Breastfeeding counselling mentorship programme feasibility: a mixed-methods study

Abstract

Objectives: To determine the feasibility of implementing a facility-based breastfeeding counselling (BFC) mentorship programme and its effect on mentee confidence and client perceptions of BFC. Setting: Mbagathi County Referral Hospital in Nairobi, Kenya. Participants: Health facility management, health workers (twenty-one mentees and seven mentors), 120 pregnant women in the third trimester who attended an antenatal care (ANC) appointment at Mbagathi Hospital and reported receiving BFC during a visit in the 2 weeks prior and 120 postpartum women in the postnatal care ward who delivered a full-term infant and reported receiving BFC. Design: Mixed-methods study incorporating online surveys, client exit interviews, key informant interviews and focus group discussions. The 4-month intervention involved facility-wide orientations, selection and training of mentors, assigning mentees to mentors and implementing mentorship activities. Results: The programme successfully maintained 90·5 % mentee retention (19/21) over 4 months. At baseline, mentees demonstrated high knowledge (94 % questions answered correctly), which was maintained at endline (92 %). Mentees showed significant improvement in confidence counselling on breastfeeding and infant feeding (67 % at baseline v. 95 % at endline, P = 0·014). The percentage of ANC clients who felt BFC gave them more knowledge increased from 73 % to 97 % (P < 0·001). Among postnatal care clients, those reporting friendly treatment increased from 89 % to 100 % (P = 0·007), verbal mistreatment declined from 7 % to 0 % (P = 0·044) and those feeling discriminated decreased from 11 % to 2 % (P = 0·03). Key enablers included administrative support, structured mentorship tools and peer learning communities. Implementation barriers included scheduling conflicts, staff shortages and high patient volumes. Conclusions: BFC mentorship was feasible in this setting and was associated with improved health worker confidence in BFC. The programme can be successfully implemented with supportive facility leadership, well-matched mentors and mentees and adaptable mentorship approaches.