Barriers Perceived by Managers and Clinical Professionals Related to the Implementation of Clinical Practice Guidelines for Breastfeeding through the Best Practice Spotlight Organization Program

Monitoring the Sustainability of a Breastfeeding Guideline During the COVID-19 Pandemic: A Mixed-Methods Study

AIM

To analyse the impact of the COVID-19 pandemic on the sustainability of a breastfeeding (BF) clinical practice guideline (CPG) for women without COVID-19, throughout the 5 waves of the pandemic.

DESING

A mixed-methods design was utilised.

METHODS

For the quantitative approach, an interrupted time series design was utilised, as well as the analysis of CPG sustainability reports as a qualitative approach. The study setting was in a health area in the Spanish health system from April 2019, until October 2021. The sample was composed of 2239 mother-infant dyads.

RESULTS

The exclusive-BF rate at hospital discharge obtained values between 90% and 94.8%, without statistically significant changes. A significant increase in the risk of not starting BF in the first feeding was observed (adjusted odds ratio = 9.36; 95% CI: 1.04-84.13), between the pre-pandemic period and the first wave. Skin-to-skin contact (SSC) decreased in the first wave to 82.20%, and the oscillations observed throughout the pandemic were not statistically significant. In general, the qualitative indicators were maintained. A decrease was observed in the spaces used for postpartum care due to the re-assigning to the intensive care unit. Also, the acquisition of materials and equipment decreased.

CONCLUSIONS

The measures implemented for the sustainability of the BF CPG during the 5 waves of the pandemic were positive. The programmes of implementation of BF guidelines were shown to resist the COVID-19 pandemic.

IMPACT

Our findings contribute to the understanding and evolution of the main indicators of the sustainability of a BF CPG on COVID-19 context, providing details on the magnitude of the effect and the process of change.

REPORTING METHOD

The Preferred Reporting Items for observational studies (STROBE) checklist was followed.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Effectiveness of dissemination strategies of maternal clinical guidelines: A narrative review

BACKGROUND

 Maternal clinical guidelines (MCGs) provide evidence-based recommendations for skilled birth professionals (SBPs) at the point of care. The dissemination strategies and use of MCGs are inconsistent among skilled birth providers despite their potential to improve the maternal care outcomes.

AIM

 This study examined the effectiveness of dissemination strategies of MCGs by SBPs in a primary care setting.

METHOD

 We searched in Medline, PubMed, CINAHL and Google Scholar. Search terms were effectiveness, dissemination and use, MCGs, SBPs and primary health care facilities. Studies published in English, conducted between 2010 and 2023 and focussing on dissemination strategies and use of MCGs were included. The final articles were presented in narrative format.

RESULTS

 The search yielded 212 studies. After removing duplicates, seven articles that met the inclusion criteria for the review were included. The narrative review summarised the findings as: Use of MCGs which showed the barriers and enablers for the use of maternal guidelines. The level of adherence to MCGs was summarised, and one study showed the use of support supervision and collaboration improved aspects of MCGs.

CONCLUSION

 The findings show how skilled attendants acknowledge that MCGs can contribute to improving maternal outcomes. They further describe how, in practice, they are rarely used at the facility level. There is a need for more research on dissemination strategies to ensure improved use of MCGs in primary health care facilities.Contribution: We highlight the key gap in the dissemination of MCGs at primary health care facilities which if improved can potentially improve the use of MCGs.

Factors Influencing Health Professionals' Decisions Regarding the Indication of Infant Formula: A Qualitative Exploration in Uruguay

BACKGROUND

Health systems are fundamental to the promotion and protection of breastfeeding. Health professionals have a pivotal influence on families' infant feeding decisions and may act as facilitators or barriers to adequate breastfeeding practices.

RESEARCH AIM

To explore factors influencing health professionals' decisions regarding the indication of infant formula in Montevideo, the capital of Uruguay, an emerging Latin American country.

METHOD

This was a qualitative study based on semi-structured interviews with 30 health professionals (neonatologists, pediatricians, family doctors, and nurses) working in primary and secondary care in both private and public health institutions. The interviews were audio-recorded, transcribed, and analyzed using content analysis based on deductive-inductive coding.

RESULTS

The narratives of the participants identified maternity wards as the healthcare sites where the indication of infant formula occurs most frequently. Motives underlying the indication of infant formula by health professionals were diverse. The type of birth and the conditions of the child and the mother were the most relevant in secondary care, whereas maternal work was the main determining factor in primary care. A wide range of factors encouraging and discouraging the indication of infant formula were identified by health professionals in primary and secondary healthcare locations, which were related to all the levels of influence of the socioecological model.

