Schmied Virginia, Thomson Gillian, Byrom Anna, Burns Elaine, Sheehan Athena, Dykes Fiona
School of Nursing and Midwifery, University of Western Sydney, Sydney, Australia.
Maternal and Infant Nutrition and Nurture Unit (MAINN), School of Health, University of Central Lancashire, United Kingdom.
Women Birth. 2014 Dec;27(4):242-9. doi: 10.1016/j.wombi.2014.05.005. Epub 2014 Jun 21.
Implementation of the Baby Friendly Health Initiative (BFHI) is associated with increases in breastfeeding initiation and duration of exclusive breastfeeding and 'any' breastfeeding. However, implementation of the BFHI is challenging.
To identify and synthesise health care staff perceptions of the WHO/UNICEF BFHI and identify facilitators and barriers for implementation.
Seven qualitative studies, published between 2003 and 2013 were analysed using meta-ethnographic synthesis.
Three overarching themes were identified. First the BFHI was viewed variously as a 'desirable innovation or an unfriendly imposition'. Participants were passionate about supporting breastfeeding and improving consistency in the information provided. This view was juxtaposed against the belief that BFHI represents an imposition on women's choices, and is a costly exercise for little gain in breastfeeding rates. The second theme highlighted cultural and organisational constraints and obstacles to BFHI implementation including resource issues, entrenched staff practices and staff rationalisation of non-compliance. Theme three captured a level of optimism and enthusiasm amongst participants who could identify a dedicated and credible leader to lead the BFHI change process. Collaborative engagement with all key stakeholders was crucial.
Health care staff hold variant beliefs and attitudes towards BFHI, which can help or hinder the implementation process. The introduction of the BFHI at a local level requires detailed planning, extensive collaboration, and an enthusiastic and committed leader to drive the change process. This synthesis has highlighted the importance of thinking more creatively about the translation of this global policy into effective change at the local level.
实施爱婴医院倡议（BFHI）与母乳喂养开始率的提高、纯母乳喂养持续时间以及“任何形式”母乳喂养持续时间的增加相关。然而，实施BFHI具有挑战性。
识别并综合医疗保健人员对世界卫生组织/联合国儿童基金会BFHI的看法，确定实施的促进因素和障碍。
对2003年至2013年间发表的七项定性研究进行元民族志综合分析。
确定了三个总体主题。首先，BFHI被不同地视为“一项理想的创新或一种不友好的强制要求”。参与者热衷于支持母乳喂养并提高所提供信息的一致性。这种观点与认为BFHI是对女性选择的一种强制要求且在母乳喂养率方面收获甚微却成本高昂的看法形成对比。第二个主题强调了实施BFHI的文化和组织限制及障碍，包括资源问题、根深蒂固的员工做法以及员工对不遵守规定的合理化解释。第三个主题体现了参与者中的一定程度的乐观和热情，他们能够确定一位专注且可信的领导者来引领BFHI变革进程。与所有关键利益相关者的协作参与至关重要。
医疗保健人员对BFHI持有不同的信念和态度，这可能有助于或阻碍实施过程。在地方层面引入BFHI需要详细规划、广泛协作以及一位热情且坚定的领导者来推动变革进程。这一综合分析突出了更具创造性地思考将这一全球政策转化为地方层面有效变革的重要性。
