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Improving breastfeeding support services through brief daily digital data collection.

The NHS and Local Authorities (LAs) can improve breastfeeding services. Using real-time digital technology, analysis and QI approach they will support women to overcome breastfeeding challenges and reduce health inequalities.

Read comments 7
  • Proposal
  • 2022

Meet the team


  • Pat Watson, Research Fellow, Teesside University
  • Prof. Vida Zohoori, Professor of Public Health and Nutrition, Public Health Research Centre Lead, Teesside University
  • Ros Nunn, Infant Feeding and Maternal Healthy Weight Co-ordinator, Public Health Prevention in Maternity, North East & North Cumbria Integrated Care system; NIFN North East Regional Lead

What is the challenge your project is going to address and how does it connect to the theme?

Improving breastfeeding rates can save the NHS over £50million per year, improve population health, decrease medicine, health and social-care use and reduce health inequalities.  The NHS and LAs aim to support mothers who want to breastfeed for as long as they wish. Over-stretched services require better data on breastfeeding practices – instances, duration and impact – to facilitate this.  The only breastfeeding data currently collected by the Office National Statistics is “baby first milk breastmilk” and is “baby still breastfeeding at 6-8weeks”.  This is woefully inadequate and raises questions as to how NHS/LAs can provide services breastfeeding mothers (BFM) need? Using digital mobile-friendly tools we will gather real-time data by following BFM on their daily journey.  The anonymised data will be shared with health professionals enabling them to gain useful insight and develop services which will provide better outcomes for the physical and mental health of mothers and babies.

What does your project aim to achieve?


  • Test the feasibility of collecting daily data from BFM using digital tools
  • Explore if detailed data will increase providers’ understanding of the nature and timing of breastfeeding issues


  • Collect real-time survey data from BFM (approx. 200) about their daily experience and evaluate experience of taking part in study
  • Identify and analyse issues and trends experienced by BFM
  • Facilitate workshops for providers using QI approach to develop an understanding of the challenges and create actionable outcomes to improve breastfeeding support for mothers.

Current anecdotal information will be transformed into an evidence base. Having a better understanding of the issues BFM face will enable commissioners and service providers to tailor resources and support to the needs of mothers, enabling mothers to continue breastfeeding for as long as they wish and not switch to other feeding methods when a crisis occurs.

How will the project be delivered?

An advisory group of service providers, commissioners, BFMs and researchers will support and guide the project throughout including co-designing study, risk and money management and facilitating gatekeeping access to participants.

To develop a deeper understanding of the issues, we will use Appreciative Inquiry with providers (infant feeding co-ordinators and health visitors):

  1. Workshop 1– Discover and Dream – What is going well? What else is possible?
  2. Survey BFM – brief daily online survey; demographic; evaluation of taking part – recruitment will focus on areas of low breastfeeding rates, particularly mothers from lower-socioeconomic backgrounds.
  3. Workshop 2 – Design – What would it look like? Using the data gathered through the surveys on challenges – what can be done to support BFM to breastfeed for longer, what will it look like and who needs to be involved?
  4. Workshop 3 – Destiny/Deliver and evaluate – What can we do to make sustainable changes to support BFM?

How is your project going to share learning?

We aim to demonstrate that through the use of digital technology it is now possible to proactively ask patient/service users about their health and wider experiences in real-time.  Although piloting with breastfeeding, we believe that this approach is useful for other physical and mental health areas.  We will use the learning from this feasibility project to apply for additional funding to further develop the concept.

Dissemination activities:

  • Present learning to the National Infant Feeding Network North East North Cumbria (NIFN NENC), participating LAs and BFM networks
  • Share the learning with other Q members
  • Produce a short report for the APPG (All-Party Parliamentary Group) on Infant Feeding and potentially present to the group
  • Peer-reviewed journal article.

How you can contribute

  • Are there any Q members who work with breastfeeding mothers in geographical areas of high breastfeeding rates? Why has it worked in your area, but not in other areas such as the North East? In the North East breastfeeding rates are 50% initiation but dramatically drop to 34% within the first 6-8 weeks (and in some areas only 26%)
  • Is anyone aware of other studies that ask users questions daily?
  • General sense checking – what issues do you foresee in this project?
  • Does anyone have expertise conducing daily surveys?
  • Do you think using Appreciative Inquiry is useful for this sort of project?
  • Which Liberating Structure/s have you found works well in conjunction with Appreciative Inquiry?

Plan timeline

1 Sep 2022 Project starts; convene advisory group and co-design survey
8 Sep 2022 Design and create mobile-friendly survey tool
1 Dec 2022 Workshop 1 - Discover and dream - What is going well?
16 Dec 2022 Regulatory approvals received
4 Jan 2023 Launch survey, recruit BFM
31 Mar 2023 Surveys close
3 Apr 2023 Analyse data from surveys
2 May 2023 Workshop 2 - Design - Using new insights - What could services look like?
31 May 2023 Report to Q on progress
15 Jun 2023 Workshop 3 - Destiny/ Deliver and evaluate - How to create sustainable changes?
26 Jun 2023 Dissemination activities


  1. Hi Sarit, Paula and Lizzie,

    This sounds like a really useful project.

