Medicina comunitaria y educación para la salud

Abstracto

An Analysis of the Adoption and Implementation of Breastfeeding Policies in Washington State Clinics

Johnston S, Steinman LE, Bradford V, Walkinshaw LP, Johnson DB

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.