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Table 5 Components of Burke-Litwin model (1992), related findings, and recommendations to facilitate uptake and implementation of the BFHI

From: Perspectives about the baby friendly hospital/health initiative in Australia: an online survey

Macro level
Components related to the BL modelFindings related to each componentRecommendation examples
1. External environment1.1 Influence of infant formula industry via their formula promotion advertising
1.2 Influence of societal attitudes
1.3 Influence of social media
Minimising the impact of formula promotion on mothers, families, and communities
Ensuring that formula industry act responsibly within social media context
Improving public support of breastfeeding by improving societal knowledge and acceptance of breastfeeding
Improving the breastfeeding messages on social media
2. Leadership support2.1 Government support and intervention
2.2 Policy support and implementation to facilitate uptake and implementation of the BFHI
2.3 Organisational leadership to facilitate uptake and implementation of the BFHI
Government intervention to promote the BFHI
Establishment of supportive policies to facilitate uptake and implementation of the BFHI
Evaluating and improving current policies and guidelines
Strengthening the WHO Code implementation by legislation
Develop and engage credible leadership to implement change
Providing adequate and essential resources
3. Mission and strategies3.1 Setting strategies to achieve the BFHI accreditation
3.2 Setting strategies to maintain reaccreditation
3.3 Establishment of plans to check feedbacks to ensure maintenance of Ten Steps
Increasing number of accredited facilities
Prioritising facilities with lower than optimum breastfeeding rates (e.g. initiation rate) for potential BFHI accreditation
Prioritising facilities where best standard (Ten Steps) are not well established and/or practiced for potential BFHI accreditation
Checking feedback from health professionals, stakeholders, and consumers
4. Organisation culture4.1 Organisational culture support of the BFHI uptake and implementation Organisational cultural change -changing attitudes and practices-might be essential to implement the BFHI
Staff attitudes towards breastfeeding must align with the BFHI standards
Micro level
5. Management practices5.1 Supportive management to implement the BFHI Develop and engage reliable and supportive management
Managers must support staff to implement the BFHI by allocating required resources (e.g. free available educational materials) within facilities
6. Systems6.1 Promotion of multidisciplinary team involvement
6.2 Establishment of an interdisciplinary team approach
6.3 Improvement in referral systems
Establishing strategies to harmonize involvement among professional groups towards BFHI
Improving inter professional collaboration
Ensuring the referral of mothers to supportive breastfeeding groups post discharge to ensure continuous care
7. Structure7.1 Continuous monitoring of the BFHI
7.2 Implementing structural change within related facilities to improve care
7.3 Implementing structural change in models of care to improve care
Establishment of formal organisational structures to evaluate and/or monitor implementation of the BFHI
Establishment and promotion of breast-milk banks within maternity facilities
Promotion of continuous midwifery models of care
8. Work unit climate8.1 Improving communication and/or interaction skills between healthcare staff and mothers Providing a continuous relationship between mothers and staff during the care period
Improving communication skills between healthcare staff and mothers
Improving interaction skills between healthcare staff and mothers
9. Motivation9.1 Motivating organisations and/or individuals to facilitate uptake and implementation of the BFHI Reinforcing the public health impacts of the BFHI to motivate individuals and organisations
Using motivating agents to ensure forward movement with the BFHI implementation
10. Task requirements and individual skills/abilities10.1 Improving breastfeeding and BFHI related knowledge amongst staff, mothers, family members, and community Educating staff about the benefits of the Ten Steps
Establishment of compulsory breastfeeding training programs for staff
Providing up to dated and easily accessible training resources for staff
11. Individual needs and values11.1 Addressing mothers’ needs and values
11.2 Addressing staff’s needs and values
Addressing cultural differences in BFHI guidelines
Providing culturally appropriate compassionate care for mothers
Identifying staff needs to provide resources accordingly
12. Individual and organisational performance12.1 Successful uptake and/or implementation of the BFHI Achieving successful uptake of the BFHI
Achieving successful implementation of the BFHI