Summary of the impact

This case study describes the impact of a programme of work led by Professor Fiona Dykes, within the Maternal and Infant Nutrition and Nurture Unit (MAINN), at UCLAN. The unit was established in 2000 by Dykes. The research conducted in MAINN is underpinned by a range of interpretive and critical theoretical perspectives; it also actively engages in knowledge translation in a range of local, national and global contexts. Impact is particularly highlighted with regard to Global Policy, namely the WHO Global Strategy for Infant and Young Child Feeding, National Policy to include the UNICEF UK Baby Friendly Initiative (BFI), Key DoH publications and the NICE agenda.
http://www.uclan.ac.uk/research/environment/groups/maternal_and_infant_nutrition_and_nurture_ unit.php

Underpinning research

The portfolio of work includes the development, validation and evaluation of a tool to assess breastfeeding skills in a range of health practitioners (Hall Moran et al 1999, 2005). In 2001, in recognition of work in this area, Dykes and Hall Moran were then appointed as facilitators for the European Region for the Development of the WHO (2003) Global Strategy for Infant & Young Child Feeding, Budapest; they were named as contributing authors on the subsequent WHO publication (Dykes 2001, Hall Moran 2001). The Global Strategy is widely regarded as the international benchmark for guiding policy and practice in optimisation of infant and young child feeding and the impact continues to be substantial in the 2008-2014 assessment period. Six years after the publication of the Global Strategy, Dykes and Hall Moran published an edited book, critiquing the challenges to implementation in diverse cultural settings (Dykes and Hall Moran 2009)

In 2000, Dykes was appointed as a member of the UNICEF UK BFI Education Standards Committee; she participated in the development of standards for breastfeeding education in UK universities. To launch this initiative, she presented the strategy at a UNICEF National conference in 2000. She then participated in the conduct of a comprehensive, UK-based consultation exercise on the feasibility and implementation of the education standard; the ratified version was subsequently published (UNICEF UK 2002). These education standards are now being implemented in Universities across the UK, as recommended by NICE http://www.unicef.org.uk/BabyFriendly/Health-Professionals/Going-Baby-Friendly/University/University-Accreditation/

In 2003, Dykes was commissioned by the DoH to conduct an evaluation of approx. 80 DoH funded out-reach projects (approx. 2 million pounds invested by DH over the three year funding window from 1999-2002). This work was published by the DoH (Dykes 2003) and in 2004 was converted by the DoH into a policy document, Good Practice and Innovation in Breastfeeding (DoH 2004) http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/ dh_4098162.pdf with full acknowledgement to Dykes. This guide was distributed and utilised across the UK to support achievement of government targets related to infant feeding policy and practice. The synthesis was also referenced in the DoH publication, Choosing a Better Diet. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/ dh_4105709.pdf

Dykes joined UCLAN in 1992, initially as a Senior Lecturer; she was appointed as a Reader in 2002 and as a Professor in 2007. Victoria Hall Moran joined UCLAN as a post-doctoral Research Fellow in 1998; she became a Senior Lecturer in 2001 and a Reader in Maternal and Child Nutrition in 2012. Gill Thomson was appointed to UCLAN as a Research Associate in 2008; she was promoted to Research Fellow in 2010 and Senior Research Fellow in 2013. All three remain at UCLAN to date. Others more recently appointed in MAINN are Dr Renee Flacking and Dr Nicola Crossland.

References to the research

Publications:

UNICEF UK BFI (2002) Introducing the Baby Friendly best practice standards into breastfeeding education for student midwives and health visitors UNICEF: London.

Underpinning funding for DoH synthesis:

£20,000 DoH to UCLAN — Synthesis of DH funded infant feeding projects

Details of the impact

The portfolio of work is impacting policy and practice in the 2008-2014 REF period in a number of ways. It provides a framework of best available evidence to implement effective and quality service interventions to improve infant feeding experiences and well-being of service users.

In 2008, Dykes was commissioned by DoH (NW Regional Public Health Group 2008) to co- ordinate a team in writing Addressing Health Inequalities: A North West Breastfeeding Framework for Action. This is utilised widely in the North West to support those in both commissioning and delivering services related to infant and young child feeding.

UNICEF UK education standards, referred to above, are being implemented in academic institutions across the UK, as recommended by NICE.

In recognition of their expertise, both Dykes and Hall Moran have been invited to contribute to the development and review of NICE guidelines: In 2008, Dykes was commissioned to write a briefing paper, Intervention guidance on how to improve breastfeeding rates in hard to reach groups (Dykes 2008). As a result of the work, Dykes conducted for the DoH (see section 2) she was appointed by NICE, in 2008, as a member of National Topic-specific Advisory Group:
http://www.nice.org.uk/usingguidance/commissioningguides/breastfeed/tag.jsp
This group produced commissioning guidelines on `peer support programmes for women who breastfeed'; these are now being implemented in maternity services across the UK.

In 2011, Hall Moran was invited onto an Expert Group to review the 2008 NICE public health guidance for health professionals and other primary care services to improve the nutrition of pregnant and breastfeeding mothers and children in low income households, incorporating guidance for encouraging breastfeeding including training for health professional and involvement of breastfeeding peer supporters (NICE 2011).

