to include a significant number (>10%) of people from ethnic minorities (either African, Caribbean or from the Indian subcontinent). The remaining 6 studies (<a class="bibr" href="#niceng194er21.s1.1.ref4" rid="niceng194er21.s1.1.ref4">Hoddinott 2012</a>, <a class="bibr" href="#niceng194er21.s1.1.ref5" rid="niceng194er21.s1.1.ref5">Hughes 1997</a>, <a class="bibr" href="#niceng194er21.s1.1.ref8" rid="niceng194er21.s1.1.ref8">Martyn 1997</a>, <a class="bibr" href="#niceng194er21.s1.1.ref11" rid="niceng194er21.s1.1.ref11">Roberts 2009</a>, <a class="bibr" href="#niceng194er21.s1.1.ref12" rid="niceng194er21.s1.1.ref12">Sherriff 2009</a>, <a class="bibr" href="#niceng194er21.s1.1.ref13" rid="niceng194er21.s1.1.ref13">Stewart-Knox 2003</a>) did not report the ethnicity of their participants.</p><p>Most studies did not report the mode of birth. Those that did (n=2) reported a variety of modes of birth.</p><p>Data from the included studies were explored in a number of central themes and subthemes:</p><div id="niceng194er21.s1.1.4.1.1"><h5>Theme 1. Information</h5><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>Sub-theme 1.1.</dt><dd><p class="no_top_margin">Lack of information provision – especially compared to breastfeeding parents</p></dd></dl><dl class="bkr_refwrap"><dt>Sub-theme 1.2.</dt><dd><p class="no_top_margin">Inconsistent and poor communication of information</p></dd></dl><dl class="bkr_refwrap"><dt>Sub-theme 1.3.</dt><dd><p class="no_top_margin">Receiving information antenatally</p></dd></dl><dl class="bkr_refwrap"><dt>Sub-theme 1.4.</dt><dd><p class="no_top_margin">Sources of information</p></dd></dl></dl></div><div id="niceng194er21.s1.1.4.1.2"><h5>Theme 2. Feeling unsupported if choosing to formula feed</h5><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>Sub-theme 2.1.</dt><dd><p class="no_top_margin">How others interacted with formula feeding parents</p></dd></dl><dl class="bkr_refwrap"><dt>Sub-theme 2.2.</dt><dd><p class="no_top_margin">Feeling neglected – especially compared to breastfeeding mothers</p></dd></dl><dl class="bkr_refwrap"><dt>Sub-theme 2.3.</dt><dd><p class="no_top_margin">Switching from breast to formula feeding</p></dd></dl></dl></div><div id="niceng194er21.s1.1.4.1.3"><h5>Theme 3. Remote support</h5><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>Sub-theme 3.1.</dt><dd><p class="no_top_margin">Remote support as extra support as opposed to replacing face-to-face support</p></dd></dl><dl class="bkr_refwrap"><dt>Sub-theme 3.2.</dt><dd><p class="no_top_margin">Timing of remote support</p></dd></dl><dl class="bkr_refwrap"><dt>Sub-theme 3.3.</dt><dd><p class="no_top_margin">Response time of different communication technologies</p></dd></dl><dl class="bkr_refwrap"><dt>Sub-theme 3.3.</dt><dd><p class="no_top_margin">Privacy and security of video support</p></dd></dl><dl class="bkr_refwrap"><dt>Sub-theme 3.4.</dt><dd><p class="no_top_margin">Location of video support</p></dd></dl></dl></div><div id="niceng194er21.s1.1.4.1.4"><h5>Theme 4. Fathers are able to support better when formula feeding</h5><p>The included studies are summarised in <a class="figpopup" href="/books/NBK571565/table/niceng194er21.tab2/?report=objectonly" target="object" rid-figpopup="figniceng194er21tab2" rid-ob="figobniceng194er21tab2">Table 2</a>.</p><p>See the literature search strategy in <a href="#niceng194er21.appb">appendix B</a> and study selection flow chart in <a href="#niceng194er21.appc">appendix C</a>.</p></div></div><div id="niceng194er21.s1.1.4.2"><h5>Excluded studies</h5><p>Studies not included in this review with reasons for their exclusion are provided in <a href="#niceng194er21.appk">appendix K</a>.</p></div></div><div id="niceng194er21.s1.1.5"><h4>Summary of studies included in the evidence review</h4><p>A summary of the studies that were included in this review are presented in <a class="figpopup" href="/books/NBK571565/table/niceng194er21.tab2/?report=objectonly" target="object" rid-figpopup="figniceng194er21tab2" rid-ob="figobniceng194er21tab2">Table 2</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng194er21tab2"><a href="/books/NBK571565/table/niceng194er21.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figniceng194er21tab2" rid-ob="figobniceng194er21tab2"><img class="small-thumb" src="/books/NBK571565/table/niceng194er21.tab2/?report=thumb" src-large="/books/NBK571565/table/niceng194er21.tab2/?report=previmg" alt="Table 2. Summary of included studies." /></a><div class="icnblk_cntnt"><h4 id="niceng194er21.tab2"><a href="/books/NBK571565/table/niceng194er21.tab2/?report=objectonly" target="object" rid-ob="figobniceng194er21tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Summary of included studies. </p></div></div><p>See the full evidence tables in <a href="#niceng194er21.appd">appendix D</a>. No meta-analysis was conducted (and so there are no forest plots in <a href="#niceng194er21.appe">appendix E</a>).</p></div><div id="niceng194er21.s1.1.6"><h4>Quality assessment of clinical outcomes included in the evidence review</h4><p>See the evidence profiles in <a href="#niceng194er21.appf">appendix F</a>.</p></div><div id="niceng194er21.s1.1.7"><h4>Economic evidence</h4><div id="niceng194er21.s1.1.7.1"><h5>Included studies</h5><p>A single economic search was undertaken for all topics included in the scope of this guideline but no economic studies were identified which were applicable to this review question. See the literature search strategy in <a href="#niceng194er21.appb">appendix B</a> and economic study selection flow chart in <a href="#niceng194er21.appg">appendix G</a>.</p></div><div id="niceng194er21.s1.1.7.2"><h5>Excluded studies</h5><p>No economic studies were reviewed at full text and excluded from this review.</p></div></div><div id="niceng194er21.s1.1.8"><h4>Economic model</h4><p>No economic modelling was conducted for this review question because the committee agreed that other topics were higher priorities for economic evaluation.</p></div><div id="niceng194er21.s1.1.9"><h4>Evidence statements</h4><div id="niceng194er21.s1.1.9.1"><h5>Clinical evidence statements</h5><div id="niceng194er21.s1.1.9.1.1"><h5>Theme 1. Information</h5><div id="niceng194er21.s1.1.9.1.1.1"><h5>Sub theme 1.1. Lack of information provision – especially compared to breastfeeding parents</h5><ul><li class="half_rhythm"><div>High quality evidence from 6 studies (N=155) reported on this theme. Women felt that they were never given any information or help with formula feeding, for example with preparing bottle feeds, how much to feed their baby and how to interpret their baby’s behaviours and how to respond appropriately. Women were specifically interested in information on the nutritional content of baby milk, provided in a user friendly format. All the information, leaflets and discussions were focused on breastfeeding. Women were also not specifically aware about the implications of introducing bottle feeding early on and how that might impact breastfeeding.</div></li></ul></div><div id="niceng194er21.s1.1.9.1.1.2"><h5>Sub theme 1.2. Inconsistent and poor communication of information</h5><ul><li class="half_rhythm"><div>High quality evidence from 2 studies (N=129) reported on this theme. Women reported being given contradictory information by different members of staff. Poor communication and conflicting advice left women feeling confused and demoralised. Women expressed a desire for continuity of care, particularly for the aim of successful infant feeding.