Abstract
Breastfeeding policies are a promising systems-level approach to address the disparities in breastfeeding support. While there have been increased efforts to improve hospital maternity care practices, less attention has been focused on the adoption and implementation of similar breastfeeding support strategies in clinics that reach families during prenatal and postnatal care. This study investigates how the process of developing evidence-based breastfeeding policies and practices is supported or hindered in clinic settings. Qualitative, semi-structured interviews were conducted with 19 clinic staff at 17 Washington State clinics via phone. For the primary study, the interview guide and coding scheme were developed based upon the Greenhalgh “Diffusion of Innovation in Service Organization Framework”. The secondary analysis included an additional thematic content analysis of coded clinic transcripts and synthesis of the themes using the Greenhalgh framework. Factors that hindered breastfeeding policy adoption and implementation included negative perceptions of breastfeeding policies, inadequate knowledge-sharing networks, limited devoted resources, and lack of leadership buy-in. Components that facilitated the adoption of breastfeeding policies included positive perceptions of breastfeeding policies, engaged champions, adequate staff training, and external motivation through incentives and mandates. The in-depth evaluation of dynamic breastfeeding policy adoption and implementation provides valuable insight into the drivers and obstacles of policy development. Clinics play an integral role in the breastfeeding continuum of care and would benefit from further policy process research, inclusion in breastfeeding initiatives and adequate financial and technical support.
Highlights
IntroductionIn the United States, breastfeeding initiation rates continue to improve, from 71.4% in 2002 to 81.1% in 2013.7,8 rates for breastfeeding duration and exclusive breastfeeding remain below Healthy People 2020 (HP2020) targets and World Health Organization (WHO) recommendations.[7,9,10] U.S families – those from communities of color, low income households, and rural regions – face substantial obstacles to achieving their breastfeeding goals.[11,12,13,14,15] Though 80% of expectant mothers intend to breastfeed, 60% do not reach the breastfeeding goals they hoped to achieve.[11,12] This disparity between intent and outcome underscores the need to exercise “collective societal responsibility” to eliminate barriers to breastfeeding including economic obstacles, sociopolitical factors, and inconsistent healthcare access.[16,17,18]
While there have been increased efforts to improve hospital maternity care practices, less attention has been focused on the adoption and implementation of similar breastfeeding support strategies in clinics that reach families during prenatal and postnatal care
Five components of the Greenhalgh framework help to describe the complex dynamics of policy adoption in clinics included characteristics of the innovation, system antecedents, system readiness, communication & influence, and outer context
Summary
In the United States, breastfeeding initiation rates continue to improve, from 71.4% in 2002 to 81.1% in 2013.7,8 rates for breastfeeding duration and exclusive breastfeeding remain below Healthy People 2020 (HP2020) targets and World Health Organization (WHO) recommendations.[7,9,10] U.S families – those from communities of color, low income households, and rural regions – face substantial obstacles to achieving their breastfeeding goals.[11,12,13,14,15] Though 80% of expectant mothers intend to breastfeed, 60% do not reach the breastfeeding goals they hoped to achieve.[11,12] This disparity between intent and outcome underscores the need to exercise “collective societal responsibility” to eliminate barriers to breastfeeding including economic obstacles, sociopolitical factors, and inconsistent healthcare access.[16,17,18]. To achieve breastfeeding equity, breastfeeding policy initiatives must incorporate policy process research pertaining to clinics
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