Breast is best for love or money: user guide
Contents
1. 7 THE NSMC BREAST IS BEST FOR LOVE OR MONEY 8 If there are reasons to expect higher or lower breastfeeding rates at 6 8 weeks add or subtract 1 10 If you have survey data of breastfeeding rates before and after intervention or if you are dealing with a target group of mothers with known different rates of take up lower or higher than indicated by national statistical analysis of their age and the age at which they completed education you can adjust the figures by adding or subtracting from the expected rate by entering an adjustment here It will be important to demonstrate why the expected figure should be adjusted for the mothers you are targeting 9 Which year s prices are you using The tool allows you to choose which year s prices you wish to work in known as the base year for the analysis Generally this should be the first full year of the intervention for which you have outcome data You have to input costs in terms of that year s prices so you may have to adjust for inflation between the year in which the intervention was planned and developed and the base year of the intervention This is included to prevent the tool from becoming out of date 10 Enter your weight for disadvantage if you wish to This allows you to give an extra value to impacts on disadvantaged and hard to reach groups A value between 0 and 100 per cent can be used but enter zero if you do not wish to apply a weight giving that2. The NSMC and Dr Lister would also like to thank the Project Advisory Board the NICE team who provided cost data the WHO team who provided the Global Health Risk data colleagues from South ampton and York University from who provided input and guidance the Rechord team who worked on the presentation of the tool the team from Matrix consulting who provided quality assurance and the many local social marketing groups and experts who tried it out and suggested improvements Any remaining errors and omissions remain the re sponsibility of the author THE NSMC BREAST IS BEST FOR LOVE OR MONEY 14 References 1 NICE Promotion of Breastfeeding Initiation and Duration Evidence into Practice Briefing of 2006 and the UNICEF Baby Friendly Initiative which stresses the importance of community support for breast feeding to six months and sets out a seven point plan to support this including a range of behaviour change actions It also describes many advantages of continuation of breastfeeding 2 This showed that in England 78 per cent of mothers initiated breastfeeding but breastfeeding prevalence fell to 62 per cent after two weeks 50 per cent of mothers were breastfeeding at six weeks and 26 per cent were still breastfeeding at six months but in virtually all cases this was not exclusive i e the babies were given other food 3 Published in the report by Colin Mathers Gretchen Stevens and Maya Mascarenhas of 2009 Global Hea
3. QALYs using a conversion factor of 1 705 appropriate for age five and duration of illness of six months This is taken from Sassi 2006 While not perfect this is the best available estimate Further research could improve this conversion factor Net cost to the public sector This is the summary of public sector costs per year shown in the Data page resulting from the costs you reported Net cost to the public sector This is the summary of public sector costs per year shown in the Data page resulting from the costs you reported Cost per QALY This is derived by dividing QALY gain by public sector cost This is shown as a central estimate and high and low values Cost Savings to the NHS The NICE costing report Postnatal care routine postnatal care of women and their babies from 2006 indicates that a ten per cent improvement in breastfeeding would result in savings to the NHS of some 5 6 million in 2005 2006 prices or 6 4 million in 2007 2008 prices arising from reductions in Otitis Media Gastroenteritis Asthma and reduced costs to the NHS of formula and teats Breastfeeding is also considered to reduce other infections reduce the likelihood of obesity and de velopmental problems for children It is also seen to reduce ovarian and breast cancer risks for mothers These cost impacts were not considered so these estimates are likely to be conservative For all these reasons this tool can only provide a broad
4. and secure their involvement in achieving your objectives Our tailored interactive workshops delivered by The NSMC s expert behaviour change professionals will explore how to take an audience led approach to your challenge using the latest thinking in behaviour change from your sector Implementing an effective behaviour change project Whatever your behavioural challenge our experts unrivalled experience in delivering behaviour change programmes will ensure it is addressed cost effectively Our network of consultants and suppliers means the best specialists will take your project forward Training and resources To give you and your team the skills you need to run your own behaviour change projects we provide both classroom and e learning training courses Devised and delivered by expert professionals they draw on real experience of what works To help ensure your staff have the right tools and support when they need them our online planning guide and toolbox provides everything they need to plan and implement a behaviour change programme Tried and tested by a range of professionals and organisations we can develop specialised versions tailored to meet your organisational needs Supporting your organisation to keep your audiences at the heart of everything you do We ll help you develop and conduct research that will give you a firm foundation for a behaviour change intervention Our expe