</div></li></ul></div><div id="niceng194er21.s1.1.9.1.1.3"><h5>Sub theme 1.3. Receiving information antenatally</h5><ul><li class="half_rhythm"><div>High quality evidence from 2 studies (N=56) reported on this theme. Women who had attended antenatal care sessions reported that they were taught about breastfeeding, but not about formula feeding. Women were left to self-educate or learn from friends and family but they would have appreciated learning about breast and formula feeding at the same time with an open discussion about both. In addition, women wanted healthcare professionals to show them how for example to make up a bottle, if only to confirm their self-education was correct. Women also wanted skilled facilitation of interactive discussions with individuals, families or groups regardless of feeding intention, which cover the practical and emotional realities of breast and formula feeding and involve parents who have had feeding difficulties and not always lived up to ideals.</div></li></ul></div><div id="niceng194er21.s1.1.9.1.1.4"><h5>Sub theme 1.4. Sources of information</h5><ul><li class="half_rhythm"><div>Moderate quality evidence from 2 studies (N=41) reported on this theme. Women tended to approach friends and family for advice and information on formula feeding before contacting a healthcare professional. However, they would have preferred to receive this information directly from healthcare professionals.</div></li></ul></div></div><div id="niceng194er21.s1.1.9.1.2"><h5>Theme 2. Feeling unsupported if choosing to formula feed</h5><div id="niceng194er21.s1.1.9.1.2.1"><h5>Sub theme 2.1. How others interacted with formula feeding parents</h5><ul><li class="half_rhythm"><div>Moderate quality evidence from 5 studies (N=2153) reported on this theme. If women have chosen to formula feed, they did not want to hear comments that made them feel pressured, guilty, like a failure or inadequate, similarly they did not want to be spoken to ‘like naughty children’ or ‘reprimanded’ for not breastfeeding. In addition, women who were unable to breastfeed were left feeling like they were causing their babies harm by switching to formula feeding. However, some women found healthcare professionals were able to offer words of comfort when they added formula to their feeding schedule.</div></li></ul></div><div id="niceng194er21.s1.1.9.1.2.2"><h5>Sub theme 2.2. Feeling neglected, especially compared to breastfeeding mothers</h5><p>High quality evidence from 3 studies (N=1495) reported on this theme. Women formula feeding felt unsupported and neglected with their postnatal care, particularly when compared to women who were breastfeeding.</p></div><div id="niceng194er21.s1.1.9.1.2.3"><h5>Sub theme 2.3. Switching from breast to formula feeding</h5><ul><li class="half_rhythm"><div>Low quality evidence from 1 study (N=38) reported on this theme. The care provided by health care professionals when women were choosing to change from breast to formula feeding could influence whether a women felt supported or judged.</div></li></ul></div></div><div id="niceng194er21.s1.1.9.1.3"><h5>Theme 3. Remote support</h5><div id="niceng194er21.s1.1.9.1.3.1"><h5>Sub theme 3.1. Remote support to complement rather than replace face-to-face support</h5><ul><li class="half_rhythm"><div>Moderate quality evidence from 1 study (N=91) reported on this theme. Women had concerns about the impact that support provided via video might have on existing services. Women did not want new technologies to replace or reduce face-to-face contact during the postnatal period. Women were concerned about over-reliance on remote support and the possibility of technological solutions being used in order to save money.</div></li></ul></div><div id="niceng194er21.s1.1.9.1.3.2"><h5>Sub theme 3.2. Timing of remote support</h5><ul><li class="half_rhythm"><div>Moderate quality evidence from 1 study (N=91) reported on this theme. Women thought that remote support was especially useful during ‘out of hours’, when face-to-face support is not readily available.</div></li></ul></div><div id="niceng194er21.s1.1.9.1.3.3"><h5>Sub theme 3.3. Response time of different communication technologies</h5><ul><li class="half_rhythm"><div>Moderate quality evidence from 1 study (N=91) reported on this theme. Women said that e-mail and text messaging facilities were easier to use and more accessible than video. However, they wondered whether support would be available instantly and whether they would know if a text or e-mail had been successfully delivered. Women also made positive references to national websites currently sending weekly information via e-mail to registered mothers.</div></li></ul></div><div id="niceng194er21.s1.1.9.1.3.4"><h5>Sub theme 3.4. Privacy and security of video support</h5><ul><li class="half_rhythm"><div>Low quality evidence from 1 study (N=91) reported on this theme. Views varied in relation to privacy and security issues. Some women said they were reluctant to use video because of privacy and security concerns, while others felt more confident as long as security was assured by service providers. Women said they would feel somewhat reassured about this if they were talking to familiar staff.</div></li></ul></div><div id="niceng194er21.s1.1.9.1.3.5"><h5>Sub theme 3.5. Location of video support</h5><ul><li class="half_rhythm"><div>Low quality evidence from 1 study (N=91) reported on this theme. Women valued receiving support from the comfort of their home. Women did not want to travel to use a video link facility, as in that case, they would rather travel to speak to a professional face-to-face. Women mentioned the challenges that some mothers can face in relation to leaving the home after giving birth (for example lack of personal transport, distance to travel, responsibilities of other children and the physical limitations after a difficult birth or caesarean section).</div></li></ul></div></div><div id="niceng194er21.s1.1.9.1.4"><h5>Theme 4. Fathers are better able to support when formula feeding</h5><ul><li class="half_rhythm"><div>Low quality evidence from 1 study (N=8) reported on this theme. Fathers felt that using formula could allow them to be more involved in feeding, assisting them to bond with the baby and to monitor how much the baby was taking.</div></li></ul></div></div><div id="niceng194er21.s1.1.9.2"><h5>Economic evidence statements</h5><p>No economic evidence was identified which was applicable to this review question.</p></div></div><div id="niceng194er21.s1.1.10"><h4>The committee’s discussion of the evidence</h4><div id="niceng194er21.s1.1.10.1"><h5>Interpreting the evidence</h5><div id="niceng194er21.s1.1.10.1.1"><h5>The outcomes that matter most</h5><p>This review focused on the information and support that parents find helpful for formula feeding. To address these issues the review was designed to included qualitative data and as a result the committee could not specify in advance the data that would be located. Instead they identified the following main themes to guide the review although the list was not exhaustive and the committee were aware that additional themes may be identified. Suggested themes for information included:
