Presentation at Making Links Conference 2010 in Perth, Western Australia. www.makinglinks.org.au

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Dr Roslyn Giglia PhD MPH GradDipDiet APD
Making links using an internet intervention to
support breastfeeding mothers, and dietitians
to conduct research, in regional Western
Australian (WA)
17 November 2010

2. Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J
Overview
• The importance of breastfeeding
• Why support regional women?
• The research study
• The website
• Progress to date and preliminary results
• Making links

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CRICOS Provider Code 00301J
Breastfeeding
Benefits for the mother include protection from
• Breast, Ovarian and Endometrial cancer
• Type 2 diabetes
• Metabolic syndrome
• Cardiovascular disease
• Osteoporosis
• Obesity

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CRICOS Provider Code 00301J
Breastfeeding
Benefits for the baby include protection from
• acute diarrhoea
• lower respiratory tract infections
• ear infections
• asthma
• necrotising enteritis
• botulism
• SIDS
• diabetes,
• childhood lymphoma
• coeliac disease.
• cardiovascular disease
• rheumatoid arthritis,
• some cancers
• obesity

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CRICOS Provider Code 00301J
Regional Women
In isolated areas mothers are limited with regard to the
availability of health services.
The further away a mother is from a major metropolitan
centre the less likely that she will be able to immediately
access a doctor, child health nurse or lactation consultant in
response to any breastfeeding problems she may have.

6. Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J
Regional Women
Difficulty with breastfeeding in the early postpartum period
is a significant risk factor for the early cessation of
breastfeeding, particularly in the first four weeks.
Early support for breastfeeding mothers is a leading factor
in breastfeeding maintenance.

7. Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J
The internet is overcoming isolation…
Although there are other breastfeeding Websites
in existence (most obviously the Australian
Breastfeeding Association), this intervention will
provide individualised feedback and information
for women on their breastfeeding concerns in the
absence of other support.
Build a virtual community.

8. Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J
The internet is overcoming isolation…
Although there are other breastfeeding Websites
in existence (most obviously the Australian
Breastfeeding Association) this intervention
differs from other sites by providing;
- individualised feedback and information for women on their
breastfeeding concerns in the absence of other support
- online education sessions
- the opportunity to breastfeed using webcam support with a
lactation consultant
- private and secure community
- an understanding of regional problems involving regional
people

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CRICOS Provider Code 00301J
The Research Study
• Recruitment in hospital or through the Child Health Nurses
• Women randomised to a control or intervention group for the website
• Women provided with a username and password
• Women complete a baseline survey when in hospital or first log on
• Women are then surveyed online at 4, 10, 16, 26, 32, 40 and 52
weeks
MASS MAILER PROGRAM which is automated to the database.
Women can be reminded about their surveys
Send reminder SMS through email2SMS

10. Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J
Results
Formative results (n= 31)
Usefulness of Discussion
Forums
81% of women surveyed responded
useful or very useful
Usefulness of Education
Sessions
84% of women surveyed responded
useful or very useful
Not so sure about the
Webcams
48% undecided 39% useful or very
useful

11. Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J
Results
Formative results (n = 31)
Usefulness of an interactive
Breastfeeding Website
97% of women surveyed responded useful or
very useful
Usefulness of chat rooms
74% of women surveyed responded useful or
very useful

12. Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J
The Website

13. Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J

14. Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J
30.07.10Footer text - slideshow title

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CRICOS Provider Code 00301J
What the website aims to do
Aims to create a virtual community
Discussion forums
Social networking site
Profiles of each person
Confidential contact form so women can email each other
Track log on and Website useage
Access to a lactation consultant online

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CRICOS Provider Code 00301J
How it works – Other features
Videos and presentations
SLIDE SHARE
WEB Present
Webcam to view breastfeeding technique
Skype

17. Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J

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Progress to date
Currently have approximately 120 Women enrolled on the
website.
58 in the control and 62 in the intervention group.