5. percentage more value to interventions for disadvan taged people The tool does this by simply adding an extra value to the percentage of clients in the most disadvantaged 20 per cent using IMD scores or in some other way you may define This means that for example if you chose a weight of 50 per cent and all the clients were in the most disadvantaged group a value of the outcomes will be shown as 50 per cent more than the outcomes for a project which did not address disadvantaged people However while this value is shown in the Results page it does not affect the main outcomes reported which are not weighted Giving an extra weight or utility value to disadvan tage is controversial Department of Health policy is not to weight QALYs because everyone s health is equally valuable However it is arguable that ad dressing disadvantage is an important priority and thus of more value 11 Enter the Reach of the intervention optional The Reach of the project is a term used in the Health England Leading Prioritisation HELP scheme If you want to apply their measure of the value placed on addressing equity and the priority of this project you may include a value here to represent the proportion of people who could be eligible for the intervention if it were extended nationwide There are about 450 000 new mothers and 605 births each year This would be about one per cent of the population A subgroup of mothers targeted for
6. costs may include staff time for Midwives or Health Visitors and other staff advising or conducting the development of the project b NHS annual revenue costs per year These costs may include Midwifery staff or Health Visitor time working with the behaviour change project plus the additional costs generated by increased uptake of services e g extra mothers seeking help The ongoing cost of midwifery support for mothers as recommended by the Baby Friendly Initiative should not be included as this is a part of the basic service level required The cost of premises and or equipment should be included only if they are specific to the project and would otherwise not be required or if they are in such high demand that other valuable activities must be curtailed 3 Over how many years should development and training costs be spread Capital costs and project development costs will be spread over the life of the intervention You need to select the number of years that the intervention will benefit from the setup costs 4 Add in any other public sector costs if relevant a Project development and capital expenditure If the intervention requires input by other public sector providers such as social workers community support workers or teachers set up costs for their training may be relevant However it is important to consider only additional costs above those already incurred by services in the normal course of their wo
7. example young mothers will be some proportion of one per cent you do not need to be very precise 12 Disadvantage Weight Generated by HELP The results will also show the effect of weighting for disadvantage and a priority score from the HELP programme This project surveyed the way 99 public health professionals prioritised projects it then developed a formula to model their values Utility as a preference curve based on cost effectiveness Cost per OALY C the reach of the project what proportion of the population could benefit R and impact on disadvantage percent of clients in most disadvantaged 20 per cent D This tool derives a weight for disadvantage by substituting values from the current project in this formula It is also replicates the utility score that would be given by the HELP formula Utility e 0 0000586x C 0 0435987 x R 0 119895x D For a detailed explanation of this see http help matrixknowledge com You may choose to ignore these methods of weighting outcomes and treat disadvantage as a separate issue as DH suggest To do this you may wish to make use of the Health Inequalities Interven tion toolkit available from the London Health Obser vatory at www lho org uk LHO_Topics Analytic_Tools Health InequalitiesInterventionToolkit aspx You may also wish to refer to the DH DCFS guide to equity assessment in breastfeeding Commissioning local breastfeeding support services Equit
8. indica tions of potential cost impacts Research is needed to improve these estimates and communicate them to local teams A ten per cent improvement would increase breast feeding initiation and months of breastfeeding from the current level which is 78 per cent of the potential maximum for initiation and 34 per cent for continua tion If it is assumed that initiation produces 25 per cent of cost savings and 75 per cent of savings arise from continuation a ten per cent improvement would equate to 7 8x0 25 3 4x0 75 4 5 of the potential costs arising from sub optimal breastfeed ing in respect of Otitis Media Gastroenteritis and Asthma If this equates to 6 4 million savings then the hypothetical full cost impact from these causes would be 6 400 00 0 045 142 200 000 The tool uses this as a baseline for estimating the impact of improving breastfeeding rates Value for money The value for money can be estimated as a cost per health risk gain as a per QALY and as a cost net of NHS savings per OALY THE NSMC BREAST IS BEST FOR LOVE OR MONEY 10 Cost savings per mother contacted This is simply the estimate of NHS cost savings divided by the number of mothers contacted as entered in the Data input page Cost saving per additional mother who continues to breastfeed This is cost savings to the NHS per additional mother who meets the six to eight week indicator This is given as a range Total cost savings to
