Carolina Global Breastfeeding Institute (CGBI), Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA.
Int Breastfeed J. 2013 May 20;8(1):5. doi: 10.1186/1746-4358-8-5.
The Ten Steps to Successful Breastfeeding are maternity practices proven to support successful achievement of exclusive breastfeeding. They also are the basis for the WHO/UNICEF Baby-Friendly Hospital Initiative (BFHI). This study explores implementation of these steps in hospitals that serve predominantly low wealth populations.
A quasi-experimental design with mixed methods for data collection and analysis was included within an intervention project. We compared the impact of a modified Ten Steps implementation approach to a control group. The intervention was carried out in hospitals where: 1) BFHI designation was not necessarily under consideration, and 2) the majority of the patient population was low wealth, i.e., eligible for Medicaid. Hospitals in the research aspect of this project were systematically assigned to one of two groups: Initial Intervention or Initial Control/Later Intervention. This paper includes analyses from the baseline data collection, which consisted of an eSurvey (i.e., Carolina B-KAP), Maternity Practices in Infant Nutrition and Care survey tool (mPINC), the BFHI Self-Appraisal, key informant interviews, breastfeeding data, and formatted feedback discussion.
Comparability was ensured by statistical and non-parametric tests of baseline characteristics of the two groups. Additional findings of interest included: 1) a universal lack of consistent breastfeeding records and statistics for regular monitoring/review, 2) widespread misinterpretation of associated terminology, 3) health care providers' reported practices not necessarily reflective of their knowledge and attitudes, and 4) specific steps were found to be associated with hospital breastfeeding rates. A comprehensive set of facilitators and obstacles to initiation of the Ten Steps emerged, and hospital-specific practice change challenges were identified.
This is one of the first studies to examine introduction of the Ten Steps in multiple hospitals with a control group and in hospitals that were not necessarily interested in BFHI designation, where the population served is predominantly low wealth, and with the use of a mixed methods approach. Limitations including numbers of hospitals and inability to adhere to all elements of the design are discussed.
For improvements in quality of care for breastfeeding dyads, innovative and site-specific intervention modification must be considered.
成功母乳喂养的十个步骤是经证实可支持纯母乳喂养成功实现的产妇实践。它们也是世界卫生组织/联合国儿童基金会爱婴医院倡议（BFHI）的基础。本研究探讨了在主要为低收入人群服务的医院中实施这些步骤的情况。
采用混合方法收集和分析数据的准实验设计被纳入干预项目中。我们比较了修改后的十个步骤实施方法对对照组的影响。该干预措施在以下医院进行：1）不一定考虑 BFHI 指定，2）大多数患者人群为低收入，即有资格获得医疗补助。参与该项目研究方面的医院被系统地分配到以下两个组之一：初始干预组或初始对照组/后期干预组。本文包括基线数据收集的分析，其中包括电子调查（即卡罗莱纳州 B-KAP）、婴儿营养和护理产妇实践调查工具（mPINC）、BFHI 自我评估、关键知情人访谈、母乳喂养数据和格式化的反馈讨论。
通过对两组基线特征的统计和非参数检验，确保了可比性。其他有意义的发现包括：1）普遍缺乏用于定期监测/审查的一致母乳喂养记录和统计数据，2）对相关术语的广泛误解，3）医疗保健提供者报告的实践不一定反映他们的知识和态度，以及 4）发现具体步骤与医院母乳喂养率相关。出现了一套全面的促进和阻碍十个步骤启动的因素，并确定了医院特定的实践改变挑战。
这是首批在多个医院进行的对照研究之一，这些医院不一定对 BFHI 指定感兴趣，服务人群主要为低收入人群，且使用混合方法。讨论了包括医院数量的限制以及无法遵守设计的所有要素的局限性。
为了提高母乳喂养母婴对护理质量的满意度，必须考虑创新和特定于地点的干预措施修改。