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<ul><li class="half_rhythm"><div>differences in types of bottles and teats</div></li><li class="half_rhythm"><div>differences in formula milks (brands,1st stage, 2nd stage etc.)</div></li><li class="half_rhythm"><div>frequency (routines) and volume of formula</div></li><li class="half_rhythm"><div>how to know when the infant has had enough/ too much milk</div></li><li class="half_rhythm"><div>the best environment to feed in and how to feed when out</div></li><li class="half_rhythm"><div>items to buy for bottle feeding</div></li><li class="half_rhythm"><div>cleaning and sterilising bottles</div></li><li class="half_rhythm"><div>how to make up feeds</div></li><li class="half_rhythm"><div>special formula milk (for example anticolic milk)</div></li><li class="half_rhythm"><div>responsive feeding – what stress cues to be aware of</div></li><li class="half_rhythm"><div>technique for feeding (burping etc.)</div></li><li class="half_rhythm"><div>machines available (‘perfect prep’ machines).</div></li></ul></p><p>Suggested themes for support included:
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<ul><li class="half_rhythm"><div>types of support, for example midwife, health visitor, GP, NCT group, maternity support worker, infant feeding specialist, helplines, telephone support, text support, children’s centres, internet resources, online forums</div></li><li class="half_rhythm"><div>emotional support, for example to help manage disappointment of being unable to breastfeed</div></li><li class="half_rhythm"><div>accessibility of support, for example out of hours, availability of appointments, language barriers, cost, when it should be given (antenatal / postnatal), frequency, where support is delivered (for example in home setting / support group)</div></li><li class="half_rhythm"><div>reliability, for example trust in the information given.</div></li></ul></p><p>The evidence review provided data relating to the themes set out in the protocol and additional themes that were not set out in the protocol. The committee were able to draft a number of recommendations in relation to the themes identified, however some of the studies were limited in the terms of the level of detail reported.</p></div><div id="niceng194er21.s1.1.10.1.2"><h5>The quality of the evidence</h5><p>The evidence was assessed using GRADE-CERQual methodology and the overall confidence in the findings ranged from low to high. The review findings were generally downgraded because of methodological limitations in the included studies, including, for example that data saturation was not discussed, that authors did not discuss the potential influence of the researchers and there was no discussion of contradictory data.</p><p>Some review findings were downgraded because of concerns about relevance for the context and population of interest to this guideline. Concerns ranged from minor to moderate, with the majority of review findings being minor. The most common concern was related to the transferability of findings to ethnic minorities. Some studies did not report information relating to ethnicity or socioeconomic status.</p><p>Concerns about coherence were no or very minor for all findings except one, ‘feeling supported with formula feeding’ which was rated moderate since studies indicated mothers felt supported and also unsupported with formula feeding.</p><p>Concerns about adequacy ranged from no or very minor to moderate. Moderate concerns were given to any theme that was supported by only 1 study of moderate quality.</p><p>The committee also highlighted that a number of the studies included in the review were published 15–20 years ago, with very few which provide an insight into the last 5 years. The committee agreed that the older studies may not provide an accurate or reliable insight of current formula feeding practice.</p></div><div id="niceng194er21.s1.1.10.1.3"><h5>Benefits and harms</h5><p>The committee agreed that breastfeeding has additional health benefits for both the baby and mother over formula feeding, nonetheless when discussing the baby’s feeding options with the parents, healthcare professionals should acknowledge that emotional, social, financial, and environmental factors come into play for parents when deciding whether to breastfeed or formula feed their baby. The evidence from this review showed that women who formula feed may feel judged by healthcare professionals. In view of this, healthcare professionals should be respectful of the parents’ choice when it comes to deciding whether to breastfeed or formula feed. The committee agreed that the content of the assessment should be aligned with recommendations on communications with women from the provision of information about the postnatal health of women in evidence review G.</p><p>The committee discussed the extent to which formula feeding should be discussed with parents during the antenatal period. Considering the amount of information that is provided to pregnant women during antenatal care, it would not be feasible or practical to provide information about formula feeding to women who are not considering it and who express they want to exclusively breastfeed. Therefore, the committee agreed that if parents are considering formula feeding, discussion around formula feeding should be held during pregnancy and continued after birth. In addition, those who need to formula feed for example, because they are advised not to breastfeed due to specific long-term medications, or have physiological or anatomical circumstances making exclusive breastfeeding unachievable should get information about formula feeding. The committee emphasised that this should occur before and after the baby is born, to ensure the mother has sufficient information and support to feed her baby. In the antenatal period, discussion and information provision is important so that women know what to expect and how to safely start formula feeding. However, the committee noted that discussion and information provision in the postnatal period is also crucial as some women might be more receptive of the information once they are actually feeding the baby.</p><p>The committee agreed that parents should be provided with a one-to-one discussion about safe formula feeding. The evidence showed that mothers did not want remote support to replace face-to-face support, so the committee recommended to provide face-to-face support. The committee also recommended that information from face-to-face support should be supplemented (not replaced) by written, digital, or telephone information to ensure accessibility for the mother and her family.</p><p>The evidence showed that mothers who were formula feeding felt they were not offered the same support or treated equally when compared to mothers who were breastfeeding. The committee therefore, tried to align their support recommendations with those from the breastfeeding review (see evidence review S). Similar recommendations were therefore made for face-to-face support about recognising feeding cues from the baby, paced bottle feeding, dangers of ‘prop’ feeding, appropriate feeding positions and bonding with their baby through good feeding practices. Paced bottle feeding is still a relatively new concept for healthcare professionals and parents, the committee agreed that feeding more slowly would most likely lead to more of the feed being taken by the baby and a less “windy, colicky” baby, thus aiding the feeding experience and ensure feeding is effective.