Table 3 Summary of selected attitude and practice questions from the semi-structured key informant interview guide[39]

• Could you please describe the current practice of these 10 Steps in your facility? ( Walk the respondent through each of the Ten Steps. )

 a. Does hospital policy reflect the Ten Steps? How is the policy communicated to staff? Communicated to patients? Is the policy posted?

 b. Who receives training for providing breastfeeding-supportive care?

 c. Does your facility have a prenatal class for patients? Is BF included in the prenatal class? Is there a specific breastfeeding class?

 d. How do staff support women to initiate BF w/in an hour? What does the staff do to help mom initiate? Are babies placed skin-to-skin? What does that look like?

 e. What do staff do to show women how to breastfeed? Who is mainly responsible for fulfilling this task? Do staff teach hand expression, how to pump?

 f. How often do breastfed infants receive something other than human milk? What about infants who stay primarily in the nursery?

 g. What happens at night re: rooming-in? How do moms respond to the idea of rooming-in?

 h. In general what do staff think “on-demand means”? What does on-demand mean to you? What are some of the cues that staff use to know when to feed the baby? What do staff teach mothers re: when to feed their baby.

 i. Are pacifiers readily available for babies? If a baby is not breastfeeding well what sorts of techniques do staff use to supplement the infant (ask about cup feeding, bottle feeding, other)?

 j. What does the facility do to foster the establishment of support groups? How does staff refer moms to support groups? What support is available in the community that you’re aware of?

• Are there any barriers, here at your facility, that may make it more difficult to implement these 10 Steps?

1. (for each Step) Could you explain for me your perceptions of Staff ability to work together to practice Step ____?

 a. What factors influence staff members’ ability to work

together to implement this Step?

 b. What factors make staff members more able to practice the Step?

 c. What factors make staff members less able to practice the Step?

2. Could you explain for me your perceptions of Staff commitment to work together to practice Step ____?

 a. What factors influence staff members’ commitment to work together to implement this Step?

 b. What factors make staff members more committed to practice the Step?

 c. What factors may lead staff members to be less committed to implement this Step?