Peer Support and Community Interventions Targeting Breastfeeding in the UK: Systematic Review of Qualitative Evidence to Identify Inequities in Participants' Experiences.

Abstract

Rates of breastfeeding remain low in the UK, with variations between population groups. Peer support and community interventions are intended to increase breastfeeding, but there is limited understanding if they cause inequities in participants' experiences. We conducted a systematic review synthesising qualitative evidence from the UK to understand: (1) what social characteristics are relevant to participants' experiences of interventions? and (2) how are participants' experiences influenced by different social characteristics? The scope of the review was informed through stakeholder consultation with women (n = 7) and peer supporters (n = 6). Searches of nine databases updated an existing systematic review. We screened relevant systematic reviews and undertook citation tracking. We conducted framework synthesis and assessed certainty of evidence with GRADE-CERQual. Fifty-five studies, with 68 linked reports, were included. Inequity generating experiences were identified across the course of intervention participation: (1) lack of information about intervention eligibility and culturally appropriate recruitment procedures; (2) limited accessible provision for continued attendance; (3) inadequate consideration of participation needs related to socioeconomic status, socio-cultural background, physical characteristics, and individuals' breastfeeding journeys; and (4) enduring structural barriers (e.g. community norms) to breastfeeding inhibiting sustained behaviour post-intervention. Evidence suggests that differential intervention experiences may lead to inequities in outcomes, particularly among individuals from different socioeconomic and ethnic backgrounds. Peer and community provision needs to be tailored to the social characteristics of different populations. Future qualitative research needs to move beyond participants' general intervention experiences and consider specific issues pertaining to recruitment, drop-out and post-intervention behavioural maintenance. Systematic Reveiw Registration: PROSPERO CRD42024537108.