</p><p>The evidence showed that some fathers were usually supportive of formula feeding because they perceived it as the only way in which they could bond with their baby. Some fathers were unaware that they could have an important role and still bond with their baby even if breastfeeding was the chosen method of feeding. Furthermore, sometimes feeding is used a way to sooth and comfort the baby, however, there may be a risk of overfeeding if this is done frequently for formula-fed babies. Therefore, the committee recommended to provide information about how to comfort and soothe the baby in other ways than feeding.</p><p>The evidence showed that there are multiple reasons why mothers do not seek information or support with formula feeding. Mothers felt they would be judged for wanting information or support on formula feeding, knowing it would go against the message from healthcare professionals that breastfeeding is best. For some mothers, formula feeding was not their first choice and they had intended to breastfeed. These mothers in particular would need sensitive support since there could be negative emotional consequences when being faced with, for whatever reason, the need to switch to formula feeding. In addition, mothers were unaware or did not have a good understanding of the support services available to them. The committee therefore recommended that where it is needed or requested information and support should be provided for mothers and families in a non-judgemental way.</p><p>Although no evidence was located about whether mothers and families understood the differences between breast milk and formula milk, the committee agreed this should be a key issue covered by the information being provided. They were unable to set out those differences (for example in terms of health benefits) in the recommendations because this was not within the remit of any of the review questions. On the basis of their expertise the committee agreed that in practice healthcare professionals would be able to draw on their own knowledge to provide this information to mothers and families.</p><p>The evidence presented to the committee did show that mothers who had chosen to formula feed lacked information on the different types of formula milk, how to safely prepare formula feeds and the volume of milk required when formula feeding. From the committees own experience, providing such information on how to formula feed properly could reduce the incidence of situations such as gastroenteritis and constipation of the baby that may be a direct consequence of inappropriate sterilising or making bottles up incorrectly. The committee therefore recommended that mothers and families who were formula feeding should be informed about first infant formulas (including how to interpret the nutritional information on the labels between the different brands), how to prepare formula (including a practical demonstration if requested), and the volume of formula milk required.</p><p>The committee discussed that some women choose to partially breastfeed and partially use formula to feed their babies. This ‘mixed feeding’ is common practice and may work well with some families. At the same time, the evidence showed that mothers who were trying to establish breastfeeding were unaware of the possible adverse effects of introducing formula on breastfeeding success. The committee therefore agreed that it is important to provide information about the ways to maintain adequate milk supply when supplementing with formula. In addition, the evidence showed that mothers who were considering or choosing to change from breastfeeding to formula feeding would feel unsupported by healthcare professionals in making this decision. The committee therefore recommended that to ensure mothers felt supported and could make informed decisions about infant feeding, that mothers should get balanced information about breastfeeding and formula feeding. This would help women to make an informed and guilt-free decision about supplementing with formula milk or changing from breastfeeding to formula feeding.</p></div></div><div id="niceng194er21.s1.1.10.2"><h5>Cost effectiveness and resource use</h5><p>No economic evidence is available for this review question. The committee agreed that providing information and support for formula feeding to parents entails small costs (additional health professional time), although some information and support is already provided in current practice. For parents who are formula feeding their babies, these recommendations are expected to reduce unsafe formula feeding patterns, increase parents’ knowledge and confidence, and improve babies’ feeding, thus improving health outcomes for the babies. Therefore, the committee expressed the view that the recommendations are likely to lead to efficient use of healthcare resources.</p></div><div id="niceng194er21.s1.1.10.3"><h5>Other factors the committee took into account</h5><p>The committee noted during protocol development that certain subgroups of women may require special consideration due to their potential vulnerability:
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<ul><li class="half_rhythm"><div>young women (19 years or under)</div></li><li class="half_rhythm"><div>women with physical or cognitive disabilities</div></li><li class="half_rhythm"><div>women with severe mental health illness</div></li><li class="half_rhythm"><div>women who have difficulty accessing postnatal care services.</div></li></ul></p><p>A stratified analysis was therefore predefined in the protocol based on these subgroups. However, considering the lack of evidence for these sub-groups, the committee agreed not to make separate recommendations and that the recommendations they did make should apply universally.</p></div></div><div id="niceng194er21.s1.1.reflist0"><h4>References</h4><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="niceng194er21.s1.1.ref1"><p id="p-183">
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<strong>Graffy 2005</strong>
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</p>Graffy, J., Taylor, J., What information, advice, and support do women want with breastfeeding?, Birth (Berkeley, Calif.), 32, 179–186, 2005 [<a href="https://pubmed.ncbi.nlm.nih.gov/16128971" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16128971</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng194er21.s1.1.ref2"><p id="p-184">
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<strong>Hoddinott 1999</strong>
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</p>Hoddinott, P., Pill, R., Neonatal. Nobody actually tells you: a study of infant feeding, British Journal of Midwifery, 7, 558–565, 1999</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng194er21.s1.1.ref3"><p id="p-185">
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<strong>Hoddinott 2000</strong>
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</p>Hoddinott
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P., Pill
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R., A qualitative study of women’s views about how health professionals communicate about infant feeding, Health Expectations, 3, 224–233, 2000 [<a href="/pmc/articles/PMC5060110/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5060110</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/11281933" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11281933</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng194er21.s1.1.ref4"><p id="p-186">
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<strong>Hoddinott 2012</strong>
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</p>Hoddinott, P., Craig, L. C. A., Britten, J., McInnes
