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Abstract
Background: The Baby-Friendly Hospital Initiative (BFHI) is a global initiative that is impacted by local context and systems. Research shows that BFHI has a positive impact on breastfeeding initiation and duration, however, there is limited adoption and implementation of BFHI. Despite several years of federal and state support, only five of 60 hospitals in Washington state are designated Baby-Friendly. A few hospitals are moving toward BFHI, but many more are not interested in pursuing the designation.
Research Aims: The purpose of this study is to identify the factors which positively or negatively impact adoption and implementation of BFHI in Washington state.
Methods: To conduct this qualitative secondary analysis, we read and summarized coded text from 18 hospital sector interviews using Greenhalgh’s Diffusion of Innovations framework to identify themes and influences which help or hinder adoption and implementation of BFHI.
Results: Six key themes emerged as the major factors influencing adoption and implementation of BFHI: innovation, system antecedents, communication and influence, readiness, implementation, and outer context. Multi-level factors that help or hinder adoption and implementation of BFHI and BFHI-type policies include: written policy, time and funding, hospital administrator support, preexisting knowledge, knowledge sharing networks, physician support, training and education, community support, and external laws, policies, and standards.
Conclusion: Recommendations for improving BFHI adoption and implementation include appointment of a program coordinator to oversee implementation, lead multidisciplinary workgroups, and assure annual trainings for all staff at each maternity care site; community systems that build normative support for breastfeeding and assure that all families have access to prenatal education on breastfeeding; and state or national level initiatives that provide training, education, and technical assistance that includes developing model breastfeeding policies provided by Washington State Department of Health (WA DOH) and other stakeholders. Supportive systems and environments are built through effective policy adoption and implementation processes; knowledge about these processes can be applied to facilitate adoption and implementation of policies that support mothers in achieving their breastfeeding goals.