9. is limited evidence to suggest that sub opti mal breastfeeding may be linked to increased risk of infant deaths However this is a complex issue with multiple causes and for this reason the tool does not include an estimate of deaths from this cause This could be done if there were expert consensus on this issue Weighting for Disadvantage Your Weights The tool permits you to add an extra value to the percentage of clients in the most disadvantaged 20 per cent using IMD scores or in some other way you may define This is simply the result of applying the weight or extra value you selected to the percentage of targeted mothers who are disadvantaged Health England Leading Prioritisation HELP weighting and utility score This applies the HELP formula for assessing the utility or priority of the intervention To put this in context you should consult the website introduced in the Data Input section of this guide Table 2b Societal Impact Net Impact on Stakeholders This estimates the financial impact on the NHS and mothers in terms of savings In this case savings are not a particularly important goal for either mothers or the NHS as breastfeeding is primarily concerned with improving health and wellbeing Table 2c Societal Impact Social Return on Investment The calculation of Social Return on Investment SROI does not take into consideration any weighting applied to QALYs as above SROI is calculated in two ways as t
10. SMC Fleetbank House Salisbury Square London EC4Y 8JX T 020 7799 7900 0207799 7701 www thensmc com Designed by Toby Hopwood
11. Y 1 Enter the total number of mothers contacted per year These should be mothers who have initiated breast feeding and need support and encouragement to continue to six weeks and beyond This should include all mothers contacted not just those who continued breastfeeding to six weeks The number of contacts and outcomes may include indirect community multiplier contacts i e other mothers whose behaviour is changed only if evidence is available 2 Percentage of mothers who achieved the behaviour change target This is your target for the intervention or a record of the level of breastfeeding actually achieved amongst the mothers contacted It should be higher than the expected level generated by the age and education of the mothers targeted and any adjustment you make Otherwise the intervention will be shown as having a negative effect 3 Percentage of mothers in the most disadvantaged 20 or in a specially disadvantaged group This provides a measure of the extent to which the intervention is targeted at disadvantaged groups If there is no bias towards disadvantage 20 per cent of respondents would be expected to be in this category Disadvantage may be measured by the Index of Multiple Deprivation IMD scores see Glossary or other ways determined locally 4 Behaviour Indicator for success in encouraging breastfeeding This is the indicator for the target you are trying to achieve Enter the name of the indicator
12. d users to update the tool as further evidence becomes available Look Up Tables This page provides details of the inflation factors used in the tool It can be updated but again it is suggested that this should only be attempted by advanced users Inflation estimates for NHS costs are taken from official projections Costs to mothers are assumed to rise at four per cent per year 13 THE NSMC BREAST IS BEST FOR LOVE OR MONEY Other sources of help and guidance It is important to stress that this tool is intended to support evaluation alongside the application of qualitative guidance It is not intended to replace or supplant any such guides Commissioning local breastfeeding support services DH DCFS at www dh gov uk prod_consum_dh groups dh_digitalassets documents digitalasset dh_106497 pdf Commissioning local breastfeeding support services Equity Impact Assessment www dh gov uk prod_consum_dh groups dh_digitalassets documents digitalasset dh_106502 pdf ChiMat Child and Maternal Health Observa tory which includes a suite of on line tools for presenting key data and indicators undertaking needs assessment capacity planning and more www chimat org uk Dyson L Renfrew M McFadden A McCormick F Herbert G and Thomas J 2005 Promotion of breastfeeding initiation and duration Evidence into practice briefing NICE Acknowledgements This guide was written by Dr Graham Lister an Associate of The NSMC