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R. M., A serial qualitative interview study of infant feeding experiences: Idealism meets realism, BMJ Open, 2 (2) (no pagination), 2012 [<a href="/pmc/articles/PMC3307036/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3307036</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/22422915" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22422915</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng194er21.s1.1.ref5"><p id="p-187">
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<strong>Hughes 1997</strong>
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</p>Hughes, P., Rees, C., Clinical. Artificial feeding: choosing to bottle feed, British Journal of Midwifery, 5, 137–142, 1997</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng194er21.s1.1.ref6"><p id="p-188">
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<strong>Keely 2015</strong>
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</p>Keely, A., Lawton, J., Swanson, V., Denison, F. C., Barriers to breast-feeding in obese women: A qualitative exploration, Midwifery, 31, 532–9, 2015 [<a href="https://pubmed.ncbi.nlm.nih.gov/25726006" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25726006</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng194er21.s1.1.ref7"><p id="p-189">
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<strong>Lagan 2014</strong>
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</p>Lagan, B. M., Symon, A., Dalzell, J., Whitford, H., ‘The midwives aren’t allowed to tell you’: perceived infant feeding policy restrictions in a formula feeding culture - the Feeding Your Baby Study, Midwifery, 30, e49–e55, 2014 [<a href="https://pubmed.ncbi.nlm.nih.gov/24238979" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24238979</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng194er21.s1.1.ref8"><p id="p-190">
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<strong>Martyn 1997</strong>
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</p>Martyn, T., How mothers choose babymilk brands, Modern midwife, 7, 10–14, 1997 [<a href="https://pubmed.ncbi.nlm.nih.gov/9146224" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9146224</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng194er21.s1.1.ref9"><p id="p-191">
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<strong>Murphy 2000</strong>
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</p>Murphy, Elizabeth, Risk, responsibility, and rhetoric in infant feeding, Journal of Contemporary Ethnography, 29, 291–325, 2000</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng194er21.s1.1.ref10"><p id="p-192">
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<strong>Redshaw 2012</strong>
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</p>Redshaw, M., Henderson, J., Learning the Hard Way: Expectations and Experiences of Infant Feeding Support, Birth-Issues in Perinatal Care, 39, 21–29, 2012 [<a href="https://pubmed.ncbi.nlm.nih.gov/22369602" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22369602</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng194er21.s1.1.ref11"><p id="p-193">
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<strong>Roberts 2009</strong>
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</p>Roberts, A., Hoddinott, P., Heaney, D., Bryers, H., The use of video support for infant feeding after hospital discharge: A study in remote and rural Scotland, Maternal and Child Nutrition, 5, 347–357, 2009</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng194er21.s1.1.ref12"><p id="p-194">
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<strong>Sherriff 2009</strong>
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</p>Sherriff, N., Hall, V., Pickin, M., Fathers’ perspectives on breastfeeding: ideas for intervention, British Journal of Midwifery, 17, 223–227, 2009</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng194er21.s1.1.ref13"><p id="p-195">
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<strong>Stewart-Knox 2003</strong>
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</p>Stewart-Knox, B., Gardiner, K., Wright, M., What is the problem with breast-feeding? A qualitative analysis of infant feeding perceptions, Journal of Human Nutrition and Dietetics, 16, 265–273, 2003 [<a href="https://pubmed.ncbi.nlm.nih.gov/12859708" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12859708</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng194er21.s1.1.ref14"><p id="p-196">
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<strong>Williamson 2012</strong>
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</p>Williamson, I., Leeming, D., Lyttle, S., Johnson, S., ‘It should be the most natural thing in the world’: Exploring first-time mothers’ breastfeeding difficulties in the UK using audio-diaries and interviews, Maternal and Child Nutrition, 8, 434–447, 2012 [<a href="/pmc/articles/PMC6860601/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6860601</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/21696542" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21696542</span></a>]</div></p></li></ul></div></div></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng194er21.appa"><h3>Appendix A. Review protocols</h3><p id="niceng194er21.appa.et1"><a href="/books/NBK571565/bin/niceng194er21-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Review protocol for review question: What information on formula feeding do parents find helpful?</a><span class="small"> (PDF, 334K)</span></p><p id="niceng194er21.appa.et2"><a href="/books/NBK571565/bin/niceng194er21-appa-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Review protocol for review question: What support on formula feeding do parents find helpful?</a><span class="small"> (PDF, 300K)</span></p></div><div id="niceng194er21.appb"><h3>Appendix B. Literature search strategies</h3><p id="niceng194er21.appb.et1"><a href="/books/NBK571565/bin/niceng194er21-appb-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Literature search strategies for review questions: What information on formula feeding do parents find helpful? What support with formula feeding do parents find helpful?</a><span class="small"> (PDF, 481K)</span></p></div><div id="niceng194er21.appc"><h3>Appendix C. Clinical evidence study selection</h3><p id="niceng194er21.appc.et1"><a href="/books/NBK571565/bin/niceng194er21-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Clinical study selection for review questions: What information on formula feeding do parents find helpful? What support with formula feeding do parents find helpful?</a><span class="small"> (PDF, 224K)</span></p></div><div id="niceng194er21.appd"><h3>Appendix D. Clinical evidence tables</h3><p id="niceng194er21.appd.et1"><a href="/books/NBK571565/bin/niceng194er21-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Clinical evidence tables for review questions: What information on formula feeding do parents find helpful? What support with formula feeding do parents find helpful?</a><span class="small"> (PDF, 713K)</span></p></div><div id="niceng194er21.appe"><h3>Appendix E. Forest plots</h3><div id="niceng194er21.appe.s1"><h4>Forest plots for review questions: What information on formula feeding do parents find helpful? What support with formula feeding do parents find helpful?</h4><p>No meta-analysis was undertaken for this review and so there are no forest plots.