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CRICOS Provider Code 00301J
Progress to date
Have a very keen and competent PhD student living and
working in Geraldton
An amazing Web designer/mistress

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CRICOS Provider Code 00301J
Progress to date (as of 18/08/2010)
By far the most visited page is the front
page/news/welcome pages. 160 hits
Next most visited pages are both the Surveys page, and
the Thank you for Completing your Survey page. 58 hits
Next is the Messages page (private messages) which has
been visited 57 times
Next is the main forums page, 49 times
The introductions thread has been visited 48 times

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Quotes
‘Thank you for your advice Jenny in regards to my
questions was very helpfull and nice to know that people
are there to help if possible even though its my 3rd you still
sometimes question if what you are doing is the right
thing.’

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Quotes
‘I know what you are saying about living remotely we live 25klm's from
town not far I know but far enough to make it hard to meet people ect.
Anyhow chat one day soon hopefully with you all. ‘….
‘Yeah I understand my mum is only 20kms from gero and it took her
yrs to get some good friends.’…
‘20klm's out of gero south or north? I live south side do you live in
Gero aswell? I know what you mean by taking years to get friends
here, Doesn't help that Gero is such a clicky place either, well that's
how I found it so far I been here for just over 2 years now and still feel
like a stranger in my parents group.’….
‘I now live in Perenjori, but come to gero every now and then maybe 1
day we could meet for a coffee or something. I found it so hard
meeting people up there, here I'm lucky as my partners family live here
so have a bit of support.’

23. Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J
Results (n= 89)
What does the Midwest Mum look like?
Age: 30 (19-43 years)
91% married / de facto
length of residence in Midwest: 13 years
Distance from Geraldton:
50% live within 15 mins (drive) of CBD
19% live 60mins or more from Geraldton (most remote – 5 hours)
52% reported a family income of >$72,800
Education
32% degree or higher
•4% less than Yr 10 education
•30% TAFE / trade

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The Midwest Mum (cont’d)
88% Australian-born
18% paid maternity leave
Hospital of birth
52% GRH
46% SJOG
31% EDP (77% of EDP clients from GRH)
Health insurance:
Private - 53%
Public– 47%

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And what about the baby?……
First baby for approximately
a third of women
42% second baby
45% male, 55% female
Mean birthweigth: 3518g
Mean gestational age: 40.9
weeks
Picture: Queensland Health

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CRICOS Provider Code 00301J

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Support from Hospital staff
92% felt that help and information was sufficient in hospital
For women who felt that information or help was not sufficient,
comments included:
“Breastfeeding was not successful first time around”
“Needed help to get started again”
“Assumed I knew what I was doing [because this was not first baby]”
“More time spent with me”
“Help with positioning”
21% felt that they received conflicting advice
Mostly related to differing opinions about feeding techniques
old fashioned vs new knowledge
Demand feeding vs by-the-clock feeding
“Top-ups”
Timing of feeds (frequency and duration)
Perceived position of midwife on feeding method

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CRICOS Provider Code 00301J
Who are mums likely to ask for help?
Referral for breastfeeding problems after discharge:
50% said no contact had been given
Contact sources:
30% - CHN
21% hospital MW
11% GP
19% ABA
9% LC
Likely support post-discharge:
Mothers said that they were most likely to contact the
CHN (40%), their mothers (18%) or hospital MW (16%)
4% would contact a lactation consultant, 5% would
contact ABA

29. Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J
My 2020 Vision for Making Links
Robust breastfeeding data from regional WA
Regional Infant Feeding study (RIFS) become a truly
whole of WA research project
Dietitians involved with local and meaningful research

30. Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J
30.07.10Footer text - slideshow title

31. Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J
Big picture – My 2020 Vision
Up take of the research in other health regions of WA
All of these regions and/or people are looking to become
involved
Kimberley; Tracy Leon
Goldfields; Stephanie Samantha, Sharon Er, Rachael Nugent, Isabel
Growden
South West; Deb Brealey, Narelle Norrish
Midwest; Rebecca Sparrowhawk
This collaboration will enable an almost State wide
regional cohort of breastfeeding data to be collected

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School of Public Health
Western Australian Centre for Health
Promotion Research
Thankyou