241502 Breastfeeding-Friendly Heatlhcare (BFHC) Project: Identification of strategies and process approaches that support implementation of the Ten Steps to Successful Breastfeeding

Tuesday, November 1, 2011: 11:30 AM

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), LCCE , Carolina Global Breastfeeding Institute, Department of Maternal and Child Health, School of Public Health, University of North Carolina, Chapel Hill, NC
Miriam Labbok, MD, MPH, FACPM, IBCLC, FABM , Carolina Global Breastfeeding Institute, Department of Maternal Child Health, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC
BACKGROUND An objective of Healthy People 2020 is for hospitals to become more breastfeeding-friendly, i.e., implement the Ten Steps to Successful Breastfeeding. US studies exploring such implementation are predominantly single hospital studies. The Breastfeeding Friendly Healthcare Project (BFHC) explores Ten Steps implementation in multiple hospitals and identifies strategies across similar and differing contexts. METHODS The study follows a phased quasi-experimental operations research design using multiple-case study methods. The BFHC collected breastfeeding and Ten Step compliance data by reviewing documents and medical records and administering the Baby-friendly Self Appraisal Tool, the CDC mPINC, an individual-level Electronic Survey of hospital staff, and Key Informant Interviews. Pre-post changes in breastfeeding rates and Step compliance were tested for statistical significance. Facility-specific strategies for Step implementation were documented. Strategies were triangulated with pre-post changes in breastfeeding rates and Ten Step compliance. Within-case and cross case analyses identify case-specific and project-wide successful strategies. RESULTS Preliminary results suggest: 1) trainings that meet staff where they are vis--vis breastfeeding attitudes and practices may be more effective than traditional approaches; 2) hospital staff identify improving group efficacy towards Step implementation as important to success; 3) successful implementation requires leadership support; and 4) rounding on breastfeeding data leads to improved breastfeeding support. CONCLUSIONS This study makes a significant contribution in its use of multiple-hospitals in exploring the implementation of the Steps. Standard approaches may not be effective across all contexts and should be tailored to specific hospital contexts. How strategies interact with hospital context may inform other hospitals' implementation efforts.

Learning Areas:
Administration, management, leadership
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Public health or related nursing
Public health or related organizational policy, standards, or other guidelines
Public health or related research

Learning Objectives:
Describe strategies used in the Breastfeeding Friendly Healthcare Project that resulted in implementation of the Steps and increased breastfeeding. Discuss how implementation strategies interact with hospital-specific contexts. Explain the benefits of conducting multiple-case study operations research for studying the implementation of evidence-based practices, specifically the implementation of the Ten Steps.

Keywords: Quality Improvement, Breastfeeding

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have worked with the Breastfeeding Friendly Healthcare Project for 2 years. I am trained in monitoring and evaluation, multiple-case study research methods, and operations research methods. I conducted the data analyses for this presentation.
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.