</p></div></div><div id="niceng194er21.appf"><h3>Appendix F. GRADE-CERQual tables</h3><p id="niceng194er21.appf.et1"><a href="/books/NBK571565/bin/niceng194er21-appf-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">GRADE-CERQual tables for review questions: What information on formula feeding do parents find helpful? What support with formula feeding do parents find helpful?</a><span class="small"> (PDF, 432K)</span></p></div><div id="niceng194er21.appg"><h3>Appendix G. Economic evidence study selection</h3><p id="niceng194er21.appg.et1"><a href="/books/NBK571565/bin/niceng194er21-appg-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Economic evidence study selection for review questions: What information on formula feeding do parents find helpful? What support with formula feeding do parents find helpful?</a><span class="small"> (PDF, 280K)</span></p></div><div id="niceng194er21.apph"><h3>Appendix H. Economic evidence tables</h3><div id="niceng194er21.apph.s1"><h4>Economic evidence tables for review questions: What information on formula feeding do parents find helpful? What support with formula feeding do parents find helpful?</h4><p>No economic evidence was identified which was applicable to these review questions.</p></div></div><div id="niceng194er21.appi"><h3>Appendix I. Economic evidence profiles</h3><div id="niceng194er21.appi.s1"><h4>Economic evidence profiles for review questions: What information on formula feeding do parents find helpful? What support with formula feeding do parents find helpful?</h4><p>No economic evidence was identified which was applicable to these review questions.</p></div></div><div id="niceng194er21.appj"><h3>Appendix J. Economic analysis</h3><div id="niceng194er21.appj.s1"><h4>Economic analysis for review questions: What information on formula feeding do parents find helpful? What support with formula feeding do parents find helpful?</h4><p>No economic analysis was conducted for these review questions.</p></div></div><div id="niceng194er21.appk"><h3>Appendix K. Excluded studies</h3><div id="niceng194er21.appk.s1"><h4>Excluded studies for review questions: What information on formula feeding do parents find helpful? What support with formula feeding do parents find helpful?</h4></div><div id="niceng194er21.appk.s2"><h4>Clinical studies</h4><p id="niceng194er21.appk.et1"><a href="/books/NBK571565/bin/niceng194er21-appk-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (332K)</span></p></div><div id="niceng194er21.appk.s3"><h4>Economic studies</h4><p>No economic evidence was identified for this review.</p></div></div><div id="niceng194er21.appl"><h3>Appendix L. Research recommendations</h3><div id="niceng194er21.appl.s1"><h4>Research recommendations for review questions: What information on formula feeding do parents find helpful? What support with formula feeding do parents find helpful?</h4><p>No research recommendations were made for these review questions.</p></div></div></div></div><div class="fm-sec"><div><p>Final</p></div><div><p>Evidence review underpinning recommendations 1.5.1 and 1.5.16 to 1.5.20</p><p>These evidence reviews were developed by the National Guideline Alliance, part of the Royal College of Obstetricians and Gynaecologists</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2021.</div><div class="small"><span class="label">Bookshelf ID: NBK571565</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/34191442" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">34191442</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobniceng194er21tab1"><div id="niceng194er21.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">Summary of the protocol (PICo table)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571565/table/niceng194er21.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng194er21.tab1_lrgtbl__"><table class="no_bottom_margin"><tbody><tr><th id="hd_b_niceng194er21.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_niceng194er21.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pregnant women and women who have given birth to a healthy term baby and their partners.</td></tr><tr><th id="hd_b_niceng194er21.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Phenomenon of Interest (information)</th><td headers="hd_b_niceng194er21.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Views and experiences of the information about formula feeding which is provided antenatally or in the first eight weeks after birth. Themes will be identified from the literature. The committee identified the following potential themes (however, they are aware that not all of these themes may be found in the literature and that additional themes may be identified):
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<ul><li class="half_rhythm"><div>differences in types of bottles and teats</div></li><li class="half_rhythm"><div>differences in formula milks (brands,1st stage, 2nd stage etc.)</div></li><li class="half_rhythm"><div>frequency (routines) and volume of formula</div></li><li class="half_rhythm"><div>how to know when the infant has had enough/ too much milk</div></li><li class="half_rhythm"><div>the best environment to feed in and how to feed when out</div></li><li class="half_rhythm"><div>items to buy for bottle feeding</div></li><li class="half_rhythm"><div>cleaning and sterilising bottles</div></li><li class="half_rhythm"><div>how to make up feeds</div></li><li class="half_rhythm"><div>special formula milk (e.g. anticolic milk)</div></li><li class="half_rhythm"><div>responsive feeding – what stress cues to be aware of</div></li><li class="half_rhythm"><div>technique for feeding (burping etc.)</div></li><li class="half_rhythm"><div>machines available (‘perfect prep’ machines).</div></li></ul></td></tr><tr><th id="hd_b_niceng194er21.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Phenomenon of Interest (support)</th><td headers="hd_b_niceng194er21.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Views and experiences of the support available for formula feeding antenatally or during the first 8 weeks after birth.</p>
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<p>Themes will be identified from the literature. The committee identified the following potential themes (however, they are aware that not all of these themes may be found in the literature and that additional themes may be identified):
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<ul><li class="half_rhythm"><div>types of support e.g. midwife, health visitor, GP, NCT group, maternity support worker, infant feeding specialist, helplines, telephone support, text support, children’s centres, internet resources, online forums, etc</div></li><li class="half_rhythm"><div>emotional support e.g. to help manage disappointment of being unable to breastfeed</div></li><li class="half_rhythm"><div>accessibility of support e.g. out of hours, availability of appointments, language barriers, cost, when it should be given (antenatal / postnatal), frequency, where support is delivered (for example in home setting / support group) etc</div></li><li class="half_rhythm"><div>reliability e.g. trust in the information given.</div></li></ul></p>