13. f breastfeeding at 6 8 weeks given age and education of targeted mothers This is the percentage of mothers contacted who would be expected to continue breastfeeding to six weeks given their typical age and level of education you identified You can adjust this if there are special circumstances that justify this or if you have specific survey data This figure will change as you adjust it and a warning note will be generated if the target rate for your intervention is below the level that would have been expected without intervention as this would generate a nonsense negative impact The calculation of the expected level of breast feeding at initiation six weeks and six months is based on the figures reported in the Infant Feeding Survey of 2005 Survey results for the UK showed a clear association between the age and education of mothers and prevalence of breastfeeding such that for mothers e Age under 20 at birth 55 per cent at six weeks 14 per cent and at six months seven per cent e Age 20 to 24 at birth 66 per cent at six weeks 31 per cent and at six months 12 per cent e Age 25 to 29 at birth 76 per cent at six weeks 47 per cent and at six months 31per cent e Age 30 at birth 84 per cent at six weeks 60 per cent and at six months 36 per cent e Educated up to 16 at birth 61 per cent at six weeks 27 per cent and at six months 12 per cent e Educated up to 18 at birth 73 per cent at six weeks 42 per cent and at si
14. gative cost a payment to mothers Development and capital costs will be spread over the life of the intervention These should include costs relating to the design and application of a specific behaviour change project for targeted mothers General needs assessment such as a JSNA should be excluded Research conducted during the scoping phase for the specific project should be included b Annual revenue costs per year of supporting the intervention Annual revenue costs should include direct manage ment and staff time It should also include consuma bles such as leaflets incentives if applicable and rent of facilities and equipment if relevant Where the project or elements of it is contracted to private or voluntary sector providers VAT should be excluded because this is a transfer to govern ment All other costs relating to one year of full operation and management of the contract should be included Full public sector staff costs and on costs should be included but not unavoidable central overheads e g management and premises costs that are not changed by the project 2 In the field entitled What are the Table 1 the following costs should be considered and included when relevant a NHS set up costs including capital training and reorganisation Capital or other one off setup costs such as retrain ing and reorganising staff and services should be spread over the life of the project Setup
15. h Value for Money leading behav Breast is best for love or money user guide About The NSMC We are The NSMC the international centre of behaviour change expertise We re dedicated to making change happen that improves people s lives We do this by supporting organisations to design cost effective programmes that help people adopt and sustain positive behaviours those that improve their lives Eating healthily being more active and saving energy are just some of the positive changes we have helped our clients achieve As well as programme support and strategic advice we also provide professionals with the skills and resources to design and deliver their own cost effective behaviour change programmes Originally set up by the UK Government we now have a global reach applying social marketing skills knowledge and experience from around the world to solve behavioural challenges Contents 13 14 15 THE NSMC Introduction Using the tool Interpreting the results Other pages of the tool Acknowledgements References BREAST IS BEST FOR LOVE OR MONEY Introduction The NSMC has worked with leading The tools have two important uses health economists and NICE to develop a suite of online tools These will help practitioners and commissioners to calculate the value 1 To help plan for proposed social marketing and behaviour change programmes by estimating the likelihood that they will provide
16. he net impact on all stakeholders divided by the total cost to stake holders and as the value of the OALYs increased by the intervention valued at 25 000 in 2007 For more details of the SROI approach see the Glossary and related links from The NSMC website The tool permits you to add an extra value to the percentage of clients in the most disadvantaged 20 per cent THE NSMC BREAST IS BEST FOR LOVE OR MONEY 12 Other pages of the tool The other pages of the tool can be explored by users but these are basically working sheets All references have been referred to in the Data input and Results sections of this guide Impacts The Impacts page of the tool provides a mechanism for comparing the expected rate of breastfeeding and the rate targeted or achieved as a result of the e intervention This uses the formulae explained at point 8 of the Data Input guide The Impacts page also provides high and low scenarios varying the expected rate of breastfeed ing to provide a range of results reflecting the uncertainty in these estimates These data can be improved but it is suggested that this is a task for advanced users National Data The National Data page of the tool brings together relevant data as introduced elsewhere in this guide It provides estimates of the health impacts of breast feeding in terms of DALYs and OALYs While this page can be updated again we suggest this should be done by advance