In recognition of the expertise of Dykes with regard to support for breastfeeding women she was invited by University of Western Sydney (UWS) to collaborate with Virginia Schmied in conducting a meta-synthesis on breastfeeding support. This is published with the Joanna Briggs institute and has been developed into best practice guidance at the Institute (Schmied et al 2009). It has also been published in Birth (Schmied et al 2011). In recognition of her on-going input, Dykes was appointed as Adjunct Professor at UWS in 2008. Schmied was appointed as Visiting Professor at UCLAN in 2012 to acknowledge strong collaborations.

Dykes and the MAINN team have convened four international peer reviewed conferences in 2007, 2009, 2011 and 2013 (forthcoming) drawing an international audience, representatives from the DoH, NICE, UNICEF and WHO. These conferences have provided an opportunity to disseminate research in MAINN as well as invite internationally renowned speakers.
http://www.uclan.ac.uk/conference_events/nutrition_nurture_infancy_childhood.php

Based on their previous evaluation work, Dykes and Thomson were commissioned by NHS North Lancashire to conduct a longitudinal evaluation of the BFI in the community (Thomson et al 2012), by NHS Blackpool to evaluate the breastfeeding peer support service and by the DoH in 2011 to conduct an evaluation of methods of providing information on infant feeding as part of the BFI in the UK (Dykes et al 2012) and by the Breastfeeding Network (BfN) to undertake an evaluation of the National Breastfeeding Helpline (2011). These projects have been undertaken utilising an action research framework in terms of insights and outcomes being shared with providers and commissioners on an ongoing basis to inform future service delivery. Key findings from these studies have been fed back at health professional and service user forums within the local NHS trusts and at national and international conferences.

In 2011, Dykes was invited by the largest Childbirth Charity in the UK, National Childbirth Trust (NCT) to become Research Adviser and, in addition, to support them in the development of a portfolio of work related to offering and evaluating breastfeeding peer support. Further bidding activity is underway to support this.

In 2013 research undertaken by Dykes and Thomson has had a major influence on a reconfiguration of The UNICEF UK Baby Friendly Initiative; this work is cited extensively in the supporting document and Dykes is also thanked in the acknowledgements section; the work was mentioned at the National UNICEF Conference in 2012 (Cardiff) (UNICEF UK 2013).

In 2012, Dykes was invited to be a collaborator in a subsequently successful NIHR bid. HTA 10/31/02 BIBS; Benefits of Incentives for Breastfeeding and Smoking cessation: a platform study for a trial (Stirling, UCLAN, Aberdeen, Newcastle, Glasgow). Hoddinott P (PI — Stirling), Dykes F (PI — UCLAN), Bauld L, Campbell M, Ludbrook A, Sniettahotta F. https://www.bibsstudy.net/ Total Grant: £322,127 with £64,372 to UCLAN.

Sources to corroborate the impact

Publications

UNICEF UK BFI (2002) Introducing the Baby Friendly best practice standards into breastfeeding education for student midwives and health visitors UNICEF: London.

Dykes F (2008) Intervention guidance on how to improve breastfeeding rates in hard to reach groups (to include the role of peer education and social networks). Commissioned briefing paper funded by and for NICE.

North West Regional Public Health Group (2008) Addressing Health Inequalities: A North West Breastfeeding Framework for Action is utilised widely in the North West to support those in both commissioning and delivering services related to infant and young child feeding.
http://www.infantfeedingwm.org.uk/documents/NWBreastfeedingFrameworkDocument.pdf
[accessed on 30/01/2013]

NICE (2008) Commissioning guidelines on `peer support programmes for women who breastfeed'.
http://www.nice.org.uk/usingguidance/commissioningguides/breastfeed/commissioning.jsp
[accessed on 30/01/2013]

Schmied V, Beake S, Sheehan A, McCourt C, Dykes F (2009) Meta-synthesis of women's perceptions and experiences of breastfeeding support. Joanna Briggs Institute (Adelaide) JBI Library of systematic reviews 7, 583-614.

Thomson G, Bilson A, Dykes F (2012) `Changing Hearts and Minds': An evaluation of implementation of UNICEF UK Baby Friendly Initiative in the community. Midwifery 28, 258-264.

Schmied V, Beake S, Sheehan A, McCourt C, Dykes F (2011) Meta-synthesis of women's perceptions and experiences of breastfeeding support. Birth: Issues in Perinatal Care 38, 49-60.

NICE (2011) Maternal and Child Nutrition: Review Proposal
http://www.nice.org.uk/nicemedia/live/11943/53898/53898.pdf [accessed 30/01/2013]

Dykes F, Richardson-Foster H, Crossland H, Thomson G (2012) `Dancing on a thin line': Evaluation of an Infant Feeding Information Team to implement the WHO Code of Marketing of Breast-milk Substitutes. Midwifery 28, 765-771.

UNICEF UK (2013) Evidence and rationale for the UNICEF UK Baby Friendly Initiative: a resource for practitioners. London: UNICEF.
http://www.unicef.org.uk/Documents/Baby_Friendly/Research/baby_friendly_evidence_rationale.pd f [accessed 13/09/2013]