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</td></tr><tr><th id="hd_b_niceng194er21.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Context</th><td headers="hd_b_niceng194er21.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Studies from the UK only.</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">GP: General Practitioner; NCT: National Childbirth Trust</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng194er21tab2"><div id="niceng194er21.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of included studies</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571565/table/niceng194er21.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng194er21.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_niceng194er21.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng194er21.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Participants</th><th id="hd_h_niceng194er21.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Methods</th><th id="hd_h_niceng194er21.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Themes</th></tr></thead><tbody><tr><td headers="hd_h_niceng194er21.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng194er21.s1.1.ref1" rid="niceng194er21.s1.1.ref1">Graffy 2005</a>
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</p>
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<p><b>Aim of the study</b>
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<ul><li class="half_rhythm"><div>To examine women’s information, advice, and support they receive with breastfeeding.</div></li></ul></p>
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</td><td headers="hd_h_niceng194er21.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>N=649 women from London</p>
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<p>Ethnicity (n=640): UK and other white n=440 (68.8); African and Caribbean n=103 (16.1); Indian subcontinent n=50 (7.8); Other n=47 (7.3)</p>
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</td><td headers="hd_h_niceng194er21.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Questionnaire</td><td headers="hd_h_niceng194er21.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Feeling unsupported if choosing to formula feed</div></li></ul></td></tr><tr><td headers="hd_h_niceng194er21.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng194er21.s1.1.ref2" rid="niceng194er21.s1.1.ref2">Hoddinott 1999</a>
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</p>
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<p><b>Aim of the study</b>
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<ul><li class="half_rhythm"><div>To examine antenatal expectation and postnatal experiences of first-time mothers.</div></li></ul></p>
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</td><td headers="hd_h_niceng194er21.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N=21 women from deprived inner London area</td><td headers="hd_h_niceng194er21.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">One-to-one interview</td><td headers="hd_h_niceng194er21.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Information</div></li></ul></td></tr><tr><td headers="hd_h_niceng194er21.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng194er21.s1.1.ref3" rid="niceng194er21.s1.1.ref3">Hoddinott 2000</a>
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</p>
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<p><b>Aim of the study</b>
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<ul><li class="half_rhythm"><div>To look at how communication by health professionals about infant feeding is perceived by first time mothers.</div></li></ul></p>
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</td><td headers="hd_h_niceng194er21.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N=21 women from deprived inner London area</td><td headers="hd_h_niceng194er21.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">One-to-one interview</td><td headers="hd_h_niceng194er21.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Feeling unsupported if choosing to formula feed</div></li></ul></td></tr><tr><td headers="hd_h_niceng194er21.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng194er21.s1.1.ref4" rid="niceng194er21.s1.1.ref4">Hoddinott 2012</a>
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</p>
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<p><b>Aim of the study</b>
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<ul><li class="half_rhythm"><div>To investigate the infant feeding experiences of women and their significant others.</div></li></ul></p>
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</td><td headers="hd_h_niceng194er21.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N=36 women from Scotland</td><td headers="hd_h_niceng194er21.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Semi-structured interviews</td><td headers="hd_h_niceng194er21.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Information</div></li><li class="half_rhythm"><div>Feeling unsupported if choosing to formula feed</div></li></ul></td></tr><tr><td headers="hd_h_niceng194er21.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng194er21.s1.1.ref5" rid="niceng194er21.s1.1.ref5">Hughes 1997</a>
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</p>
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<p><b>Aim of the study</b>
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<ul><li class="half_rhythm"><div>To establish what influences women to bottle feed</div></li></ul></p>
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</td><td headers="hd_h_niceng194er21.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N=20 women</td><td headers="hd_h_niceng194er21.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Semi-structured interviews</td><td headers="hd_h_niceng194er21.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Information</div></li></ul></td></tr><tr><td headers="hd_h_niceng194er21.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng194er21.s1.1.ref6" rid="niceng194er21.s1.1.ref6">Keely 2015</a>
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</p>
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<p><b>Aim of the study</b>
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<ul><li class="half_rhythm"><div>To explore the views and experiences of obese women who had either stopped breastfeeding or were no longer exclusively breastfeeding 6 to 10 weeks postpartum, despite an original intention to do so, in relation to current breastfeeding support services.</div></li></ul>
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</p>
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</td><td headers="hd_h_niceng194er21.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N=28 women from Scotland</td><td headers="hd_h_niceng194er21.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Semi-structured interviews</td><td headers="hd_h_niceng194er21.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Information</div></li></ul></td></tr><tr><td headers="hd_h_niceng194er21.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng194er21.s1.1.ref7" rid="niceng194er21.s1.1.ref7">Lagan 2014</a>
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</p>
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<p><b>Aim of the study</b>
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<ul><li class="half_rhythm"><div>To explore the expectations and experiences of postnatal mothers in relation to infant feeding.</div></li></ul></p>