17. lth Risks mortality and burden on disease attributable to selected risk factors 4 Green S and Miles R 2007 The Burden of Disease and Illness in the UK Oxford Healthcare As sociates 5 See the U S Department of Health and Human Services The Surgeon General Call to Action to Support Breastfeeding Washington DC U S De partment of Health and Human Services Office of the Surgeon General 2011 table 1 6 Franco Sassi Calculating QALYs comparing QALY and DALY calculations Health Policy and Planning 2006 21 5 402 408 15 THE NSMC BREAST IS BEST FOR LOVE OR MONEY Further support from The NSMC Practical advice and support If you need some fresh thinking to improve your results we ll carry out an expert review of your current approach to behaviour change Practical recommendations on how to plan manage implement and evaluate your projects will ensure you re able to make progress Need help taking a behaviour change approach forward We can develop a behaviour change strategy for your organisation ensuring you re better placed to deliver effective future programmes We ll support you through developing and managing your project with mentoring offered as and when you need it Using our learning by doing approach we bring our tried and tested behaviour change planning process to your behavioural challenge To help make your project happen we can also bring your stakeholders together
18. m projects it will allocate one off planning and start up costs over the lifetime of the interven tion project Detailed advice on what costs should be included is provided in the NICE costing guidelines available on The NSMC website www thensmc com resources vfm quidelines It is important to note that while a health risk reduction may have lifetime impacts for mothers and children This is reflected in the way health impacts are measured as risks generated or reduced by the continuation of breastfeeding over a six month period The tool does not forecast future behaviour nor does it discount future impacts Below are further details of what should be included in each field THE NSMC BREAST IS BEST FOR LOVE OR MONEY 2 Avoid any double counting except for incentives 3 THE NSMC BREAST IS BEST FOR LOVE OR MONEY 1 In Table 1 please enter the a Cost of planning and developing the intervention The separation between intervention costs and NHS costs assumes that behaviour change support may be funded by a PCT Clinical Commissioning Group or Local Authority separately from the provision of services such as Maternity and Health Visitor services Furthermore aspects of the intervention might be funded by employers or give rise to costs to others Throughout this analysis all costs are mutually exclusive so avoid any double counting except for incentives which are both a cost to the intervention and a ne
19. mothers This shows the cost savings to mothers of not needing to buy sterilisers and formula This depends upon the estimated cost of these items which depends on whether they simply delay purchasing equipment and simply save the cost of formula or do not use bottle feed at any stage As this is very dependent on local circumstances this estimate can be changed in the data input page Cost savings to mothers per mother contacted This simply divides total savings to mothers by the number contacted Cost savings to mothers per additional mother who continues to breastfeed This is the savings that a mother would make by con tinuing to breastfeed to six weeks Cost savings to mothers per mother contacted This simply divides total estimated savings to mothers by the number of mothers contacted OALY per additional mother breastfeeding to 6 weeks This is the health risk gain in QALYs for each mother achieving the six week indicator target Odds ratio This is a commonly used measure of the effective ness of an intervention It is a measure of the probability of a mother achieving the target with the support of the inter vention compared with her chances of achieving it 11 THE NSMC BREAST IS BEST FOR LOVE OR MONEY without support In other words it measures how effective the intervention is in changing behaviour Table 2 a Societal Impact in terms of the human value of QALY gains The Human value This table applies a
20. rk and training b Annual revenue costs per year Annual costs to other public sector services should be included here It is important to consider only ad ditional costs above those already incurred by such services in the normal course of their work 5 Charges costs or incentive payments to clients if relevant If mothers pay for items or services the aggregate annual cost should be recorded as a social cost rather than a project cost Payments to mothers as incentives or subsidies should be included as both an element of project cost and as a payment to clients The aggregate level of all incentives or subsidies for a year should be entered as a negative number 6 Employer costs if relevant a Project development and capital expenditure If employers or other partners such as supermar kets or food producers contribute to the cost of an intervention this should be recorded as a social cost and this should reduce the public sector intervention costs In this box enter any capital or start up costs to employers b Annual revenue costs per year Annual costs to employers should be entered here if relevant Table 2 Clients and Outcomes Enter information on the number and characteristics of clients and outcomes planned or achieved The tool can be used to assess planned interventions or to evaluate current projects THE NSMC BREAST IS BEST FOR LOVE OR MONEY 4 5 THE NSMC BREAST IS BEST FOR LOVE OR MONE
