# Co‐Development of an Evidence‐Based Breastfeeding Support Intervention, Optimised for Delivery in Healthcare Settings, and Adaptations for Mothers With Long‐Term Conditions: The Action for Breastfeeding (A4B) Programme

## TL;DR

The A4B Programme is a new breastfeeding support intervention designed for healthcare settings, with adaptations for mothers with long-term conditions.

## Contribution

The study co-developed an evidence-based breastfeeding support intervention optimized for healthcare settings and adapted for mothers with long-term conditions.

## Key findings

- The A4B Programme includes four core components: antenatal, postnatal, follow-up, and signposting.
- Materials and guidance for adoption and delivery were co-designed with stakeholders.
- The programme includes adaptations to support mothers with long-term conditions.

## Abstract

This intervention development study aimed to work with a wide range of stakeholders across the UK to integrate existing global evidence on the effectiveness and implementation of breastfeeding support for mothers with/without long‐term conditions and co‐develop a complex intervention optimised for delivery in healthcare settings. The intervention development process was informed by four systematic reviews, conducted alongside an embedded programme of co‐production work between 2020 and 2025, involving: two stakeholder working groups (SWG) and two parent panels (PP) that met at regular intervals during the study; six focus group discussions (FGD) to ensure engagement with parents from socially disadvantaged groups; and 10 co‐production workshops (Co‐PW) involving parents, third sector organisations, healthcare practitioners, managers, commissioners, policymakers, and academics. Systematic reviews synthesised data from 116 randomised controlled trials and 16 process evaluations of breastfeeding support interventions for healthy mothers; and 22 trials and 24 studies on views/experiences of breastfeeding support in mothers with long‐term conditions. The co‐production work involved 23 stakeholders and 16 parents in SWG and PP meetings, 15 parents in FGD, and 128 stakeholders in Co‐PW. The resulting Action for Breastfeeding (A4B) Programme comprised four core components (antenatal, postnatal, follow‐up, and signposting) with associated implementation strategies, mechanisms of action, and outcomes for evaluation. Materials and guidance to support adoption and delivery were co‐designed. The A4B Programme provides an evidence‐based and co‐produced intervention to deliver organised support for breastfeeding mothers in healthcare settings, with proposed adaptations for mothers with long‐term conditions. Some uncertainties remain and these will be investigated in our future work.

There is strong evidence that breastfeeding support works, yet many women still stop early due to lack of adequate support, indicating that improvements amply demonstrated in research are not effectively translating into real‐world outcomes.This intervention development study combined the use of high‐quality evidence on both effectiveness and implementation, alongside an extensive programme of stakeholder engagement work, to improve potential for context‐adapted real‐world adoption.To promote sustainable and inclusive scale‐up, the Action for Breastfeeding Programme is optimised for delivery in healthcare settings and includes adaptations for women with long‐term conditions, ensuring that tailored support can be delivered for all women.

There is strong evidence that breastfeeding support works, yet many women still stop early due to lack of adequate support, indicating that improvements amply demonstrated in research are not effectively translating into real‐world outcomes.

This intervention development study combined the use of high‐quality evidence on both effectiveness and implementation, alongside an extensive programme of stakeholder engagement work, to improve potential for context‐adapted real‐world adoption.

To promote sustainable and inclusive scale‐up, the Action for Breastfeeding Programme is optimised for delivery in healthcare settings and includes adaptations for women with long‐term conditions, ensuring that tailored support can be delivered for all women.