Expert opinions on an optimal infant feeding quantitative data framework: a mixed methods Delphi-style study

To robustly evaluate breastfeeding interventions and share learning across the UK, there is a need for collection and alignment of data at national level. However, overarching frameworks remain inconsistent between different UK nations. This study aimed to determine how expert stakeholders involved in research, policy and practice would define an ideal dataset for collecting infant feeding data. Using the Delphi method, three stages of consultation were completed with a total of 41 stakeholders. During stage 1, qualitative and quantitative surveys were distributed to an interdisciplinary panel. They were asked to openly define ideal definitions and timepoints for potential indicators, before rating their agreement with consensus statements generated from initial qualitative responses. During stage 2, policy-led stakeholders discussed outcomes from stage 1 as part of a consensus workshop. Each nation was then invited to submit a final consultation response in stage 3. Individual-level panel consensus was defined as agreement among ≥70% of stakeholders (stage 1), and group-level consensus was defined as ‘unanimous’ or ‘partial’ final agreement between nations (stages 2 and 3). During stage 1, 13 of 15 indicators reached consensus for definitions, and 11 of 13 for timepoints. During stages 2 and 3, 5 of 7 indicators reached final agreement. Data collection was suggested to focus on the intention to breastfeed (around birth), and the early initiation of feeding (from birth to 10 days). Monitoring of ‘exclusive’ breastfeeding from 0–6 months, ‘any’ breastfeeding from 0–24 months, and complementary feeding at 6 and 12 months, were identified as key touchpoints. At present, no indicator is collected consistently in line with these findings across all nations. These results support opportunities to improve comparability across the UK. Further work should consider the feasibility of data collection in routine practice, and the adjustments needed to support implementation. We confirm that Public Health Wales is responsible for supporting delivery of work aligned with the All-Wales Breastfeeding Action Plan, led by Rachel Bath, Rachel Evans, & Varsha Nagaraj, who co-developed this study as participating stakeholders. No additional funds were sought for this project..