National BFI Symposium April, 2015 Catherine Lowes & Evelyn te Nyenhuis Provincial Infant Feeding Surveillance Pilot Study

Part of the Locally Driven Collaborative Project (LDCP)program at Public Health Ontario Part of the Locally Driven Collaborative Project (LDCP) program at Public Health Ontario LDCP program helps Ontario public health units worktogether to conduct applied research and programevaluation on critical public health problems orprograms LDCP program helps Ontario public health units work together to conduct applied research and program evaluation on critical public health problems or programs Views expressed in this presentation are the views of theLDCP Breastfeeding team members and do notnecessarily reflect those of Public Health Ontario Views expressed in this presentation are the views of the LDCP Breastfeeding team members and do not necessarily reflect those of Public Health Ontario 2 Locally Driven Collaborative Project: Breastfeeding

Baby-Friendly Initiative (BFI) status – an Ontario Ministry of Health accountability agreement indicator  Health units require comparable and standardized data for designation  Infant feeding surveillance informs program planning and evaluation  Long Term Goal: comparable province-wide infant feeding surveillance data collection method or tool in Ontario Background and Rationale 3

To work collaboratively with Ontario health units to develop a standardized tool and method for collecting infant feeding surveillance data that will enable public health units to have locally useful and externally comparable data. 4 Objective

Prior to 2012 most of mothers we called within 48 hrs of discharge from hospital/midwifery care as per Healthy Babies Healthy Children (HBHC) program (specially funded by MCYS) Accountability Agreements: BFI status as indicator (MHLTC) 5 A little bit about Ontario…

In 2012 MCYS made improvements to HBHC program changed to a more comprehensive program focusing on families “with risk” Provincially funded universal calling ended Some health units continued the 48 hr call, or re-instated it 6 A little bit about Ontario…

7 Project Team

8 Multiphasic Project Phase 1 Situational Assessment Phase 2 Develop Pilot Model Phase 3 Pilot Test Phase 4 Evaluate Pilot Phase 5 Summary of Project and Recommendations

Environmental scan of all 36 Ontario public health units using a stakeholder survey Scoping review of the scientific and grey literature Advisory panel includes: BCC, BFI Ontario, BORN (Better Outcomes and Registry Network) and several Epidemiology network and workgroups 9 Phase 1: Situational Assessment

With consultation from Advisory Panel created Pilot surveillance tool: Questionnaire Access database Pilot surveillance methods: Data collection procedures 10 Phase 2: Pilot Surveillance Model

Health Unit Size of Health Unit Data Collection Method Time Points 48 hrs 2 wks 6 wks 2 mths 6 mths 12 mths AlgomaSmall Telephonexxxx BrantMedium Telephonexxxx Haldimand- Norfolk Small Telephonexxx NiagaraMedium Telephonexxxx YorkLarge Telephonexxx PorcupineSmall Onlinexx KFL&AMedium Telephonexx Phase 3: Pilot Site Characteristics 11

TIME POINT Response Rates Timeliness – 1 st Call to Completed Survey (Days) 48 hr81.80% Mean = 1.51 (SD = 1.90) Median = 1 day n = 2 2 Weeks71.60% Mean = 2.04 (SD =3.06) Median = 1 day n = 4 2 months/6 Weeks71.36% Mean = 3.57 (SD = 4.35) Median = 2 days n = 4 6 Months55.53% Mean = 3.50 (SD = 5.09) Median = 1 day n = 5 Phase 4: Evaluation Results 12

13 Phase Four: Preliminary Results Phase 4: Evaluation Results cont’d… Data quality, accuracy and completeness Surveys well completed when able to reach clients Some issues with using different data bases Simplicity and cost Ease of use rated ~ 4 / 5, but steep learning curve with database; suggestions for improvement given Costs were reasonable – mainly staff time Questionnaire relevance and function Short to conduct and easy to follow Relevant to BFI designation and supportive to clients Most clients willing to answer all questions (decline to answer Income = 17%; Ethnicity = 3%) Lessons and suggestions Aided ability to collect consistent data for BFI designation

Fairly positive feedback from PHUs: “Positive impact… highlighted how to collect data which we need to do for BFI.” “… We became BFI designated in February of this year. So that data collection was really critical for us to have.” “… having it standardized -- would be the best way to compare the information and the breastfeeding rates across Ontario...” 14 Phase 4: Qualitative Feedback

Final Report includes the following components and recommendations for a standardized infant feeding surveillance model: Summary of pilot study results Standardized questionnaires (English and French) Standardized process for data collection (including sampling, time points, consent, and contact methods) Sample surveys and guidance document 15 Phase 5: Final Report

Timepoints: BORN data cube for breastfeeding initiation Option 1:Retrospective survey at one time point – 6 mths Option 2: Multiple time points at 2 mths and 6 mths Surveillance continue past 6 months up to 2 years Sampling - conduct a census sample or a selection sample Consent ISCIS as sampling frame Incorporate consent for survey in Healthy Babies Healthy Children (HBHC) screen Intervention - do not provide interventions to women during survey 16 Phase 5: Recommendations

Contact Contacts methods piloted: and telephone; consider diversifying methods of contacting women (e.g., text message, QR codes, App) Increase time window for contacting women from 2 wks to 4 wks Questionnaire: 2 versions completed – one vs. multiple time points Core and optional questions Core questions needed to meet BFI data requirements Analysis - APHEO Core Indicators project create syntax and develop a standardized method of analysis Database – develop a database accessible for all health units in future 17 Phase 5: Recommendations cont’d

The LDCP Breastfeeding team would like to thank Public Health Ontario for its support of this project. The team gratefully acknowledges funding received from PHO through the Locally Driven Collaborative Projects Program 18 Acknowledgements

19 Contact Information Team Lead: Gillian Alton ext 3470 Final Report on PHO website: