Cardiff School of Social Sciences

Research Interests

• Ecological and systems approaches within public health
• Infant feeding: experiences, policy, intervention
• Policy evaluation and the research-policy interface
• Design and evaluation of complex interventions
• Participatory research methods

PhD Topic/Area

Over recent decades mothers’ decisions about feeding their babies have been framed as an area of public health concern.  Increased scientific consensus around evidence for poorer health outcomes associated with formula feeding have led to a national and international policy drive to improve breastfeeding prevalence rates, with a global recommendation of exclusive breastfeeding to around six months with continued breastfeeding to up to two years and beyond.  Over the same time period public health interventions have been increasingly informed by socio-ecological theory and, more recently, by complex systems theory – both of which emphasise wider context for decision-making and multiple influences on behaviour, shifting the focus on intervention away from individuals as isolated targets for change.

In Wales, a multi-faceted breastfeeding strategy, which was intended to influence the context for infant feeding decisions within different settings and to address social polarisation in feeding behaviours, has been in place since 2001. Despite this, whilst breastfeeding initiation rates have increased, so far there has been limited impact on breastfeeding continuation rates, and in less affluent communities where there is as yet no evidence of a shift towards a culture in which breastfeeding beyond the early days is normalised. Furthermore, mothers frequently feel pressured over their feeding decisions whether they breastfeed, or use formula milk, or both.

This PhD research explores the extent to which ecological theory and systems approaches have penetrated the infant feeding intervention culture, and draws on systems concepts – including ‘unintended effects’, feedback, system compensation – to explore current policy challenges, and to identify barriers and facilitators to effective and acceptable intervention beyond the health service.  The research will bring together findings from (1) a sample of the intervention literature taken at time-points over recent decades, and (2) an extended case study of the Welsh breastfeeding strategy.  The research will seek to develop new models and metaphors relevant to current policy challenges.

Supervisors

Professor Laurence Moore, DECIPHer, Cardiff University   
Dr Julia Sanders, South-East Wales Trials Unit, Cardiff University