    In terms of collecting data, I wonder if you've considered partnering with one of the breastfeeding tracker apps out there? There are quite a few on the Android store that are free to download and provide an opportunity to record left/right breast and how long the feed was, as well as bottle feeds, wet nappies and other things. You could either consider asking the app provider for data / ask them to help you recruit, or you could just suggest to mums to use the app and download the data and send it to you. Personally when I was on maternity leave, I found that things that were on my phone got my attention quite a bit (easy to handle whilst breastfeeding) whilst those  that needed a computer were much harder, so whatever method you choose, a mobile-friendly survey would make sense.

    I've also recently been in touch with a European-based company called LactApp who are keen to trial their product in the UK (they provide training and guidance material to support breastfeeding). Happy to make an introduction if you would find it useful.


    1. Hi Megan

      Thank you for your helpful feedback. Glad you think our project will be really useful.

      We had initially considered approaching the existing breastfeeding tracking apps to ask if we could use their data (anonymised). We thought there is no need to try to reinvent the wheel. The challenge we found is that they are international companies and as such don’t store the data here in the UK which mean that there are all sorts of additional regulatory hoops we would need to overcome in order to access their data.  There is also the question as to whether the terms and conditions the user signed includes permissions for researchers to access the data. I read in the news recently about an app that is in a bit of hot water because of this.

      The data that we want isn’t collected by existing companies. It would be quite a regulatory challenge to set it up. Therefore we decided to create it ourselves as part of this Q funding and it will be much easier to abide by the regulations and other hoops as we are based here in the UK. The data we collect will be used as part of our QI part of this project as the ultimate aim is to improve provision of support services to breastfeeding mothers and we feel we can achieve this though the collection of local data and understanding the issues mothers may face.

      We agree, having a mobile-friendly survey will be much better and easier to use.  We are therefore planning on creating a mini mobile app for the survey. Once the users’ month of participation is over, we will be asking users about their experience as part of an evaluation. This will help us learn about how user friendly and easy or not it was to reply to surveys and where we can make improvements.

      Outside of this Q application, it will be useful to speak with your contact at LactApp to learn more about their app.

      Many thanks again for your valuable comments and insights, we will be taking them on board.

      Kind regards

      Sarit, Paula and Lizzie

  2. Hi Sarit,

    Please email


  3. Hi,

    I really like this idea, so much potential.

    If you wanted to develop the idea as per Jo Scott's comment about using multiple data sources I wonder about using some prescribing data. For example,

    1) high or low rates of prescribing for oral thrush in the under 5s?

    2) high rates of Cow's Milk Protein Allergy infant formula prescribing would suggest a lack of support for BFM when coupled with that data?

    This data is relatively easy to access and analyse but there is a time delay.  Additionally, if accessible, the addition of tongue tie data would also help build a narrative.

    Good luck!


    1. Guest

      Sarit Carlebach 3 months, 2 weeks ago

      Thanks for your positive comments Rebecca

      The points you raise are thought provoking, we hadn’t thought about asking our survey participants about medication.  This would be an added interesting dimension.

      I was wondering if it would be possible to chat with you to about how we could access existing prescribing data? Also are there other prescriptions that might indicate issues with breastfeeding and baby nutrition?

      Kind regards



  4. Hi Sarit, Paula and Lizzie

    You may already have seen, a Q Exchange project from 2020 was focused on implementing a breastfeeding information app. Different focus of work but they may have useful learning about co-designing/collecting data from breast-feeding mothers?

    Q member Sabrina Das has shared her learning from co-designing in antenatal services, and also has a Q Exchange idea up related to birth options - so different side of the mother's journey, but potential learning that could be relevant to your project.

    I'd be interested in what other members suggest about daily surveys...I don't think this is quite what you are looking for but the only thing I can think of is learning from organisations that take a learning health systems approach - using regular data from multiple sources, and how daily (or more regular) 'pulse survey' data can be used to inform decisions

    Best of luck developing your idea!



    1. Hi Jo,

      Thank you very much for your helpful comments and suggestions, they are much appreciated.

      We were excited to see that LatchAid had received funding from Q. Their focus is on supporting breastfeeding mothers.  What we are planning to do is look at breastfeeding from the perspective of providers of support.  We all know how tough things are in the NHS and the continual cutting of services, infant feeding staff are trying their best with limited resources.  I breastfed both my children a few years ago and experienced no end of challenges.  When I returned to work as a researcher, I thought let’s have a look at what is happening and see what the data is telling us. I was astonished to find that there isn’t any, not anymore. The last national survey took place in 2010 and the only data ONS collect on breastfeeding are whether the baby has had breastmilk when born and then 6-8 weeks later whether it is still breastfeeding. That’s it.

      We want to take advantage of the benefits and availability of digital technologies to find out from mums on a daily basis if/what issues they may have so that services are able to put in place resources that are based on data. Zoe-Covid App is a great example ( and through the use of the short daily survey they were able to identify that there were many more predictors that a person had Covid than the original symptoms of high temperature and persistent cough.

      As the excellent examples you gave, we too very much believe that you need to have all parties involved from the start and use supportive approaches to help move services forward. We shall take the examples to the rest of the team to learn from the experiences of others here in Q. We haven’t had the space in the ideas form to say that we already had initial discussions with commissioners, providers and breastfeeding mothers and they are all very supportive of our idea.  There is an obvious need.

      Thanks again for taking the time and commenting.

      All the best

      Sarit, Lizzie and Paula

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