226567 Similarities and differences between Baby-friendly assessment tools: Findings from an operations research multi-case study examining hospitals' adherence to the Ten Steps to Successful Breastfeeding

Wednesday, November 10, 2010

Nathan C. Nickel, MPH , Carolina Global Breastfeeding Institute, Department of Maternal and Child Health, Gillings School of Global Public Health at the University of North Carolina-Chapel Hill, Chapel Hill, NC
Emily C. Taylor, MPH, CD(DONA) , Carolina Global Breastfeeding Institute, Department of Maternal and Child Health, Gillings School of Global Public Health at the University of North Carolina-Chapel Hill, Chapel Hill, NC
Miriam Labbok, MD, MPH, FACPM, IBCLC , Carolina Global Breastfeeding Institute, Department of Maternal and Child Health, Gillings School of Global Public Health at the University of North Carolina-Chapel Hill, Chapel Hill, NC
Mary Rose Tully, MPH, IBCLC , Carolina Global Breastfeeding Institute, Department of Maternal and Child Health, Gillings School of Global Public Health at the University of North Carolina-Chapel Hill, Chapel Hill, NC
Introduction: The Carolina Global Breastfeeding Institute (CGBI) developed the Breastfeeding Friendly Healthcare Initiative (BFHCI), to support hospitals in implementing the Ten Steps to Successful Breastfeeding. This study presents similarities and differences between three instruments assessing hospitals' adherence to the Steps. Methods: The BFHCI uses multi-case study methods to study eight cases (i.e., hospitals). Authors present data from: 1) the Baby-friendly Self Appraisal Tool (SAT) administered to nurse management; 2) the CDC Maternity Practices in Infant Nutrition and Care (mPINC) administered to each hospital's IBCLC; and 3) an electronic survey of knowledge attitudes and practices regarding the Ten Steps (E-KAP) administered to maternity staff and hospital administration. Hospital scores for each Step using data from mPINC and SAT followed the respective instruments' scoring guides. Hospital Step scores calculated from the E-KAP reflected whether surveyed staff reported practices complying with each Step. Results: The number of Steps credited to hospitals varied by instrument. Data from the SAT indicated greater compliance than data from the mPINC for some steps. The mPINC indicated greater compliance for other Steps. Data from the E-KAP indicated lower compliance for all Steps when compared to either the mPINC or SAT data. Hospital E-KAP knowledge scores were all below 70%. Data from the SAT and mPINC indicated all staff received the training necessary to provide breastfeeding support. Discussion: A Hospital's depicted adherence to the Steps depends on the instrument used. The mPINC and SAT produce differing findings which may not reflect actual hospital staff knowledge or practice.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Planning of health education strategies, interventions, and programs
Program planning
Provision of health care to the public
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
1) Discuss the similarities and differences between three tools' ability to assess a hospital's adherence to the Ten Steps: The Baby-friendly self assessment tool, the CDC National Survey in Maternity Practices in Infant Nutrition Care, and an individual E-survey of hospital staff's knowledge attitudes and practices regarding the Ten Steps. 2) Identify and discuss implications for assessing hospitals' progress towards implementing the Ten Steps. 3) Evaluate the strengths and weaknesses of various forms of Baby-friendly assessment. 4) Identify approaches that hospitals and state organizations may consider to assess adherence to the Ten Steps. 5) Formulate alternative assessment approaches to use in addition to the Baby-friendly self-appraisal tool and the mPINC.

Keywords: Health Care, Breastfeeding

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was instrumental in designing the baseline assessment for the project. I performed the necessary analyses for this project. I also have no conflicting relationships to report.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 5017.0: Breastfeeding Poster Session