CONCLUSIONS

Strategies to reduce the use of infant formula in Uruguay should include improving the support and guidance provided to families in the maternity ward, strengthening the implementation and monitoring of the Baby-Friendly Hospital Initiative, and improving the current maternity leave regulations.

Scoping Review of Baby-Friendly Hospital Initiative Compliance and Breastfeeding Initiation in Sri Lanka

OBJECTIVE

To synthesize the evidence for associations between Baby-Friendly Hospital Initiative (BFHI) compliance and breastfeeding initiation in Sri Lanka.

DATA SOURCES

We searched PubMed, ProQuest, Scopus, Embase, MEDLINE, and CINAHL using various Boolean operators for multiple search terms. Studies conducted in Sri Lankan published in English from April 1, 2000, to April 30, 2020 were considered. We also searched Sri Lankan government and international organization websites and hand-searched reference lists of the included documents.

STUDY SELECTION

We screened the titles and abstracts of 99 records and retrieved 31 documents for review and assessment. We selected 24 documents, including the full texts of primary research articles, reviews, discussions, letters to the editor, and government reports if they specifically addressed breastfeeding initiation and BFHI compliance in Sri Lanka.

DATA EXTRACTION

We extracted the data for author(s), year of publication, study setting, study design, aims of the study, population and sample size, inclusion and exclusion criteria, data collection methods, participant response rate, prevalence, associated factors of breastfeeding initiation, and BFHI compliance and its contributing factors if they were available depending on the type of document.

DATA SYNTHESIS

We synthesized the data narratively to address the research questions. We identified contradicting reports of the prevalence of breastfeeding initiation (23.5%-100%) across Sri Lankan hospitals. Breastfeeding initiation was significantly associated with mode of birth. We identified inconsistent compliance with the BFHI, and poor compliance was associated with inadequate staff training and ineffective monitoring systems.

CONCLUSION

We found inadequate evidence to clarify the association between BFHI compliance and breastfeeding initiation in Sri Lanka. It is therefore not possible to conclude whether adherence to Baby-Friendly care is optimizing breastfeeding initiation in Sri Lanka.

Barriers and Facilitators for Exclusive Breastfeeding within the Health System and Public Policies from In-Depth Interviews to Primary Care Midwives in Tenerife (Canary Islands, Spain)

The aim of this study is to describe the perspectives of Primary Care midwives regarding factors that benefit or are detrimental to exclusive breastfeeding (EBF) within the health system and public policies. The study was carried out in Tenerife (Canary Islands, Spain) and is based on qualitative methodology. Twenty in-depth interviews were carried out with midwives who work in Primary Care centres in Tenerife, using a content analysis approach. The transcript data were then encoded following an inductive approach. The factors, according to midwives, that affect EBF, with regard to the healthcare system, are related to training of healthcare professionals in breastfeeding and their support to women during pregnancy, childbirth and postnatal care. Regarding public policies, midwives believe the maternity leave periods in Spain, together with a lack of laws and social policies to protect EBF are detrimental. The findings from our study show that there is a need to boost training and the role of professionals in EBF and, at the same time, promote protective policies that foster equality, favouring, among other issues, the work-life balance.

A Mixed-Methods Examination of Inpatient Breastfeeding Education Using a Human Factors Perspective

Objective: The objective of this study was to examine postpartum, inpatient mother-lactation educator (LE) breastfeeding education, resulting perceptions, and patient-reported worries and outcomes. In the breastfeeding literature, there is inadequate insight into the mother-LE relationship, and specifically, the extent to which contextual factors are elicited and information is tailored accordingly. In this study, we were specifically interested in maternal contextual factors. Materials and Methods: Using a mixed methods approach, we (1) captured 20 postpartum, inpatient mother-LE breastfeeding education sessions and analyzed them for the presence of maternal contextual factors, (2) administered separate perception questions to mothers and LEs, and (3) conducted 13 follow-up interviews with mothers after being discharged from the hospital. Results: Inpatient breastfeeding education is delivered in dynamic and busy clinical settings, characterized by potential distractions such as delivery of medical care. Maternal contextual factors are infrequently elicited during the education. Although both LEs and mothers rate the sessions positively, potential gaps remain as highlighted by the analyses of semistructured interviews with mothers. Conclusion: Human factors perspective, theories, and methods are relevant to the characterization of facilitators and barriers of current breastfeeding education, as well as to the development of interventions to support the delivery of human-centered, effective, and timely breastfeeding education.