Applying the ARCS design model to breastfeeding advice by midwives in order to motivate mothers to personalise their experience

Janine Stockdale, Marlene Sinclair, WG KERNOHAN

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Background. Improving the implementation of evidence-based practice is critical to achieving the public health agenda.However, progress is hampered by the lack of a comprehensive and coherent framework to guide the theoretical and systematicdesign of complex interventions. Breastfeeding is a good example; in spite of the immense public health value, no theoreticallydesigned,complex intervention exists that is capable of establishing persistence to breastfeed.Objective. This paper reports how a complex intervention was designed by applying the systems approach of the Attention,Relevance, Confidence, Satisfaction (ARCS) model of motivational design, as a means of theoretically addressing low maternalpersistence in the first three weeks of learning.Design. Following an introduction to the model, a stepwise account of the diagnostic, design and evaluation phases appliedwithin a suburban trust (3600 births annually) is reported. The diagnostic phase included nine structured observation studiesof routine educational environments (167 hours observing 130 women and 20 midwives over a three-month period) andmotivational profiling of 202 women who were learning to breastfeed in the early weeks using the Breastfeeding MotivationalInstructional Measurement Scale. Diagnostic results identified a direct theoretical relationship between routine antenataleducation and the lack of maternal goals and postnatal motivation to persist. The design phase reports how the motivationaldeficits mapped in the diagnostic phase were resolved through the application of theoretical motivational tactics and redesignedbreastfeeding education. Evaluation phase summarises the findings from a feasibility trial (ISRCTN47056748) confirming ashypothesised. Following motivational enhancement of breastfeeding education, there was a significant increase (p
Original languageEnglish
Pages (from-to)4-10
Number of pages7
JournalEvidence Based Midwifery
Issue number1
Publication statusPublished (in print/issue) - 31 Mar 2014


  • ARCS model
  • breastfeeding
  • complex intervention
  • goals
  • motivation
  • theory
  • evidence-based midwifery


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