Renfrew Mary J, Herbert Gill, Wallace Louise M, Spiby Helen, McFadden Alison
Mother and Infant Research Unit, Department of Health Sciences, University of York, Heslington, York, UK.
Matern Child Nutr. 2006 Oct;2(4):245-61. doi: 10.1111/j.1740-8709.2006.00067.x.
This paper reports on an approach to practice development in breastfeeding as part of a national programme of work to address inequalities in maternal and child nutrition. The production and dissemination of evidence and guidelines is necessary but not sufficient on its own to effect change in practice, particularly when dealing with complex public health issues. In the case of breastfeeding, review evidence and national guidance have shown that multifaceted changes are essential if policy aspirations are to be realized. The objectives of the programme described here were to (1) inform and enable practice development in breastfeeding in low-income areas; (2) evaluate the impact of approaches used; and (3) develop robust approaches and appropriate material for use nationally. A conceptual framework was established, and a six-stage process is outlined. The recruitment of four sentinel sites across whole health economies, involving professionals and the voluntary sector, was an essential component of the programme. The strength of the model is that it provides a structured, cross-sectoral approach to practice development in public health. A key challenge is to identify whose responsibility it is to resource practice development when a number of disciplines and sectors are involved. This question needs to be addressed if public health guidance is to be of sustained benefit.
本文报告了一种母乳喂养实践发展方法，作为解决母婴营养不平等问题的国家工作计划的一部分。证据和指南的制定与传播是必要的，但仅靠自身并不足以实现实践中的变革，尤其是在处理复杂的公共卫生问题时。就母乳喂养而言，审查证据和国家指南表明，若要实现政策目标，多方面的变革至关重要。此处所述计划的目标是：（1）为低收入地区的母乳喂养实践发展提供信息并使之成为可能；（2）评估所采用方法的影响；（3）开发适用于全国的有力方法和合适材料。建立了一个概念框架，并概述了一个六阶段流程。在整个卫生经济体中招募四个定点监测点，让专业人员和志愿部门参与其中，这是该计划的一个重要组成部分。该模式的优势在于它为公共卫生实践发展提供了一种结构化的跨部门方法。一个关键挑战是，当涉及多个学科和部门时，确定由谁负责为实践发展提供资源。如果要让公共卫生指南持续发挥作用，就需要解决这个问题。