21. rts will help ensure you get the most from your research budget Our One Stop Shop database of unpublished market research gives you the means to quickly get to grips with your audience and behavioural challenge It will enable you to focus your research and make the best use of your resources If you re pushed for time our data synthesis service will package up the most relevant research into your challenge held on the One Stop Shop for you Providing best practice in behaviour change ShowCase is our online case study database of behaviour change initiatives From smoking to active travel young people to health professionals it highlights honest learning and success from the real world on a wide range of issues and audiences You can follow the journey project teams took and find detailed information on the how of delivering a behaviour change intervention Capitalise on others achievements and learn from their mistakes and barriers without having to commission expensive research Independent evaluation We have specialist experience of evaluating behaviour change programmes of all kinds We ll help you demonstrate the impact of your projects to your stakeholders and capture lessons to improve future work We ll also help you put together an evaluation plan that will ensure you collect the right information to effectively measure success and avoid knowledge gaps from the outset Contact The N
22. social value to the improvement in health risks for mothers and babies gained as a result of the intervention It can be regarded as the cost of pain and grief caused by death and illness In discussion with Robert Anderson Economic Adviser to Department of Health in 2011 it has been pointed out that the Department of Health s official position is that a QALY can be valued at 60 000 as derived from Department of Transport willingness to pay survey of 1991 1992 Highways Economics Note 1 in respect of fatal accidents updated to 2007 values However in practice as NHS expenditure is limited it is accepted that the marginal productivity of the NHS is four QALYs per 100 000 and for this reason a value of 25 000 can be applied While the Department of Health continue to refer to a survey carried out in 1991 1992 for the Department of Transport it should be noted that this willingness to pay survey focused on traffic accident outcomes These include early death which has a particular emotional value Another estimate of the value of a QALY gain can be based on the upper estimate of the value placed on non fatal injury derived from the same survey which gives an estimate of 27 000 This is close to the figure used by the National Institute of Health and Clinical Excellence of 30 000 Thus for this purpose a value of 25 000 in 2007 2008 updated for inflation in incomes has been used but this can be varied if required There
23. sons Undue pressure rather than empowerment would be counterproductive to the wellbeing of such mothers While there are guides to good practice in this field some of which are listed in the final section of this guide in preparing this tool the author was unable to find specific research evidence or clear consensus estimates on many aspects of the impact of breast feeding Full health impacts and cost implications for the NHS the cost of not breastfeeding to mothers and the relative impact of initiation as compared to continuation of breastfeeding were unavailable In order to address this the tool provides preliminary estimates of these factors in the hope that experts in the field will be able to adjust the tool as more evidence and clear consensus emerges It is hoped that the work being undertaken at York University due to report in June 2012 may improve these initial estimates In the meantime the outcomes produced by this tool should be treated with caution and the data supporting the tool will need to be improved and updated as we learn more about the impacts of support for breastfeeding Data input Completing the data input sheet The following section provides details of what data should be included in each section of the tool and also what evidence has been used in its develop ment Intervention costs The tool can be used to evaluate costs and outcomes over one year or over a shorter period For longer ter
24. tential health risk gain from improved breastfeeding is taken from WHO estimate of the burden of disease for High Income European countries attributable to sub optimal breastfeeding in 20043 This estimate has been applied to estimates of total UK DALYs derive from Green and Miles 2007 and adjusted by population for England The value shown represents the estimated current value of the lifetime reduction in health risk arising from 9 THE NSMC BREAST IS BEST FOR LOVE OR MONEY the project It is important to note that the model estimates health impacts in terms of lifetime health risks It is not possible to provide a timescale for all resulting impacts on health or costs but because these factors are discounted to the base year the equivalent health impact and cost burden can be estimated Most of the health gain relates to immediate impacts on the health of the baby However there are also lifetime risks to the child and the mother captured by the Burden of Disease assessment These risks are generated at the time of breastfeeding rather than as a result of continued behaviour thus there is no need to project long term behaviour or discount the benefits as they are already taken into account QALYs impacts Quality Adjusted Life Years QALYs are the most commonly used measure of health gain in the UK Outcomes are reported in these terms by converting from Disability Life Years DALYs to Quality Adjusted Life Years
