The training sessions took place from June to November 2004. Eighty health professionals (50 GPs, 25 health visitors, 5 midwives) were invited to attend the practice-based breastfeeding sessions. Six sessions were delivered, at which 29 GPs, 18 health visitors and 3 midwives completed the initial questionnaires (total 50; 63% of those invited). In one health centre some practice nurses also attended out of interest in the topic, but they were not asked to complete questionnaires as they did not advise breastfeeding women. Thirty-six replies (72%) were received to the second questionnaire, sent four to six weeks after each training session, from 21 GPs, 13 health visitors and 2 midwives.
There were 40 female and 10 male health professionals at the training sessions, 39 of whom had children. All but one of these children had been breastfed. Table 1 shows the characteristics by professional group.
Before the training session, the mean attitude score was 55.3 (SD 5.4) with a range of 38 to 65, indicating very positive attitudes towards breastfeeding in these groups. The mean knowledge score was 28.4 (SD 4.3) with a range of 19 to 35, again reflecting the high knowledge levels of those who attended. After training the mean knowledge score was 29.7 (SD 3.6) for the 36 who returned this questionnaire, but this overall increase was not statistically significant (Wilcoxon p = 0.23). There was a significant positive correlation between the knowledge and attitude scores before training (Spearman r = 0.71, p < 0.001), indicating that more knowledgeable health professionals also had more positive breastfeeding attitudes. Table 2 shows the mean scores for attitude and knowledge for the different professional groups before and after the training session. Comparisons were made for those individuals who completed both pre and post intervention questionnaires. There were significant differences between the groups before and after training, particularly in breastfeeding knowledge, with GPs having the lowest scores and midwives the highest (p < 0.001). The mean knowledge scores for GPs increased after training but the increase was not statistically significant, probably because they started at quite a high level (Wilcoxon p = 0.18).
Table 3 shows that there were no significant differences between males and females in their attitude towards breastfeeding or knowledge. However those who had children showed significantly more positive attitudes towards breastfeeding and also had significantly higher knowledge scores before training. This difference was not apparent after training due to an increase in knowledge scores for those without children, which was statistically significant (Wilcoxon p = 0.04).
The main changes seen in the management of breastfeeding problems were significant increases in appropriate advice to women with mastitis to keep breastfeeding on both breasts, greater recognition of the symptoms of poor attachment at the breast, greater knowledge of how to resolve sore nipples, and increased recognition of the symptoms of nipple thrush as shown in Table 4. Health visitors particularly improved their scores on recognition of the symptoms of poor attachment at the breast, and GPs showed greatest improvement in resolving sore nipples and recognising nipple thrush.
The follow-up questionnaire showed that since the session, 12 health professionals (33%) (7 GPs, 4 HVs, 1 MW) had used the CD-ROM and 17 (47%) the information sheets, but the others reported that they had not had an opportunity to use them yet. All had found them useful for their practice. Changes in practice were reported by 15 (42%) and these included advice about thrush (n = 7, 46%), about sore nipples (n = 3, 20%), mastitis (n = 3, 20%), and more focus on positioning and attachment as a cause of problems (n = 3, 20%).
Qualitative comments (made by 16 participants) about the session were very positive and most (n = 12, 75%) had found it informative, very useful, helpful and appropriate. Others commented that "it was good to have GPs and health visitors discussing these topics together at a practice-based session" and that "it should form part of mandatory training for health professionals".