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</td><td headers="hd_h_niceng194er21.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N=38 women in focus groups and n=30 women in interviews from Scotland</td><td headers="hd_h_niceng194er21.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Focus groups and one-to-one interviews</td><td headers="hd_h_niceng194er21.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Information</div></li><li class="half_rhythm"><div>Feeling unsupported if choosing to formula feed</div></li></ul></td></tr><tr><td headers="hd_h_niceng194er21.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng194er21.s1.1.ref8" rid="niceng194er21.s1.1.ref8">Martyn 1997</a>
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</p>
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<p><b>Aim of the study</b>
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<ul><li class="half_rhythm"><div>To identify influences determining how and why mothers choose one brand of baby milk rather than another.</div></li></ul></p>
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</td><td headers="hd_h_niceng194er21.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N=20 women</td><td headers="hd_h_niceng194er21.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Semi-structured interviews</td><td headers="hd_h_niceng194er21.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Information</div></li></ul></td></tr><tr><td headers="hd_h_niceng194er21.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng194er21.s1.1.ref9" rid="niceng194er21.s1.1.ref9">Murphy 2000</a>
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</p>
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<p><b>Aim of the study</b>
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<ul><li class="half_rhythm"><div>To explore how mothers deal with the threat to their identities as good mothers from feeding practices.</div></li></ul></p>
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</td><td headers="hd_h_niceng194er21.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N=24 women from Nottingham</td><td headers="hd_h_niceng194er21.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Qualitative one-to-one interviews</td><td headers="hd_h_niceng194er21.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Feeling unsupported if choosing to formula feed</div></li></ul></td></tr><tr><td headers="hd_h_niceng194er21.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng194er21.s1.1.ref10" rid="niceng194er21.s1.1.ref10">Redshaw 2012</a>
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</p>
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<p><b>Aim of the study</b>
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<ul><li class="half_rhythm"><div>To understand what is needed in the early days to enable breastfeeding to continue.</div></li></ul></p>
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</td><td headers="hd_h_niceng194er21.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N=1436 women</td><td headers="hd_h_niceng194er21.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Open questions from questionnaire</td><td headers="hd_h_niceng194er21.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Feeling unsupported if choosing to formula feed</div></li></ul></td></tr><tr><td headers="hd_h_niceng194er21.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng194er21.s1.1.ref11" rid="niceng194er21.s1.1.ref11">Roberts 2009</a>
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</p>
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<p><b>Aim of the study</b>
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<ul><li class="half_rhythm"><div>To investigate whether future video support after hospital discharge would be feasible and acceptable to mothers as a useful method of post-natal support for infant feeding, and explore general views on the potential use of other communication technologies.</div></li></ul></p>
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</td><td headers="hd_h_niceng194er21.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N=91 women responded to questionnaire. n=20 women participated in qualitative interviews from rural Scotland</td><td headers="hd_h_niceng194er21.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Semi-structured qualitative telephone interviews and postal questionnaire</td><td headers="hd_h_niceng194er21.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Information</div></li><li class="half_rhythm"><div>Remote support</div></li></ul></td></tr><tr><td headers="hd_h_niceng194er21.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng194er21.s1.1.ref12" rid="niceng194er21.s1.1.ref12">Sherriff 2009</a>
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</p>
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<p><b>Aim of the study</b>
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<ul><li class="half_rhythm"><div>To explore fathers’ experiences during the pregnancy, birth and up to the first year, and to provide insight into current issues and problems from a father’s perspective and to identify possible interventions which could contribute to achieving behaviour change (only data referring to the antenatal period were extracted for this review).</div></li></ul></p>
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</td><td headers="hd_h_niceng194er21.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N=8 fathers from different socio-economic groupings from Brighton and Hove</td><td headers="hd_h_niceng194er21.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Semi-structured in-depth interviews</td><td headers="hd_h_niceng194er21.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Fathers able to support better when formula feeding</div></li></ul></td></tr><tr><td headers="hd_h_niceng194er21.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng194er21.s1.1.ref13" rid="niceng194er21.s1.1.ref13">Stewart-Knox 2003</a>
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</p>
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<p><b>Aim of study</b>
|
|
<ul><li class="half_rhythm"><div>To define and explore factors determining infant feeding decisions in Northern Ireland.</div></li></ul></p>
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|
</td><td headers="hd_h_niceng194er21.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N=12 pregnant women at various stages of pregnancy</td><td headers="hd_h_niceng194er21.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 focus groups (7 and 5 participants each). Health promotion materials were presented as cues and prompts.</td><td headers="hd_h_niceng194er21.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
<ul><li class="half_rhythm"><div>Information</div></li></ul></td></tr><tr><td headers="hd_h_niceng194er21.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng194er21.s1.1.ref14" rid="niceng194er21.s1.1.ref14">Williamson 2012</a>
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</p>
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|
<p><b>Aim of study</b>
|
|
<ul><li class="half_rhythm"><div>To explore the experiences of first-time mothers who struggled with breastfeeding.</div></li></ul></p>
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|
</td><td headers="hd_h_niceng194er21.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N=8 first-time mothers</td><td headers="hd_h_niceng194er21.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Semi-structured interviews and audio-diary recordings</td><td headers="hd_h_niceng194er21.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Feeling unsupported if choosing to formula feed</div></li></ul></td></tr></tbody></table></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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