25. value for money for money of their social marketing 2 To evaluate whether social marketing and and behaviour change programmes behaviour change interventions were value for The breastfeeding tool is one of those money upon completion developed The tools go beyond costs to the NHS to include wider societal costs 1 THE NSMC BREAST IS BEST FOR LOVE OR MONEY Using the tool These notes are intended to help users and provide links to the relevant evidence used to prepare the tool You may also wish to refer to the Glossary and NICE Intervention Costing Guidelines available on The NSMC s website Most users may choose only to use the Data Input and Results pages but advanced users can also make use of other pages to update the tool as further evidence becomes available This tool applies to social marketing and pro grammes to support behaviour change for mothers This includes peer support local media campaigns and targeted community action as recommended by NICE and UNICEF The tool is not intended to be applied to hospital based interventions to promote higher breastfeed ing initiation rates but to community based inter ventions designed to encourage the continuation of breastfeeding to six to eight weeks and beyond It is also important to note at the outset that social marketing or other programmes in this field must recognise the needs of mothers who may be unable to continue to breastfeed for a variety of rea
26. x months 20 per cent e Educated beyond 18 at birth 90 per cent at six weeks 68 per cent and at six months 27 per cent e UK average at birth 76 per cent at six weeks 48 per cent and at six months 25 per cent e English average at birth 78 per cent at six weeks 50 per cent and at six months 26 per cent To model this accurately would require an analysis of the combined effect of the two variables on breast feeding technically called the coefficient of multiple determination It is possible to approximate to this assuming that age predominates over education level so that only a third of the impact of education level is taken into account For the purpose of this tool the following approximation was used to generate expected breastfeeding rates BF e BF at Initiation 78 21 if under 20 or 10 if 20 24 or 0 if 25 29 or 11 if over 30 5 if educated to 16 1 if educated to 16 18 4 7 if educated beyond 18 e BF at 6 weeks 50 34 if under 20 or 17 if 20 24 or 1 if 25 29 or 12 if over 30 7 if educated to 16 2 if educated to 16 18 6 7 if educated beyond 18 e BF at 6 months 26 18 if under 20 or 13 if 20 24 or 6 if 25 29 or 11 if over 30 4 3 if educated to 16 1 7 if educated to 16 18 0 7 if educated beyond 18 THE NSMC BREAST IS BEST FOR LOVE OR MONEY 6 It will be important to demonstrate why the expected figure should be adjusted for the mothers you are targeting
27. y Impact Assessment at www dh gov uk prod_consum_dh groups dh_digital assets documents digitalasset dh_106502 pdf THE NSMC BREAST IS BEST FOR LOVE OR MONEY 8 Interpreting the results The results page reports a wide range of outcome measures that were requested by various local and national users during the piloting of these tools You may decide that some of these are not relevant to your needs it is up to you to choose which measures are most useful for your purposes You need to take into account the decision makers priorities and the strength of the available evidence which varies for different outcome measures Table 1 Net Local Public Sector Cost per Lifetime Health Gain This table provides a range of outcome and value for money measures requested by users Sensitivity analysis In general it is more reasonable to report a range of possible outcomes rather than just reporting a single central estimate The sensitivity analysis shows a high and low value range arising from different assump tions about behaviour the extent of persistence and the rate of health recovery see Glossary Sensitivity analysis in this tool does not consider the uncertainty in underlying estimates of health gain and costs which are treated as consensus estimates Users can also vary the input data and other factors to generate other sensitivity analyses and to examine what if questions Health impact The estimate of the po
28. you are using e g breastfeeding at six to eight weeks 5 Typical Age of mothers targeted The typical age of mothers and level of education data are used to generate the expected level of breastfeeding at six weeks This is based on the National Infant Feeding Survey of 2005 6 Select the typical age of mothers targeted and numbers completed their full time education These data are used to generate the expected level of breastfeeding at initiation They use formulae reflecting how the expected breastfeeding initia tion and continuation rates vary with the age and education level of mothers These formulae may be improved as behaviour changes and better evidence becomes available They are based on the evidence of the National Infant Feeding Survey of 2005 and can be viewed at the Impacts page If you do not have age and education data for the mothers targeted or if you have not targeted the intervention in this way e g if you are targeting mothers from a specific ethnic minority you may need to refer to the NIFS or generate your own specific baseline survey data of a comparable group of mothers This will allow you to generate an estimate of the number of mothers who would be breastfeeding at six weeks without the intervention To enter the value you find simply chose central values for age and education here and then adjust to the value you find from the survey in the adjustment box at question 8 below 7 Expected level o
Download Pdf Manuals
Related Search