Evidence map›Paper›PMID 39800745›Full record

ArticleArchives of public health = Archives belges de sante publique2025

Establishing trust through home visits during pregnancy: a realist evaluation of a Danish breastfeeding support intervention.

Anne Kristine Gadeberg, Ingrid Maria Susanne Nilsson, Ulla Christensen, Marie Honoré Jacobsen, Henriette Knold Rossau, Sarah Fredsted Villadsen

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In one paragraph

Article in Archives of public health = Archives belges de sante publique, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Trial
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Anne Kristine GadebergSection of Social Medicine, Institute of Public Health, University of Copenhagen, Gothersgade 160, 1123, Copenhagen, Denmark.
Ingrid Maria Susanne NilssonThe Danish Committee for Health Education, Copenhagen, Denmark.
Ulla ChristensenSection of Social Medicine, Institute of Public Health, University of Copenhagen, Gothersgade 160, 1123, Copenhagen, Denmark.
Marie Honoré JacobsenSection of Social Medicine, Institute of Public Health, University of Copenhagen, Gothersgade 160, 1123, Copenhagen, Denmark.
Henriette Knold RossauSection of Social Medicine, Institute of Public Health, University of Copenhagen, Gothersgade 160, 1123, Copenhagen, Denmark.
Sarah Fredsted VilladsenSection of Social Medicine, Institute of Public Health, University of Copenhagen, Gothersgade 160, 1123, Copenhagen, Denmark. sfv@sund.ku.dk.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundBreastfeeding has numerous health benefits but social inequality in breastfeeding is documented in many high-income countries. The evidence for improving breastfeeding support through prenatal encounters is conflicting, but points towards a mechanism activated through a positive relationship between the families and their health care providers. A Danish intervention included a home visit by a health visitor during pregnancy to prolong breastfeeding and reduce social inequality in its rates. The purpose of this study was to investigate how this home visit affected breastfeeding support across socioeconomic groups with attention to how, and for whom, it activated a mechanism of improved relationship and trust between the health visitor and the family.

methodsOur study used a realist evaluation approach and was embedded in a cluster randomized trial carried out in 20 municipalities. In the intervention arm, we observed 35 home visits delivered by the health visitors, interviewed 16 mothers and conducted 6 focus groups with a total of 34 health visitors to examine the intervention mechanisms and contextual factors that influence the generation of outcomes. The analysis applied Luhmann's, and Brown and Meyers' concepts of trust as middle-range theories.

resultsThe pregnancy home visit helped early establishment of trust which enhanced the subsequent breastfeeding support postpartum in numerous ways. In realist terms, our central mechanism of change, the establishment of trust, had optimal conditions for success in the contextual setting of the pregnancy home visit where there was time, peace, undisturbed conversations, mental capacity to reflection, and a perceived more even power balance between the family and the health visitor which resulted in a range of positive outcomes. The mechanism resulted in improved tailored breastfeeding support postpartum, families reaching out to the health visitor sooner when experiencing breastfeeding difficulties, and families expressing a more positive experience of breastfeeding. The mechanism was activated across the different socioeconomic groups.

conclusionsThe circumstances of the pregnancy home visit helped to establish trust between the health visitor and the family. Especially for families in vulnerable positions, the pregnancy home visit seems to be a potent driver for enhancing the gains from breastfeeding support.

Indexed as

BreastfeedingComplex interventionsHome visit, trustInterventionPrenatal supportRealist evaluationRelational supportSocial inequality

Identifiers

PMID39800745
PMCPMC11727675

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LicenceCC BY-NC-ND
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.